It’s day two in the hospital, your breasts are ready to burst.  They feel filled to the brim, but you are still making colostrum.  Your nurse is trying to help you get your baby to latch on but your breasts are so full your nipples have almost disappeared.  The nurse tells you that you have flat nipples and she runs and gets a nipple shield.  The shield works great, now that the baby has something to latch on to, the crying has stopped, and the baby is able to eat.  Finally you can breathe a sigh of relief. You are now a breastfeeding momma, and best of all you can go home knowing that your baby won’t starve.

The day after you get home your milk comes in.  Your milk is flowing fast and furious; you can see it filling up the little plastic shield every time your baby pauses.  Your breasts are beginning to get smaller.  Your nipples emerge from the edema and can finally be seen again.  They don’t look flat to you, but what do you know.  You have already accepted the news that your nipples are flat, so in comparison to other mother’s nipples they must be very flat or else the nurse wouldn’t have said anything. 

A week goes by, your beautiful baby is eating so well, but this nipple shield is getting to be a bit of a pain.  You have to keep it nearby; it has to be washed constantly.  You remember thinking that one of the great things about breastfeeding is that you don’t have to wash bottles all the time.  Now you are constantly cleaning this silly nipple shield.  Bravely you decide to try and nurse your baby without the shield.  But your poor little angel looks confused.  Your soft nipple just doesn’t feel right to him.  Where is that hard feeling that he has come to associate with your milk?  Frustrated he pulls away.  You pull him closer but he won’t have anything to do with it.  Then the crying begins and you feel like you are right back where you started from. 

Unhappily you resign yourself to having to use the shield, but it is so annoying.  Going out in public is the worst.  Not only do you have to get it out, and put it on (which takes two hands), whenever the baby finishes eating there is always a little milk left in the shield and try as you might it drips all over you as you remove the shield from your nipple.  So much for being able to discreetly breastfeed at the mall!  In fact using the nipple shield makes you feel so exposed and vulnerable that you decide you will only feed your baby bottles of pumped milk when you go out.  Of course this means you can’t go out for very long before you start to feel full and need to either pump or go home and feed the baby.  Other mothers have it so easy.  You don’t want to complain, but you wish had been blessed with normal sized nipples.  Life would be so much easier.   

This is an unfortunate scenario, but it happens a lot more often than you might think.  Mothers are often told they have flat nipples when in reality their breasts have become so swollen that their poor little nipples have almost disappeared.  Breasts swell up for two reasons.  Naturally they get swollen because of all the milk they are now making, but also they swell up because of all the excess fluid in a mother’s body.  Ankles get swollen, wrists get swollen, the face gets swollen, etc and so do the breasts.  All that fluid from the IV in your arm has to go some where!  A sunken nipple can usually be drawn out with a little teasing.  Luckily, happy babies (as opposed to babies who aren’t offered the breast until they are screaming with hunger) are even better experts at getting a nipple to emerge than their mothers are!   

Nipple shields are also used when a mother is experiencing pain in her nipples.  Nipple pain happens when a baby doesn’t latch on deeply enough.  Mothers are always amazed at how much less pain they feel when a baby is latching correctly.  It’s like the difference between getting your thumbnail caught in a door and sucking peacefully on your thumb. One makes you cry out and the other relaxes you.  And think about it, after you pinched your thumb in a door what do you do?  You put it in your mouth and suck on it!  Mothers fear that having their baby suck on a damaged nipple will hurt (which it will if the baby isn’t latching on correctly).  But a nipple shield will not change the way a baby latches on.  Only time spent improving the latch will do that.  

Nipple shields are often used with sleepy babies as well.  Sometimes a newborn is very sleepy and it is hard to get him interested in the breast.  He could be sleepy because of a very long labor (long labors are tiring for babies too!), or because some of the drugs he was exposed to during labor are still in his system, or maybe it was because he was born a little bit early and he just doesn’t have very much stamina yet.  The hardness of the shield and fact that it can hold a few drops of milk often gets the baby interested in the process of feeding.  But as we saw above, it doesn’t get the baby interested in the mother’s breast.  And once the baby has safely passed the sleepy phase the same problem remains. His brain has already become hard wired to connect the shield with a full belly.  A naked nipple just confuses him.

Worst of all, the mother using a nipple shield often thinks the problem lies with her.  She thinks her body is defective.  Women already have enough body issues to deal with, we already worry about the size of our thighs, our butts and our bellies; do we really need to make women feel insecure about the size of their nipples as well?  So now we have a mother who feels her body is inadequate, and who feels that she can never be a normal mother.  Does she feel empowered by breastfeeding?  I don’t think so.

