#include "headerA.incl"

Breastfeeding/Nursing/Infant Nutrition

#include "headerB1.incl"

See also:

Subsections on this page:

Bare fingers should not go in baby's mouth

It is unprofessional for healthcare providers, including lactation consultants, to put a bare finger in your baby's mouth.  There is no way to sterilize underneath the fingernails, and many, many women carry yeast under their nails.  Thrush is a yeast infection in the baby's mouth and mother's breast ducts that can be very painful for both mother and baby; it is easily transmitted by bare fingers in the mouth.  Every professional should don sterile gloves before putting fingers in the baby's mouth or touching the mother's breast.

Corrolary: If you want baby's mouth to go on mom's breast, then bare fingers shouldn't touch mom's breast either!

ACOG Gets Behind Breastfeeding!

ACOG's Breastfeeding Toolkit - It's about time! Don't underestimate the power of making it easier for OBs to bill for breastfeeding care. This may be all the impetus they need to pursue the necessary training.

The United States Breastfeeding Committee (USBC) is an independent nonprofit coalition of more than 40 nationally influential professional, educational, and governmental organizations, that share a common mission to improve the Nation’s health by working collaboratively to protect, promote, and support breastfeeding.

The USBC e-Newsletter, Staying Abreast, is published in a weekly news brief format, called the Weekly Wednesday Wire. Past issues are archived on the USBC website. [Ed: They also get my award for Best Newsletter Name - Staying Abreast.  Wow!  Kudos to the one who thought that up!]

 Health Care Reform Boosts Support for Employed Breastfeeding Mothers

Breastfeeding Rooms at Work—It's the Law

The new health care bill that President Obama signed into law may make life for working and nursing moms a little easier. With support from the U.S. Breastfeeding Committee, who outlined the provisions in the law, employers (with more than 50 employees) will be required to provide "a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk." That's good news! This new measure gives mothers more incentive and support to continue breastfeeding after returning to work. Learn more by reading the full text of the bill.


New research project on the lactation and breastfeeding experiences of bereaved mothers after a pregnancy loss or infant death.

The impact of traumatic birth experiences on breastfeeding.

New and Notable

Lack of breastfeeding costs lives, billions of dollars - If most new moms would breastfeed their babies for the first six months of life, it would save nearly 1,000 lives and billions of dollars each year, according to a new study published Monday in the journal Pediatrics.

Working Moms Have New Breastfeeding Rights Under the ACA (8/6/14) - Under the Affordable Care Act, employers must provide time and space for new mothers to express milk for their babies until the child turns one year old.

The lives of nearly 900 babies would be saved each year, along with billions of dollars, if 90 percent of U.S. women breast-fed their babies for the first six months of life.

Published online April 5, 2010
PEDIATRICS (doi:10.1542/peds.2009-1616)
The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis
Melissa Bartick, MD, MSca, Arnold Reinhold, MBAb

Conclusions Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.

Peaceful Revolution: Motherhood and the $13 Billion Guilt by Melissa Bartick
This great article explains the difference between a birth environment and healthcare system that is truly supportive of breastfeeding and the
one that is common in most places in the U.S. today.  Then it asks, "Do you feel guilty for not breastfeeding? Or do you feel angry because it didn't have to be this way? "

‘Babywise’ Linked to Babies' Dehydration, Failure to Thrive

The relationship between maternal intravenous fluids and breast changes in the postpartum period: a pilot observational study (CMEs) Speaker: Sonya Kujawa-Myles , RN, MScN, IBCLC

Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. . . . Women who received IV fluids during labour had higher levels of edema postpartum and rated their breasts as firmer as and more tender than women who did not receive IV fluids.

Mother's milk made to order for boys, girls - "Mothers are producing different biological recipes for sons and daughters," says Katie Hinde, an evolutionary biologist at Harvard University.
Studies in humans, monkeys and other mammals have found a variety of differences in both the content and the quantity of milk produced. One common theme: baby boys often get milk that is richer in fat or protein - and thus energy - while baby girls often get more milk. 

Silent reflux is common in infants because their sphincters are undeveloped, they have a shorter esophagus, and they lie down much of the time.  Jeanne Batacan provides a nice handout that shows breastfeeding positions that can reduce reflux.  It may be important to angle the baby's sleeping position, too.

There's a very controversial study that recommends giving formula to newborns to promote breastfeeding.  This seems like pretty twisted logic to me, but here's what the experts say about this study:

Breastfeeding Medicine - Physicians blogging about breastfeeding, Early, limited data for early, limited formula use

The results challenge both dogma and data linking supplementation with early weaning, call into question the Joint Commission’s exclusive breastfeeding quality metric, and will no doubt inspire intimations of a formula-industry conspiracy. Before we use this study to transform clinical practice, I think it’s worth taking a careful look at what the authors actually found.

I hate to be cynical, but is it possible that this is related to the financial relationship between the AAP and the makers of Enfamil formula?

It has come to my attention that the AAP has contracted with Mead Johnson to provide AAP-branded materials as part of the formula manufacturer’s maternity discharge pack!

The A.A.P. has a financial relationship with several companies that manufacture formula. Enfamil’s maker, Mead Johnson, currently supports a grant for the academy’s educational perinatal pediatrics conferences, conducted for training physicians specializing in newborn care. Mead Johnson also supports the organization’s annual Neonatal Education Awards. Abbott Nutrition, the maker of Similac, is another big supporter of the A.A.P., donating toward the academy’s journal, Pediatrics in Review, through an educational grant. The Nestlé Nutrition Institute, the parent company of the infant formula maker Gerber, funds the American Academy of Pediatrics’ Healthy Active Living for Families program.

Ultrasound reveals breastfeeding mechanics - Although it might look like a baby is chewing on the mother's nipple, ultrasound images show that the infant actually removes milk by sucking

To Succeed At Breast-Feeding, Most New Moms Could Use Help by Nancy Shute [9/23/13]

Will my insurance cover a lactation consultation?

Sign On to Support Breastfeeding: A Vision for the Future! from The United States Breastfeeding Committee (USBC)

The Vision is aimed to increase awareness of the importance of breastfeeding and these nine crucial objectives that must be met in order to fully address the barriers faced by mothers:

1. Meet and exceed the Healthy People objectives to increase the proportion of mothers who breastfeed.
2. Implement maternity care practices that foster normal birth and breastfeeding in every facility that cares for childbearing women.
3. Ensure that health care providers provide evidence-based, culturally competent birth and breastfeeding care.
4. Create and foster work environments that support breastfeeding mothers.
5. Ensure that all federal, state, and local laws relating to child welfare and family law recognize the importance of breastfeeding and support its practice.
6. Implement curricula that teach students of all ages that breastfeeding is the normal and preferred method of feeding infants and young children.
7. Reduce the barriers to breastfeeding imposed by the marketing of human milk substitutes.
8. Protect a woman’s right to breastfeed in public.
9. Encourage greater social support for breastfeeding as a vital public health strategy.

David Stark is working on a breastfeeding DVD, which promises to be fabulous!  Check out the preview!

Everyone interested in breastfeeding should be familiar with the work of Dr. Nils Bergman about "Kangaroo Mother Care."  As he says, "breastfeeding is brain wiring".

Kangaroo Mother Care Promotions aims to promote the spread and implementation of Kangaroo Mother Care as the standard method of care for all newborn babies, both premature and full term.  This is the website of Dr. Nils Bergman.

Powerpoint Presentation: Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience: Implementing Best Practice in U.S. Hospitals, Breastfeeding program 2007

mymilkies.com offers a milk saver for milk dripping from the "other" breast.

The Smell of Mom: Scientists Find Elusive Trigger of First Suckling in Mice [10/4/12] - A team led by biologists at The Scripps Research Institute has solved the long-standing scientific mystery of how mice first know to nurse or suckle.

" the results indicated that the trigger for the first suckling in newborn mice is a blend of chemicals that is specific for each mouse mother. The brain of a mouse does not recognize this maternal "signature blend" automatically with neural circuits that are fully programmed by the mouse genome. It must learn the signature blend before it is able to suckle. In a narrow time window after birth, a re-exposure to this maternal odor mix triggers suckling. Thus, a behavior that appears completely innate is triggered by a mechanism that is partly learned."

Moral of the story . . . mom and baby should be together as much as possible after birth, and baby should not be bathed until breastfeeding is well established.  It probably also makes sense for mom to use unscented products in her personal care.

National Registry for Lactation Research

Dr Tom Hale and Dr. Judy Hopkinson  of Texas are starting a National Registry for Lactation Research.

Research in human lactation is sometimes rather limited  by a shortage of eligible volunteers.   This registry has been developed  to provide the scientific community with a registry of potential volunteers for studying human lactation under special circumstances.  These circumstances include certain medical conditions, problems with lactation, and use of specific drugs during breastfeeding.  Women who are currently breastfeeding, and/or women planning to breastfeed after delivery,  are included in this registry.

They are looking for moms with:

Hepatitis C
Hepatitis B
Cystic Fibrosis
"Suspected Yeast Infections of Nipple"
Insufficient Milk Supple
Persistent plugged ducts (>3/week)
Polycystic Ovarian Syndrome
Milk coagulates on storage
Planned Pregnancy while lactating
Chronic breast pain
Raynaud's of the nipple
Breast implants
Breast reduction
Fibrocystic breast disease
Rusty-pipe syndrome
Pathological breast engorgement
Infant with PKU
Lactation failure of unknown origin
Growth faltering after 4-6 months

or who are taking :

Celexa (citalopram)
Enbrel (etanercept)
Flagyl (metronidazole)
Interferons (Betaseron, etc)
Lamictal ( lamotrigine)
Milk thistle
Motilium (domperidone)
Neurontin (gabapentin
Paxil (paroxetine)
Prilosec (omeprazole)
Prozac (fluoxetine)
Reglan (metoclopramide)
Relafen (nabumetone)
Ritalin (methylphenidate)
St. John's Wort
Vioxx (rofecoxib)
Zoloft (sertraline)

Gerber has a 24-hour breastfeeding hotline with a Lactation Educator - 1-800-4-GERBER, i.e. 1-800-443-7237



Find A 
Enter ZipCode

Enter Country If Not US

Are you wondering if a medication or medical procedure will be a problem for a breastfeeding mom?

You can call the Infant Risk Center -- run by Dr. Thomas Hale's team in Texas (author of Medications and Mother's Milk -- the physician's reference for drug safety in breastfeeding). 

The InfantRisk Center will be dedicated to providing up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding.  Our goal is to provide accurate information regarding the risks of exposure to mothers and their babies.  By educating healthcare professionals and the general public alike, we aim to reduce the number of birth defects as well as create healthy breastfeeding relationships.
We are now open to answer calls Monday-Friday 8am-5pm central time. Please contact us at (806)-352-2519.

Or you can check Drugs and Lactation Database (LactMed)  - A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

Drugs and the Breastfeeding Mother: A New Clinical Report [Medscape - 10/29/13]

November 2016
Weight Change Nomograms for the First Month After Birth
Ian M. Paul, Eric W. Schaefer, Jennifer R. Miller, Michael W. Kuzniewicz, Sherian X. Li, Eileen M. Walsh, Valerie J. Flaherman

CONCLUSIONS: It is not uncommon for newborns to be below birth weight 10 to 14 days after delivery. A larger percentage of newborns delivered by cesarean had yet to regain birth weight at every time point through 1 month.

Your Guide to Breastfeeding - free from the US Government [May, 2015] - your tax dollars at work!

I really like these YouTube videos from wagonbird:

Pain-Free Latching Using the Thumbs Up Technique

Wide Pain-Free Latch for Beastfeeding Using Thumbs-Up or Flipple Technique

Alternate feeding methods for a newborn baby - How To - Learn 4 ways to feed a newborn baby apart from a baby bottle to preserve breastfeeding. 1) Syringe 2) Spoon 3) Cup 4) Finger feeding with SNS (At Breast Supplementer)

Great YouTube videos - Thanks to Jeanne Batacan!

Self attachment breast-crawl

Keep Your Baby With You After Birth

Skin to Skin in the Hospital

Laid-Back Breastfeeding
Narrated by Dr. Suzanne Colson, Researcher

Laid Back Breastfeeding

Baby-led Latching

Skin to skin breastfeeding film

Latching on a newborn on YouTube from rixaf
- This is the one that Gloria Lemay recommends.

Dr. Nils Bergman on the neuroscience behind the skin-to-skin imperative - 21st Annual International Meeting of the Academy of Breastfeeding Medicine [Oct., 2016]

Breastfeeding, Family Physicians Supporting (Position Paper) [2014]

The position paper's key recommendations, all with research literature citations, include:
Breastfeeding exclusively for 6 months, breastfeeding for at least a year, and breastfeeding for "as long as mutually desired by mother and child,"
Instituting Baby-Friendly practices in hospitals such as skin-to-skin contact at birth, supplementation only when medically necessary, no provision of formula samples or coupons,
Training FPs so that they can educate women about breastfeeding and provide breastfeeding mothers appropriate care.   

Your Baby’s “Feeding Sequence” - Suggests nursing with baby in a mostly vertical position and to continue holding baby's back and shoulders close to the body.

CHEAT SHEET FOR PARTNERS –Breast feeding support - These are concrete ways that a partner can support a breastfeeding mother; it's challenging for a new mother with sleep deprivation to pay attention all the time to all the little things that make breastfeeding work better. [Ed: I love the brilliance of this suggestion: "While she’s feeding, scan the environment she’s looking at. When she’s sitting, you’re moving. Empty the trash, clear the clutter, mop the dust bunnies, water the plants."]

Size and Volume of a Newborn's Stomach - this is my favorite depiction.  (Although the photo says theperfectlatch.com, that URL got me to a foreign language site.)

Breastfeeding support: a user’s guide - an excellent description and comparison of the qualifications of the different types of professionals and volunteers available to provide breastfeeding assistance from the Massachusetts Breastfeeding Coalition.  They have an impressive collection of activism information as well as handouts and other products for sale.

The Birth and Beyond California (BBC) Project
utilizes Quality Improvement (QI) methods and training to implement evidence-based policies and practices that support breastfeeding within the maternity care setting.

Breastfeeding the Right-Brained Way
By Kathleen Kendall-Tackett (PhD, IBCLC) & Nancy Mohrbacher (IBCLC)

Latching On - The Politics of Breastfeeding in America, a DVD

Podcasts from La Leche League International

Motherwear's Breastfeeding Blog Podcasts

Breasts in Mourning: How Bottle-Feeding Mimics Child Loss in Mothers' Brains [8/27/09 from Scientific American]


Reducing Infant Mortality and Improving the Health of Babies - this is a 15-minute, landmark video seminar about improving maternity care in the United States.

"In the US, after taking away the preterm babies, after taking away babies that had cancers and heart defects and things like that, babies who were fed anything other than breastmilk had about a 60% increase in death as compared to those that were breastfed."

The International Lactation Consultant Association (ILCA) is the professional association for International Board Certified Lactation Consultants (IBCLCs) and other health care professionals who care for breastfeeding families.

Our local lactation consultant raves about these products:

snappies makes bottles (80 ml i think) to pump into, with attached caps.  they actually make a tight seal with medela pump, unlike medela's own bottles.  tight seal really seems to make a difference.

pumpinpal makes flanges that fit into medela or ameda flanges.  they are angled so a  mom can sit back a little, vs having to sit upright.  3 different sizes, very reasonable prices.

simple wishes is a great pump bra - adjustable in several different ways so no need to buy another bra or use safety pins or other things..  and only $35.  great product.

i know in a perfect world we'd all love to see all babies nurse nurse nurse.  but when getting supply/keeping supply going is important and will help a mom keep going - glad there are good products.

The Foley Cup is like a newborn sippy cup when you need an alternative to suckling that doesn't cause nipple confusion.  How to Cup Feed

THE BABY'S PERSPECTIVE - "A course for experienced doulas, RN's, LVN's, LC's, CLE's & Infant Care Specialists who have been working as doulas for a while and want to learn the baby's perspective."  Started by Kittie Frantz, RN, CPNP-PC

Nancy Mohrbacher has a lot of resources on her web site, including her blog. Her multimedia page has Video Clips, Podcasts, and Handouts.

She has written a book incorporating the new information we have about Laid-Back Breastfeeding or Biological Nurturing:

Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers by Nancy Mohrbacher and Kathleen Kendall-Tackett

Benefits Of Breastfeeding Outweigh Risk Of Infant Exposure To Environmental Chemicals In Breastmilk

ScienceDaily (Dec. 20, 2008) ­ A study comparing breastfed and formula fed infants across time showed that the known beneficial effects of breastfeeding are greater than the potential risks associated with infant exposure to chemicals such as dioxins that may be present in breastmilk, according to a new report.
This compelling study encompassed an historical review of the medical literature and included time periods when levels of environmental chemicals were higher than they tend to be at present.

The authors of the report, Judy LaKind, PhD (LaKind Associates, Catonsville, MD), Cheston Berlin, Jr, MD (The Milton S. Hershey Medical Center, PA), and CAPT Donald Mattison, MD (National Institutes of Health), advise health care providers to continue to encourage new mothers to breastfeed their babies. In agreement with the World Health Organization's (WHO's) continuing support of breastfeeding, this study's findings, based on epidemiologic data, do not downplay the adverse effects of exposure to dioxins and other environmental toxins. However, the authors distinguish between the statistical significance of risk/benefit assessments in an individual compared to population effects.
"When breastmilk was chosen by regulatory agencies as a handy medium for measuring environmental toxins, the public became alarmed that breast milk was contaminated. The authors, eminent authorities on the subject have put these fears to rest," says Ruth A. Lawrence, MD, Editor-in-Chief of Breastfeeding Medicine, from the Department of Pediatrics, University of Rochester School of Medicine and Dentistry.

More Breast-Feeding Could Save Billions and Prevent Thousands of Breast-Cancer Cases [6/7/13]

ABCs of Breastfeeding - a nice pictorial guide.  Thank you to Dr. Jane Morton at Stanford and her team.

Hand Expression of Breastmilk - great video with Jane Morton, chair of the Stanford Department of Breastfeeding Medicine.  They have a nice section on Getting Started with Breastfeeding.

Report from PH at the breastfeeding conference, 200:

"Jane Morton, MD (she developed the Breastfeeding Medicine Program at Stanford) - spoke about increasing milk supply.  She says that "hands-on pumping" - her term for expression/compression during pumping - will greatly increase supply, and that babies find it easier to learn to nurse if milk flows and that volume is the determinant of flow.

First 3 days - hand express and feed with spoon.  When baby at breast - "compress compress compress" - it wakes the baby up to spur him to keep sucking.  her analogy:  we help babies learn to walk by holding their hands, we help them learn to ride bikes by holding the bike - we should help them learn to nurse!

her website for step by step teaching about Hand Expression of Breastmilk and Maximizing Milk Production with Hands On Pumping 

useful products:

Cryovial by Econo-Lab, Inc.
easyexpression.com for halter top

new pump bra available in may - adjustable.  www.simplewishes.com

"Making Enough Milk" www.breastmilksolutions.com

Also - another reminder about lightbulbs/glasses that block blue lights at night. "

How to Nurture a Mother - Mothers need to be nurtured so they can nurture their newborn.  A mother who isn't resting and eating/drinking well is more likely to have breastfeeding problems.  If you're trying to help a family member or friend with breastfeeding issues, start with bountiful nurturance.

NOTE - Dr. Jack Newman has moved his website to ibconline.ca/
Many of the links on this website go to his old web pages, so you may need to go to the above site and search for the desired information.  Sigh.

Dr. Jack Newman is perhaps the best expert on breastfeeding.  He and Teresa Pitman have co-written The Ultimate Breastfeeding Book of Answers : The Most Comprehensive Problem-Solution Guide to Breastfeeding

BreastFeeding Inc - Superb breastfeeding resources from Canada's Dr Jack Newman and lactation consultant Edith Kernerman

Dr. Newman's Breastfeeding Handouts and Video Clips by Dr. Jack Newman

Breastfeeding - Starting Out Right

Is My Baby Getting Enough Milk?

The CDC Guide To Breastfeeding Interventions offers guidance to policy and program professionals in selecting promising breastfeeding promotion and support activities. [June, 2005]

Inspired by a recent article in the Herald Sun (Australia) reporting that young women are reluctant to breastfeed their babies due to fear of public embarrassment, the Holistic Moms Network has launched a new project to highlight the beauty and confidence of breastfeeding women.  HMN members from across North America submitted photos of themselves proudly breastfeeding their children – everywhere from the Eiffel Tower to the Brooklyn Bridge – for the Nursing Our Future video featured on the organization’s website. [Or try YouTube]

Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs.
Labarere J, Gelbert-Baudino N, Ayral AS, Duc C, Berchotteau M, Bouchon N, Schelstraete C, Vittoz JP, Francois P, Pons JC.
Pediatrics. 2005 Feb;115(2):e139-46.

This study provides preliminary evidence of the efficacy of breastfeeding support through an early, routine, preventive visit in the offices of trained primary care physicians. Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes. Multifaceted interventions aiming to support breastfeeding should involve primary care physicians

The Milky Way, the newsletter of MOMS

Making Our Milk Safe (MOMS), the parent organization


LLL Breastfeeding Helpline -- US - The breastfeeding community throughout the United States has access to a 24 hour toll free helpline service by calling 1-877-4-LALECHE (1-877-452-5324). This helpline provides information, education, and support for women who want to breastfeed, and to healthcare providers and others.

Common Sense Breastfeeding - Breastfeeding carries with it a whole series of built-in instincts, and it makes sense to listen to them. These pages may help you hear yourself.

CAM Region 3 Meeting Notes on Breastfeeding from Ami Burnham - April 16, 2010

Laughter improves breast milk's health effect - FAMED for its restorative powers, it now seems that laughter also helps breast milk to fight skin allergies.  Breastfed babies with eczema experienced milder symptoms if their mothers laughed hours before feeding them, according to a study by Hajime Kimata at the Moriguchi-Keijinkai Hospital in Osaka, Japan.

Welcome to Mom's Breastaurant! - At Mom’s Breastaurant our mission is to promote a breastfeeding culture by giving breastfeeding moms a safe, comfortable, clean place to nurse during outdoor events such as street fairs, festivals, and concerts. Our tents are temperature controlled, have comfortable chairs and offer clean diaper changing stations.

The Academy of Breastfeeding Medicine

I love this t-shirt for mamas that reads, "I Make Milk - What's Your Super Power?"  Right on!!!

Why African Babies Don't Cry by J. Claire K. Niala (12/31/10)

"My Grandmother's gentle wisdom:

1. Offer the breast every single moment that your baby is upset – even if you have just fed her.

2. Co-sleep. Many times you can feed your baby before they are fully awake, which will allow them to go back to sleep easier and get you more rest.

3. Always take a flask of warm water to bed with you at night to keep you hydrated and the milk flowing.

4. Make feeding your priority (especially during growth spurts) and get everyone else around you to do as much as they can for you. There is very little that cannot wait.

Read your baby, not the books. Breastfeeding is not linear—it goes up and down and also in circles. You are the expert on your baby's needs."

And, of course, how could we go through life without a Dr. Seuss-style verse about breastfeeding:

A Dr. Seuss Variation

Would you nurse her at the park?
Would you nurse him in the dark?
Would you nurse him with a boppy?
And when your boobs are feeling floppy?,

Mandy & Matt: A solution for breastfeeding attachment through co-bathing by Midwifery Birthing Services - Shows how the techniques can be adapted and used when mother and baby are having problems establishing breastfeeding. If the first hours after birth have been disturbed and mother and baby have not been able to learn together how to breastfeed, resulting problems can be corrected by creating the conditions that trigger the innate reflexes in the baby, thus enabling the baby to relearn how to find the nipple, attach and suck successfully.

Babies have mirror neurons (also called mimc neurons) that cause them to mimic others' actions.  So if you want your baby to open the mouth in a nice, wide gape to latch on, show your baby what you mean, and really stretch that mouth wide open!!! (Yes, this is the basis for the old "monkey see, monkey do" truism!)

Neural mechanisms of imitation.
Iacoboni M.
Curr Opin Neurobiol. 2005 Dec;15(6):632-7. Epub 2005 Nov 3.

Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support?
Ekstrom A, Widstrom AM, Nissen E.
Birth. 2006 Jun;33(2):123-30.

" . . . the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care."

A Mother's Feelings for Her Infant Are Strengthened by Excellent Breastfeeding Counseling and Continuity of Care
Anette Ekström, PhD, RNM and Eva Nissen, PhD, RNMTD
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e309-e314 (doi:10.1542/peds.2005-2064)

CONCLUSION. . . . guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant.

LLLI Responds to AAP Policy Statement on Sudden Infant Death Syndrome

Massachusetts Breastfeeding Coalition's Response to AAP SIDS Recommendations

Attachment Parenting International Position Paper regarding the new recommendations by the American Academy of Pediatrics

Breastfeeding Is Associated with a Lower Risk of SIDS According to The Academy of Breastfeeding Medicine

How to Find Lactation Consultants

15 Years After Innocenti Declaration, Breastfeeding Saving Six Million Lives Annually - Unicef Press release [22 November 2005] – Six million lives a year are being saved by exclusive breastfeeding, and global breastfeeding rates have risen by at least 15 per cent since 1990.

Clinical Protocols  from The Academy of Breast Feeding Medicine

Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey
Anne Merewood, MA, IBCLC*,{ddagger}, Supriya D. Mehta, PhD, MHS§, Laura Beth Chamberlain, BA, IBCLC{ddagger}, Barbara L. Philipp, MD*,{ddagger} and Howard Bauchner, MD, MPH*,||
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 628-634 (doi:10.1542/peds.2004-1636)

Conclusion. Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates.

Here's the list of Baby-Friendly Hospitals and Birth Centers.

Nurse-N-Glow Pillow - an all-in-one night-time nursing aid.  Seems like a great shower gift to me, and no, I'm not making any money off this recommendation . . . I'm just *so* impressed that someone would design something that is so obviously designed to make nightime nursing and co-sleeping easier.  Thank you!!!

Wow!  I can't believe I'm raving about this product because it's not the bells and whistles that produce the breastmilk, but it seems really well designed and really, really useful!

Back Buddy® maternity support pillow is an award-winning back support pillow, designed by a Chiropractor and a mother of three.

I really like that it's made in the USA from non-toxic materials.  And I think the small arm rests on the side are brilliant.  However, I take issue with their implications that you need this for breastfeeding.  In fact, this pillow is incompatible with sidelying and laid-back-nursing positions.  However, many first-time moms need to start with upright breastfeeding for the first few days, at least, and this could help alleviate the back and shoulder soreness that is common.  It also MIGHT help the moms remember to bring the baby to the breast, rather than the other way around.  I do worry that it's incompatible with wrap-around nursing pillows such as My Brest Friend and the Boppy Pillow.