Does this mean we should never use nipple shields?  No, although I would spend a lot more time trying old fashioned skin to skin time before I would reach for a shield.  My biggest issue with nipple shields is the lack of follow up.  Sending a mother home from the hospital with a nipple shield and no follow up is just wrong, especially if a shield is being used to correct a temporary situation like engorgement, sore nipples, or a sleepy newborn.  Unless someone is willing to track her progress in weaning from the shield it really shouldn’t be used. 

In my opinion the process of how to wean from a nipple shield should be started the very first time it is introduced.  The original goal to breastfeed as opposed to feeding through an artificial nipple should not be forgotten.  Mothers should be told to think of the shield as a tool to get them to the next level.  It can take a lot of work to reach that goal, and that is where we let mothers down.  We get so caught up in the more immediate goal (feed the baby) that we forget the long term goal (to breastfeed the baby).  If the goal is to merely feed the newborn the mother can express her milk and give it to her baby with a dropper, spoon, or cup.  If the goal is to breastfeed then the baby needs to spend more time at the mother’s breast.   Mothers should be encouraged to get their babies used to the breast without the shield from the very beginning.  Learning to enjoy holding her baby skin to skin upon her breast without the pressure of having to feed is the first step towards weaning from a shield.   But it takes time.

Time however is a luxury you don’t find in most hospitals.  There isn’t enough time to try “skin to skin” (and just so you know a mere half hour isn’t nearly long enough), there isn’t enough time to teach hand expression, there isn’t enough time to cup feed a baby, and there certainly isn’t enough time to call a mother at home and see if she is making any progress weaning from a shield.  What we are really saying is that there isn’t enough time to give mothers the support they need to learn to breastfeed (as opposed to feeding through a plastic shield).  Instead we only take them part of the way there and then leave them dangling on their own, feeling like either they or their baby is defective.  We don’t give mothers the time they need in the very beginning to get off to a good start.  Is it any wonder that three or even five months later the mother with perfectly normal nipples is thinking about weaning to formula just so she can go to the mall?

I have been breastfeeding Baby Roku for 6 months and am so happy that things are going smoothly! It was not always this way though. I had a very difficult time for the first 3 months. He was getting enough to eat, as indicated by his above average weight gain, but I was in severe pain. I had mastitis twice, both times with a fever above 103. I could not imagine breastfeeding without pain as I walked around my house without a shirt for almost 90 days. I dreaded the days I had to wear a bra and cringed at the thought of wearing a sports bra to the gym (let alone the pain that would occur from the ‘bounce’ during cardio).

I wanted to love to breastfeed so bad so I did a ton of research online as well as obtained help from a few different lactation consultants in my community. I also attended my local La Leche League Meetings for support. If you are having trouble breastfeeding, I highly recommend that you do all of these things before switching to formula. Every day that I was in pain, I committed to one more day of breastfeeding and, fortunately, Baby Roku and I made it through the tough times and are successfully breastfeeding today…and I love it! I had really only planned to nurse him for 6 months, but now that things are going so well I plan on nursing him for at least a year. Another reason that I have decided to breastfeed him for longer is that I now have a better understanding of the massive benefits that he will obtain from breast milk over formula. I also like knowing what is in his food. As someone who eats mostly raw, I know what is in everything that I eat. I don’t feel like I would ever really know what is in formula including any residual BPA that might be absorbed into the formula from the container.

I would like to help moms that are having breastfeeding challenges to do their best to stick with it! I have put together some tips that helped me get through the rough period in the beginning, and I really hope that it will be helpful if you are having troubles similar to mine before deciding to switch to formula.

Proper Latch
Not until about 3 months into breastfeeding did I feel like Baby Roku and I consistently had a proper latch. There are a lot of great resources online that provide illustrations of how the proper latch should look. Here is a link to a great resource for advice on obtaining the proper latch: How to Latch. I looked at a ton of stuff online and still had trouble. I obtained one-on-one support before leaving the hospital and also consulted with 3 lactation consultants over the phone. I also went back to the hospital with Baby Roku to sit with the lactation consultant for an hour as she watched me feed. However, there was one piece of advice that really helped me finally overcome my challenges. I could not get Roku to open his mouth wide enough before latching. Someone from La Leche League told me to try lowering his head before pulling him in for the latch. So, instead of having his head right in front of my breast, bring his head in from below. This totally worked! I had been nursing him with the boppy pillow much too high. I thought the perfect position of the pillow was directly in front of my breasts, so I propped it up on the arms of my glider and set him on top. Once I lowered the boppy pillow, his mouth came from below which (magically) made him open his mouth much wider. This was a great start!