Breast is Best, but it Could Be Better: What is in Breast Milk That Should Not Be? [Medscape registration is free]  This article provides many helpful tips about avoiding toxic chemicals that could be passed to your baby through breastmilk.  [NOTE - Compounds found in air in the home could pose more of a health risk to breast-fed babies than chemicals they are exposed to through their mother's milk, researchers in the United States said on Tuesday.  They found that a nursing infant's exposure to gases known as volatile organic compounds (VOCs) from indoor air was 25-135-fold higher than from breast milk.]

Levels of Lead in Breast Milk "Quite Low" Even With High Maternal Lead Exposure

AAP Releases Revised Breastfeeding Recommendations (Feb., 2005)

The policy recommendations include:

    * Exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.
    * Mother and infant should sleep in proximity to each other to facilitate breastfeeding;
    * Self-examination of mother's breasts for lumps is recommended throughout lactation, not just after weaning;
    * Support efforts of parents and the courts to ensure continuation of breastfeeding in cases of separation, custody and visitation;
    * Pediatricians should counsel adoptive mothers on the benefits of induced lactation through hormonal therapy or mechanical stimulation.
    * Recognize and work with cultural diversity in breastfeeding practices
    * A pediatrician or other knowledgeable and experienced health care professional should evaluate a newborn breastfed infant at 3 to 5 days of age and again at 2 to 3 weeks of age to be sure the infant is feeding and growing well.

Of particular interest to midwifery and natural childbirth advocates are changes from the 1997 policy.  In particular, the policy includes as additional ways to support breastfeeding avoiding procedures that interfere with breastfeeding or traumatize the infant, including unnecessary, excessive and overvigorous suctioning of the oral cavity etc. Under immediate postpartum care, health care professionals are urged to allow skin to skin contact immediately upon delivery and continuing until the first feeding is completed. The policy states that a few assessment measures can be accomplished while the newborn is with the mother and lists others that should be delayed (weighing, measuring, bathing, etc.) until after the first feeding, and that the mother is an "optimal heat source for the infant."  These policy statements are right in line with what midwives already try to do!

Breastfeeding and the Use of Human Milk - Policy Statement from the AAP Section on Breastfeeding
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506 (doi:10.1542/peds.2004-2491)

Breastfeeding and the use of human milk from the National Guideline Clearinghouse, and a version highlighted by a lactation consultant.

Breastfeeding saves babies' lives

Breastfeeding and the risk of postneonatal death in the United States.
Chen A, Rogan WJ.
Pediatrics. 2004 May;113(5):e435-9.

In addition to its many known bonding and health benefits, breastfeeding appears to lower the risk of a baby dying during its first year of life, US research indicates. "Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality," the researchers observe. To address this issue, Aimin Chen and Walter Rogan, from the National Institute of Environmental Health Sciences in North Carolina, analyzed data from the 1998 National Maternal and Infant Health Survey. They compared breastfeeding patterns between 1204 infants who suffered postneonatal death-between 28 days and 1 year of age, for reasons other than cancer and congenital anomaly-and 7740 who were still alive aged 1 year. Children who had ever been breastfed were 21 percent less likely to die during the postneonatal period than those who had never been breastfed, and the risk declined with increasing duration of breastfeeding. In addition, the level of protection provided by breastfeeding varied with cause of death, ranging from an odds ratio of 0.59 for injuries to 0.84 for sudden infant death syndrome. Chen and Rogan conclude that "assuming causality... promoting breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the USA each year."

We have known for a long time that breastfeeding offers very significant health advantages to babies and children.  It is time that the evaluation of all aspects of perinatal care integrate this factor in assessing safety.  For example, homebirth is exemplary in promoting breastfeeding . . . there is no separation of mother and baby as observation of unstable newborns takes place right in mother's arms, suctioning that might affect breastfeeding is kept to the minimum necessary for safety, and babies aren't subjected to the hospital germs which could make them sick and unable to nurse. The negative effects of circumcision on breastfeeding must also be considered a specific danger of circumcision.

Fentanyl during labor may impede breastfeeding

The impact of intrapartum analgesia on infant feeding
Sue Jordana, Simon Emeryb, Ceri Bradshawa, Alan Watkinsc Wendy Friswellb
BJOG: An International Journal of Obstetrics & Gynaecology 112 (7), 927-934.

Conclusions  A dose response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well-established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.

Breast milk protects against diarrhea [10/25/04] - The Journal of Pediatrics 2004; 145: 297-303

Research findings suggest another positive reason for mothers to breast-feed their babies.

Oligosaccharides in breast milk can help to protect infants against diarrhea, researchers have found, providing more evidence in support of breast-feeding.

Milk storage diminishes antioxidant activity [10/25/04] - Archives of Disease in Childhood Fetal and Neonatal Edition 2004; 89: F518-20

Assessing the effect of storage conditions on the antioxidant content of human and formula milk.

Breast milk loses its antioxidant activity if stored for longer than 48 hours, study findings indicate, although refrigeration is better than freezing and thawing in this regard.

N. Hanna (Robert Wood Johnson Medical School, New Jersey) and co-workers measured the antioxidant activity of a range of human term and preterm milk, as well as five brands of formula milk, stored for different periods at various temperatures.

Fresh human milk had the highest antioxidant capacity of all the samples, irrespective of whether the mother had delivered prematurely or at term.

Furthermore, fresh human milk had significantly higher antioxidant activity than all formula milks tested.

With respect to storage of human milk, however, antioxidant activity was reduced if milk was kept at either -20°C or 4°C.

Few Mothers Meet Breastfeeding Goals, Study Shows - 8/5/04 - Only 14 percent of U.S. mothers exclusively breastfeed their babies for the minimum recommended six months, according to government data released on Thursday.

I personally find this statistic incredibly shocking.  Breastfeeding is arguably the most important way to protect a baby's health, yet our healthcare system is doing so little to support it.  We have routine separation of mothers and babies in hospitals and the pushing of all sorts of interventions that are harmful to the breastfeeding relationship but are supposedly done for the baby's own good.  I don't think so!

In homebirth practices, the breastfeeding rate is over 95%.  These lucky babies will get immeasurable benefits beyond the 20% reduction in mortality.  Why doesn't our healthcare system support midwife-attended-homebirth as the surest way to protect a baby's health?

It still amazes me that hospitals cannot provide breastfeeding support 24 hours/day for such a life-saving matter.

But nobody makes money off of healthy babies. This is no exaggeration. I recently attended a CIMS Forum and was talking with someone about the title of the talk - "Economic Disincentives for Mother-Friendly Care," the woman said that they had closed the highly successful lactation center at her hospital. When she asked a hospital admin why, that was his reply.

Report warns of continuing violations of code on breast milk substitute marketing - [BMJ  2004;328:1218 (22 May)] - "[T]he Switzerland based company Nestlé was responsible for more violations than any other company,"

Boycott Nestle

OK . . . if I can boycott Nestle, so can you.  It happens that I love chocolate, and it further happens that the chocolate I love best is made by Nestle.  My favorite candy bars are Nestle's Crunch, $100,000 Bar and KitKat.  I LOVE their hot chocolate mix, and, of course, Nestle's Tollhouse Morsels.  Oh, did I mention those great new Treasures morsels with coconut?!?  Unfortunately, Nestle is actively killing thousands of babies around the world through their unethical business practices in pushing formula to families that cannot afford to use it properly and safely.  I can no longer come home from births where we struggle to help babies breastfeed because it's so good for them, and then eat a Nestle's Crunch to keep myself awake on the drive home and then make a nice cup of hot chocolate while I do birth laundry.

http://www.babymilkaction.org/ has lots of information about the worldwide boycott, and they have a list of Nestlé subsidiaries, including the obvious ones like Nescafe, Nesquik and Nestea, but also including some surprising ones - Carnation, Alcon, Purina and Friskies.  Breastfeeding.com offers a great handy visual list of Nestlé affiliates.

If I can boycott Nestle, so can you!

If you need more motivation to boycott Nestle, then read breastfeeding.com's Stuff That Will Make You Mad

"Mr Ian Smith of York, gave his account of the company's ethics: "As one the members of Synod from York, where we have a significant Nestlé presence, I was invited, before the last debate on this subject in 1994, to meet some of their directors to discuss the issue. At that time they freely admitted that they were the market leaders of a trade that was being mishandled in some parts of the world. I observed that this resulted in many thousands of infant deaths. The response was that if they didn't sell the product someone else would. We've heard that line with regard to landmines recently: In other words, it's better that they're killed by our products rather than someone else's. Nestlé admitted that the business has its unethical side, but they still push it hard. They say they will stop - if others do too."

Let Baby Choose Which Side to Nurse On

Try this experiment:  When baby fusses, wanting to nurse, hold baby right in the middle of your chest.  You may be amazed that baby will then lunge towards one side or the other, choosing which side meets the immediate nursing need.  If baby's really hungry, they would probably choose the breast that is fuller, where the milk will come out faster and satisfy baby's hunger more quickly.  If baby just wants a little snack or is thirsty, baby may choose the breast that is less full, so that the flow of milk from the full breast isn't overwhelming.  Give it a try and please send feedback if you'd like. [NOTE - If a baby consistently prefers one side, it's worth considering the possibility that they are having some pain when nursing on the other side, possibly due to some residual birth trauma.  Try a different hold on the side they usually don't like, e.g. try the football hold, or sidelying from the top breast, or lying flat on your back with the baby on your belly.  If the baby suddenly is interested in the breast that they previously avoided, it makes sense to take them for a chiropractic or craniosacral evaluation.]



"Colostrum is so important that most infants would simply die without it."  This is the claim of Symbiotics - The Colostrum Company, which is selling bovine colostrum for consumption by adult humans.

"People need to understand that when they're deciding between breastmilk and formula, they're not deciding between Coke and Pepsi... they're choosing between a live, pure substance and a dead substance made with the cheapest oils available." -Lactation Consultant Chele Marmet

Some wonderful articles by Sarah J. Buckley, MD, from the section on Mothering - Care of the Newborn at Women of Spirit

Food for Thought - Call It "Early Breastmilk", not Colostrum
I have attended quite a few breastfeeding workshops in the past 3 years and they have all said that the new attitude toward early breastmilk is NOT to refer to it as colostrum, but to call it what it is - breast milk.  The people from whom I learned this were (on three occasions) Certified Lactation Consultants.  They were teaching primarily to hospital personnel and were very concerned about changing the image that the first milk is somehow not breastmilk.  This milk HAS protein and all the other components which define milk.  So it is not something OTHER than milk.

Falling in Love: The Chemistry of the First Breastfeed

Breastfeeding and CranioSacral Therapy: When It Can Help by Dee Kassing, BS, MLS, IBCLC

Breastfeeding Foundations for Nurses and Midwives - a fantastic online course from Australia.

First-Time Mothers at Greater Risk of Breast Abscess [Medscape registration is free]

The deadly influence of formula in America by Dr. Linda Folden Palmer [A Natural Family Online Special Report:]

The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, support and promotion of breastfeeding.

Excerpt from Nursing the Caesarean Born, by Michel Odent, MD -  Midwifery Today Issue 69

Nursing Family Newsletter's Resources and Links

Breastfeedingonline.com hopes to help empower women to choose to breastfeed and to educate society at large about the importance and benefits of breastfeeding. - the web site of Cindy Curtis, RN, IBCLC!

Latching and Positioning Resources from kellymom.com.  Great set of Latch-on pictures with description

The World of Latch-On: One Leader’s Journey by Diane Wiessinger, MS, IBCLC

"Watch your language!"  By Diane Wiessinger, MS, IBCLC

nursingmother.com now has online How-To videos so that you can see what it looks like when the baby is on right and what it looks like when you have it wrong.

The  International Lactation Consultant Association offers a great document - Evidence-based Guidelines for Breastfeeding Management During the First Fourteen days (1999) - this is a terrific document available as a FREE download. The guide provides 24 key strategies to guide health professionals in providing optimal care to mothers and infants during the crucial first 14 days.  [Another link to this same document.]

Milky Way Press's Breastfeeding Basics and Beyond(TM) series:  Reading Your Baby's Body Language and Breastfeeding's Number One Question:How Will I Know My Baby Is Getting Enough Milk?by Beverly Morgan, Lactation consultant, lactation educator, author, speaker.

Welcome to Lactation Consultant.Info -  Breastfeeding Help and Information from Marie Davis, R N, IBCLC

Best practice guide to common breastfeeding problems from Australia

Feeding Frenzy
How big business and politics conspire against breastfeeding mothers
by Maureen Turner - April 15, 2004

IUDs: Great Contraceptive, But Not For Nursing Moms from Dr. Dean Edell

Medications and Lactation: What PNPs Need to Know [Medscape registration is free.]

"Breast milk has consistently been confirmed to provide infants and children with unique, species-specific nutrients that are ideal for infants' immune protection, growth, development, and emotional well-being. Few maternal medications are contraindicated for lactating mothers and their breastfeeding infants "

Breastfeeding Pharmacology - from the web pages of Dr. Tom Hale, author of Medications and Mothers’ Milk

Breastfeeding Difficulties from ivillage.com

Lactation Education Resources

Healing Through Breastfeeding: A Sexual Abuse Survivor - This is an incredibly touching story about how newborn self-attachment helped a mother to reframe her thoughts about her breasts and breastfeeding.


FDA’s Breast Pump Website

Breast Pumps Are Finally Getting Better. Here’s How. By Elissa Strauss

Limerick makes breast pumps that have silicon flanges, which are often more comfortable than a stiff plastic.  The pump uses a combination of suction and massage for optimal milk transfer.  They are also assembled in the US!

The Medical Supply House

motheringfromtheheart.com carries a diverse product line, including breast pumps and specialty feeding devices, such as the Hazelbaker™ FingerFeeder.  (The FingerFeeder allows baby to be in control and pace the feed. It is the only special feeding method that provides the touch of the human skin. [Ed: Although you would want to be really sure the human finger doesn't carry yeast!  You don't want to add thrush to an already difficult situation!])

Spectra seems to be an Australian breast pump manufacturer; their pumps are starting to become available in the US.  From a very satisfied mom: "spectra s1 is wayyyy better than either medela or ameda ... I get more ounces, it's portable and way less noisy and way more comfortable. and it is a closed system which medela is not."

2010 - Lactation consultants are raving about Hygeia’s breastpumps, including EnJoye™, the only green breastpump.

Gerber has a new Massaging Manual Breast Pump

Encouraging Patients to Use a Breast Pump (after returning to work) - great article from Medscape [Medscape registration is free]

Pumping Moms Information Exchange

White River Concepts - "Medical study rates WRC pump equal to nursing babies for stimulating milk production" -  An unusual pump for people who don't letdown to the usual top-of-the-line hospital pumps.  It uses compression as well as suction and is much more like baby.

Breast Pump Comparisons - this compares features of some major brands.

Medela has a web page on how to find out which breastpump is right for you. And they have a very helpful rental location finder.



Nursing Bras/Nursing Clothes

Women seem to recommend the following bras as good for nursing:

Decent Exposures

Motherwear wants to help women like you find the support and confidence to breastfeed whenever and wherever your babies are hungry. Free breastfeeding guides, along with clothes that were designed and made with you and your baby in mind.

Mother's Nature carries Nursingwear, Nursing Bras (Medela, Bravado), Medela Breastpumps and Accessories, Breastfeeding Accessories, Over the Shoulder Baby Holder Sling, Cloth Diapers, Toys, Books for Pregnancy and Childbirth. There are also new Auction Pages!!

NURTURED BABY Organic Cotton Bras, Bravado Nursing/Maternity Bras and Maternity Underwear

Clothes for the Nursing Mother

Breastfeeding WebRing

Great Site with Lots of Information and Support

Promotion of Mother's Milk, Inc. (ProMoM) is a nonprofit organization dedicated to increasing public awareness and public acceptance of breastfeeding, including 101 Reasons to Breastfeed Your Child. This site is the new home of J. Rachael Hamlet's Breastfeeding Advocacy Page.

Australian Breastfeeding Association - formerly the Nursing Mothers' Association of Australia

Breastfeeding.com - We are here to give you the best in breastfeeding information, support, humor, news, supplies, advocacy, stories, attitude and more.  [This site has good general breastfeeding information. They will also send you a lovely poster with the top 12 reasons to breastfeed.]

BestFed.com - "Breastfeeding  for as long as your child wants to is probably THE most important thing you can do for the health and wellbeing of your child after birth."

1998 Breastfeeding Resource Guide - San Diego County Breastfeeding Coalition

Lactnet Archives - http://community.lsoft.com/archives/LACTNET.html

NURSING MOTHER’S COUNSEL (Fort Wayne, Indiana, USA - Local Chapter)
NURSING MOTHER’S COUNSEL National Organization

La Leche League

Management of nipple pain and trauma - by Wendy Nicholson RM IBCLC 5.4.98

Joy Johnston's Resource Centre - Midwifery Care and Breastfeeding - Lactation consultation
This site has some really terrific articles on breastfeeding.

Baby-friendly Hospital Initiative (launched by WHO and UNICEF in 1991) - The BFHI, sponsored by the World Health Organization and UNICEF, is a world-wide effort to improve breastfeeding rates. Based on the ten steps to successful breastfeeding, the initiative encourages hospitals to examine their practices, make the appropriate changes and then apply for recognition as a Baby Friendly Hospital.

World Health Organization (WHO) on Breastfeeding

Kathy Dettwyler's Thoughts on Breastfeeding and her supporting medical references

INFACT Canada - The Infant Feeding Action Coalition - Canada home page

The Parent-L Breastfeeding Resources Page:

The Bright Future Lactation Resource Centre is an education and motivation resource for Lactation Consultants and others providing parents with infant feeding information.

Fenugreek: One Remedy for Low Milk Production By Kathleen E. Huggins, RN, MS
Kathleen Huggins is a Director of the Breastfeeding Clinic at San Luis Obispo General Hospital, CA. She is the author of The Nursing Mother's Companion and coauthor of The Nursing Mother's Guide to Weaning.

How to Know a Health Professional is not Supportive of Breastfeeding
by Jack Newman, MD.

The purpose of MOBI (Mothers Overcoming Breast feeding Issues) is to give women a place to discuss their emotions over not being able to breast feed successfully.

The Human Milk Banking Association of North America, Inc. represents all of the North American human milk banks which collect, pasteurize, and distribute donated mother's milk.

Project "Got Breastmilk?" - beautiful photographs of breastfeeding mothers and babies

Smoking leaves taste in breast milk -U.S. study
New England Journal of Medicine, Nov., 1998

Effects of Mag. Sulfate on Breastfeeding

I've heard that in India, breastfeeding mothers are encouraged to follow a special diet for the first 8-12 weeks, as food eaten during that time has a lifelong influence on the baby's tastes.  (Please contact me if you have more information about this.  Thanks.)

Veg Pregnancy & Breastfeeding - from vegetarianbaby.com

Midwifery and Breastfeeding Bumper Stickers - Texas Sticker Company & Label Exchange

An Overview of Milk - Biology of Lactation

5 Breastfeeding Tips After a C-Section By Robin Elise Weiss, PhD

Associations Among Lactation, Maternal Carbohydrate Metabolism, and Cardiovascular Health.

Stuebe A1.
Clin Obstet Gynecol. 2015 Dec;58(4):827-39. doi: 10.1097/GRF.0000000000000155.

In mammalian reproductive physiology, lactation follows pregnancy; growing evidence suggests that disruption of this physiology affects a woman's lifetime risk of metabolic disease. These differences may reflect lactation-induced mobilization of fat stores and modulation of maternal stress reactivity. In addition, confounders may play a role: women who breastfeed for long durations are more likely to engage in other healthy behaviors, and obesity and insulin resistance may interfere with breastfeeding physiology. These findings underscore the importance of evidenced-based care to enable women to achieve their infant feeding goals.  [Ed: I've had clients who felt that higher carb intake and glucose levels increased their engorgement issues, even weeks after the birth.  I haven't read the full text of this article, but it may be related.]

Biological Nurturing and Newborn Self-Attachment

I used to think that newborn self-attachment was kind of a fad--a sort of circus trick.  After learning more and seeing it happen a number of times, I'm convinced that this really is what the baby is expecting.  The laid-back position triggers all these great breastfeeding instincts in babies, so they really do latch on all by themselves.  (We're prepared to help them, of course, if needed.)  You have to be patient, though, because it can take 20-30 minutes, usually starting about 20 minutes after the birth, after the baby is done with the gazing phase.  But as I watch the babies bob the head up and down and open the mouth wider and wider, it seems that they may also be undoing some of the head compression of birth, thereby avoiding some of the latch problems we see in babies who still have some bone over-riding in the skull plates.

I would love to see this taught as the default approach to baby-led breastfeeding.

Delivery Self-Attachment with Lennart Righard, MD. - This 5:50 YouTube video compares newborns from two groups - mothers who had medicated and unmedicated labours. Baby needs rest the first 15-20 minutes of life. After this period of rest it takes time and patience but the baby will find its way to the breast unassisted using the crawl and stepping reflex and latch on.

A New Approach: Biological Nurturing and Laid-Back Breastfeeding By Jeanne Batacan, CMA, ICCE, CLC, CD - this lovely article gives a nice, short description of easy self-attachment for baby's first breastfeeding session as well as subsequent feedings.

Laid-Back-Breastfeeding By Nancy Mohrbacher, IBCLC, FILCA - this is an excellent summary!

Here's one with pictures:

Some Ins and Outs of Laid-Back Breastfeeding
By Nancy Mohrbacher, IBCLC, FILCA - These laid-back positions not only make breastfeeding less work for mothers, they also make it easier for babies to take the breast deeply, especially during the early weeks. . . .  One common question I am often asked is whether these positions are practical after a cesarean birth. The answer is most definitely yes.

Lying Down May Help Breastfeeding

"A study of 40 mothers breastfeeding in different positions found that babies' natural reflexes kicked in more easily when the mothers were lying down. . . . Dr Suzanne Colson, senior midwifery lecturer at Canterbury Christ Church University, advises women on a technique called biological nurturing where the mother lies down and lets the baby lie on its tummy on top of her. . . . She spotted 17 reflexes in babies when they were breastfed lying down, including reflexes normally associated with other mammals who feed their babies in this way. Breastfeeding in a sitting-up position only promoted the three normally seen reflexes - routing, latching and sucking. Mothers who breastfed lying down seemed to have more success and, although the majority of women in the study had initially reported problems with breastfeeding, after using the technique all the women continued breastfeeding."

Your Baby Is Speaking to You: A Visual Guide to the Amazing Behaviors of Your Newborn and Growing Baby by Kevin Nugent and Abelardo Morell
In this book, the authors say that the self-attachment process is the baby's opportunity to tell the story of their birth.  This is just yet another good reason for supporting self-attachment.

Womb to World: A Metabolic Perspective by Suzanne Colson has a nice section on Biological Nurturing

Here are some other articles by Suzanne Colson:

Bringing nature to the fore - Suzanne Colson argues that it is time to draw up breastfeeding competencies in order to promote the ‘nature’ perspective within early breastfeeding support

Colson S., (2005) Maternal breastfeeding positions: Have we got it right? - Part 1 (The Practising Midwife 8:10;24-27)

Colson S., (2005) Maternal breastfeeding positions: Have we go it right? - Part 2 (The Practising Midwife 8:11; 29-32)

‘White blood’: dose benefits of human milk

Suzanne's Publications

and Biological Nurturing Resources - DVD, posters and handouts

Here's a neat biological basis for why biological nurturing or self-attachment works:

A single postnatal injection of oxytocin rescues the lethal feeding behaviour in mouse newborns deficient for the imprinted Magel2 gene.
Schaller F, Watrin F, Sturny R, Massacrier A, Szepetowski P, Muscatelli F.
Hum Mol Genet. 2010 Dec 15;19(24):4895-905. Epub 2010 Sep 28.

"The onset of feeding at birth is a vital step for the adaptation of the neonate to extra uterine life. . . . [I]njection of a specific oxytocin (OT) receptor antagonist in wild-type neonates recapitulated the feeding deficiency seen in Magel2 mutants, and a single injection of OT, 3-5 h after birth, rescued the phenotype of Magel2 mutant pups, allowing all of them to survive. Our study illustrates the crucial role of feeding onset behaviour after birth. We propose that OT supply might constitute a promising avenue for the treatment of feeding difficulties in PW neonates and potentially of other newborns with impaired feeding onset."

This also explains why it's so important for the baby to nurse within the first hour after birth, when the oxytocin levels in both mother and baby are still high!

Delivery Self Attachment by Lennart Righard, M.D. - This video depicts a newborn's ability at birth to crawl up to a breast and ATTACH HIMSELF UNASSISTED!

OK!!!  I have FIRST-hand experience with this.  Sometime last year in an issue of Mothering magazine, there was an entire article on the phenomenon....even with pictures.  It was really neat.  I remember showing it to DH and saying....wow...that is really cool, but at the SAME TIME I told him....well...I am so excited about other things RIGHT after the birth that I am not really interested in repeating the experiment......but it really is neat.

WELL....after my baby was born....we were all laughing and crying and I was talking with the MW's when they got there and I didn't really notice, but my baby WAS crawling/inching her way along up my abdomen.  I DID notice because all of the sudden I said "HEY!!!"  and I looked down and she had ATTACHED her mouth to MY NIPPLE and was SUCKING!!!  It was the COOLEST thing!!!

I think this happened because as this was my first HB, no nurse or OB was RUSHING to cut the cord and take her off of me.  And secondly, this was an unassisted and there WERE NO MW's for about 10 minutes, so I said to DH and everyone, let's just keep her on my belly with the warm towels on top of her and then when the MW's get here THEY can cut the cord and all. So...my baby was on my belly for a significant amount of time....and I think THAT is what enabled the experiment to be a success even though we weren't even trying!!!

One other significant thing I remember from the article is that it is very important if you want to repeat the experiment is that you do not wash the baby's hands at ALL.  They say that the baby needs to be able to smell the amniotic fluid on their hands and that the nipple smells like amniotic fluid too and that is why they are attached to it.

Initiation of Breastfeeding by Breast Crawl - this is similar to the Breast Self Attachment video.

YOUR BABY KNOWS HOW TO LATCH-ON - Great 5-minute video from ameda.com

Study Challenges Conventional Breastfeeding Advice, Suggests Mothers Should Be Semi-Reclined to Nurse More Effectively

Effects of Birth Practices on Breastfeeding

See also: Birth Trauma and Breastfeeding Difficulties

I was reading through a copy of my baby's hospital records, and was flabbergasted by the "Infant Recovery Record", which is a record of baby's first hour.  There were some pre-fab options for the "Activity" column, and it did not include breastfeeding!  The options were Active, Active When Stimulated, Irritable, Lethargic, Quiet, and Sleeping.  Sigh.

Wow!  This is really sad.  At my homebirth, the midwives charted the important details of breastfeeding: Rooting, Latching, Time of first latch, duration of latch, and even which breast he was on!  And the followup care papers had a separate, fairly detailed section for breastfeeding assessment at each followup appointment.

It's important to consider birthing practices that affect breastfeeding because they have a strong effect on the baby's ultimate health:

Separation of mother and baby

There's a great book about this, Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum by Mary Kroeger.  You can also get this book from the La Leche League Store.

The breastfeeding rates in my homebirth practice are close to 100%, and if you consider how significantly this increases birthing safety, it makes homebirth significantly safer than hospital birth.

Hospital practices that impede breastfeeding:
1) Washing babies shortly after birth . . . this can wait until eight hours after the birth; I think the WHO recommends six hours, but I find that babies often have a special, post-birth stupor that lasts about six hours, and this starts after baby has gone through all the instinctive post-birth activities (breathing, gazing, self-attaching, breastfeeding) that take about two hours.
2) Using those horrible clamps on baby.  They have got to make a belly-to-belly position uncomfortable for the baby.  Breastfeeding-Friendly Cord Closures are readily available.

Alta Vista search for information about "birthing practices" AND breastfeeding

Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study.
Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I.
Anesthesiology. 2005 Dec;103(6):1211-7.

CONCLUSIONS: Among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than woman who were randomly assigned to receive less fentanyl or no fentanyl.

Changing hospital practices to increase the duration of breastfeeding. - an oldie but a goodie!

Hospital policies and practices that promote breastfeeding result in more mothers choosing to breastfeed following delivery

WHO/UNICEF Baby-Friendly Hospital Initiative

Hospital Support for Breastfeeding and Associated Outcomes

Homebirth Most Significant Factor in Successful Breastfeeding

Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother-infant pairs from Ireland and the UK. [full text]
Quigley C1, Taut C2, Zigman T3, Gallagher L4, Campbell H5, Zgaga L2.

BMJ Open. 2016 Aug 8;6(8):e010551. doi: 10.1136/bmjopen-2015-010551.

RESULTS: Home birth was found to be significantly associated with breast feeding at all examined time points, including at birth, 8 weeks, 6 months and breast feeding exclusively at 6 months. In GUI, adjusted OR was 1.90 (95% CI 1.19 to 3.02), 1.78 (1.18 to 2.69), 1.85 (1.23 to 2.77) and 2.77 (1.78 to 4.33), respectively, and in UKMCS it was 2.49 (1.84 to 3.44), 2.49 (1.92 to 3.26), 2.90 (2.25 to 3.73) and 2.24 (1.14 to 4.03).

CONCLUSIONS: Home birth was strongly associated with improved breast feeding outcomes in low-risk deliveries. While the association between home birth and breast feeding is unlikely to be directly causal, further research is needed to determine which factor(s) drive the observed differences, to facilitate development of perinatal care that supports breast feeding. [Ed: I believe that homebirth *IS* directly causal.  For all the reasons that it's easier for a woman to labor and give birth without interventions at home, it's also easier for a woman to breastfeed without interventions.]

In this study, 89.7 percent of babies were fully breastfeeding at six weeks.

Outcomes of planned home births with certified professional midwives: large prospective study in North America [Full-text article]
Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager
BMJ  2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. [NOTE - CPMs are equivalent to Licensed Midwives in California and some other states.]

What is the single most positive contributing factor for the successful establishment of breastfeeding?


I assume the gentle birth, the avoidance of tubes down the baby's throat, the time to allow for baby-led nursing, and the general calm and quiet help a lot. But the studies say it's the simple fact that the midwife shows up at the home at 24 hours, 3 days, 5 days, whatever it takes to get that mom and baby nursing well.

This is the sort of thing I fret about when I hear people talking about extending hospital stays for new moms and babies.

I'm thinking - get them out of that hospital and away from the infection threats as soon as possible. Instead, use the money from the cost of an extra day in the hospital to pay for three home visits from a birthing professional and a week's worth of household help. This would go a long way towards helping breastfeeding.

Growth Charts for Breastfeeding Babies

Study Shows Some Newborns Lose Weight Much Faster Than Previously Recognized [12/1/14] - NEWT Newborn Weight Tool is first to help parents and pediatricians assess newborn weight loss

New Pediatric Growth Charts Reflect Breastfeeding as the Norm

Acta Paediatrica: WHO Child Growth Standards

The following information is from Volume 3, Issue 3 of Research Summaries for Normal Birth, July 2006, from the Lamaze Institute for Normal Birth:

Summary: The first of a series of new pediatric growth charts have been released by the World Health Organization (WHO). The new growth standards were developed to replace existing pediatric growth charts based on growth patterns in predominantly formula-fed populations. Beginning almost a decade ago, the WHO undertook a detailed and elaborate statistical study, sampling thousands of infants from eight ethnically diverse, economically stable nations where at least 20% of women had access to breastfeeding support and followed WHO infant feeding guidelines. The healthy, term infants who participated were followed by trained researchers biweekly for 2 months, monthly up to 12 months, and bimonthly up to 24 months. An additional sample of children was followed up to 71 months. Breastfeeding support was provided as needed. Data were collected on infant growth patterns and achievement of motor skills.

The resulting infant growth standards offer pediatric providers and parents the first evidence-based information on how children should grow under optimal conditions. The researchers found that there was very little ethnic variability in average growth or achievement of motor skills, suggesting that poverty and sub-optimal nutrition are responsible for previously observed regional variability in infant growth.

Significance for Normal Birth: The WHO infant growth charts are an important step in positioning breastfeeding as the norm and reversing decades of erroneous advice to parents of breastfed infants who were told that their infants were failing to thrive because they gained weight more slowly than formula fed infants. Now, more formula fed babies will be seen to “fall off the curve” by gaining weight too rapidly, an important predictor of childhood obesity.

The results of the WHO Multicentre Growth Reference Study provide solid evidence that breastfeeding contributes to the optimal growth and motor development of infants. Interventions in normal birth, including cesarean surgery and unnecessary separation of mothers and babies impede women’s ability to initiate successful breastfeeding with their newborns thereby contributing to less than optimal infant growth and development.

Average Growth Patterns of Breastfed Babies from kellymom.com, with a great list of related references and resources.

"The 2000 CDC growth charts can be used to assess the growth of exclusively breast-fed infants, however when interpreting the growth pattern one must take into account that mode of infant feeding can influence infant growth. In general, exclusively breast-fed infants tend to gain weight more rapidly in the first 2 to 3 months. From 6 to 12 months breast-fed infants tend to weigh less than formula-fed infants." [from the CDC Growth Charts FAQ]

Baby growth charts to be revised - The World Health Organization is to issue new guidelines on measuring the growth rates of babies.

Current charts are based on calculations using the growth patterns of babies fed largely on formula milk from 20 years ago.
But bottle-fed babies put on weight more quickly than those that are breast-fed, meaning breast-fed children could be shown as underweight.
The new recommended charts are based on data from breast-fed babies.

Breastfeeding and Drugs

Are you wondering if a medication or medical procedure will be a problem for a breastfeeding mom?

You can call the Infant Risk Center -- run by Dr. Thomas Hale's team in Texas (author of Medications and Mother's Milk -- the physician's reference for drug safety in breastfeeding). 

The InfantRisk Center will be dedicated to providing up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding.  Our goal is to provide accurate information regarding the risks of exposure to mothers and their babies.  By educating healthcare professionals and the general public alike, we aim to reduce the number of birth defects as well as create healthy breastfeeding relationships.
We are now open to answer calls Monday-Friday 8am-5pm central time. Please contact us at (806)-352-2519.

LactMed: A New NLM Database on Drugs and Lactation is a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. The database was produced by the National Library of Medicine as part of the Toxicology Data Network. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider. The database is searchable by drug name.

Breastfeeding and Drugs - from motherisk.org

Drugs in Pregnancy and Lactation from Harbor UCLA Medical Center

CARE Northwest gives free telephone advice to pregnant and breastfeeding women about the possible effects of drug and chemical exposure. Call Monday through Friday, 8 a.m.-4 p.m.: 888-616-8484.

Breastfeeding and Alcohol

What about drinking alcohol and breastfeeding? from La Leche League

From Dr. Jack Newman's More Breastfeeding Myths:

5. A mother should not drink alcohol while breastfeeding. Not true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers.

Breastfeeding And Alcohol from breast-feeding-information.com

The Breast Milk Cocktail -- the author finds contradictory info on alcohol and caffeine By Elizabeth Agnvall

Beer, Alcohol And Breastfeeding

Alcohol, breastfeeding, and development at 18 months.  [ Full text ]
Little RE, Northstone K, Golding J; ALSPAC Study Team.
Pediatrics. 2002 May;109(5):E72-2.

DISCUSSION: We were unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing.

Breastfeeding and alcohol from Britain's National Childbirth Trust:

"Hale (Dr Thoms Hale in Medications and Mothers Milk, the international textbook on this topic, all research based) says the mother needs to have a blood level of 300 mg alcohol per decilitre of blood before her infant shows significant side effects (mainly sedation).

The legal drink driving limit in the UK is 80mg of alcohol per 100ml of blood.

100ml is a decilitre so this means you would have to be between 3 and 4 times the legal limit for driving before the alcohol you were drinking had significant effects on your baby....and actually feeding at the time you were affected, too.

Alcohol reaches the breastmilk shortly after it reaches the bloodstream - so fairly quickly, in other words, but in dilute quantities. Hale says 'the absolute amount transferred into milk is low'.

You can be sure your breastmilk is clear of alcohol when your bloodstream is clear of it, and the usual guide for this is that the body processes alcohol at a rate of one and a half to two hours per unit.

Just as your body deals with alcohol, and any effects of it are temporary (apart from people who drink chronically over years, whose brain and liver are affected) , your baby's body deals with the very small traces of alcohol in the milk.

There are reports in Hale of effects on milk supply, let down and taste, but these will be temporary."

Breastfeeding Benefits to Mother

Breast-Feeding Can Help Mom's Heart Decades Later

Duration of Lactation and Incidence of the Metabolic Syndrome in Women of Reproductive Age According to Gestational Diabetes Mellitus Status: A 20-Year Prospective Study in CARDIA--The Coronary Artery Risk Development in Young Adults Study.
Gunderson EP, Jacobs DR Jr, Chiang V, Lewis CE, Feng J, Quesenberry CP Jr, Sidney S.
Diabetes. 2009 Dec 3. [Epub ahead of print]

Conclusions: Longer duration of lactation was associated with lower incidence of the metabolic syndrome years post-weaning among women with a history of GDM and without GDM controlling for preconception measurements, BMI, socio-demographic and lifestyle traits. Lactation may have persistent favorable effects on women's cardiometabolic health.

Learn more about the benefits of breast-feeding from the National Women's Health Information Center.

Breastfeeding as Birth Control

September, 1999 - [Medscape article] The World Health Organization asserts in the September issue of Fertility and Sterility that "...the lactational amenorrhea method is a viable approach to postpartum contraception."  [NOTE that co-sleeping will significantly increase the effectiveness as it encourages the baby to nurse during the night; some say that babies must nurse as often as every six hours in order for LAM to be effective.]

Breastfeeding Benefits to Baby

Breastfeeding and the risk of postneonatal death in the United States.
Chen A, Rogan WJ.
Pediatrics. 2004 May;113(5):e435-9.

    OBJECTIVE: Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality. We evaluated the effect of breastfeeding on postneonatal mortality in United States using 1988 National Maternal and Infant Health Survey (NMIHS) data. METHODS: Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included. We calculated overall and cause-specific odds ratios for ever/never breastfeeding among all children, conducted race and birth weight-specific analyses, and looked for duration-response effects. RESULTS: Overall, children who were ever breastfed had 0.79 (95% confidence interval [CI]: 0.67-0.93) times the risk of never breastfed children for dying in the postneonatal period. Longer breastfeeding was associated with lower risk. Odds ratios by cause of death varied from 0.59 (95% CI: 0.38-0.94) for injuries to 0.84 (95% CI: 0.67-1.05) for sudden infant death syndrome.

CONCLUSIONS: Breastfeeding is associated with a reduction in risk for postneonatal death. This large data set allowed robust estimates and control of confounding, but the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child. Assuming causality, however, promoting breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the United States each year.

Here's a new one!

Teens Breast-fed as Infants Have Stronger Leg Muscles
They did better on horizontal jump, "explosive strength" tests, study finds

Longer breastfeeding is associated with increased lower body explosive strength during adolescence.
Artero EG, Ortega FB, et al.
J Nutr. 2010 Nov;140(11):1989-95. Epub 2010 Sep 22.

"Significant differences among the categories of breastfeeding duration were tested using ANCOVA after adjusting for a set of potential confounders: gestational and current age, birth weight, sexual maturation, fat mass, fat-free mass, maternal education, parental weight status, country, smoking behavior, and days of vigorous physical activity. Longer breastfeeding (either any or exclusive) was associated with a higher performance in the standing long jump test in both boys and girls (P < 0.001), regardless of fat mass, fat-free mass, and the rest of potential confounders. In adolescents who were breastfed for 3-5 mo or ?6 mo, the risk of having a standing long jump performance below the 5th percentile was reduced by half compared with those who were never breastfed [odds ratio (OR) = 0.54, 95% CI = 0.30-0.96, P < 0.05; and OR = 0.40, 95% CI = 0.22-0.74, P < 0.01, respectively). These findings suggest a role of breastfeeding in determining lower body explosive strength during adolescence."

Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e380-e386 (doi:10.1542/peds.2005-1496)

CONCLUSIONS. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour.

PubMed citation

This is a pretty amazing statistic, and it's important to consider this anytime you're also considering the safety of birthing practices that affect breastfeeding:

Separation of mother and baby

There's a great book about this, Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum by Mary Kroeger

The breastfeeding rates in my homebirth practice are close to 100%, and if you consider how significantly this increases birthing safety, it makes homebirth significantly safer than hospital birth.

A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health
Kathleen Kendall-Tackett
International Breastfeeding Journal 2007, 2:6     doi:10.1186/1746-4358-2-6

Breastfeeding fights depression
08 May 2007
International Breastfeeding Journal 2007; 2: 6

MedWire News: Breastfeeding can help new mothers fight depression, research shows.

Kathleen Kendal-Tackett (University of New Hampshire) says that depression is common among new mothers, and affects anywhere from 10 percent to 20 percent of postpartum women.

"Since depression has devastating effects on mother and baby, it's vital that it be identified and treated promptly," she adds.

Kendal-Tackett says that new mothers experience an increase in inflammation due to high levels of pro-inflammatory cytokines.

Common experiences associated with new motherhood such as disturbed sleep and postpartum pain can also act as stresses that cause pro-inflammatory levels to rise, she says.

Breastfeeding can reduce women's stress levels so that their inflammatory response systems remain inactive. This then reduces their risk of depression.

But Kendal-Tackett notes this is only true when breastfeeding is "going well."

"When breastfeeding is not going well, particularly if there is pain, it becomes a trigger to depression rather than something that lessens the risk."

She concludes: "Mother's mental health is yet another reason to intervene quickly when breastfeeding difficulties arise."

Higher Concentration of Vitamin C in Breast Milk Linked to Lower Rate of Infant Atopy  CME

Vitamin C in breast milk may reduce the risk of atopy in the infant.
Hoppu U, Rinne M, Salo-Vaananen P, Lampi AM, Piironen V, Isolauri E.
Eur J Clin Nutr. 2005 Jan;59(1):123-8.
CONCLUSION: A maternal diet rich in natural sources of vitamin C during breastfeeding could reduce the risk of atopy in high-risk infants.

Breast-Feeding Cuts Risk of Respiratory Disease

[Oct., 2001]  Healthy children who are breast-fed are one-third less likely to develop a lower respiratory tract infection compared with bottle-fed babies, according to a review of the medical literature presented here Monday at the American Academy of Pediatricians' annual meeting.

"If you breast-feed for at least 4 months, your child will experience one-third the risk of hospitalization for lower respiratory disease,'' lead author Dr. Virginia Bachrach, a community pediatrician in Palo Alto, California, told Reuters Health. The protection seems to last for the first year of life, Bachrach noted.

Bachrach said that 6% of all US infants less than 1 year of age are hospitalized annually for lower respiratory tract disease, which elevates their risk for later illnesses such as asthma and creates a costly healthcare burden.

Ayala Ochert wrote a fabulous article, "The Science of Mother's Milk", in La Leche League's journal, New Beginnings, Issue 3, 2009.  "Breastmilk contains literally thousands of different components that support the immune system in some way."  To read more about this topic, search for oligosaccharides and her reference, L. A. Hanson's Immunobiology of Human Milk: How Breastfeeding Protects Babies.

Association of Breastfeeding With Maternal Control of Infant Feeding at Age 1 Year
Taveras, E. M., mGillman, M. W.
PEDIATRICS (doi:10.1542/peds.2004-0801)

"Mothers who fed their infants breast milk in early infancy and who breastfed for longer periods reported less restrictive behavior regarding child feeding at 1 year."

Study: Breast Feeding Cuts Infant Death 20 Percent [5/2/04] - Breast-fed children in the United States are 20 percent less likely to die during the first year of life than whose who are not nursed.

The Target Flap - December, 1998

Target's Lullaby Club advertisement carried an editorial about advantages of bottle feeding vs. breastfeeding.
This website shows a large ad by TARGET stores outlining the many advantages of bottle-feeding.  ARGH!!!  A couple advantages it states are how bottle-feeding doesn't tire mom or baby, and that it may help the baby sleep through the night, how dad can help in feeding, how you can still eat spicy foods, how since it takes longer to digest formula, baby doesn't need to be fed often (that's like saying that since disposable diapers are so absorbent, babies can sit in their own waste without leaking for many more hours than before!!!).

Target's Response

A response to Target's response:

I understand that you think you were being "fair" in presenting "both sides" of the breastfeeding vs. bottle feeding question.  Unfortunately, you neglected the "side" that is most important - the baby's.

A newborn has an immature immune system that is incapable of mounting an adequate defense against many germs, especially the more virulent, antibiotic-resistant bacteria.  Nature intended that the breastfeeding mother be an extension of the baby's immune system, providing vital antibodies and macrophages. Every newborn relies on breastfeeding to provide a defense against life-threatening infections.

Next time you wish to expound on the alleged benefits of bottle feeding, I hope you'll do so from the point of view of the person most affected - the baby.

The FDA's "Breastfeeding Best Bet for Babies":

Rachael's page on "Why Breastfeeding is Important":

This contains references to research showing, among other things, that BF'd children are smarter, healthier, have less risk of SIDS etc,

The newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.
Dr. Grantly Dick-Reed

Preliminary Growth Charts for Breastfed Babies

USDANEWS/Article5/August 1997 - The Ideal Infant Food - "Loving Support Makes Breastfeeding Work." USDANEWS GREEN LINE VOLUME 56 NO.7 - AUGUST 1997

UPI Summary of Breastfeeding Advantages

Advantages of Breastfeeding Links - This page was written in the interest of supporting and promoting breastfeeding for all moms and babies. UNICEF states that 1 million babies die each year as a result of being fed artificial formula, some die from diarrhea and other intestinal illnesses , some die from malnutrition because their families can not afford to purchase formula, and some die from the illnesses that formula fed babies are more likely to contract.

From: C-upi@clari.net (UPI / LIDIA WASOWICZ, UPI Science Writer)

Subject: Health Today [Jul 28]

Date: Mon, 28 Jul 1997 0:50:49 PDT
Breastfeeding Protects Against Ear Infections: A study shows babies who drink from the breast rather than the bottle are less likely to develop ear infections. The study by the National Center for Chronic Disease Prevention and Health Promotion shows babies fed nothing but mother's milk were 70 percent less likely to develop ear infections in their first year of life than infants who got formula only. The authors say this study is very important because only 53 percent of U.S. women breastfeed their children. That means 47 percent of babies are at increased risk of ear infections.

Breast Milk May Reduce Risk of Schizophrenia

Effect of Breastfeeding On Immunity

Vaccinating babies without vaccinating babies -A baby makes copies of maternal immune cells it acquires through mother's milk [10/7/16]

"Summary:  Scientists have long understood that mother's milk provides immune protection against some infectious agents through the transfer of antibodies, a process referred to as "passive immunity." A research team now shows that mother's milk also contributes to the development of the baby's own immune system by a process the team calls "maternal educational immunity."

"In some instances, our work has shown that immunity [against TB] is far more effective if acquired through the milk than if acquired through direct vaccination of the baby."

This is just one more reason why it's so important to tailor birth practices and postpartum support to make happy breastfeeding easier.

Maternal Milk T Cells Drive Development of Transgenerational Th1 Immunity in Offspring Thymus. [Full text]
Ghosh MK1, Nguyen V1, Muller HK2, Walker AM3.
J Immunol. 2016 Sep 15;197(6):2290-6. doi: 10.4049/jimmunol.1502483. Epub 2016 Aug 5.

Using multiple murine foster-nursing protocols, thereby eliminating placental transfer and allowing a distinction between dam- and pup-derived cells, we show that foster nursing by an immunized dam results in development of CD8(+) T cells in nonimmunized foster pups that are specific for Ags against which the foster dam was immunized (Mycobacterium tuberculosis or Candida albicans). We have dubbed this process "maternal educational immunity" to distinguish it from passive cellular immunity. Of the variety of maternal immune cells present in milk, only T cells were detected in pup tissues. Maternal T cells, a substantial percentage of which were CD4(+)MHC class II(+), accumulated in the pup thymus and spleen during the nursing period. Further analysis of maternal cells in the pup thymus showed that a proportion was positive for maternal immunogen-specific MHC class II tetramers. To determine the outcome of Ag presentation in the thymus, the maternal or foster pup origin of immunogen-responding CD8(+) cells in foster pup spleens was assessed. Whereas ∼10% were maternally derived in the first few weeks after weaning, all immunogen-responding CD8(+) T cells were pup derived by 12 wk of age. Pup-derived immunogen-responsive CD8(+) cells persisted until at least 1 y of age. Passive cellular immunity is well accepted and has been demonstrated in the human population. In this study, we show an arguably more important role for transferred immune cells: the direction of offspring T cell development. Harnessing maternal educational immunity through prepregnancy immunization programs has potential for improvement of infant immunity.

Sugars in Human Mother's Milk are New Class of Antibacterial Agents [8/21/17] - an interdisciplinary team of chemists and doctors at Vanderbilt University have discovered that some of the carbohydrates in human milk not only possess antibacterial properties of their own but also enhance the effectiveness of the antibacterial proteins also present.

Effect of Breastfeeding On Intelligence

Although this study was published in 2006, it appears that it was based on data collected in 1979; it is hard to know whether the data collection standards from 1979 would hold up against today's standards.
"Setting: 1979 US national longitudinal survey of youth."

Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis
Geoff Der 1*, G David Batty 1, Ian J Deary 2
BMJ, doi:10.1136/bmj.38978.699583.55 (published 4 October 2006)

Conclusions Breast feeding has little or no effect on intelligence in children. While breast feeding has many advantages for the child and mother, enhancement of the child's intelligence is unlikely to be among them.

On the other hand, this 2004 study showed that although parental intelligence is also correlated, it appears that breastfeeding, in and of itself, also increases intelligence.

Influence of breast-feeding and parental intelligence on cognitive development in the 24-month-old child.
Gomez-Sanchiz M, Canete R, Rodero I, Baeza JE, Gonzalez JA.
Clin Pediatr (Phila). 2004 Oct;43(8):753-61.

"The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child's mental development at 24 months of age. Parental intelligence also appears to influence cognitive development."

Breast Milk May Reduce Risk of Schizophrenia

Breastfeeding Rights

Breastfeeding in Whose Public? by Peggy O'Mara, editor of Mothering Magazine

A Current Summary of Breastfeeding Legislation in the U.S. - a state-by-state guide to breastfeeding laws in the U.S. from La Leche League.

State Legislation that Protects, Promotes, and Supports Breastfeeding: An Inventory and Analysis of State Breastfeeding and Maternity Leave Legislation

California Governor Signs Bill Assuring Right to Breastfeed in Public

Vitamin D and Other Vitamins in Breastmilk

Some pediatricians routinely recommend vitamin supplements for newborns, such as Pedia Tri-Vite Drops 50 mL - the emphasis seems to be on vitamin D.  These may be important for babies who are
breastfed by mothers with vitamin deficiencies from poor nutrition.  However, research shows that they are not necessary for babies breastfed by mothers with adequate supplementation.

A breastfed baby's vitamin D needs will be met if the mother is getting 6400 IU daily of vitamin D.  This can be taken daily or several days' worth or even a week's worth of supplementation can be taken all at once, since vitamin D is stored in the liver and fatty tissues.

The benefits of vitamin A for the baby of a well-nourished woman are limited to 48 hours after the birth, which happens to be when a breastfed baby is getting high levels of vitamin A from the mother's colostrum or early breastmilk.

Vitamins for Breastfed Babies from the AAP [11/21/2015] - Human milk provides sufficient amounts of vitamins, except for vitamin D.  [Ed: This is probably because most people are deficient in vitamin D.  However, see below for research showing levels of maternal vitamin D supplementation which meet baby's needs.]

Vitamin A supplementation for breastfeeding mothers
- the Cochrane Collaboration reports that the amount of vitamin A in well-nourished mothers' breast milk is sufficient to meet the needs of their infants

This is one reason we encourage lactating women to continue taking their prenatal vitamins or make sure they're getting adequate nutrition.

Now, there is excellent evidence to show that babies benefit from ongoing oral supplementation with vitamin K for the first three months after birth, even if they received a vitamin K injection at birth.

Vitamin D

Maternal Vitamin D Status: Effect on Milk Vitamin D Content and Vitamin D Status of Breastfeeding Infants
Adekunle Dawodu4,* and Reginald C. Tsang5
Adv Nutr. 2012 May; 3(3): 353–361.

[R]ecent studies showed that high-dose vitamin D supplementation of 4000 IU/d and 6400 IU/d of vitamin D of healthy lactating mothers can increase the vitamin D concentration of milk to a level that supplies adequate vitamin D intake for the breastfeeding infant even though both mother and infant were limited in sunlight exposure.  [Ed: It makes sense to go for the higher numbers of 6400 IU daily;  this is what continuing education lactation educators recommend.  The higher numbers will also help the mother to absorb the calcium she needs to pass along to her baby.]

Dr. Mercola's comments on the issue of Vitamin D in breastmilk - Pregnant women have an added reason to get their vitamin D levels checked. As the study shows, if a breastfeeding woman is deficient in vitamin D, then her breast milk and breastfeeding baby will be too.