Pain Relief
Heat is your friend. Not only does it help to relieve pain, it helps your milk flow faster. Heat for about 2 minutes before feeding. If you are really sore, apply a cool compress after feeding. Pain IS NOT inevitable, however I tried very hard to do everything correctly and still had pain. I purchased some ice/hot packs that were available at target with their nursing supplies. I ended up buying 2 packs; one set I kept in the freezer and the other available for heating. Don’t overheat the packs because you can burn yourself and also ruin the packs. Also, even though the heat may feel good, do not heat for a long period of time. This can make the problem worse. A nice warm shower along with massage helps with pain relief. I started to do this every morning and found it to be a critical step in my daily routine.

What did NOT work for me was any kind of packaged soother that did not have a hole in the middle. My nipples were extremely sore, so covering them up with something only made things worse. If you do use something that covers the entire area, do not wear under your bra for a long period of time. You need to keep this area dry and free of any moisture.

Engorgement
At first I did not feel like I was producing enough milk. Then, literally overnight, I became engorged. I think this was when Roku was about 4 days old. I tried to pump, but nothing would come out. Unfortunately for me, this led to my first case of mastitis. One way to try and avoid this is to put a cabbage leaf over your breast. This actually worked very well for me to reduce engorgement.

How to Avoid Mastitis
After speaking to other mom’s, so many have had varying cases of mastitis. It can be very painful. It can be prevented by reducing engorgement (see above) and not wearing tight fitting clothing. You should also make sure that your breasts are dry before putting on a bra. My doctor gave me advice that ended up leading to another case of mastitis. He told me to use the plastic dome shaped devices that are used for inverted nipples in order to keep my bra from touching my skin. This temporarily relieved the pain of my skin touching cloth, however the pressure of the plastic ended up clogging my ducts causing another case of mastitis! I would just recommend being bra-less and shirtless as much as possible if you think you are getting mastitis. How can you tell if you have mastitis? An area on your breast will be bright red and hot. You will probably have a fever. In my case, I had a fever of over 103. Whatever you do, do not stop feeding your baby on that breast. Your baby is more efficient than a pump for extracting the milk and that will help to reduce the engorgement. It hurt a little at first when I started to nurse, but it actually feels a lot better once the baby latches. If you can position them so that there lower jaw is on the affected area, that helps too. If you are able to do this, the sucking motion actually massages the affected area and reduces the pain. With a high fever, you might think the last thing you would want to do is nurse your baby! However, it is actually it is not that bad if you just where something cool (or nothing at all), drink plenty of water, and relax, knowing that your baby will not get sick from you.

As far as taking antibiotics if you have mastitis, I would have to say that it is different in every situation. I decided not to take the antibiotics I was prescribed and ended up getting much worse with an extremely high fever. After one day of antibiotics, I felt better. I would probably seek a homeopathic remedy had I been educated about the possibility of this at the time.

Crying While Feeding
My hungry baby would cry while I was feeding him and I could not figure out why. Was it because of something I ate and he didn’t like the milk? Was he already teething at 3 months? It is so hard to know why, but in my particular case I finally found out it was because he was TIRED! He had just woken up only 1.5 hours ago, but he was already tired. He wanted to eat, but needed to sleep. After learning that he needed a nap so soon after waking, I made sure to feed him a bit earlier. I was feeding on cue, but at this particular time of day I anticipated the tired spell and fed him before it started. Another reason he cries while feeding is because he needs to burp. Try pausing the feeding to burp your baby to see if that helps them relax. They may also be crying because it is taking to long for the milk to come out. You can apply heat (as mentioned earlier) to help the ‘let down’ occur faster. The most important thing to do is to try your best to read their cues and not give up!

At about 9p.m. two nights ago, my right breast started to feel engorged. During Baby V’s first night-feed a short while later, he could not get the milk out. I suspected a blocked duct and tried pumping, but saw no improvement. Trying to feed Baby V several times through the night did not help either.

By 4a.m., I felt very uncomfortable and painful. A few hours later, I developed a 37.8 degree Celcius fever and felt chills all over even though I was wearing long sleeves and pants. It seemed like flu has set in, and I recognised these as symptoms of potential mastitis.

On my nurse’s advice, I placed cold cabbage leaves on the swollen area and rested in bed, feeding Baby V as frequently as possible. The cabbage leaves reduced the engorgement within half a day and I felt much better.

I also used a sterilised needed to burst a nipple bleb, which contains blocked milk.

Within a day, I recovered and continued to use cabbage leaves treatment for one more night. Fortunately, this problem was solved quickly. Otherwise, infection could have set in and I would have needed to seek medical help.