Hollis and Wagner announced their lab has determined that lactating mothers need at least 3,600 IU a day of cholecalciferol (the natural form of vitamin D) to maintain their own and their infant’s vitamin D levels. 2,000 IU was inadequate. Only when Hollis and Wagner gave lactating mothers 3,600 IU of cholecalciferol did the mother have enough vitamin D to maintain their own and their infant’s blood levels. 3,600 IU of vitamin D is about 10 times what the federal government says lactating women should get and is almost twice what the federal government says may be toxic.

Sunlight and Vitamin D: Exposing the Benefits from La Leche League

Sunlight Deficiency: Helping Breastfeeding Mothers Find the Facts from La Leche League

From what I have learned it is not necessary to supplement your diet with vitamin D alone. As long as you are nursing your baby, it is however important to continue taking your prenatal vitamins. What I recommend to clients is to also ensure eating ample varieties of foods that are high in vitamins and minerals. A food is an immediate source of nutrition and should not be regarding as only filling your belly when your hungry. Foods such as dairy products- milk, cheese-, eggs, fatty saltwater fish (such as halibut and tuna), oatmeal, sweet potatoes, vegetable oils and dandelion greens. Herbs high in vitamin D are nettle, alfalfa, horsetail and parsley. Although, I do not recommend taking parsley at all while nursing unless you wish to decrease your breast milk production. Another very simple way of implementing vitamin D into your system is just a few minutes of sunlight a day. When the skin is exposed to the sun's ultraviolet rays, a cholesterol compound in the skin is transformed into a precursor of vitamin D.

Vitamin D for Babies

Vitamin D Supplementation of Breast-Fed Infants [Medscape registration is free]

Vitamin supplements in children - Are they necessary? Are they good? A study published in Pediatrics this month suggests that multivitamin supplementation may be associated with an increased risk of babies developing asthma and food allergies. [More information about Supplements for Kids]

Do your children need nutritional supplements? Part II [5/8/11]

Breasfeeding and Working

Rachael's page on "Breastfeeding and Returning to Work":

Workplace Breastfeeding Programs: Employer Case Studies is designed to help employers create programs and policies that encourage new moms to breastfeed after they return to work.

Insurance Coverage for Breast Pump

We seem to be up against a wall, trying to get a breast pump covered through my husband's insurance (Blue Cross Blue Shield), although everyone i talk to (besides our insurance rep and anyone related to our insurance) says they should definitely be covered.

I recently got my pump through Edgepark medical supplies, and had it 100% covered by my insurance - Anthem BC/BS. I have a PPO plan, and I was told that I could get a new pump again next year if I wanted. I had to be at least 36 weeks into my pregnancy at the time of ordering for full coverage, and it took about a week for processing and shipping.

Contact your insurance, tell them about the problem and ask for a GAP request to buy one locally. Worked for me!

Prescription doesn't play  role. Code means nothing too. Just get someone in your insurance who KNOWS (obviously that  rep doesn't know anything). There must be a company your insurance works with. Just get their number and call.

In my case I have Cigna insurance, so I called Cigna and they directed me to Carecentrics (800) 411-2305. Carecentrics directed me to Sterling Medical to get my free Ameda pump. I got prescription, but when I called to order - no one cared for it. They said they will call midwives to get their own authorization. In 2 days they confirmed that pump was covered and shipped it and I got it.

My understanding of breastpump insurance coverage is that the extent of coverage varies widely from plan to plan. Your carrier should provide you with the an exact statement of your breastpump coverage.

Anecdotally I've had people say that their insurance covers both pump and accessories to only a handpump. Regardless, it shouldn't be a big deal for the company to provide you that detail in writing. Make sure you have the exact statement of coverage on company letterhead before making any purchases you wouldn't otherwise make.

Maybe also talking to your dr about it could help.

I recommend contacting your Congressperson. Their staff can explain your rights and then advocate on your behalf. If let me know if you'd like help figuring out who represents you.

My insurance plan may pay for me to get the Medela double breasted electronic one. I was told I had to wait until after the baby was born (like when I get discharged from the hospital) and to have my doc write a prescription for the pump with the diagnosis of engorgement, (one can also use feeding problem, inverted nipples, premature baby held in hospital etc.) You have to go to a Medical supplier to rent/buy it if the insurance company is going to pay or help pay for it.

Human Milk Storage

Human Milk Storage Information from LLL

Re: Stinky Milk

"Sometimes thawed milk may smell or taste soapy. This is due to the breakdown of milk fats. The milk is safe and most babies will still drink it. If there is a rancid smell from high lipase (enzyme that breaks down milk fats) activity when the milk has been chilled or frozen, the milk can be heated to scalding (bubbles around the edges, not boiling) after expression, then quickly cooled and frozen. This deactivates the lipase enzyme. Scalded milk is still a healthier choice than commercial infant formula."

Storing Expressed Milk

Breastfeeding Nutrition

Spirulina is fantastic for nursing mothers! It is filled with chlorophyll, rich in protein, contains all 8 amino acids and has B12 (important source for vegetarians). The chlorophyll nourishes blood (a precursor to breast milk in Chinese Medicine) and helps remineralize the body--including calcium, which is obviously lost during lactation & pregnancy. Spirulina helps balance blood sugar and helps with energy and stamina. I recommend a product called Pure Synergy for all my patients including pregnant and nursing moms. There's more in it than spirulina.

Newborn Who Won't Nurse From the Start

If a baby consistently prefers one side, it's worth considering the possibility that they are having some pain when nursing on the other side, possibly due to some residual birth trauma.  Try a different hold on the side they usually don't like, e.g. try the football hold, or sidelying from the top breast, or lying flat on your back with the baby on your belly.  If the baby suddenly is interested in the breast that they previously avoided, it makes sense to take them for a chiropractic or craniosacral evaluation.  This goes double for a baby who won't nurse well at all.  Compressed skull bones can make it painful to open their mouth wide enough to latch on

I don't think that the problem that I'm going to post about is GBS because these moms haven't had PROM or any of the other symptoms. But once in a while and just this last week I had the experience again, are those darned babies that refuse to nurse for hours after birth. Then the worry about hypoglycemia, dehydration etc. It seems that you just can't get anything down them at all. This last one seemed to thrust her tongue when anything was put in her mouth. She wouldn't even take my finger. We really worked with this one and finally but these babies every once in a while are what make me want to pull my hair out. You just can't get them to nurse for anything.

I agree, this is a really tough situation. I have had similar difficulties with babies in the past. I have not seen it as the result of any infectious process. I generally try the suggestions below. Perhaps this info will help you out next time.

Sometimes these babies seem to have gotten into the habit of sucking something like a fist or the side of their hand in utero ( I check their hands for a little blister like area) which seems to make them prefer to suck with the tongue thrust, and resist anything (finger, breast) deeper into their mouth. It takes quite a bit of patience and gentleness to get them to accept the finger. I try gentle stroking of the face and lips to stimulate baby and then try 'tongue walking' -walking my finger slowly from tip towards back of tongue drawing it down and forward with pad of my index finger.

Sometimes they are just what is sometimes called an 'aggressive non-nurser' - they arch away from the breast and scream and refuse to nurse. With these babies, I try to gently curl them into 'C' shape which is neurologically more conducive for feeding. Then I would try the facial stroking- starting from the nose, and stroking out towards cheek and then down towards chin- and from midline upper lip- around and down too chin and lower lip. Then try positioning them in the clutch/football hold for nursing- to maintain the 'C' curl. See if this helps.

When I worked as a hospital nurse, I used to see a great deal more of what you are describing. Some babies are born reluctant nursers. Sometimes the circumstances of birth can play a role too, as in a very long, difficult birth or sometimes, even an extremely rapid birth.

Babies who are deeply suctioned at birth (sometimes necessary if there is mec) can develop oral aversions. Also some kiddos seem to develop habits in utero that contribute to nursing problems. Last April, we had a little one born who, first of all, was somewhat depressed and needed some active resuscitation post-birth, then had some tachypnea and transient nasal flaring and grunting. Things settled down quickly but the baby did not nurse for a good 12 hours post-birth. Fortunately, the parents gave birth at my partners house, and stayed the night because they were so tired, and this allowed us more time to work with them. Finally, the other thing I discovered the following morning, was that the baby had developed the habit of sucking on her lip and was very resistant initially to the breast.

When I have babies who don't exhibit interest in nursing in the first few hours, I always look for reasons (difficult birth, any signs of distress, maybe too much environmental stimuli, and so on). I encourage skin to skin contact and consistent gentle efforts to offer to nurse. As far as getting babies to take my finger, I have found that it is helpful to be very gentle about this...... I tickle the lips with my finger just as I would have mom do with her nipple, and let the baby set the pace with accepting my finger. This seems to work well most of the time.

Finally, if baby continues to be reluctant and it is getting on to be 24 hours, I try to get mom set up with a hospital grade electric breast pump to start stimulating milk production, continue with skin to skin, etc. If mom can get some colostrum, it can be cup fed to the baby or an eye dropper can be used. If I can't get the mom to pump or get any colostrum, I would consider using formula at that point in a cup (just small amts). Sometimes, once the baby gets a little something in his or her tummy, they figure out that they want to eat.....

I wouldn't worry TOO much about them if all else seems normal. Some babies just don't want to nurse till they get hungry and it really doesn't hurt them to go for a while. (Remember the huge controversy in the 60s about "early feeding", when it was considered unhealthy to allow feeds before 24 hours?). If a baby is showing any signs of hypoglycemia - and wont nurse or take a bottle - then you can correct it easily with a tiny bit of syrup or Karo on your finger.

I would just keep an eye on these kids, keep attempting every couple hours. They might take a day or two to get the hang of life outside the womb where they have to work for their supper!

IF ALL ELSE IS NORMAL, they probably will become ravenous on day two or three when the milk comes in...

This last baby that didn't nurse finally started at 18 hours. I had the parents giving her sterile water w/sugar. This seemed to get her interested and all is well now. No I don't remember in the 60's about the delayed feeding. I think I was in high school and not even thinking about this. But I'm glad to hear it. Thanks.

Newborn Who Won't Nurse Enough

You said that she's too exhausted to suck.  Babies with jaundice are often very sleepy babies; one of my babies slept a lot when she had jaundice too.  Getting a sleepy baby to wake up can increase nursing which will also lead to pooping eventually.  Here are some things we found to help wake her up:
1) dress her only lightly -- we had to take her hat and long-sleeved outfit off.  Of course, you don't want a newborn to get too cold (and it is chilly outside now), but for our baby it was really helpful to just have her dressed in just her diaper.  We would sit by the window in the sunlight in just her diaper and nurse as much as possible.
2) rub her feet, or even give her a gentle all-over massage while she nurses
3) switch breasts whenever she starts to fall asleep, even when she's not done on one side.
4) breast compressions -- if I would help push the flow of milk out to her, she would wake up a little to take in the extra milk
5) if she really, really doesn't want to wake up or can't stay awake to nurse, something very very cold on her feet, back, or belly can do it.  We used cold wet washcloths, items out of the refrigerator or even the freezer when it got really bad.
6) we had to set an alarm that went off every 3 hours, and we would wake her up to nurse whether she asked for it or not.  This isn't something that a newborn without jaundice typically needs, but it is pretty important for a baby with jaundice, though eventually (in a couple weeks) you won't need to be quite so rigid anymore.  The trick is to keep going back to bed between nursings until you have had a full amount of sleep; then you can manage to get enough rest even though you're waking up multiple times during your "night".

People are worried about the baby not pooping because it probably means there isn't enough incoming milk to push it out.  I would focus on creating an ideal environment for the baby to nurse and don't focus on trying to make the baby poop.  The baby is not constipated.  I guarantee it.  Babies don't have enough intestinal flora to form solid stool until they're around 10 days old.

So, ideally you could get help from a lactation assistant:

Otherwise, follow these steps:

Help mom to relax in a reclining position, with a warm blanket behind her and around her shoulders but naked from the waist up and with her chest and belly exposed to the baby.  Get baby naked.  Make sure the room is not too hot.  (A hot baby is too lethargic to want to nurse.)  While you are trying to get baby to nurse, it is fine for baby to be a little cooler.  This will raise the baby's adrenaline to give them more energy to nurse, and they will be more interested in mom's body as a source of warmth.  (It's fine if baby has a diaper on, but absolutely naked is even better since diapers impede babies movement.)  Place baby on mom's chest, with the baby's head between her breasts and the baby's feet towards her feet.  Let the baby find the way to the breast to latch on.

If the weather is very warm, you may need to have a fan creating a gentle breeze on the baby.

This works 9 times out of 10.

See Biological Nurturing and Newborn Self-Attachment

Thanks for the tons of suggestions I got over the weekend. Almost all of the suggestions worked - removing her diaper during feeding worked the most. Light massage with olive oil also stimulated her to feed more. [Ed: Note that this may be related to the oxytocin surge.]

Contented Babies Who Don't Nurse Often Enough

On the Popular Misconception that A Baby Won't Starve Itself

This is a common misconception. Some babies are content to quietly sleep themselves into Failure to Thrive or even death. Diaper count is useful but often hard for mom to focus on. Before meconium is passed 2-3 wet diapers a day is okay. as doulas here are some tips to check on breastfeeding:
At 2 week PP visit look at baby... talk to mom.. Does he appear healthy and alert? Is he growing well? gaining 4-8oz. week from bottom weight?

Slow weight gain has the potential to be serious...but with close monitoring and good breastfeeding management it can be turned around. Mom and baby can continue to have a happy nursing relationship.

You can boost baby's caloric intake using the settled fat from mom's own expressed milk. The mom can express some of that copious milk supply, leave it to stand then skim off the fat layer that settles out and mix it with a small portion of the thinner milk, this would supply baby with a great caloric boost to try and up the weights.

A mom with lots of milk is doing something right to keep the supply going strong. I agree that baby should be encouraged to nurse more often and as long as possible on the one breast as possible, only switching when baby seems completely done and uninterested in "working" the breast. Offering the second breast that will supply and easy "slurp" is good for a top off.

Sugar Water Is Never Appropriate

Just a little note of correction here, no baby should ever be given sugar water under any circumstance. If they are not nursing and you are simply concerned about dehydration, simple water is best. If they are not nursing or not nursing sufficiently, they should be given formula (by bottle, cup, syringe, finger, whatever). Giving a baby glucose water is like feeding them cocacola. Not good. It leads to destabilized blood glucose levels because they put out a lot of insulin when they first get the sugar and then can drop their blood glucose levels precipitously as they metabolize the sugarload. These kind of blood sugar surges and declines can lead to mild behavior changed (such as irritability and difficulty nursing -- just what you are trying to fix) all the way to coma and brain damage in a susceptible baby whose well meaning parents feed it too much sugar water.

The American Academy of Pediatrics stated a few years ago unequivocally that infants should never be fed sugar water. Regular water for dehydration prevention or to stimulate nursing is sufficient in most cases. A non-nurser needs whole calories such as that provided by pumped breast milk or formula, not the "empty" calories and sugar rush provided by glucose water.

If you are still not convinced, the next time you have to do a three hour glucose test on a woman, ask her how she feels an hour after the 100 gm glucose load on an empty stomach. Most of my clients say they feel flushed and lightheaded. Then ask them how they feel at the end of the test. Most of my clients say they feel tired and listless. Is this really what you want to put a newborn through?

I do not mean to sound harsh, I know that midwives who recommend sugar water are doing what they think is right, but I urge all of you who still recommend sugarwater to reconsider this advice and gather whatever information you need to convince yourself and you clients that pumped breastmilk or formula is best.

I cringe every time I enter the newborn nursery at my back-up hospital and see the cases of glucose water. Can't seem to convince them.

With regards to giving a newborn sugar water, I attended a Perinatal conference in Texas in 1996 and heard a speaker refer to just that! The speaker said that research has shown that supplementing with oral sugar water may actually delay the excretion of bilirubin in a newborn's immature digestive system! I am so glad you brought this subject up!

Latch Problems

Suck Training can help with latch problems.

During my training as an LC, we learned of the correlation between receiving IVs and poor latch (not just with narcotics).  The excessive fluids the mom received can cause edematous nipples (which are usually not noticeable by one who doesn't know what they are looking for).  So they explained the importance of getting a full birth hx on a mom with nursing difficulties. One thing to ask is if she was pitted (or had any IVs).  With such a large,  edematous nipple, latching is often more difficult for the baby.  This usually takes 24-72 hours to resolve, but as we know, if there isn't help with poor latching the first day, nursing difficulties can be long-term.  I think if a mom is aware of what the problem might be and is given tips to work with the issue, she is more likely to be armed to deal with the problem.

This helps us to remember that ANYTHING we do that interferes with the nl process of birth may cause problems later, so we all need to choose our interventions wisely and be prepared for the potential consequences.  I would never have thought of a pit IV as having problematic sequelae for latching.

Latch Problems after Several Months

There are a number of reasons why latch problems might appear after baby has been nursing fine for several months.

Developmentally, babies start to become more interested in the world around them; you may need to minimize distractions to keep baby latched on well.

Also, as babies get heavier, their position often changes; their weight may be pulling them off the breast.  Better support with pillows may be needed.

Also, last but definitely not least, as a woman's fertility cycles return, she may notice breast sensitivity at certain times in her cycle.  Some women will say that nipple soreness around the time of ovulation was their first inkling that fertility was returning.

Tongue Tie and Lip Tie

NOTE - If you think your baby has a tongue tie and might need laser surgery, it's important to look into your dental insurance and make sure to add baby quickly.  The procedure costs close to $2000 in some areas.

See also: MTHFR and Tongue Tie

There is some thinking that tongue tie and lip tie are more likely if the mom is deficient in folate; folate is different from folic acid.  I can't find anything in classic medical literature about this, and it's mean to "blame the mom" without proof.  But I also believe that moms are entitled to information they might need.  So if you have a family history of tongue tie, it might mean that you have a genetic vulnerability and need to be sure you're getting adequate folate, not just folic acid.

Frenotomy Surgeons and Practitioners directory

Tongue-Tie & the Breastfed Baby by Diana West, BA, IBCLC from La Leche League - This is a good basic explanation of how a tongue-tie affects breastfeeding.

"Tongue-tie has been documented to affect 3-10% of all babies.  As we learn more about how to accurately identify it, some lactation consultants are beginning to think even more babies are affected."

Tongue Tie - Tongue Tie is one of the most common causes for breastfeeding troubles for a new mother and baby.  Tongue-tie often causes multiple issues in regards to breastfeeding and be one of the largest hindrances to breastfeeding a newborn child as many pediatricians and healthcare providers are not always in the know about the severity of tongue tie. Many babies go misdiagnosed and mother’s may give up due to the pain and emotional set-backs they experience as a result. [Sylvia Boyd is a very experienced lactation consultant.  Thank you! for sharing this great information!]

Breastfeeding: what to do about ankyloglossia, lip-tie from the AAP [2015] - Difficulties with newborn breastfeeding can occur when movement of the infant’s tongue or upper lip is restricted. These
conditions, ankyloglossia (tongue-tie) and concomitant lip-tie, are characterized by congenitally short frenulums of the tongue and upper lip.

Ankyloglossia - Tongue and Lip Ties by Beverly Morgan, IBCLC, FILCA  from MOBI (Mothers Overcoming Breastfeeding Issues)

Dr. Lawrence Kotlow specializes in pediatric dentistry in Albany, NY.  His web pages on Breastfeeding Health have great videos about various types of tongue tie.

IATP: International Affiliation of Tongue-tie Professionals on Facebook

Efficacy of neonatal release of ankyloglossia: a randomized trial. [Full Text Free]
Buryk M, Bloom D, Shope T.
Pediatrics. 2011 Aug;128(2):280-8. Epub 2011 Jul 18.

We demonstrated immediate improvement in nipple-pain and breastfeeding scores, despite a placebo effect on nipple pain. This should provide convincing evidence for those seeking a frenotomy for infants with signficant ankyloglossia.

Is My Baby Tongue-tied?  from Catherine Watson Genna BS, IBCLC.  Here's the first page of her article in the Journal of Human Lactation

I have heard there's a great Facebook support group for tongue tie issues, but the biggest one is closed.  There are a number of newer small ones that might be worth checking out.

Breastfeeding a Baby with Tongue-Tie - KellyMom has a great collection of resources!

Suck Dysfunction from lowmilksupply.org

The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment [11/19/12] from theleakyb@@b - this has some photos of a lip tie.

What is a Lip Tie? How to Diagnose and Treat by Jennie on January 22, 2013

Tongue Tie and Lip Tie FAQ [10/2/2014] by Bobby Ghaheri

How to Examine a Baby for Tongue-Tie or Lip-Tie [2/15/14] by Bobby Ghaheri

Diagnosing Tongue-Tie in a Baby is Not a Fad [2/18/14] by Bobby Ghaheri - he quotes that the prevalence of ankyloglossia in the population is approximately 4-5% and that inheritance is also passed in an autosomal dominant fashion (like Acevedo).  The increase in overall rates of breastfeeding explains why pediatricians might be getting more complaints about tongue ties.  But it doesn't explain the drastic increase that lactation consultants are seeing.  We need more research to identify the role of MTHFR issues.

The Problem With Breastfeeding Compensations For Tongue/Lip Tie [6/23/16] by Bobby Ghaheri

The Difference Between a Lip Tie and a Normal Labial Frenulum [19.8.14] by Bobby Ghaheri

The Misunderstanding of Posterior Tongue Tie Anatomy and Release Technique [8/19/15] by Bobby Ghaheri

How Does An Upper Lip Tie Affect Breastfeeding? [March 6, 2014] by Bobby Ghaheri.  If you don't have a local pediatric dentist who specializes in lip tie, then you could take this article to your favorite dentist.  Any dentist can correct this if they are informed as to how important it is.

DrGhaheri.com's articles about Tongue Tie | Tongue Tie and Breastfeeding | Tongue Tie Laser Surgery

The Discovery of the Upper Lip Tie [2/26/13] by awarriormom

Discovering And Correcting Lip Tie On A Toddler And An Infant [3/6/2013] by Ladan, a mother

E-News 16:7 - Tongue Tie - An archived issue of Midwifery Today E-News

Tongue Tie from Carmen Fernando, a speech-language pathologist based in Sydney, Australia.  She has a section on Breastfeeding and an extensive Photo Gallery.

Breastfeeding Health - excellent videos to help diagnose and document treatment for tongue tie from Dr. Lawrence Kotlow, a specialist in pediatric dentistry

The Hazelbaker Assessment Tool for Lingual Frenulum Function
is one tool that may be used to grade the severity of the tongue-tie objectively. (Video clip of assessment being done).

Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.
[full-text HTML or full-text PDF]
Ballard JL1, Auer CE, Khoury JC.
Pediatrics. 2002 Nov;110(5):e63.

CONCLUSION: Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.

A tongue-tie can make a good latch difficult or impossible, and it can be cut in a simple procedure called a frenotomy.  The connective tissue may stretch, so some mothers will take it day by day before deciding to have it cut.  If it's really interfering with breastfeeding, it probably makes sense to cut it sooner rather than later.  But if it's a borderline case, you may choose to wait and see.

Ankyloglossia from  Newborn Photo Gallery from Stanford Med School

The Murphy Maneuver for diagnosing tongue tie

If baby is having trouble breastfeeding and you are not sure if he is tongue-tied, San-Diego pediatrician Dr. James Murphy suggests pushing your little finger to the base of the tongue on one side and sweeping it across the other side to see what you can feel. If you feel little or no resistance more than a small “speed bump,” then most likely there is no problem.

Should you feel a large speed bump that you can get past with a little more effort, it is most likely a “tree trunk” frenulum, a short, wide band of tissue buried in the floor of the mouth and attached to the base of the tongue. It usually, though not always, restricts tongue movements and causes latch problems even though it looks like there isn’t enough there to be a problem.

When you can’t sweep your finger across without pulling it back to “jump over a fence,” the frenulum is a fibrous band attached closer to the front of the tongue. It may be buried underneath the floor of the mouth or visible as an external web. If you see a narrow white streak running down the middle of the floor of the mouth that feels like a wire, it usually extends to the front of the tongue like a string. Pushing your finger into this “piano wire” frenulum will often cause the tip of the tongue to tilt downward and the center if the tongue to pill down and crease along the middle. “Tree trunk, “fence,” and “piano wire” frenulums are red flags for significant tongue function impairment.

For comprehensive, evidenced-based guidelines on breastfeeding management, check out ABM’s Clinical Protocols, including our protocol for managing Neonatal Ankyloglossia.

This tip and other gems come from the Association for Breastfeeding Medicine

For comprehensive, evidenced-based guidelines on breastfeeding management, check out ABM’s Clinical Protocols.

Frenectomy Exercises with Melissa Cole of Luna Lactation

Apparently the o-ball can be used to encourage baby to stretch the tongue?  One mama couldn't get her baby to use it but as a last-ditch attempt to soothe a cranky baby while cooking dinner, she gave her daughter a wire whisk to play with; the happy baby started playing with it with her tongue.  What baby could resist all those interesting wires?

Inverted Nipples

Thanks to Marsha Bearden RN, IBCLC, a lactation consultant in Alabama, who wrote to tell me that her web site offers the Niplette for sale!

Avent sent me a sample when I faxed them a request on my midwife letterhead.  I can see that it would work well, and it's got some rave reviews on some of the lactation lists.  Combined with the research, I'd say it's definitely worth a try.  However, it is pricy - $50 retail.

The sample came with a brochure listing a toll-free number; it didn't work when I tried it, but here it is, just in case: 1-888-Niplette (647-5388).  Their main number is 800-542-8368, and you can theoretically order the Niplette from that number.  Good luck.  The Avent America site has a Store Locator Page.

Most references to the Niplette appear to be British.  I did find some sites with pictures of the product in use:  Here's a British Avent site, a French Avent site and a Dutch site .

The "Niplette": an instrument for the non-surgical correction of inverted nipples.

McGeorge DD
Br J Plast Surg 1994 Jan;47(1):46-9

Inverted and non-protractile nipples are a common problem which cause psychological distress and interfere with a woman's ability to breast feed. A new instrument, the "Niplette", readily corrects the defect without the need for surgery. It is cheap and all patients found it comfortable and easy to use. Breast feeding is possible after treatment. The device should replace surgery in medical practice for this common condition.

Interesting articles from Lactnet about the Niplette:

Hoffmann's hypothesis, shells and Niplette

Re: Niplette

I have heard of the nipplette and it seems to work fairly well but is outrageously expensive. There is another product on the market that is better in my opinion. It is called Evert (?) and was invented by Edie Armstrong. You can reach her at: Edie Armstrong BSN, IBCLC, Fairfax, mailto:earmstr@erols.com

There is also an easy way to make something similar yourself: Take a 10cc syringe and cut off the end where the needle goes. A hacksaw works well. (Take off the needle first!) Take the plunger and insert it into the end you just cut off. The uncut end fits over most nipples. Have the mom place it over her nipple and gently have her pull back on the plunger. This pulls the nipple out very well and its cheap!

Another thing to do is have the mom use the Hoffman technique. Have the mom place her thumbs on the areola at 12 & 6 and gently pull her thumbs apart. Tell her to work all around the areola and do it 2-3 X a day. This helps break the adhesions that are holding the nipple in.

I have moms do these and using nipple shells starting about 30 weeks. If you don't catch the inverted nipples until after the baby is born they still work. Using the syringe right before the baby latches will really help.

Treatment of inverted nipples using a disposable syringe.
Kesaree N, Banapurmath CR, Banapurmath S, Shamanur K
J Hum Lact 1993 Mar;9(1):27-9

Seven mothers who had inverted nipples were helped to breastfeed their infants with the assistance of a simple device made from a 10 ml disposable syringe. These women were able to successfully breastfeed within one week. On follow-up, these mothers were able to sustain adequate breastfeeding.

Preparing for breast feeding: treatment of inverted and non-protractile nipples in pregnancy. The MAIN Trial Collaborative Group.
Midwifery 1994 Dec;10(4):200-14

CONCLUSIONS: in the light of the findings from this and a previous single centre trial, there is no basis for recommending the use of either Hoffman's nipple stretching exercises or breast shells as antenatal preparation for women with inverted and nonprotractile nipples who wish to breast feed. Given the lack of evidence to support these and other antenatal preparations there are no grounds for midwives to continue routine breast examination in pregnancy for this purpose.

Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples.
Alexander JM, Grant AM, Campbell MJ
BMJ 1992 Apr 18;304(6833):1030-2

CONCLUSIONS--Recommending nipple preparation with breast shells may reduce the chances of successful breast feeding.  While there is no clear evidence that the treatments offered are effective antenatal nipple examination should be abandoned.

You can order the Evert-It Nipple Enhancer (here's a picture) - item No 441-21, $19.95 in the Accessories section of the online La Leche League Store.

Larry's Flat or Inverted Nipples FAQ - A summary of a devoted dad's research into inverted nipples - from The Nursing Baby


See also: Nasal Oxytocin Spray for cases of stubborn engorgement that persists beyond one week and doesn't respond to improvements in baby's latch and breastfeeding patterns.

NOTE - One of my clients found that nighttime engorgement was waking her even before her baby needed to nurse, even some weeks after the birth.  She figured out that it seemed to be related to her carbs intake late in the evening.  When she had carbs, the engorgement woke her.  Without the carbs, she did not get severe engorgement and was able to sleep longer.  Heh, it's worth a try!

This actually makes me wonder if there is such a thing as "lactational diabetes".  It makes sense to me that an animal who has recently given birth might want to extract as many calories as possible in those first days after the birth, when she is resting and needing to stay close to the next to guard the offspring.  And since lactation requires even more calories than gestation, it would make sense to me that this condition could continue for several months after the birth.

In any case, for women who have severe engorgement and ongoing lumps, it might be worth trying a low-carb diet for a few days to see if things improve.

Breast Engorgement - Prevention & Treatment

A Well-Oiled Machine by Jill Stansbury, N.D. - The little-studied and underappreciated lymph system keeps internal fluids flowing and contributes mightily to immune function.  [Although this isn't directly about breast engorgement, I think it's a good explanation of the lymph system, which is largely discounted in Western medicine.]

Oketani Breast Massage - relieves engorgement and improves milk quality

Composition of milk obtained from unmassaged versus massaged breasts of lactating mothers
FODA Mervat I. (1) ; KAWASHIMA Takaaki (2) ; NAKAMURA Sadako (2) ; KOBAYASHI Michiko (3) ; OKU Tsuneyuki (2) ;

Background: The Oketani method is a program of breast massage and clinical counseling developed by the midwife Satomi Oketani. The purpose of this study is to examine the effects of the method on the quality of breast milk by determining the chemical composition of the milk before and after massage. Methods: Milk samples were obtained immediately before and after massage from healthy, exclusively breast-feeding Japanese mothers at two different periods of lactation one <3 months the other >3 months after parturition. Lipids, whey protein, casein, lactose, ash, and total solids in milk were measured in milk samples. The gross energy content of milk was estimated. Results: Breast massage significantly increased lipids in the late lactating period but not in the early lactating period. In the early lactating period casein was increased by breast massage but was not significantly affected in the late lactating period. Breast massage caused a significant increase in total solids from the first day to 11 months post partum. The gross energy in the late lactating period was significantly increased by breast massage but not in the early lactating period. Lactose was not significantly changed by breast massage. Conclusions: Breast massage improves the quality of human milk by significantly increasing total solids, lipids, and casein concentration and gross energy. The milk of mothers treated by Oketani breast massage may improve the growth and development of infants.

More information about Oketani massage at:

Treatments for breast engorgement during lactation.
Snowden H, Renfrew M, Woolridge M.
Cochrane Database Syst Rev. 2001;(2):CD000046.

"AUTHORS' CONCLUSIONS: Cabbage leaves and gel packs were equally effective in the treatment of engorgement. Since both cabbage extract and placebo cream were equally effective, the alleviation in symptoms may be brought about by other factors, such as breast massage. Ultrasound treatment is equally effective with or without the ultra-wave emitting crystal, therefore its effectiveness is more likely to be due to the effect of radiant heat or massage. Pharmacologically, oxytocin was not an effective engorgement treatment while Danzen and bromelain/trypsin complex significantly improved the symptoms of engorgement. Initial prevention of breast engorgement should remain the key priority."

Cabbage Leaves for Engorgement

The following was written by a Sister Merle Lees who has been researching this topic.

The use of cabbage leaves is a very old treatment, having been used in England as far back as 25 years ago. Cabbage leaves have also been used for various other complaints over the years.

The cabbage belongs to the "Brassicacae Family" and contains mustard oil, magnesium, oxalate and sulphur heterosides. Sulphur in amnio acid methionine acts as an antibiotic and anti-irritant, which in turn draws an extra flow of blood to the area. This dilates the capillaries and acts as a counter irritant, thus relieving the engorgement and inflammation and allowing milk to flow freely.

For Engorgement or Encouraging Letdown

If you're engorged and/or want to encourage letdown, you take a small disposable diaper ( I use them because I'm lazy and I guess a little selfish, but you can get a couple from a friend or neighbor if you don't use them) Anyway, you put about a cup of water in it and microwave it just for a few seconds. You have to experiment with it and really feel around so it's warm, not scalding hot. Then you take the diaper and mold it around your breast in your bra. It fits great, doesn't get you all wet like a washcloth and can be reheated over and over. I found this to work wonders during those first days when I was too stressed out to get a good letdown right away, and when I needed to pump and my baby wasn't able to inspire me, that warm diaper worked like a charm. 

Can anyone give me some information on the use of cabbage leaves for breast engorgement when lactation first gets going? I've heard about it but know very little.....how and why does it work? Does it matter what type of cabbage?

In the unit where I work in Victoria, Australia, we use fresh, cold cabbage leaves frequently for the postnatal women for breast engorgement. It works fantastically and feel very soothing as well as reduces the supply.

A comparison of chilled and room temperature cabbage leaves in treating breast engorgement.
Roberts KL. Reiter M. Schuster D .
Journal of Human Lactation. 11(3):191-4, 1995 Sep.

ABSTRACT: This study compared the effectiveness of chilled and room temperature green cabbage leaves in reducing the discomfort of breast engorgement in postpartum mothers. Twenty-eight lactating women with breast engorgement used chilled cabbage leaves on one breast and room-temperature cabbage leaves on the other for a two-hour period. Pre-treatment pain levels were compared with post-treatment levels for both conditions. There was no difference in the post-treatment ratings for the two treatments; mothers reported significantly less pain with both treatments. We concluded that it is not necessary to chill cabbage leaves before use.

A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation.

Kvist LJ1, Hall-Lord ML, Rydhstroem H, Larsson BW.
Midwifery. 2007 Jun;23(2):184-95. Epub 2006 Oct 18.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: if acupuncture treatment is acceptable to the mother, this, together with care interventions such as correction of breast feeding position and babies' attachment to the breast, might be a more expedient and less invasive choice of treatment than the use of oxytocin nasal spray. Midwives, nurses or medical practitioners with specialist competence in breast feeding should be the primary care providers for mothers with inflammatory symptoms of the breast during lactation. The use of antibiotics for inflammatory symptoms of the breast should be closely monitored in order to help the global community reduce resistance development among bacterial pathogens.

Cabbage leaves are commonly used to treat engorged breasts. I advise women to separate two fresh (not cooked) leaves and gently bruise the inner side with a kitchen utensil i.e. rolling pin. Then one leaf is placed on each breast for 15- 20 minutes. This can be repeated as often as desired. There have been a few studies that demonstrate efficacy, but they have had small numbers.

Other advice for engorgement or mastitis include hot compress before feeding and cold afterwards.

A randomized, controlled trial was conducted to evaluate the effect of cabbage leaves on mother' perceptions of breast engorgement and the influence of this treatment on breastfeeding practices. The subjects, 120 breastfeeding woman 72 hours postpartum, were randomly allocated to an experimental group who received application of cabbage leaves to their breasts, or to a control group who received routine care. The experimental group tended to report less breast engorgement, but this trend was not statistically significant. At six weeks. woman who received the cabbage leaf application were more likely to be breastfeeding exclusively, 76 and 58 percent (36/35 vs. 29/50;P=0.09) and their mean duration of exclusive breastfeeding was longer. (36 vs. 30 days; P=0.04) The greater breastfeeding success in the experimental group may have been due to some beneficial effect of the cabbage leaf application, or may have been secondary to reassurance and improved confidence and self esteem in these mothers
BIRTH 20:2 June 1993

Growth Spurts

Growth spurts from kellymom.com

Breastfeeding During a Baby's Growth Spurt from about.com

For Increased Milk Supply

How to Increase Your Breastmilk Supply - The Summarized Version By Pam Caldwell at HerbLore

How does milk production work? from kellymom.com - Excellent article including information that was new to me.  Breasts make more milk when they're emptier, which is why emptying the breast frequently builds up the supply.

One of my clients found that Mrs. Patel's teas from mrsmilk.com worked well for her to increase supply.  (NOTE - I would not recommend the sugary dessert bars since elevated glucose may contribute to engorgement.)

NOTE - Recent insertion of an IUD with hormones might reduce your milk levels.

NOTE - If you think you need to increase your milk supply because the baby has suddenly seemed hungry all the time, needing to nurse every hour or so, consider that the baby is having a growth spurt and may be ramping up the milk production through the increased nursing; then you don't need to do anything but nurse the baby and keep up the nutrition, hydration and rest that allow your body to make all the milk that your baby needs.

NOTE - If a woman doesn't respond to efforts to increase her milk supply as expected, consider the possibility that there may be underlying thyroid problems.  Even if she's already had her thyroid tested in this pregnancy, consider doing another thyroid test or referring to a physician for evaluation.

The Breastfeeding Mother's Guide to Making More Milk: Foreword by Martha Sears, RN (Breastfeeding Mothers Guide) by Diana West and Lisa Marasco

One of our local doulas strongly recommends this book: "This book is excellent for figuring out why there is low milk production (which is the first step) and how to bring it back up. Out of all the lactation books that are for problem solving this is the best I have read so far. Organized and clear with a lot of problem solving ideas and multiple routes to solutions that are specific to the problem. The only thing that I did not like is that one of the websites it refers to throughout the book is no longer supporting the text it refers to."

I like MegaMam from Tri-Light Health; it's a tasty glycerine formula so my clients will actually take it! and they like not taking alcohol-based herbs while breastfeeding.

Has anyone tried Go-Lacta™?  It's the leaves of the Malunggay tree (moringa oleifera), an Asian lacatagogue from Sugarpod Organics.

These suggestions can be found in After the Baby's Birth by Robin Lim and Earl Mindell's Herb Bible:

Alfalfa - 3 to 6 daily (capsules) or 1 tablsepoon with 8 ouces hot water brewed into tea daily.
Anise - 1 teaspoon powder (crush seeds) in 1 cup boiling water 3 times daily.
Dill - 2 teaspoons seeds steeped in 1 cup hpt water for 10-15 minutes.
Strain. Take 1/2 cup 2 to 3 times daily.
Fennel - 10 to 20 drops in water  of extract daily. Can purchase as a tea.
Fenugreek - 2 capsules 3 times a day
Red raspsberry leaf tea
Blessed Thistle - 2 capsules 3 times a day
Caraway - 3 to 4 drops of extract mixed in liquid 3 to 4 times a day. Can brew herb into tea.
Brewer's yeast - 2 capsules 3 times a day.
Shatavari - an Ayurvedic herb. up to 3 grams of powder in a cup of warm milk with honey and ghee.

Can buy a variety of prepared commercial products:
Mother's Milk Tea by Traditional Medicinals

Magnetic Mama Lactation Tea with blessed thistle, borage, alfalfa, red clover, raspberry, fenel, nettles, hops, peppermint from Moonflower

Midwife Formula 6-L: Mega mam with milk thistle, chast tree, fennel, borage, red raspberry, lemon balm from Spirit Led

Fennel is a good lactation stimulant and one of the easiest ways to take it in quantity is the candy coated seeds you get from Indian food shops. If you've no Asian food shop close (and it has to be the sort frequented by Asians, rather than the Asian run corner shop) just boil normal fennel seeds for five minutes, strain and add honey if you want. If she doesn't like the taste of fennel, other lactation stimulants are fenugreek, celery and nettle.

Sometimes a mom's milk supply appears not to come in because she's having so much difficulty relaxing during a feed.  This can be the result of a difficult previous birth or breastfeeding experience, ambivalent feelings about breastfeeding or body image, or whatever.  Obviously, you want to address the basics - helping her to get completely relaxed, maybe nursing baby in a warm bath or with her feet in warm water or wrapped in a warm blanket, aromatherapy, lots of warm loving support, and . . . music, music, music!

I was delighted with the results we got when a mom started listening to Renee Smith's music - it's a wonderful combination of more traditional lullaby styles with more nurturing lyrics.  My personal favorite is her Angels & Mermaids CD, with her Lullabies For My Little Angels a very close second.  Her Seeds & Songs To Make 'em Grow is a wonderful collection for "older children", i.e. toddlers and pre-schoolers, not to mention their parents!  I don't know what it is about this music, but it always makes me so happy!  Cheaper than therapy and lots more fun.

Chiropractic Helps New Mothers Produce Milk

An article in the March 2007 issue of the scientific periodical, the Journal of Clinical Chiropractic Pediatrics, presents three documented case studies of chiropractic care helping new mothers who were unable to produce adequate mother's milk.  A reduction in mothers milk, known as "Hypolactation" can be a serious problem that can create health issues for both the mother and child.

The first case was a women who went to the chiropractor on the referral of her midwife.  She had given birth 10 days earlier to her second child and unlike her first, she was unable to establish a milk supply for her second baby.  The patient had no other medical issues other than difficulty in swallowing a glass of water.

An examination determined that she had a subluxation, and specific chiropractic care was initiated to correct that issue.  After her second visit the patient commented that she found it much easier to swallow. By the third visit she noticed visible changes in her breast and the production of milk.  This improvement resulted in a positive weight gain for the infant who was forced to depend of formula until the mothers milk issues were resolved.

The second patient went to the chiropractor for upper back pain but was also unable to produce sufficient milk to feed her one month old infant.  Her examination showed no medical history for her problems, however, the chiropractic portion of her exam showed subluxations.  She began a series of specific chiropractic adjustments for subluxation correction.  By the forth visit the patient was noticing breast enlargement and the production of milk.  She also became pain free from the upper back pain she was experiencing.

The third case was a women who came into the chiropractor's office with her daughter six days after birth.  She was sent there on the recommendation of the hospital lactation consultant. As in the previous cases, subluxations were found and care was initiated to correct them.  In this case it took only 24 hours for the positive results to show, and for this mother to be able to feed her infant naturally.

Based on their case studies and the volumes of previous research, these researchers concluded that subluxations and the neurological interference they cause play a major role in Hypolactation.  The researchers suggest, "Chiropractic evaluation for subluxations would be a key element in the holistic assessment of the failure to establish milk supply in the postpartum patient."

Ellen Roos - Passion Flower Music - Songs that see and stir, love and forgive, lift, bless and free! Her first album is Lavender and Morning Sun.

Herbs/Homeopathics for Breastfeeding (Galactagogues)

The FDA just issued a black box warning about the prolonged use of Reglan. Basically it has been found to induce tardive dyskinesia symptoms in rare patients AFTER several months of use.

I would suggest that mothers use Reglan only for a month or 2 at most and then taper off of it.

Tom Hale Ph.d., 6/21/09

Tardive Dyskinesia Center

Galactagogues from Dr. Thomas Hale's web pages, including discussions of domperidone, reglan, blessed thistle, fenugreek, oxytocin nasal spray, lovonox.

Herbal Galactagogues Compiled by Gretchen Humphries [March 02, 2000]

Mamatini is a great-tasting organic herbal infusion specifically designed to meet the needs of pregnant and nursing moms. Mamatini is doctor-designed to give you the confidence, energy, and strong milk supply you need to raise a healthy baby.  [Ed: Convenient but pricey!]

Herbs for Milk Production

Blessed Thistle IS awful - so bitter. I make up tea for my moms with 2 oz fennel seed, 1-2 oz of other aromatic seed (fenugreek, dill, caraway, anise - whatever I have), sometimes an ounce of Oatstraw (or Chamomile), and a few PINCHES of blessed thistle. It is quite powerful, and the other aromatic seeds are also good milk supporters, so no need for more. You can't taste it at this concentration.

This makes 2-3 quarts - enough for a week or two unless correcting a real problem with supply. Steep in a closed jar at overnight. I like to give moms a little baggy of it for mental support that first time they think "ACK, no milk". The few that really need it buy more on their own.

I don't add raspberry leaf - I think someone mentioned it counteracts milk-supporters to some degree. Anyone else heard this?

I suppose you could take BT in capsule form if more was needed, but have never encountered that degree of problem.

To increase milk try any of these (or combo): fennel seed tea or capsules, hops tea (or good quality non-alcoholic beer), two 500-mg capsules morning/evening of vitex (chaste berry), blessed thistle, aniseeds, nettles, raspberry leaf tea/capsules, fenugreek, nurse often, marshmallow root, alfalfa, brewer's yeast pills, zinc, selenium, vit E, iron, soy, wild yam, and a lot of fruits and vegetables.

I've had moms use Blessed Thistle to increase the fat content of breastmilk and had it work wonders.

From our local herbalist:

I have much experience with this (the Fenugreek part anyway!).  The dose of Fenugreek depends on her situation (i.e. how much milk she's already making and how much increase she needs).  I recommend starting with a low dose of 3 caps three times a day.  With our Fenugreek, she should see results within 24 hours or less.  If the increase hasn't been achieved, then she can go up to 4 caps 4 times a day.  Fenugreek should be taken as a "single" meaning not blended with anything else.  This is because the Fenugreek dose needs to be consistent and regulated for best results.  When it's in a blend, it's nearly impossible to regulate how much FG is in each dose, which can cause an up and down supply, or for some, a decrease.  When she's achieved her goal and her supply is stable, she can then slowly wean down from it and be done.  Here's more on Fenugreek and how to use it correctly.  We have it in vegi-cap and tincture (liquid extract)  - it's organic, very fresh and according to our clients, works much better than any FG gotten off a store shelf.  This is probably a freshness issue.  Here's the link:


And for more ideas on how to increase milk production:


She may not necessarily need FG.  Once she starts, she needs to be consistent until ready to wean down.  I do a lot of this work, and would be happy to talk to her about her situation and what would be most helpful for her.  In order to have it affect her blood sugar, she would need to take very large amounts of it - grams.  I tend towards low blood sugar, and I did not notice any effects when I was taking FG.  It should not be  a problem at all.  Again, I'm happy to speak with her about this.

Homeopathics for Milk Production

Lactuca Virosa - A true galactogogue that really brings in milk. Take 4 pellets, 4 times per day.

"A new mother may experience great stress if her new baby has difficulty with breastfeeding. This stress often becomes part of a vicious cycle, further exacerbating the problem. Homeopathic Silicea (taken by Mom and imparted to baby through the breast milk) helps the delicate infant who needs appetite stimulation, and helps with watery stools and vomiting after nursing."  For other tips on homeopathics for nursing and newborn care, see the EMAZING.com archives of the Homeopathic Health Tip of the Day

Don't Touch Baby on Back of Head While Nursing

Dr. Maryelle Vonlanthen spoke at the 1995 Arkansas Midwifery Conference. In her talk she stated that newborns have a reflex on the back of their head that makes them arch backwards when that part of the head is touched. She suggested that those helping a mother with her first nursings should be careful not to touch the back of the babies head since that would only make the baby come away from the breast not toward it. She suggests holding the baby by the nape of the neck instead of the head to bring it into the breast.  You can hold the baby's neck in the web of the hand and push between baby's shoulder blades with the heel of the hand.

Herbs to Avoid During Lactation from HerbLore (scroll down the page)


Serious risks associated with domperidone

FDA Warns Against Women Using Unapproved Drug, Domperidone, to Increase Milk Production - [Mon Jun 7, 2004] "Breast-feeding women should not take the drug domperidone to boost milk production, because it may put them at risk of serious heart problems and sudden death . . ."

I have personal experience with it and have done much of my own research.  I recommend looking at what Jack Newman has to say- he is definitely an authority on the subject.  http://www.drjacknewman.com/  Also, read Medications and Mother’s Milk, by Thomas Hale.

As for how it will work, if her supply is low due to a hormonal issue, it is likely to work as it increases prolactin.  Sometimes there is no way to know the cause and the only way to know if something works is to try it.  I second what others said about Reglan…I would definitely steer clear of that!  Domperidone is not available in the US, which is why Reglan is often prescribed, but Domperidone is easy to get from overseas through www.inhousepharmacy.com.  My understanding of why it has not been approved in the US is because there was an incidence of heart failure associated with BUT it had been given through an IV to an immuno-compromised person.  It has been used for quite some time to increase milk production with apparently good/ safe results.  I, myself, had a good experience with it. I tend to be pretty anti-pharmaceuticals and given my situation, I was pretty comfortable taking it.   In my case, I took it for about 4 or 5 mos and once I weaned off of it, I was able to maintain the supply I had while taking it with no problem.  I also used many herbs, acupuncture, etc. first and decided to try Dom when they weren’t quite getting me to where I needed to be.

Lastly, I recommend any mom who is truly struggling with low milk supply (or any other unusual BF difficulty) to join the Mothers Overcoming Breastfeeding Issues yahoogroup.  (mobi@yahoogroups.com).  This group has been an amazing wealth of support and information and she will hear all kinds of research and personal experiences with Dom on this list.  The author of Making More Milk is also a regular on the MOBI list.

The majority of my moms have excellent results even after a few days. A few have felt a little dizzy or off, but once they adjusted the dose things cleared up. Dr. Jack Newman uses it routinely for supply issues. (Also check his website out) and it is widely accepted and used in Canada.  Thomas Hale’s Mediations in Mothers Milk 2008 edition has some good information about the drug also.  I agree that Reglan has been a nightmare for most of the moms I work with.  The CNS side effects are not pleasant and who needs more anxiety and depression after having a baby.

Prenatal Nipple Preparation

Prevention of and therapies for nipple pain: a systematic review.
Morland-Schultz K, Hill PD.
J Obstet Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):428-37.

CONCLUSIONS: No one topical agent showed superior results in the relief of nipple discomfort. The most important factor in decreasing the incidence of nipple pain is the provision of education in relation to proper breastfeeding technique and latch-on as well as anticipatory guidance regarding the high incidence of early postpartum nipple pain.

[Lansinoh in the treatment of sore nipples in breastfeeding women]
Tanchev S, V?lkova S, Georgieva V, Gesheva Iu, Tsvetkov M.
Akush Ginekol (Sofiia). 2004;43 Suppl 3:27-30.

CONCLUSION: Lansinoh is purified lanolin suitable for prophylactics and treatment of sore nipples.

Initial Breastfeeding Pain

One thing that bothers me about lactation consulting and "experts" in nursing is the premise that breastfeeding is always comfortable (ie not painful).  All I ever see is unmedicated babies and mothers.  100% of the time breastfeeding hurts at first.  This is with a good latch and well-educated mothers in advance of the birth.  I am of the mind that it's supposed to hurt and that telling the mother that something is wrong when it hurts is very undermining.  I think the idea of painless, comfortable first week nursing is a result of most babies being born medicated out of their little minds.  The anaesthetized baby does not suck like a barracuda.

Just as birth does not progress at home in a watertub the way "they" say it "should", breastfeeding with a conscious mother and baby is very different from what I read in books and articles.  Naturally born babies, whose cords are left to pulse, and who find the breast for the first time in a relaxed, easy way
1. don't lose any weight
2. bring the milk in on Day 2
3. cause some initial soreness and trauma to the nipple that is unavoidable

I'd like to hear from others on your observations. I think we need to be cautious in telling mothers that something's wrong if breastfeeding hurts at first.  With good positioning (close to chest, tummy to tummy; ear-shoulder-hip in straight line) the mother/baby pair will sail through that initial soreness without a big deal and the nipples will toughen.  I've just had a client who was advised that it should NEVER hurt and she is essentially bottle-feeding now because she was told that the latch was wrong whenever she expressed discomfort to her lactation consultant.  It all looked fine and normal to me and I was of the mind to just persevere on through.  I'm very upset that her breastfeeding confidence was so undermined and am now of the mind to ban lactation consultant advice for the first week. The lactation cons. involved is someone I greatly admire and I know she has done wonders for women in her area but I think she's just not used to naturally born barracudas (oops I mean babies!).

I tell my clients that the baby's job is to suck, suck, suck to bring the milk in and that babies who do this are very smart babies.  They know that by bringing the milk in as quickly as possible, they'll have milk before they exhaust their birth resources.  I reassure them that once the milk is in, the baby won't need to nurse as strongly or as much, because the luscious, nutritious milk will just flow into their mouths with gentle sucking.  And it's almost always true.

General Approach to Breastfeeding Pain

One mom was generous enough to write up her recommendations for dealing with pain:

Since I have gone through similar (but probably not identical) issues, here are a few ideas to throw into the mix. Some might apply to you, some might not.

1) nipple pain plus burning deep in the breast -> need to check for thrush. The diagnosis is not necessarily easy, and it treating both mother and child need to be treated.

2) for cracks, Newman's ointment is a godsend. Even without thrush it will help with inflammation (the hydrocortisone) and healing (the antibiotic will prevent infections). On top of that, lanolin, lanolin and more lanolin. Keep it in a back pocket so that it is warm and runny, not cold and stiff, when you try to apply it to injured nipples.