Pros (of cabbage leaves):

• Simple and effective method of relieving engorgement
• Low cost

Cons:

• Leaves a vegetable smell behind for a while

Congratulations on your desire to nurse your little one.  It is an absolute joy that goes by faster than you can imagine.

Somethings to remember to help smooth things along:

• Get a well fitting nursing bra that you can easily latch/unlatch with one hand.  QT brand has an all cotton bra that fits well and has great clasps.  Ginger & O’ Malley has some pretty bras that open easily.  They are all under $15 too.  Check out Amazon and read all the reviews, you’ll find that expensive doesn’t always mean it’s better.
• Drink LOTS of water!  Have large cups filled with water at various places throughout the house.  Have a pitcher full next to where you nurse at night, it will be handy when you need to refill.
• Trouble with milk coming in?  Try drinking “Mother’s Milk Tea”.  But the best milk builder is “Brewer’s Yeast”.  Honestly though, it tastes yucky.  Some people sprinkle it on food, but I like to enjoy my meal.  So what I do is heat up about 1/4 of water, stir in 2 heaping tablespoons then stir, stir, stir, until it is dissolved.  Then add chocolate milk powder and milk, it tastes a little like a chocolate malt.
• Once your milk comes in, you may experience engorgement.  To remedy this, rub the hard spots on your breast while nursing.  Yes, it hurts, but once it’s rubbed out you will feel relief.  Switch sides and repeat.  Do this with every feeding until your body has regulated the milk supply.  The hardest spot to reach is under your arm and a little below the breast, so I recommend to start there, then go counter clockwise all the way around.
• Positioning is very important.  Hold the baby parallel to the floor.  Bring the baby to the breast, hold breast and slip into baby’s mouth.  You can also nurse while laying on your side in bed.  To burp, scoop baby onto your chest then roll onto your back.  If the baby latched on wrong…and you’ll know it when you jump off your chair from pain, then slip your pinky into the mouth to break the suction then try again.
• Keep in mind that babies go through growth spurts.  On average it is 3 weeks, 6 weeks, 3 months, 6 months, 9 months, 1 year.  During these growth spurts, your little one will nurse like crazy and this is when many women give up thinking they don’t have enough milk.  Eat a few extra nourishing snacks drink more water and nurse, nurse, nurse.  Your body will register that it needs to make more milk…and it will.  If you just keep feeding even though your breasts feel empty, you will be amazed that you will get a second or even a third let down.
• Please give it at least 6 weeks before giving up.  Everyday there are new changes to you and your baby, you may get overwhelmed. But after 6 weeks things start to smooth out and you’ll start feeling better.
• For more help or info. visit http://www.lalecheleague.net/public

• Enjoy your precious little one!

Cabbage leaves have long been touted as a treatment for engorged breasts. Slipping a couple inside your bra might stain your clothes and make you smell a bit funny, but surely that’s a small price to pay for the relief they’ll provide? Encouragingly, a quick perusal of the internet suggests there is medical evidence that they work. Several sites, including some written by doctors, cite studies that purport to demonstrate their effectiveness in lessening the discomfort of an extra-full bosom.

Like most breastfeeding mothers, I have suffered from my fair share of milk over-supply problems, particularly when C started to sleep longer at night. Would a trip to the greengrocers have helped? Past experience had taught me not to simply take a website’s word for it, so I decided to do some investigating of my own.

A study in medical journal Birth is widely reported as providing evidence supporting the use of cabbage leaves for engorgement¹. The experiment involved 120 mothers, who took part in the research during their post-partum hospital stay. 60 of the women applied cabbage leaves after a feed, leaving them in place until they had reached body temperature. This process was repeated for a total of four feeds, and after each application the women were asked to report whether they felt their breasts were engorged. A control group of 60 women, who did not use cabbage leaves, were also asked to report whether their breasts were engorged. The percentage of women who reported experiencing engorgement went as follows:

• after the 1st feed, 54% of the cabbage group and 52% of the control group;
• after the 2nd feed, 51% of the cabbage group and 57% of the control group;
• after the 3rd feed, 49% of the cabbage group and 51% of the control group;
• after the 4th feed, 54% of the cabbage group and 59% of the control group.

To at least one medical professional (see above), these figures apparently amount to women saying they ‘experienced greater relief’ when using the leaves. It’s actually pretty obvious that they say no such thing. The difference between the two groups is very small indeed, and it is not statistically significant, so the only appropriate conclusion is that there is no support for the hypothesis that cabbage leaves prevent engorgement.