3) my oldest had a really bad latch which, since it was preceded by a few scary days of no latch, no milk, weight loss > 10% and jaundice, I ignored way too long. The actual underlying cause was only identified after about 4 weeks of me gritting my teeth and a second trip to the LC: overactive letdown. My milk was flowing so fast that my son was sliding down the nipple (bad latch = decreased flow) and clamping his teeth in a attempt to tame the flood.

There is a whole different bag of tricks to handle that (and since some attempt to decrease your milk supply they should be applied progressively and carefully). See Forceful Let-down (Milk Ejection Reflex) & Oversupply from kellymom for the details. I used positioning and block nursing, mostly.

I will note that I never had oversupply (no engorgement) although both my sons gained weight very fast (3 1/2 pounds and 4 pounds the first month, respectively).

4) another thing that led to nervous baby clamping down on nipple: being in so much pain and anticipating the pain so much that I was contracting every muscle in my body before putting my son to the breast. It turns out that clamping my hand too hard on his head led him to clamping his jaw on my nipple in return. Letting him handle the latch (side lying, which I only figured out for #2, or him lying down on the breast friend) helped with that.

5) at some point I thought I had thrush, with shooting pain in the breast when my son started nursing. It took going back to work and pumping to realize that was just the way I experience letdown -- while nursing over cracked nipples I was not able to separate the sources of pain very well.

Cracked Nipples

The Pariday TendHer(TM) breast pillow was invented by three moms who experienced breastfeeding issues that included sore nipples, clogged ducts, mastitis, cracked nipples, engorgement, a poor latch and more. They found the products available for soothing breastfeeding pain had immense room for improvement. That is why TendHer pillows was born - to give real moms a real solution.

Moist Wound Healing

Nipple wound care: a new approach to an old problem.
Cable B, Stewart M, Davis J
J Hum Lact 1997 Dec;13(4):313-8
A moist environment is critical for epithelization, the proliferation and migration of epithelial cells across the surface of a wound during healing. Nipple wounds also heal by this process. Using a particular type of wound dressing, a hydrogel sheet wound covering, on a nipple wound offers several advantages. These dressings help maintain a moist environment, decrease the chance of bacterial infection, are easy to use, and provide immediate pain relief.

Moistness-The Secret of Healing Sore &  Cracked Nipples: from the San Diego Breastfeeding Coalition at breastfeeding.org

Information about Sheet Hydrogels with a list of manufacturers.

Some people are using ClearSite - a gel dressing. Call Sue Cornell at 1-800-765-8375 ext 2391 to request samples.

There's a lovely vegan product called Breast Balm from MaternaCare.

I have used this or another type on 2 women now with really good results. Both loved the way it feels, immediate relief from the pain of severely cracked nipples. I have also used it in conjunction with Lansinoh.

I have just cut them to fit around the site of the crack. I do not cover the whole nipple. So far it has worked just to tuck them into the moms bra. With a woman with smaller breasts I would have to play around and see what would work, tape maybe? I try to be sure that we have corrected the problem that has caused the crack and have the mom be fanatical about correct positioning.

So far I have been really happy with the results and have not seen a problem from the continual moisture. Small sample, I know, but I haven't heard any bad reports from lactnet either.

Geranium leaves for intractable cracked nipples. Lansinoh is also very good.

Lansinoh Samples Call (in the USA) 1-800-292-4794 and Lansinoh Laboratories will send you free samples with an informational brochure that includes LLLI's endorsement, history and phone number. They will send you a supply monthly.

Fat Babies Are Happier

Breast-Feeding Cuts Infant Infection Risk

Painful Letdown or Persistent Pain - Nipple Vasospasm and Raynaud's

Vasospasm suggests overactive muscles in the ducts; this could be the result of a magnesium deficiency, and increasing magnesium is one of the simplest remedies to a lot of problems stemming from muscular overactivity or calcium/magnesium imbalance.  [NOTE - Magnesium oxide will cause your stool to be looser; magnesium citrate has less effect on your bowels.]

Vasospasm and Raynaud’s Phenomenon - excellent resource from Dr. Jack Newman at breastfeedinginc.ca

Sore Nipples by Dr. Jack Newman

Treatments for sore nipples and sore breasts: All-Purpose Nipple Ointment by Dr. Jack Newman

Seeking Relief - Excellent page from LLL site about diagnosis and simple and more complicated treatments for nipple vasospasm

Raynaud's Phenomenon of the Nipple May Cause Painful Breastfeeding by Laurie Barclay, MD [Medscape]

Prompt treatment allows mothers to continue to breastfeed pain-free, and it avoids unnecessary antifungal therapy for misdiagnosed C albicans.

[Editor's note - Gentian violet is not a plant product; is it a toxic, carcinogenic product which may be useful as a treatment of last resort, but please don't make it the first remedy you try!]

This article has some helpful points about diagnosing thrush.  In particular, they write, "The pain caused by a Candidal infection is generally different from the pain caused by poor positioning and/or ineffective suckling. The pain caused by a Candidal infection . . . Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks."

This article on Seeking Relief gives a good description of Raynaud's or nipple vasospasm.

If you're trying to find a doctor who will prescribe Nifedipine, you should start with your family doctor, OB or pediatrician.  If they're reluctant, show them the research paper.

Hi.  I have a client who describes a painful let down.  This is the third baby, she has successfully BF the other two with no problem.  She says this is not a latch issue, and I have checked and it looks great.  The let down is painful.  Any one have any information or insight or suggestions.

I have a client who is currently mid-pregnancy.  With her previous baby, she weaned early because of  EXTREME pain with let-down.  She described normal early tenderness with initial latches that subsided with time, but increasing intense pain with let-down so that pain extended from the breast through to her back.  She confirmed there was no pain with suckling, no nipple pain, only with let-down and this included let-down from sexual stimulation and simple showering in warm water (even described as "contractions" in the breast, feeling the milk flow as "burning"). She is eager to nurse this next baby but is wary of the same experience.  She has not had issues with yeast in the past and did not describe symptoms that would jibe with thrush (in my practical experience).

Can anyone share a similar experience and how I might help her with this?

I think it always makes sense to treat persistent pain (beyond the first week or ten days) with holistic thrush treatments.  In addition, you want to rule out Raynaud's.  You can also try lobelia for spastic letdown similar to the spastic cervical dilation during labor.

I have experienced this.  It was like "pins & needles" with let-down.  I simply used labor breathing and relaxation to get through let-down, and it did get better as baby got older. By 18mo it was gone. [Ed. This sounds like a much milder version of the EXTREME PAIN that others experience.]

Resources about Nipple Vasospasm and Raynaud's

This is a very painful condition characterized by pain, numbness, burning, tingling, and extreme color changes of the nipple.  These symptoms are exacerbated by cold and emotional stress.

Treatments for Raynaud’s Phenomenon (blanching of the nipple) [search about halfway down on this page] - "The first choice for treatment is:

    * Vitamin B6. This has shown to work by trial and error, but it does seem to work. There is no scientific evidence that it works, but it does nevertheless. It is safe and will do no harm. The dose is 150 mg/day once a day for four days, followed by 25 mg/day once a day. The mother continues it until she is pain free for a few weeks. It can be restarted if necessary.

If vitamin B6 does not work within a few days, it probably won’t. It is then useful to try:

    * Nifedipine. This is a drug used for hypertension. One 30 mg tablet of the slow release formulation once a day often takes away the pain of Raynaud’s phenomenon. After two weeks, stop the medication. If pain returns (about 10% of mothers), start it again. After two weeks, stop the medication. If pain returns (a very small number of mothers), start it again. Very few mothers I am aware of took more than three courses. Side effects are uncommon, but headache does occur. "

Raynaud's Syndrome and Breastfeeding from breastfeeding.com

Nipple blanching and vasospasm


Raynaud's Phenomenon, and High Arched Palate from The Compleat Mother archives.  [This contains some overlap material from the above sites.]

Nipple Pain And Vasospasm from multiplebirthscanada.org

Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. [Free full text article]
Anderson JE, Held N, Wright K.
Pediatrics. 2004 Apr;113(4):e360-4.

" . . . Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding. . . . Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, it is often mistaken for Candida albicans infection. . . . To diagnose Raynaud's phenomenon accurately, additional symptoms such as precipitation by cold stimulus, occurrence of symptoms during pregnancy or when not breastfeeding, and biphasic or triphasic color changes must be present. . . . Treatment options include methods to prevent or decrease cold exposure, avoidance of vasoconstrictive drugs/nicotine that could precipitate symptoms, and pharmacologic measures. . . . Nifedipine, a calcium channel blocker, has been used to treat Raynaud's phenomenon because of its vasodilatory effects. Very little of the medication can be demonstrated in breast milk and thus is safe to use in breastfeeding mothers. Of the 12 mothers in our series, 6 chose to use nifedipine, and all had prompt relief of pain. Only 1 mother developed side effects from nifedipine. Pediatricians and lactation consultants should be aware of this treatable cause of painful breastfeeding and should specifically question their patients, because most mothers will not provide this information to the breastfeeding consultant. Prompt treatment will allow mothers to continue to breastfeed pain free while avoiding unnecessary antifungal therapy."

Nipple vasospasms, Raynaud's syndrome, and nifedipine. [Full text]
Garrison CP.
J Hum Lact. 2002 Nov;18(4):382-5.

This case report describes a situation in which a mother who experienced prolonged nipple pain with her first child sought help from a lactation consultant at the birth of her second child. Despite being very attentive to positioning and latch, similar pain was experienced from the first feeding with the second baby. The mother's history and symptoms were explored, and nipple vasospasms related to Raynaud's syndrome were suspected. After reviewing the literature and consulting with her personal obstetrician, the mother (a pediatrician) chose to treat with nifedipine. The mother was pain free after a 2-week course and nursing without difficulty at 4 months postpartum.

I once had a patient with painful/burning latch.  As an IBCLC I see a lot of yeast problems, latching problems and I've even seen a handful of Raynaud’s, but this patient didn't have any of that.  The baby was four months old, she had the exact same thing with her first child.  The kid had a perfect latch, she underwent a course of nystatin, followed by two courses of Diflucan (200/100 x 10 then 400/200 x 10), both she, her milk and her newborn cultured negative for yeast or bacteria.  We did a course of procardia without relief and there was no blanching with cold (even when I tried ice, no blanching).  In the end I figured it sounded more like neuropathy than anything else.  I consulted with our neurologist who agreed that ANY nerve can present with neuropathy.  We started her on a course of Neurontin and IT WORKED.  It took a little fiddling to find the right dose that would give her some relief.  The pain never completely resolved, but it did get much better.  In the end she nursed for six months and then stopped both nursing and the neurontin.

I also tend to association burning deep in the breast with yeast when it is beyond the normal "pins-and-needles" sensation.

Had a client recently who seemed to have BOTH problems. Deep burning in the breast - to the point of making her weep. And excruciatingly worse with cold that seemed like Raynaud’s. No particular pain with latching and as far as we could see - everything looked completely normal.

Her breasts looked completely normal and the baby was gaining, so it took a little while before we all figured it out (we being a pediatrician, two midwives and a lactation consultant). The Diflucan helped some, but not enough and she ended up weaning early.

Herbs and Vitamins for Nipple Vasospasm

Since the symptoms of Raynaud's are based on vasospasm, I wonder if there is a natural product used for migraines that may help?

Feverfew can help with migraines, but can also bring on the period (with a vengeance, I might add).  The best herbs for Raynaud's is Ginkgo, as it helps bring blood flow to the peripheral areas, including the nipple tips.  It's fine to use during breastfeeding.  Niacin (one of the B Vitamins) also helps, for the same reason, but too much can cause "flushing", making the skin hot and red, due to the increase in blood flow.  Niacinamide does not have this flushing effect, but I'm also not sure if it's as effective for Raynaud's.  Ginkgo is the better choice.   [from a well-respected herbalist]

correct me if I am wrong---I thought Ginkgo might be contraindicated for nursing due to the clotting changes that affect baby (esp with any birth head trauma)...not sure where I read this, but Hale says it's an L3 compound, with no human milk studies showing any transfer to milk from mom, but no "pediatric concerns" known. Humphrey thinks it is ok for Raynaud's. Who knows????I personally love Gingko, but may be hesitant to give large doses if clotting issues are unknown.

ou are correct in that Ginkgo does increase blood flow, which is what makes it so helpful for vasoconstriction and spasm, as well as helping correct memory problems, senility or dementia (increases the blood flow bringing more oxygen to the brain), and helping to prevent stroke and other diseases related to emboli. It can increase bleeding time and decrease platelet aggregation.  It's also helpful for migraines "due to its ability to stabilize platelets and serotonin levels in the brain, thereby normalizing blood flow".

So in cases where there is a fear of or potential for bleeding, such as your example of birth head trauma or hemophilia, then I would advise against the use of Ginkgo until the wound is completely healed (or never in cases of hemophilia).  In my estimation, unless there is a bleeding issue (lack of clotting) already known or present, if this were ME having the problem and thinking about taking the herb, I would take it.  The suggested dose is 1 tablespoon of the dry herb per cup of water (2-3 cups of tea per day), or 1-2 droppersful of the tincture 2-3 times a day.  (Note:  it's thought that Ginkgo can prevent ovulation through its activity as a PAF antagonist and create anovulatory menstrual cycles.  PAF is secreted by the ovary to allow release of the egg.)


see also: Candidiasis/Yeast Infections

see also: Hazards of Gentian Violet

Information Sheet and Care Plan for Yeast (Candida) from breastfeeding-basics.com

Candida Protocol from Dr. Jack Newman [Note Hazards of Gentian Violet]

Home Remedy for Thrush

Adding caprylic acid to the mother's diet can be helpful as caprylic acid is an anti-fungal made from goat's milk or other organic products.

Grapefruit seed extract (sometimes called Citricidal) is also very helpful in knocking out thrush and other candida infections.

This is from a very respected lactation consultation:

I have worked with hundreds of mom/baby pairs with thrush over the past 20 years and I have to say it has become a major problem and the reason why moms choose to stop breastfeeding.  This does not have to be the case. Mom or baby can be asymptomatic, but one can give it to the other. Both must be treated.  Also, over 50% of the strains of yeast that cause thrush can be resistant to the Nystatin.  If not resistant, many parents are applying it incorrectly and not swabbing directly on the tongue, checks and gums of the infant or they are not doing it often enough. I would suggest that the parents see a Naturopathic Doctor to work on their immune system and look at their diet. Take a good ProBiotic (45 Billion Live Organisms) we use/sell the Kendy’s Brand it is not grown on Dairy, put some on the nipples before feeds and sprinkle some in the diaper area. Most moms end on Difulcan/Fluconazole with a loading dose of 400 mg, then 200mg there after for at least 2 weeks with one refill.  Some moms have to take it for longer.  They also need to take it until the last symptom (for mom or baby) has been gone for at least 7 days.  Baby needs to be treated also. The amount of Diflucan that passes through the breastmilk is not therapeutic at all and will do nothing for the baby. The baby may be put on the same medication for the same length of time, if no response to the Nystatin.  Also, we need to watch for a secondary infection such as Staph.  When we have that much tissue break down it can happen and treatment needs to happen.  Many doctors will prescribe Dr. Jack Newman’s APNO (All purpose Nipple Ointment) for the mom to apply to the nipple to take care of this potential problem and help speed healing.

[Editor's note - Gentian violet is not a plant product; is it a toxic, carcinogenic product which may be useful as a treatment of last resort, but please don't make it the first remedy you try!]

This article has some helpful points about diagnosing thrush.  In particular, they write, "The pain caused by a Candidal infection is generally different from the pain caused by poor positioning and/or ineffective suckling. The pain caused by a Candidal infection . . . Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks."

This article on Seeking Relief gives a good description of Raynaud's or nipple vasospasm.

We fought thrush for the first 12 weeks of my daughter's life.  Nystatin didn't work.  It was awful.  Here's what I did that finally worked:  1) I gave my baby Jarrow Baby Acidophilus (mixed with water to make a paste) on my finger and rubbed it on her cheeks (check with your doc, mine said it was fine) and 2) I took a mega dose of acidophilus.  One container of Bio K acidophilus (at whole foods in the cooler) a day. It was great and worked and ended the nightmare.  This stuff is THE BEST and was a lifesaver for us.  3) You can dip your nipples in apple cider vinegar/water mix after feeding.  4) Look up thrush prevention on kellymom.com.  My doc also said it usually takes care of itself by 6mo when the babies immune system kicks in.

Natren produces a probiotic product designed specifically for infants. Life Start is made with Bifidobacterium infantis - the beneficial bacteria which is most prominent in infants.  This can be beneficial for newborn thrush, newborn diarhea or diaper rash.

BioFlora makes a product called Infantiflora, containing B. infantis, which colonizes the baby's mouth with probiotics that suppress yeast.

The makers of Floradix also make an Infant's Blend Probiotic Blend, containing B. infantis, which colonizes the baby's mouth with probiotics that suppress yeast.

If seeking help for your baby from a pediatrician, you may run into the problem that they will not also treat the yeast in the mom's breasts!

There are some options that this new mom can take.  She can get help from a lactation consultant who can be the third party to educate her existing pediatrician that mom needs to be treated too, or she can be her own advocate and provide her pediatrician with the necessary literature so that the pedi will learn as well the importance of treating both mom and baby.  The lactation consultant here gave me literature on Breastfeeding and Thrush that I would be happy to fax to you. It's not uncommon for this to happen with healthcare providers.  Our Lactation Consultants are constantly educating Pedi's and OB's on solutions to breastfeeding problems.

Yeast/Thrush from Breastfeedingonline

Identifying and Treating Thrush by Cheryl Taylor White, CBE from Dr Jay Gordon's information

It can be difficult to diagnose yeast.  A trivia-mad medical student sent me the tip that yeast fluoresces under black light.

Great all inclusive thrush information - http://www.breastfeed-essentials.com/thrush.html

Good News for Breastfeeding Moms: Treating and Preventing Thrush By Chris Hafner-Eaton

Alternate Tx for thrush - Feb 03, 2004g - In my practice, I rely on essential oil of rosemary when treating thrush & coincident candidal infection of a nursing mom. An herbalist who I'd taken care of told me about this. It has been reliable, pleasing to the infant's taste buds and not messy. I have the mom dilute 2 drops of essential oil of rosemary in 1/4 tsp. olive oil, mix well then swab the tongue & buccal mucosa with this three times a day. Mom can just use her finger to do this. I also ask that the mom purchase cocoa butter and add 2 drops of rosemary to 1/4 tsp. cocoa butter (warmed in the hands to soften it). This mix massaged into the nipple and 1 1/4 inch radially of the surrounding breast up to 6 times/day has both addressed the candida infection and helped heal up the raw areola in my experience.

My favorite remedy is for thrush/yeast infections. It is oil of oregano. Two drops in a teaspoon of olive oil rubbed on baby's feet can treat them. That same solution can be applied topically to the nipple. Most use two drops under the tongue (mom's, NOT baby's) three times a day.

Midwives (and all care providers!) need to be aware that putting our bare fingers in a baby's mouth may be the transmission vector for yeast, which then becomes thrush.  I think we're kidding ourselves if we think we're not carrying yeast under our fingernails!

All we did was to apply organic yogurt (as if it were an ointment) to baby's mouth and to nipples. Baby's thrush was completely gone in 3 days. My nipples were cracked and not healing before yogurt application. It took 3 weeks to heal completely, but the signs of healing were apparent immediately.

Thrush can be hard to diagnose - sometimes the signs are really obvious, but it can still be making it painful for baby to nurse.  If baby nursed really well for the first few days and then things fell apart, it may be that a sub-clinical thrush infection is causing baby pain with sucking and swallowing.  Especially if mom is also having strange stabbing pains in the breast, it could be thrush.  Try mild treatments for thrush and see if things improve.

I used the baking soda treatment on my breasts and in my son's mouth after every feeding, I cut out refined sugars from my diet, and washed sheets and underwear with an apple cider vinegar rinse. I think it's very important to keep hands very clean--washing them before and after nursing. You can use diluted apple cider vinegar on your breasts too after each feeding. My son had a yeast rash as well as in his mouth (the yeast will eventually travel to baby's bottom--just a matter of time) so I gave him frequent baths in diluted apple cider vinegar and let him go without a diaper as much as possible.

Acidophilus capsules work really well too, but I found just eating plain yogurt everyday helped tremendously.

Acidophilus, like all live cultures, can be terrific but babies don't manufacture the same bacteria in their guts that grown ups do, including acidophilus.  Their system are much more regulated by bifidus, which would be a terrific thing for thrush. Also, homeopathic Borax I've seen used with some degree of success. I would also hold off on the gerber foods until you figure out the thrush because a lot of canned foods already have a high yeast content as well as extra sugars that yeast thrives on.

Yes.  Have you tried a solution of baking soda?  You dissolve a teaspoon of baking soda in a cup of water.  After each nursing, swab baby's mouth firmly and thoroughly, under the tongue, inside the cheeks, and on the gums.  Use a fresh cotton swab each time.  This removes the milk and gives the thrush fungus less to live on.  Also after each nursing, wash your nipples (gently) with this solution from a separate cup labeled for yourself.  Apply a light coating of lanolin or petroleum jelly to counteract dryness.  Don't suspect that you aren't carrying the fungus just because you don't exhibit the miserable pain some mothers do.  Make a fresh solution each day and don't give up until baby is completely well.

This is an old LLL tip I always recommend to my mothers both past and  present.  I hope you'll get this thing licked...thrush can be a very persistent annoyance!

ah, I meant to mention this step too. I warned about blankets, t-shirts and bibs, but didn't say what to do about it. Vinegar makes a good rinse. I've heard baking soda can also be used -- anything to change the normal Ph.  And bleach should work to sterilise -- if your clothes can handle it.

I have found that using lanolin at any point during a thrush infestation only furthers the problem, even after a good cleansing, as it lives down in the cracks and crevices. It's great for sore nipples, but is a hindrance in the battle of thrush.  I suggest using acidophilus. Get a gauze 4x and dip it in a little of the acidophilus and swab the baby's mouth really well, and then the mothers nipples. Lots of stuff will come off of the baby's mouth.

If you're using a bottle to have the dad give the baby some expressed breastmilk, it's very important to make sure that you boil all bottle nipples and if you are using pacifiers those also.  (I would add a couple of T. of apple cider vinegar to the boiling water.  All plastic bottles, nipples, etc. are notorious for helping keep thrush alive.  You have to treat both you and the baby or it does no good to treat one of you.

Yeastie Beasties FAQ

I battled thrush for ten months with my nursing son.  I tried it all, vinegar, gentian violet 2% topically and dietary changes. Eventually I tried Nystatin and Diflucan all to no avail.  What worked was the Beat the Yeast triple kit of herbal tinctures from The Herbalist (6500 20th NE Seattle, WA., 98115).  I took the tinctures as advised and in days the thrush was markedly better.  I quit the herbs, the thrush came back.  I took the tincture regularly for two months with no recurrences and take it now as needed for vag yeast infections.  Combining herbs with a sugar and simple carbo free diet finally worked.  It was miserable!

A few ideas:

Mom and baby should probably both be taking acidophilus; Primidophilus or ABC dophilus (sp?) for baby.

Garlic rubbed on nipples, unless it stings from being too cracked.

Tea Tree Oil on the nipples. [NOTE - There is serious concern that tea tree oil may be harmful to the nursing newborn.]

Watch for secondary staph infection in nipples.

Oral Nystatin powder rather than the suspension. Costs more, tastes nasty, but it works. Dip damp finger in water, then in the Nystatin and rub around baby's mouth.

Expose nipples to brief periods of sunlight, if possible.

Plantain seeds or psyllium seeds may be soaked overnight (a teaspoon at a time) in the frig. The mucilagenous goo that results is antifungal. Can also be used on a yeast rash. Nice and cool. You can use just the goo and leave the seeds.

Pediatrician gave me this formula:

Nizoral 1/4 tab crushed once a day for 4 days for the baby Diflucan 150 mg daily for mother - usually 7 to 10 days will do it. It's a hard problem to fix.

I had a tough time with thrush and after 14 months of nursing I still have to take a few daily measures to keep the infection under control. My infection impacted both my nipples, my milk ducts (also known as intraductal yeast), my son's mouth, and his bottom. So here's my experience, I hope it's helpful. I felt all measures were worth it to continue nursing. By the time the infection was visibly apparent to doctors, I was in agony. So if you have symptoms (burning and itching on either nipples or breasts, shooting pains in breasts, other fungal infections elsewhere on your body, baby has white tongue, or baby has red dotted diaper rash) try some of the measures to see if your symptoms improve.

Daily maintenance to keep infection in mother at bay:
Yogurt (Unsweetened, I prefer Trader Joe's Greek Style or Fage, don't bother with lowfat, you'll need the calories and flavor) - 1x/day.
Soy Lecithin (Improves milk flow, prevents plug ducts, reduced burning in breasts) - 1.2g gelcaps 2x/day [Those avoiding soy will be happy to know you can also get sunflower lecithin.]
Candex (dietary enzymes which breakdown yeast) - 2 capsules/day
ProOmega Fish Oil - 1g gelcaps 2x/day with food
Diet - Avoid sugar (including baked goods), and cheese

Effective measures taken to treat intraductal and nipple infection in mother:
Diflucan (fluconazole) - 200mg loading dose followed by 100 mg for 7 days. I took this for over 30 days, it is an exceptionally high dose that should only be required for intraductal yeast.

Diet and Supplements
Yogurt (Unsweetened, I preferred Trader Joe's Greek Style or Fage) - 2 cups/day
Soy Lecithin (Improves milk flow, prevents plug ducts, reduced burning in breasts) - 1.2g gelcaps 3x/day
Candex (dietary enzymes which breakdown yeast) - 2 capsules 2x/day
ProOmega Fish Oil - 1g gelcaps 2x/day with food
Diet - Avoid sugar (including baked goods), breads, pastas, certain vinegars, processed foods, potatoes, and cheese
Jarro-dophilus (refridgerated acidophilus) - 2 capsules 3x/day
Sepia (homeopathic) - 6C 2-3 pellets dissolved under tongue 3x/day 20 minutes before or after eating
Echinacea - Standard dosage.

Nipple Hygene
Gentian violet - dilute to 0.5% and apply to nipples 2x/day, Shout will usually remove purple stains in clothing if applied and washed. within 1 day (may have to try more than once).
White vinegar -  Mix 1 tbsp vinegar with 1 cup of water and apply to nipples using a cotton ball after nursing to kill yeast.
Monistat cream (3 day vaginal cream can be used for nipples) - apply to nipples after nursing, wash off before nursing.
Natural Nipple Butter (Earth Mama Angel Baby, excellent for burning) - apply after nursing in conjunction with Monistat, wash off before nursing.
Baking soda - applied to nipples and feet each day while showering.

Other Measures
Laundry - Add 1/4 cup vinegar to each load of laundry to kill yeast.
Sterilization - Sterilize pacifiers, bottles, and breast pump equipment each day. Sunlight kills yeast, so alternatively I would set clean dishware on a sunny windowsill.

Effective measures taken to treat mouth and diaper rash infection in baby:
Jarro-Dophilus for Baby (refridgerated acidophilus powder) - 1/4 tsp in breastmilk 1x/day, express milk into a tablespoon and mix, or add to bottle.
Gentian violet - dilute to 0.5% and apply to tongue 2x/day, Shout will usually remove purple stains in clothing if applied and washed within 1 day, use a small amount on a Q-tip and apply to tongue. Be careful a little goes a long way. A study showed a weak link between Gentian Violet and certain cancers, my pediatrician and dermatologist said it was fine to use.
Vusion diaper rash cream (prescription) - absolutely the only effective diaper rash cream I found.

Ineffective measures taken to get infection under control in baby or mother:
Grapefruitseed extract - 250 mg capsules 3x/day. When passed on in breast milk it didn't agree with baby.
Odorless Garlic - 2-3 capsules 2x/day. When passed on in breast milk it didn't agree with baby.
Nystatin suspension - As prescribed, I found this worsened the condition, it's in a sugar suspension which feeds yeast, I think Dr. Sears says it is effective in only about 40% of cases.
Lansinoh nipple cream - didn't do much for me.
Lotrimin - over the counter cream) - apply to bottom 2x/day, further irritated babies bottom.

All the supplements can be purchased at Whole Foods Market, with the exception of Candex which I purchased online, and Gentian Violet which was purchased at the O'Connor Hospital Pharmacy.

The prescriptions were obtained from Dr. Honor Fullerton, she was the only doctor in that I found who was able to treat me for intraductal yeast (infection that has gone into the milk ducts). My OB, general practitioner, and previous dermatologist did not understand the nature of this infection.

Dr. Honor Fullerton
Menlo Dermatology Medical Group
888 Oak Grove Ave., Suite 8
Menlo Park, CA  94025

Hazards of Gentian Violet

From the Gentian Research Network - Gentian violet is a water soluble dye (coloring substance) used primarily in medicine to stain bacteria, but also in other histological procedures.   It is not derived from gentians, but got its name since it is pink-violet like some gentians in the genera of Centaurium,  Gentiana, and  Gentianella. Gentian violet is derived from coal tar.

Is gentian violet safe?  [Related Articles]
Phillips V.
J Hum Lact. 1993 Mar;9(1):7-8.

The FDA's 2006 Over-The-Counter List:

ANPR    PR    FR
IIIE        IIE     pending

Adverse effects of topical gentian violet - possible carcinogen, although perhaps not in very short term use???? [Medline is disappointing on this topic - there are no abstracts for the few relevant papers.  However, the titles in the Cambridge Environmental Publications List are pretty scary.  There are more scary references at The Carcinogenic Potency Project.]

My research shows that there is no consensus on the safety of gentian violet on a mother's nipple or a baby's mouth.  The baby's mouth is a mucous membrane, which is less protective than skin.  It makes sense to try other remedies first, and if a clear diagnosis of thrush has been made, and the thrush is not responsive to any other treatments, then the benefits of using gentian violet may outweigh the risks.

Gentian Violet  (Topical) from Medline Plus

"Breast-feeding—Gentian violet topical solution has not been reported to cause problems in nursing babies."

From noaa.gov - "May cause skin irritation. Harmful if swallowed. May cause respiratory and digestive tract irritation. May cause severe eye
irritation and possible injury. May cause reproductive and fetal effects."

Another NOAA page "Harmful if swallowed."

From Solving Common Breastfeeding Problems::
The use of aqueous gentian violet 0.5 per cent in the treatment of nipple thrush is no longer recommended, as recent studies suggest it is a potential animal carcinogen. It can now only be obtained by prescription.

Thrush - Treatment - from the Royal New Zealand College of General Practitioners
"The use of aqueous gentian violet 0.5 per cent in the treatment of nipple thrush is no longer recommended."

Subpart B--Listing of Specific Substances Prohibited From Use in Animal Food or Feed
Sec. 589.1000 Gentian violet.

The Food and Drug Administration has determined that gentian violet has not been shown by adequate scientific data to be safe for use in animal feed. Use of gentian violet in animal feed causes the feed to be adulterated and in violation of the Federal Food, Drug, and Cosmetic Act (the act), in the absence of a regulation providing for its safe use as a food additive under section 409 of the act, unless it is subject to an effective notice of claimed investigational exemption for a food additive under 570.17 of this chapter, or unless the substance is intended for use as a new animal drug and is subject to an approved application under section 512 of the act, or an index listing under section 572 of the act, or an effective notice of claimed investigational exemption for a new animal drug under part 511 of this chapter or 516.125 of this chapter.

[72 FR 69131, Dec. 6, 2007]

From an FDA site:
LIB 4395 Analyses of Crystal Violet & Brilliant Green
Laboratory Information Bulletin
LIB No. 4395
Volume 23, May 2007
Quantitative and Confirmatory Analyses of Crystal Violet (Gentian Violet) and Brilliant Green in Fish

from FDA Import Alert 16-131
Moreover, prolonged exposure to nitrofurans, malachite green, and gentian violet has been shown to have a carcinogenic affect.

from The National Center for Toxicological Research (NCTR), FDA's internationally recognized research center
from FDA document, CPG Sec. 578.600 Unapproved Additives for Exported Grains
"Studies at the National Center for Toxicological Research have shown gentian violet to be a carcinogen for laboratory animals."

Chronic toxicity and carcinogenicity studies of gentian violet in mice.
Littlefield NA, Blackwell BN, Hewitt CC, Gaylor DW.
Fundam Appl Toxicol. 1985 Oct;5(5):902-12.

"Gentian violet is a dye belonging to a chemical class known as the di- and triaminophenylmethanes.  . . . [G]entian violet appears to be a carcinogen in mice at several different organ sites."

From the AAP Policy Statement on "Inactive" Ingredients in Pharmaceutical Products: Update (Subject Review)
Contact dermatitis has been associated with neutral red,[126,127] D&C Yellow No. 11,[128,129] indigo carmine (FD&C Blue No.
2),[130] quinoline yellow,[129] and gentian violet (CI Basic Violet No. 3).[131,132]

Gentian Violet Policy Withdrawn - from VETERINARY NOTES - "Gentian violet is not GRAS [Generally Regarded as Safe] or GRAE for any veterinary drug use, and therefore is a new animal drug subject to section 512 of the Act."

Obstructive laryngotracheitis secondary to gentian violet exposure.
Baca D, Drexler C, Cullen E.
Clin Pediatr (Phila). 2001 Apr;40(4):233-5.

Gentian Violet can be great but it can also cause some secondary problems. I ended up in the ER with a subsequent hospital stay with my 3 week old daughter after she had an allergic reaction to GV and her esophagus got so swollen she couldn't breath well. I had never heard of it before but then had a client a few months later whose baby had the same reaction. When I put it out to my online mothering group, a few other mothers came forward with similar experiences.

I'm not saying not to use it, just make sure you're watching the baby carefully over the next few days (assuming you find the GV) to make sure he isn't having a reaction to the treatment.

I just want to throw out a cautionary note about gentian violet.
Its name is confusing and makes it sound like an herb, kind of like calendula.   But it's not from a plant.  It's a chemical compound and is potentially carcinogenic.
There may be times where the benefits outweigh the risks, but I wouldn't rush to use it.

Old Information about Gentian Violet


Lots of moms are very conscientious about drinking lots of fluids while they're nursing; there's a chance that this may stimulate additional letdown.  So if you're trying to reduce the letdown, consider NOT drinking fluids right while you're nursing and notice how this changes your letdown.   Note that there is a difference between overactive letdown and oversupply.

Over active let down in 2 months old baby is not supposed to bother the baby in terms of latch, swallow and breathing while nursing.
However it can cause to an imbalance between foremilk and hind milk which can lead to imbalance between the milk components especially lactose and fat in a feeding. That can be related to fussiness, gassy, green stool and problems with weight gain.

To take care of the over active let down hold your breast like a sandwich, press hard on the edge of the aureola but not too hard that will cause you pain. The rationale of this holding is to squeeze the ducts right above the nipple pores to make the milk flow to slow down.
 Lay back can be helpful as well. Google "biological nurturing" and try to use the position, it has many advantages and can help you with the let down.
You can also express your milk with your hands for 1-2 minutes before nursing to release the pressure.
The current and most updated recommendation is to feed from one side each feeding. The reason is to keep the milk components in the right balance for your baby.

NOTE - If you're taking encapsulated placenta, this could be causing oversupply.  Supplemental progesterone could also cause this.

One of my experienced moms observed that when she nursed side-lying, she had fewer problems with a strong letdown.  She thinks the more relaxed possession lowered her adrenaline.  Maybe this reduced the ejectile contractions of the ductal muscles???

Case Report: Overabundant Milk Supply: An Alternate Way to Intervene by Full Drainage and Block Feeding - C. GA van Veldhuizen-Staas

Overactive Let-Down: Consequences and Treatments by Mary Jozwiak

Very helpful information about oversupply from La Leche League

Oversupply Syndrome Colic Or Foremilk - Hindmilk Imbalance from Marie Davis, R N, IBCLC

Oversupply: Too Much Milk By Anne Smith - IBCLC

Oversupply from parentsplace.com

Sometimes and oversupply/engorgement issue can be due to an improper latch and poor milk transfer.  With baby having been in the NICU there is probability of some latch/transfer concerns.  That being said, here are some of my immediate thoughts for this Momma and answers to your questions.

First of all, if an oversupply is the issue, the pumping is only exacerbating the problem.  Mom can hand express for some relief, but def should not be draining the breast with a pump.  If the hand expression isn't enough relief, mom can use the pump for just a few minutes until breast is a bit softer (should probably only need to express 1 oz or so) and should limit the stimulation to the breasts as much as possible.  Mom should try and nurse baby on one side only at each feeding and may even want to explore "block nursing" where she only nurses on one breast for a certain amount of time.

Forceful Let-down (Milk Ejection Reflex) & Oversupply -Kellymom has some info on it here at the bottom of the page.

Cool compresses help and can be in many forms.  My all time favorite is the green cabbage leaves.  They are shaped perfect for the breast and fit nicely in the bra.  You can chew/cut up some of a cabbage leaf and put that inside the larger leaf too. Not only are they cool from the fridge but the cabbage has some anti inflammatory properties.  Another great and non messy tip I have seen is to fill a baby diaper (or two) with cool water and wrap those around the breasts :)  No drippy wash clothes to deal with!  The cool compress can help with pain and swelling, but tylenol and ibu can be used safely if needed.

Also, with the breast being so full and difficult for baby to latch onto, Mom can use reverse pressure softening to get the tissue around the nipple and areola to sofen enough for baby to latch.  Its pretty easy to do and REALLY effective.  Simply hand expressing a bit of milk before a feeding can help.

Reverse Pressure Softening - ... a technique to aid latching when a mother is engorged (from Kellymom)

In terms of herbs, sage can help reduce supply and lecithin can be helpful to prevent any plugged ducts.  Herblore sells sage in tea and tincture and a great little blurb about it here:
Plugged Ducts, Mastitis & Low Breastmilk Production ....Effective Natural Remedies for these Issues and More

You can get Lecithin at any health food store. 

As for the continuous leaking...once the milk supply is better regulated, it should stop or at least slow down significantly.  In the mean time, it will be important for Mom to change her nursing pads regularly.  Dark, Warm, Wet and Sweet places are a breeding ground for yeast, and the last thing Momma wants is a thrush battle!  Taking probiotics (especially if Mom has had any antibiotics) is also a good prevention.

Pumping in general will increase her milk supply, so instead of pumping to relieve pressure, she can try hand expressing. If pumping is a must, then limit it to 10 minutes. Kelly mom has another great article on Engorgement and what to do before, during and after nursing to alleviate the discomfort and help baby latch.

The main highlights of this article are to use a cool compress up to 20 minutes before nursing and then a warm-moist towel or warm water for just a minute or so right before nursing to allow the milk to flow.Avoid heat on the breast between feedings since this can cause more edema and inflammation. Instead continue to use cool compresses between feedings to help reduce swelling. During the feeding session she can massage her breasts and use compression to keep the milk flowing and discourage plugged ducts from forming.

Also, explain to this mama, that although pumping "fixes" the discomfort of being full temporarily, it will only perpetuate the discomfort, since pumping on top of feeding is basically telling her breasts to produce more! Sometimes moms forget that milk is produced on a supply and demand basis, so a reminder never hurts :-)

You might want to try some of the suggestions below, for suppressing lactation, but use these techniques in moderation. Otherwise, you may reduce your milk supply so that it is not enough for your baby.

Suppressing Lactation

“Dry up pills” and breast cancer from Midwifery Today - about possible carcinogenic effects of DES; Parlodel and Chlorotrianisene (Tace).

Lactation Suppression: Forgotten Aspect of Care for the Mother of a Dying Child [Medscape is free]

Lactation Suppression from Breastfeeding Basics

The effects of immersion and exercise on prolactin during pregnancy
Katz VL, et al.. (Eur J Appl Physiol. 1990)

Immersion in water, especially deep water immersion, reduces prolactin levels.  Women who are trying to suppress lactation may want to take frequent, long baths.  (Women immediately postpartum should consult with their care providers about the advisability of immersion.)  Since hot water can stimulate lactation, the water should preferably be on the cooler side.  A swimming pool would be ideal.

Why cabbage leaves while weaning? from ParentsPlace Lactatation Consultant Debbi Donovan , IBCLC

I would really advise that she try cabbage leaves inside her bra for suppressing lactation. To use a cabbage leaf compress, put one layer of chilled, washed fresh green cabbage leaves inside her bra cups so that the breasts are completely covered.  Leave them in until they "cook"-become soft, fragrant and translucent and start to wilt. They should then be replaced. This has been shown to be super effective and a bit smelly.

Other suggestions, were not to stimulate the  breasts (hot water, or other ways:), and to use ice packs, or frozen green peas wrapped in cloth molded to the breasts.

Eating parsley can reduce milk supply.

Homeopathic remedies include lac caninum and sometimes pulsatilla. Some people recommend Urtica Urens 1X, every 6 hours to suppress milk flow.


Plugged Ducts and Mastitis by Kelly Bonyata, BS, IBCLC from kellymom.com.

Mastitis & Plugged Ducts By Pam Caldwell at HerbLore

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment
Linda J Kvist, Bodil Wilde Larsson, Marie-Louise Hall-Lord , Anita Steen and Claes Schalen
International Breastfeeding Journal 2008, 3:6doi:10.1186/1746-4358-3-6
Published:  7 April 2008

D-mannose is a completely natural substance called d-mannose, and it works in a totally different way to antibiotics. It has been used for urinary tract infections for a while; it works by preventing the e. coli from clinging to tissues so that it can be flushed out of the body.  This is an experimental suggestion, but D-mannose can't hurt you, so it seems worth a try for women who are having recurrent episodes of mastitis.

It has been used by dairy farmers to prevent or treat mastitis in dairy cows.

Adherent and invasive Escherichia coli are associated with persistent bovine mastitis

"E.coli and other gram-negative bacteria that colonise the bladder and urinary tract have the ability to express fimbria (molecular hairs) that have lectins (special molecules) that fit precisely into the mannose receptors in our body cells. That's how E.coli has adapted to be able to attach to us. It's a bio-molecular attraction, and once it gets a grip of you, there are only two ways to deal with it.

The other way, and by far the easiest way to deal with E.coli infections, is to provide a richer supply of mannose into the urine than the E.coli can find in tissue cells. We think that in most people, the D-Mannose is in the urine within about an hour, and many users say they feel it beginning to work within that first hour, and that within the first 12 hours or so of beginning to use D-Mannose, they are able to resume normal life. We suggest to people that even if feeling so much better, they should finish the first pack, to hopefully achieve the effect of giving the bladder a good clean out.

It's simple, foolproof, and our users say it works better than any antibiotic for E.coli, and doesn't have nasty side effects. You just get rid of the bacteria, now unable to stick to the bladder and urinary tract lining, when you urinate normally."

Alternative Cystitis Treatment - this has a nice presentation to explain how d-mannose works to eliminate e coli from your body's various tracts.

With my twins, I was pumping so much and I stopped counting how many times I got mastitis after about 25 or so.  I became somewhat of an expert on how to get rid of it and I never had a case that lasted more than 48 hours and I never had to go on antibiotics.  I strongly recommend the Poke Root, which was mentioned earlier.  I also got mine through www.herblore.com.  Pam Caldwell is a fantastic herbalist and she can help you (by phone) with your mastitis and other breastfeeding questions.  You can also take echinacea and lots of vitamin C.  Before breastfeeding or pumping, I would wet a towel and microwave it to warm it up (maybe 15-30 seconds), wrap it around your breasts and then nurse or pump.  Get in the hot shower and try to hand express.  It will hurt a lot, but it is important to work that milk out. Drink tons of water and rest, rest, rest.   I also had to be very careful to clean my pump regularly and I would spread a little breastmilk around my nipple after I was done nursing or pumping to try and kill any bacteria. With twins, I had to rely heavily on other people to take care of my babies when I had the mastitis.  Most of my cases happened in the first few months and then a few times toward the end when I was weaning.  i finally resorted to sage tincture to stop my milk production because I kept getting plugged ducts when I would try to go longer in between pumpings.  After 2 days of the liquid sage (also an herblore product), my milk was totally dried up. Hang in there.

I had a bad case with my then 4 month old. My mom is a nurse and she told me hot showers/compresses and make sure you completely empty your breast, even if you have to pump. Keep your pump super clean if you are using it and eat extra healthy. Vitamin C is a major plus. However she said if it didn't go away in a day or so then I would need to see my dr. I called the dr. and they told me the same  things :) Good luck.

We've seen a huge difference in women who drink at least a gallon of water a day. Sounds like a lot but it works!  I personally have seen a difference with my 2 y.o and the 2 breast infections I got.  Yes, I let the water go and yes, I got a hunkin' breast infection.  Sounds so simple but we both swear by it!

I'm not a certified Lactation Consultant but I did do some LC training. However, most of my experience with mastitis comes from my own personal experience. I was prone to it, including the systemic symptoms. I had 5 or 6 bouts like this over a 9 year nursing history. I think some women are anatomically prone to it. For me it was almost always my right breast that caused the problem. I ended up with a tiny lump of scar tissue after one particularly bad bout.

I never took antibiotics or acetaminophen. I did go to bed (couldn't do anything else as totally out of it, delirious). Dragged myself to the tub and soaked the breast in hot, hot water. Took lots of vitamin C and nursed, nursed, nursed in all positions. Especially with baby's chin in direction of sore spot. This ended up in some pretty weird configurations of bodies.

I found that the fluishness always passed within 24 hours. The tender spot remained longer but I made a concerted effort to pay attention to it with the old Heat, Rest and Empty Breast. For the women I have helped this has always done the trick. I don't know of any who have taken antibiotics including one woman who had the most massive, blackest "bruise" I have ever seen. I did not counsel this woman and only saw her after the worst was over. She got through it without antibiotics.

I am not convinced that antibiotics are the answer to mastitis. I think it might be similar to Mendelson's comment about [name the affliction] "if you take antibiotics it will be gone in a week. If you don't take the antibiotics it will be gone in 7 days." It is possible they could contribute to the problem by not letting the body have a chance to fight infection off itself.

Echinacea was not "on the scene" yet when I was nursing. It may be helpful if taken at the onset. But it is an immune strengthener and while the immune system becomes involved in mastitis, it is the cause that needs to be treated, i.e. the "plug".

For this woman I would suggest all the other things you have suggested already. Now that she has experience with it, she should be able to recognize that sore, bruised feeling immediately and take measures to minimize its progress. I think the rest component is absolutely essential. I have found that women really need to pay attention to slowing down before mastitis resolves.

If you use homeopathic remedies at all Phytolacca and Belladonna are the two biggest mastitis remedies to consider. We often use cold packs alternating with the hot ones; also liquid chlorophyll, echinacea and one of my new favorite "natural" remedies Nutribiotics which is found in health food stores. It is a grapefruit seed extract that really knocks infections down quick!!! Can be bought in combination with Echinacea. As well as increased Vitamin C - increased Vitamin A - 50,000 to 100,000 iu for about 3 days only. That last recommendation is from a Clinical Nutritionist who says it isn't toxic this high if only using it for a short period (she says no more than 5 days at 100,000) I usually only do it for 3 days and don't need it more than that, also will usually only go up to about 50,000 or 75,000. My policy on that one is this: I use it at that high of dosage on myself and my family, no problems with it, usually only a couple of times a year when we're really battling something. I tell my clients about it and say they would have to make their own decision on it, also sharing about how FDA, AMA says Vitamin A is too toxic in that high of dosage. Definitely don't do this during pregnancy, but have seen it help in mastitis.

Since this is cold & flu season, I'll also share info about Engystol-M from -Heel Co. Have to buy it direct. This is fantastic for viruses. It helped a friend of mine get over Mononucleosis in record time.

Sudden onset mastitis is vicious! I use Echinacea 4-6 caps with Vit. C 1000 every two hours along with the things you had her do. Babe is the best pump. No lying down to nurse unless the baby is on mum's right side and she nurses the left breast. (Almost lying on the child but drains even up into the arm pit if she can manage the position.) The other thing I ran into was a woman who had 5 infections in a row, antibiotics et al. She would start feeling better and come down again. It turned out that her bra style had seams coming diagonally across the cup from the arm pit toward center. It made a VERY FAINT line as her bra wasn't very tight but enough to block off part of the flow on each side to some of the ducts. I had her change her bra style and she never had another one.

We have used garlic and echinacea with great success, at the very first sign of possible infection we have them start taking 2 tabs of garlic and one droppersful of echinacea every 15 min plus drinking 1/2 gal of water within the next 2 hours and rest.  usually knocks it by then.

Poke root is an absolute wonder cure for breast infections!  The homeopathic version (phytolacca) is also great!

Mastitis Treatment:


Natural Remedies: Meds/Antibiotics: Prevention:

Midwifery Today Summer 1992 Mastitis: positive Interventions by J. dever. She says that:

Sheila Kitzinger recommend using an oxytocic nasal spray to help with let down and apparently it can "sweep down" an infection. Can be used in conjunction with anti-biotic therapy

other things mentioned

sounds like the things that caused the breast infection are the same things that are preventing it from disappearing even with use of anti-biotics. Is she resting a lot? I know of midwives who tell their clients who are beginning to get signs of a plugged duct to get into bed with their baby and stay there until all signs have gone.

From an herbalist:  Generally when a breast infection (mastitis) appears, it is all too often because the mother is run down and needs rest. The number one thing is to get rest, and bed rest is suggested but more often than not for most, unrealistic. Next, be sure to nurse on the affected side as much as possible, keeping the breast as empty as you can, thereby allowing the infection to clear. Taking immune boosting herbs is important such as echinacea, propolis, astragalus, lemon balm, oatstraw, fenugreek, etc. These may be administered via infusion (tea), liquid extract or capsule--which ever way the client is inclined to take her protocol. Foods are important to remember also; alliums are great for boosting the immune system. Garlic, onions, chives- also burdock root, dandelion root and dandelion greens are highly nutritious and splendid sources of nutrients and minerals to boost immunity and lymph health. I always recommend a cabbage poultice to any woman experiencing breast tenderness and surely for Mastitis. It works wonders for clearing blockage and infection. Simply place a raw cabbage leaf (or a few) on the affected breast. I like to say you should treat both breasts, as with ear infections, it's very common for the infection to go from one side to other and then back again, just when you think it is clearing up. If you would like to soak a few of these cabbage leaves in warm water, that is fine too. Warmth will soothe the tender breast as well. Cabbage leaves are a perfect shape for cupping the breast, it's neat to think of their nature and how they work so effectively for this cause. Worst case scenario, poke root is great for clearing breast infection. Poke root is a highly heroic herb, a little -- I mean a little, like 5 drops extract max, goes a long way. It has been known to clear even the most persistent infection up readily; although I only go there for last resort.

Plugged Ducts

KellyMom says that "Advice to point baby’s chin (or nose) toward the plugged area is not necessarily going to be helpful as it is based on the idea that the milk ducts take a nice, direct route to the nipple – recent research tells us that this is not true, and that a particular duct might begin in one area of the breast but can “wander” in many different directions before terminating in any area of the nipple."
One mom summarized treatments really well: Whenever I have the feeling one will start I start taking lecithin supplements to help thin out the milk and make it less sticky, always nurse on that side first from different angles, motrin to help inflammation, warm rice packs before nursing and something cool after. It usually resolves in a few days.

I might add to massage the plug towards the nipple when nursing, kind of like squeezing cottage cheese through a straw, and position the baby's chin towards the plug, so the strong suction of the baby's tongue will help with this.

From Jack Newman's Blocked Ducts & Mastitis:

Potatoes (adapted from Bridget Lynch, RM, Community Midwives of Toronto). Within the first 24 hours of your symptoms beginning, you may find that applying slices of raw potato to the breast will reduce the pain, swelling, and redness of mastitis.
Cut 6 to 8 washed raw potatoes lengthwise into thin slices.
Place in a large bowl of water at room temperature and leave for 15 to 20 minutes.
Apply the wet potato slices to the affected area of the breast and leave for 15 to 20 minutes.
Remove and discard after 15 to 20 minutes and apply new slices from the bowl.
Repeat this process two more times so that you have applied potato slices 3 times in an hour.
Take a break for 20 or 30 minutes and then repeat the procedure.

Mastitis & Plugged Ducts By Pam Caldwell at HerbLore

Things I would add are:
1. massage and manual expression in the shower in addition to pumping (for drainage)
2. motrin 400-800 mg 3x per day (for inflammation) if you're into motrin
3. Soy Lecithin (I can't remember the dose but think it's on KellyMom) 3 times a day at least (helps liquefy the fat clogs) [Those avoiding soy will be happy to know you can also get sunflower lecithin.]
4. Happy Duct by Wish Garden Herbs. This stuff was a miracle worker for me and a few women have been very pleased with it when I recommended it to them. I know you can order it on line.

Sometimes using the flat side of an electric toothbrush over a superficial duct plug in the breast helps them break up, a poor man’s ultrasound therapy. -Amy Evans, California

You can try to utilize gravity by lying in a bath of hot water with the affected breast hanging while you massage.

Anatomy of the Breast shows the overall breast anatomy, including the suspensory ligament, and here's the lymphathic system.  Notice the main drainage pathways, which can help identify plugged ducts.

Add lecithin to her diet - works wonders for clogged ducts - the best form is the granular form - 1600 mg daily for alleviation and prevention of clogged milk ducts.

I have had a couple of clients that high fat foods always plugged up their ducts- fried foods, dairy products, etc.

Blocked Ducts and Mastitis from Dr. Jack Newman - discusses the use of ultrasound for a blocked duct:

If a blocked duct has not settled within 48 hours (unusual), therapeutic ultrasound often works. This can be arranged at a neighbourhood physiotherapy office or sports medicine clinic. Many ultrasound therapists are not aware of this use for ultrasound. The dose is:

2 watts/cm², continuous, for five minutes to the affected area, once daily for up to two doses.

If two treatments on two consecutive days have not worked, there is no point in continuing with ultrasound. Get the blocked duct re-evaluated at the clinic or by your own physician.   Usually, however, if ultrasound is going to work, one treatment is all that is needed.   Ultrasound also seems to prevent recurrent blocked ducts that always occur in the same part of the breast. Lecithin, one capsule (1200 mg) 3 or 4 times a day also seems to prevent recurrent blocked ducts, at least in some mothers.

I am a labor and delivery nurse and recently had my third child.  I breastfed successfully with the first two children.  I developed a persistent and recuring problem with blocked nipple pores and clogged milk ducts.  Very Painful!!  I consulted everyone at the hospital, including lactation consultants etc...  I read books and tried everything offered.  Nothing worked.  Finally one of the female MD's who used to work with midwives told me to try putting cabbage leaves in my nursing bra to soften breast tissue. Everyone laughed and thought she was crazy.  Needless to say, I was very skeptical and felt a bit silly. However, I was desperate. It worked like a charm!!!

My first action, would be to eliminate all refined sugars and flours, treat with acidophilus, increase raw foods, alternate hot/cold packs (hot before nursing and cold after).  Is she running a fever, even a low grade fever?  Yeast overgrowth is many times revealed in recurring breast infections.  I would personally use echinacea and either golden seal or oregon grape root.  Check the baby's mouth for thrush also.  If the latch has changed, then it could be due to undetected thrush.  I would also revert back to early nursing days, getting back into bed to rest, nurse and drink lots of good water.  Outside of these steps, I would consult a reputable lactation consultant.

A good friend of mine needs help with clogged ducts. She is nursing her one year old baby, and has had trouble with painful swollen clogged ducts for a full two months now. She has tried everything we can think of, and now we need your suggestions.

Two months ago a duct clogged and caused a swollen hot area under her arm the size of a cigarette pack! This original area has gone up and down, but never resolved completely. She has also shown no signs of infection in that two months. Within the two months this spot has been a problem, other ducts have clogged and unclogged with her efforts. (all on the same side)

She has tried cabbage leaves, ginger poultices, hotpacks, no bra, two bras, massage, nursing in every funky position she can think of, and now she's  been having ultrasound treatments of the affected breast. Sometimes after a treatment, she'll be nursing and a clog will suddenly resolve itself. But never this original one. And other clogs continue to come and go.

She's talked to three lactation consultants, and her midwife. None have any advice that's worked. She suspects his latch has changed??? But why at one year would he have this problem, why only one breast, and how can she fix it? She does not want to wean entirely, and even wants to avoid weaning off the affected breast due to concerns about lop-sidedness.

my thoughts are that since the worst area continues to be swollen, sometimes worse than others, but never resolved completely.... It seems some milk keeps getting through, otherwise the duct would have dried up completely by now, right?

I too had a blocked duct in my left armpit while nursing my newborn son (he's 3 months now and the problem is gone) mine was more the size of a golf ball this is what I did via the advice of my LLL leader.

1) apply heat 5-10 min prior to nursing (warm bath water, hot pack)
2) ice in between nursing, oddly this felt soooo good
3) nursed this side frequently and hand expressed the other to keep milk up
in both breasts
4) took as much bed rest as possible (had 2 infections that knocked me out,
nice bonding time with baby to lay in bed together all day, getting up had
me in tears)
5) constant self massage, though I was advised that if it didn't clear up to
call a massage therapist who is skilled in lymphatic drainage
6) in the big ball I could feel the smaller duct, I squeezed this and found
backed up milk coming out of the pore above it.  totally relieved the
pressure at times.

Anyway, the swollen duct shrunk in size by the end of the week.  Every now and then I feel it building slightly, but not with the swelling.  Good luck to your friend.

One of my clients who nursed twins gave me some really good advise about plugged ducts.  She said she would put baby on the floor and nurse hanging from above so that the breast was completely hanging straight down. (She was on all fours).  She said that always took care of the problem.

I tell my mamas that they should be humming  "rock around the clock" when using this breastfeeding position. The beauty of it is that the mom can rotate (like the hands of the clock) and make slight or major changes in where the pressure is felt on her nipple as well.  Mom might well wind up in a position impossible to create while seated or lying down unless she wants to try and have her baby wrap his/her legs around her neck!!  LOL Oh one more thing. When I advocate something like this I also quickly grab one of my baby dolls and demonstrate/model it for them.

She might want to look very closely at her nipple and see if there is a tiny white bump under the skin anywhere. There might even be a little clear blister over it. She may want to try lifting the clear skin and giving it a tiny squeeze and there is a chance that a calcified piece of milk with come out. This sometimes happens and creates the blocked duct. You can also take lecithin to help prevent these calcifications. At one time this was in the LL literature.

There may be some blood in her milk from a plugged duct that is clearing. Milk can dry and crystallize, which is why plugs hurt, but tell her to keep nursing and it'll flow out. (Baby is more efficient than the pump, too, so encourage her to get baby to the breast.)

Now if it's lots of blood, she should see a doctor or LC immediately, but it's likely it'll go away with a feeding or two.

Milk Blisters / Blebs

How do you treat a milk blister? By Kelly Bonyata, BS, IBCLC aka KellyMom

Nipple Blebs/Blisters
By Catherine Genna Watson, BS, IBCLC and Medela

Blocked Ducts & Mastitis from The Newman Breastfeeding Clinic at the International Breastfeeding Center

NIPPLE PAIN - This has a picture of a milk blister or bleb from mother-2-mother.com

Dealing with Plugs and Blebs from La Leche League

Blebs, Nipple Blisters and Plugged Ducts from Sutter Health / PAMF - This makes a distinction between a flat bleb and a filled milk pore and a milk blister, but I found it even more confusing!

LACTNET had some very helpful messages:

I had one that kept doing that until I sterilised a pair of fine sharp nail scissors and trimmed off a little of the middle loose skin. Left a small exposed patch on which I smeared a tiny bit of lanolin and expressed breastmilk, glued the edges down. Healed up. I wouldn't do this to anyone else but I always knew where the scissors were on my nipple: ultra-sensitive. Can this mother try this herself? [Ed: This would be a solution of last resort as you're actually removing skin!]

Some moms have "repeated blebs" in the same location.  But ponder the lovely poster abstract from the ABM 2012 conference by O'Hara ("Bleb histiology reveals inflammatory infiltrate that regresses with topical steroids; a case series"; link here to the published version which requires BFg Med access:
In part it says:  "The blebs caused 5 women so much pain that they requested excision of the lesions, which they tolerated well in an outpatient clinic using a punch biopsy tool after local anesthesia. Every woman’s symptoms resolved shortly after removal of the rubbery, scar-like tissue. Histology consistently revealed 1) lack of any bacteria or fungi, and 2) histiocytes with foamy cytoplasmic vacuoles and fibrin deposition. These immune cells indicated a tissue reaction to milk that has leaked from ducts into surrounding tissue. Based on these findings, subsequent patients with blebs have been treated effectively with a short daily course of a very thin layer of a mid-potency steroid under occlusion to enhance penetration into the inflamed and fibrotic tissue."

I'm surprised no one has mentioned Dr O'Hara's work on this and suggested treatment: punch biopsy followed by mid potency steroid under occlusive dressing.
Though I haven't had the need to do this yet,I plan to follow her protocol.
See Emily Healy's post dated 10 Dec 2013 in Lactnet Archives

Dee Kassing (of paced bottle feeding fame) post re-posted:

"Here's what I suggest for a "recurring" nipple bleb.  Personally, I think that it really isn't "recurring", but more likely "never quite cleared up in the first place."  I think that when that milk sits at the front of the nipple pore, thickened, so it can't get out, then the milk behind it in that particular duct also thickens as it sits there unable to move out.  Then, eventually, the mother finds a way to get the white spot at the nipple pore to go away, and she temporarily feels better.  I think she took the pressure off the tissue at the nipple pore.  But that other milk that thickened as it couldn't get out, is still there, just back farther in the breast where it can't be seen.  Then as baby nurses a few more times, or another day or two, he gradually pulls that toothpaste-thick milk down to the front of the duct, and that thick milk puts pressure on the tissue around the nipple pore again, and mom is in pain again.  But it's not a "new" bleb (at least, this is my conjecture), but just more stuck milk finally making its way down the duct.

"So I suggest that moms take a pain reliever (like Motrin) right before they nurse the baby, preferably when there is another adult in the house to take care of the baby after they've finished nursing.  Otherwise, if she is alone, she can try to do this when she expects baby to take a long nap after nursing.  She takes the pain reliever, so that it has time to get into her system, and I warn her that what I'm suggesting will not feel good.  (So she isn't cussing at me while she's in the tub, thinking I'm a complete moron.) She breastfeeds, so there's the least amount of milk/pressure in the breast as possible.  Then she gets in the tub, with the water high enough that she can comfortably lean over and submerge her breasts.  She soaks them for 3-4 minutes, to let the heat help to widen the ductwork.  Then she starts at the nipple and massages and expresses the nipple to move out any thickened milk she can.  Then she moves back to the areola and massages and expresses a strip about an inch wide, all the way around the breast.  Then she moves back about an inch toward the chest wall, and again massages and expresses any milk she can out the front of the breast.  She continues to move back on the breast, inch by inch, constantly moving the milk towards the nipple. (If she starts back at the chest wall, she's just running milk into the blockage and increasing the pressure.)  I warn her that if she manages to express any thickened milk, it is likely to feel unpleasant or even painful, but that if she manages to get it out, she will feel much better afterwards.
"I also warn her of two more things:  1.  If she gets out a plug of thickened milk, it is likely to look kind of stringy and clumpy and cottage-cheesy in the water.  If you don't warn her and she sees this, she will absolutely freak out.   2.  Then you must immediately reassure her that if she doesn't see this in the water, but the pain/plug/bleb goes away/does not return, then it won't hurt her baby to have swallowed it down.  It's just breastmilk that lost some of its water and got thick, but it still has all the antibodies and nutrients it ever had.  Otherwise, the mother's mind immediately goes from "don't worry if you see this in the water" to "what if the baby swallows that awful-looking stuff?".

"I suggest that they do this three nights in a row.  It very frequently solves the problem.   Dee Kassing"

D-MER / DMER - Dysphoric Milk Ejection Reflex

Defining D-MER from d-mer.org - Dysphoric Milk Ejection Reflex is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.

There are new treatments for D-MER (dysphoric milk ejection reflex).

Dysphoric milk ejection reflex: A case report
Alia M Heise1 and Diane Wiessinger
Int Breastfeed J. 2011; 6: 6.

Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional "drop" that occurs in some women just before milk release and continues for not more than a few minutes. The brief negative feelings range in severity from wistfulness to self-loathing, and appear to have a physiological cause. The authors suggest that an abrupt drop in dopamine may occur when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women. Clinicians can support women with D-MER in several ways; often, simply knowing that it is a recognized phenomenon makes the condition tolerable. Further study is needed.

Maternal Brachial Plexus Injury / Nasal Oxytocin Spray

Women who have a brachial plexus injury or more extensive neurological injuries may have difficulty breastfeeding.  This is because the suckling stimulation doesn't send normal nerve signals to the brain to generate oxytocin to facilitate letdown.

The most notable symptom may be ongoing engorgement, even into the third week and beyond.  The engorgement will likely contribute to nipple soreness as the baby may have difficulty maintaining an effect latch on the engorged breast.

For women with a one-sided injury, they will probably find that double pumping significantly increases the letdown on the affected side because the stimulation of the other side is generating the oxytocin.  Although the stimulation is communicated to the brain through the nervous system, the letdown response is mediated by oxytocin, which travels through the bloodstream to both sides.

These women may benefit from nasal oxytocin spray while breastfeeding on the affected side.  Some studies show that guided imagery can also be effective.

Oxytocin Levels and Effects while Breastfeeding - this has an excellent list of references!

Summary of Use during Lactation - Although oxytocin is an essential hormone in lactation, administration of exogenous oxytocin to mothers having difficulty in breastfeeding has not been clearly shown to have a beneficial effect on lactation success or in the treatment of breast engorgement. It might be of benefit in women who have lost the neuronal connection between the breast and hypothalamus. [Ed: Such as with maternal brachial plexus injury.]

Oxytocin Nasal Spray from Lactation Services Patient Education at the University of Washington Medical Center - detailed information about usage and dosage.

When is oxytocin nasal spray needed?  Oxytocin nasal spray is a synthetic form of the hormone. If your breasts are so full and firm that nursing, massage, warmth, and pumping cannot relieve the pressure after 24 hours, oxytocin nasal spray may help. It can also boost milk supply by helping to empty the breasts more completely.

Oxytocin Nasal Spray may be difficult to find.  The Empower Pharmacy carries it.

Psychogenic and pharmacologic induction of the let-down reflex can facilitate breastfeeding by tetraplegic women: a report of 3 cases.

Cowley KC1.
Arch Phys Med Rehabil. 2005 Jun;86(6):1261-4.

 . . . In particular, it is unclear whether women with SCI above T7 can sustain breastfeeding in a manner similar to neurologically intact nursing mothers. A functional let-down reflex is required to provide adequate milk to a nursing infant. Infant suckling activates tactile receptors in the breast, and this signal is carried via afferent nerves in the T4-6 dorsal roots to the spinal cord and then to neurons in the hypothalamus, which release oxytocin into the bloodstream. Oxytocin triggers milk ejection from the breast. Suckling-induced afferent stimuli are absent in women with SCI above T4 and are reduced if the injury is between T4 and T6. This report describes the breastfeeding practices of 3 tetraplegic women and shows that breastfeeding can be maintained for extended periods (12-54 wk) after delivery. Two women required active mental imaging and relaxation techniques, or oxytocin nasal spray, to facilitate the let-down reflex. These findings suggest that although an absence of suckling-induced afferent stimuli may impair the let-down reflex, long-term breastfeeding can be maintained.

Oxytocin for promoting successful lactation.
Renfrew MJ1, Lang S, Woolridge M.
Cochrane Database Syst Rev. 2000;(2):CD000156.

MAIN RESULTS: Four trials of 639 women were included. There was potential for significant bias in these trials. Restricted breastfeeding schedules may have contributed to inadequate production of milk by the participants. Sublingual and buccal preparations of oxytocin were associated with an increase in milk production. Oxytocin did not appear to increase the incidence of breast pain and 100 international units of oxytocin appeared to be slightly more beneficial than 10 international units.

REVIEWER'S CONCLUSIONS: An appropriate dose of sublingual or buccal oxytocin may help augment lactation where necessary. However if women are encouraged and supported with unrestricted breastfeeding, the need for oxytocin would probably be diminished.

Plastic Bottles are Unsafe

The Adiri™ Natural Nurser™ Ultimate Baby Bottle is soft, safe and simple. With an easy to use and dishwasher safe Fill, Twist and Feed™ system, the only nipple truly shaped like a mother's breast, soft polycarbonate-free and bisphenol-A free materials, and a unique Petal™ vent that helps reduce colic, the Adiri Natural Nurser enables the ultimate safe bottlefeeding experience.

If you're planning to give your baby expressed/pumped breastmilk at some time after 3 weeks of age, please be aware that plastic baby bottles have recently been shown to disrupt a baby's hormones; glass bottles are safe.

Toxic Baby Bottles

Toxic Baby Bottles - Scientific Study Finds Leaching Chemicals in clear plastic baby bottles

I switched to glass bottles a few months ago and I LOVE them.  Throw them in the dishwasher and they clean up so nicely.  You can buy them at Babies R Us, but I ordered mine through Amazon.com.  It looks like Amazon is only selling the 4oz size right now, so I also know you can order them online through Radiant Life :

The glass bottles are made by Evenflo. They have all the sizes available.  I was shocked and happy to see them at Babies R Us when I went there a few months ago.

The nipples that come w/ the glass bottles are not great (in my opinion) but you can substitute just about any standard nipple.  I put the Dr. Brown's nipples on mine and they worked fine.

The "safe" plastic bottles that you are referring to are at: http://newbornfree.com/

WF's sells a new brand of baby bottle called "Born Free' that does not contain the chemical.  They also make sippy cups.



  etc. etc.

  And from Mothering mag:

  I am planning on breastfeeding but wanted to know which baby bottles are best for when I will need to pump. Any insight would be appreciated.
  Recent, studies have raised concerns about certain types of baby bottles. Fortunately there are plenty of safe options readily available to new mothers. The following tips will make it easy to know which products to look for and which to avoid.
  Products to avoid
Polycarbonate bottles: Bisphenol-A is a component of #7 polycarbonate plastic, the clear, rigid variety of plastic from which many baby bottles are made. This substance has been shown to be "estrogenic": it is an endocrine-disruptor in lab animals, altering reproductive organs and functions. Bisphenol-A can leach from polycarbonate, especially when exposed to high temperatures and repeated washings.
  Rubber Nipples: Many bottle nipples are made of rubber, which may contain low levels of contaminants known as nitrosamines. These substances, found also in some foods and in tobacco, cause cancer in lab animals and contribute to tobacco-related cancers in people. Nitrosamines can be ingested through bottle nipples; however it is unknown whether this kind of exposure increases the risk of cancer. Because of cancer concerns, The Food and Drug Administration regulates the amount of nitrosamines allowable in rubber nipples, but low levels are still permissible.
  Products to look for
Glass bottles: Because the risks to humans of bisphenol-A are unknown, it makes sense to limit your baby's exposure to it. Glass baby bottles are a time-tested alternative to polycarbonate plastic. Glass is a renewable resource, easily recyclable, and does not leach toxic chemicals. Glass bottles are, of course, subject to breakage, and there are risks of serious cuts to your child. Additionally, glass can chip or crack, and can break when sterilized, allowing glass splinters to end up in baby's beverage. The American Academy of Pediatrics urges parents not to let babies go to sleep with a bottle, and toddlers should not be allowed to walk around with a bottle. These precautions help prevent tooth decay and mouth injuries; they also help prevent breakage and injuries from glass bottles. As with plastic, careful and regular inspections of the bottle allow parents to detect any flaws in the glass. Recycle any scratched, cracked, or chipped glass bottle.
  Safe plastics: Although polycarbonate bottles containing bisphenol-A are the most common kind of baby bottle on the market, there are other plastic baby bottles available that do not contain bisphenol-A. These opaque bottles are made of polypropylene and polyethylene, which are not known to leach carcinogens or endocrine disruptors. Recycling symbols can provide some information about the plastic: polyethylene has #1, #2, or #4 on the underside, and polypropylene has #5. The surest way to know whether a bottle is made of polycarbonate is to call the manufacturer. Keep in mind, though, that all plastic bottles are petroleum products, requiring the use of non-renewable resources.
  Silicone nipples: Replace standard rubber nipples (amber-colored) with clear, silicone nipples. Not only are silicone nipples free of cancer-causing nitrosamines, but they last longer. Inspect nipples regularly and discard any with cracks or tears, which can harbor bacteria and also pose a choking hazard.
  Shopping Suggestions
Baby Bottles (#5 Plastic)
Rubbermaid Chuggables Bottles
Rubbermaid Sippin' Sport Bottles
Evenflo Colored Baby Bottles
Evenflo Baby Bottles (opaque, pastel)
Gerber Baby Bottles (colors)
Medela Baby Bottles
  Baby Bottles (Glass)
Lansinoh Glass Baby Bottles
Lamby Glass Baby Bottles
Evenflo Glass Baby Bottles

One word of caution - the glass bottles cracked the plastic part of my breast pump that you screw the bottle onto.  I noticed the suction slowly getting to be less and less until it basically didn't work.  When I called Ameda to see what was going on, one of the questions they asked me was if I used glass bottles with it.  The cracking is very fine, so you don't really notice it.

Age for Introducing Bottles of Expressed or Pumped Milk

I tell each mother that latching on is like riding a bicycle.  At some point she will look down and realize that her baby latched on without any conscious effort on her part.  When latching on gets to be that easy is when she can consider introducing a bottle.  I say that for many mothers that is around six weeks but it might be earlier or later for her.

In the case of separation, La Leche League's recommendation is to start preparing 2 weeks before you will need to be separated from baby.  I usually try not to be any more specific than that because babies have their own personalities.  Some babies will never take a bottle, some will decide a bottle is easier if started too soon, and some babies will quite happily take a bottle at 2 weeks and then reject it completely at six weeks.

I haven't seen any research indicating that daily bottles are more or less effective at keeping babies willing to take bottles.  Anecdotally, I've heard from a fair number of mothers who did give daily bottles only to have baby reject bottles later on anyway and they sometimes wonder why they went through such a hassle when it didn't work.  So I try to feel out where the mother is - if she's stressed about the logistics of leaving baby, daily bottles might be comforting to her.  If she's stressed about the emotional impact of leaving baby, daily bottles might take away what little time she feels she has.

I also make sure to present other options, such as grandmother going with daughter and baby to school so daughter can breastfeed before and after class - this works if she has a one or two hour class and then a break. Also easier than trying to find a place to pump, as many schools are way behind places of employment in terms of offering pleasant places to pump and store milk.  Or if baby is at a baby sitter's, feeding right before class and checking in right after.  There are also the alternatives to offering a bottle:  cups, syringes, finger feeding.  Although the research on cups doesn't indicate it avoids "nipple" confusion, at least cup feeding avoids the superstimulus on the roof of baby's mouth that seems to be one of the problems with switching back and forth from breast to bottle.

Age for Introducing Solids

I have spent most of my adult life around long term breastfeeders. Most kids will reach out for food on mothers plate by about 8-9 months but , obviously as not all kids are the same , some show no interest. My own daughter barely ate food till 14 months and I know lots of woman whose kids started 'socially developing' their own need to eat solids past  the 'usual' age.  It seems to be a question of child led or not. Children are capable of deciding when they are ready to involve themselves in 'social' activity.

If you question most woman further you will find that the child does eat solid food but is getting the majority of nutrition form breastmilk. This means that they pick at bits of food and will entertain finger foods but do not sit down to what we in the Western world consider 'a meal' with a bowl and a specially prepared tin of something or even a hand ground organic something!!

The principle of what to give a one year old is the same as at 6 months ,although by one year there is less worry about milk allergy so that gives more choice. The only thing that is of any concern in my opinion is past 6 months the breastmilk does not have enough iron. In the areas where i lived (home birth rate of over 50% and long term BF normal, there was quite a high incidence of anaemia. It is routine to check babies for anaemia in California and apparently 20% of all kids have deficiency so my area may not have been higher than general population because they were long term breast feeding. I have commented a couple of years ago on the list about the difference between kids born to home birth midwives who do not cut cord till placenta out and those who do the cut cord immediately technique (which is most common here in the UK). When a cord is not cut the child gets more blood and therefore logically has more iron stores.

Finger foods such as apricots and mushy dark greens etc. are good sources of iron. I actually gave  my daughter a teaspoon of floradix twice a week from 6 months onward until i knew she was eating enough solid compared to breastmilk. There are lots of website and books. Look under 'natural' baby.

Someone mentioned jaw development ,but I have never been able to find any evidence about the validity of this assertion save for one small research article which i am not able to locate right now. I know that Jack Newsman will definitely have it at his fingertips and his web articles  can be found by searching under his name. This will also bring up lots of good web sites on breastfeeding and they almost always have info on weaning. Jack Enkins  book for mums is brilliant - the best i have found.

The 'jaw development' and 'child will be a late speaker' is a purely British thing that health visitors tend to mention and IMO its an urban myth and perhaps dare I say it, yet more shroud waving.

Research does show that breastfeeders have better jaw development and speak sooner than non breastfed babies.

For email support , the Natural Nurturing Network has an email list if you join the organisation. She may want to consider this attachment parenting organisation. It is one of the only ones in Britain and the majority of members (currently over 300) have all been in the same boat.

Extended Breastfeeding

The term "extended breastfeeding" implies that a shorter period is more physiological.  This same issue comes up with physiological clamping of the cord: is early clamping "premature" or late clamping "delayed"?  I like the idea of "breastfeeding to term", a phrase similar to "carrying to term" for gestation.  I like the term "natural weaning" suggested by an article below.

Breastfeeding into Toddlerhood - "Natural weaning, when allowed, occurs sometime after the child is two and one-half years old, not before.  In some societies, children will nurse for five to six years.

Breastfeeding in the Land of Genghis Khan By Ruth Kamnitzer (2/28/11) from InCultureParent - This is a great description of a culture that is wholeheartedly supportive of breastfeeding as best for babies and mamas.

“I Still Nurse My 5-Year-Old” - Have you even wondered why anyone would breastfeed a child who’s old enough to walk, talk and even go to school?  Meet a mom who’s happy to explain.

A Natural Age of Weaning by Katherine Dettwyler, PhD.  Another article, When to Wean, contains amazing information about what the actual optimal length of breastfeeding is for placental mammals. [This last article is available at birthlove.com, a subscription site that is well worth the small cost!]  "The minimum predicted age for a natural age of weaning in humans is 2.5 years, with a maximum of 7.0 ..."  [Ed: birthlove.com is not available at this time.]

So You Want to Night Wean Your Toddler

From Breast Milk to Solid Food: When's the Best Time to Make the Switch By Colleen Huber, Naturopathy Works

Tandem Nursing

In my experience as a midwife, it seems that nature intended most pregnancies to take place while the mother is still nursing an older child . . . this causes an increase in normal toning contractions (unfortunately, often mistaken for preterm labor), and in the baby's coming a few days earlier, thus resulting in a much easier labor and birth.

Nursing During Pregnancy and Tandem Nursing and Breastfeeding & pregnancy - from Kelly's AP web site.

Tandem Nursing from Mothering Magazine by Karen Plomp

La Leche League's FAQ on Tandem Nursing

Formula for Better Baby Formula

I'm not advocating using formula but found this interesting if it's needed for some reason:

Healthy Alternative to Conventional Infant Formula Part 1 (from Dr. Mercola)

Elimination Communication

This section has been moved to:  Miscellaneous Newborn Care/Natural Infant Hygiene aka Elimination Communication


#include "trailer.incl"