The authors performed a follow-up 6 weeks later, documenting the length of time for which women exclusively breast fed, and found that it was significantly longer for women who were in the cabbage leaf treatment group: they breastfed exclusively for an average of 36 days, compared to 30 in the control group. (They also mentioned that in the cabbage group fewer women stopped breastfeeding in the first week, and that more were breastfeeding at this point, although neither of these differences was significant.) Why might this be? Because these ladies applied cabbage leaves for a few hours shortly after their babies were born? The authors think this is unlikely. They conclude in their discussion:

‘…we cannot rule out the possibility that cabbage leaves had a direct effect on breast engorgement, and that this may have contributed to the increased breastfeeding success in the experimental group. However, we consider that the positive effect was more likely to have been mediated by psychological mechanisms.’

So, rather than the cabbage leaves containing something that encourages or enables women to breastfeed for longer (and, as you may have noticed, exclusive breastfeeding rates in both groups were considerably lower than the current recommendations), the difference was probably down to the psychological feel-good factor of having received treatment.

Several other studies have examined the effects of cabbage leaves in various ways, in an attempt to work out why exactly they are believed to relieve engorgement. One hypothesis is that they are cooling. The results of one study support this: an experiment comparing chilled gelpaks with chilled cabbage leaves found them to be equally effective at relieving pain². By contrast, another study found that in fact chilling made no difference, and that room temperature cabbage leaves were just as good³. In both cases, the lack of a control group meant that the relatively small improvements reported by the mothers could simply be due to the placebo effect or natural remission of the condition (the problem lessening over time), a fact acknowledged by the authors.

There are two further problems with these studies: firstly, they relied on subjective reports of pain, rather than an objective measure of physical engorgement; secondly, they failed to monitor the effect that feeding had on engorgement. A trial assessing the effectiveness of cabbage leaf extract addressed these issues, with interesting results⁴. Two creams, one containing the cabbage leaf extract and one acting as a control, reduced self reports of pain and hardness of breast tissue (measured using a device called a Roberts Durometer) by a small amount. There was no difference between the groups: whether or not the cream contained cabbage extract made no difference to the results. Yet again, we have evidence of a potential placebo effect: the mere fact of treatment, whatever it was, appeared to reduce symptoms. The women fed their babies, and the measurements were taken again. This produced a much greater reduction in reported pain and breast hardness, leading the authors to conclude that the best course of action for relieving engorgement is frequent feeding.

So, it seems the evidence for the effectiveness of cabbage leaves is virtually non-existent. No one has yet been able to elucidate how they might work, and every study conducted so far has concluded that positive results are more likely to be due to the psychological impact of medical attention than a magical property of the cabbage. Applying them may be of limited psychological benefit (as much as using a placebo cream or chilled gelpak) but it does not seem appropriate for medical professionals to recommend them, particularly when a much better course of action is simply to feed your baby. As Roberts, Reiter and Schuster conclude in their cabbage leaf extract paper, ‘until a scientific foundation for their action is established, their use remains questionable’⁴.

1. Birth. 1993 Jun;20(2):61-4.
2. J Hum Lact. 1995 Mar;11(1):17-20.
3. J Hum Lact. 1995 Sep;11(3):191-4.
4. J Hum Lact. 1998 Sep;14(3):231-6.

In addition to my nipple trauma, I had been swinging wildly between having a screaming infant and nothing to offer but (seemingly) empty breasts, and ending up with a couple of beach balls whenever C went more than three hours between feeds. I heard this was quite normal, and that my supply would ‘settle down’ soon, but it ended up adding yet another major stress to my day.

For at least a couple of weeks, the problem was particularly horrendous. C was wanting to feed almost every hour (including all through the night), making me feel as if she wasn’t getting anything out of me at all. I put this prolonged period of frenzied feeding down to a growth spurt, despite the fact that the books claim these only last 24 hours (not my experience at all – C’s last at least a week, it seems!) Eventually her ravenous hunger ceased, and she managed a four hour sleep overnight. At the moment, four hours to me is virtually sleeping through, so in theory I should have had a reasonable night. Unfortunately, I awoke two hours after her last feed with my breasts buzzing, and proceeded to lie awake watching her and almost willing her to wake up, while I swelled to watermelon proportions…

In theory I could express a bit in these situations to relieve the pressure, but I’m terrified to do this in case C then wakes up and I don’t have anything left (which is silly, because I know it doesn’t work like that, but I’m awash with paranoia). Of course, when C does then want feeding, the milk shoots out of me like an industrial water gun, leaving her gagging and gulping down significant amounts of air. Arrgh! I was almost reduced to rocking in the foetal position, repeating, ‘my supply will settle down soon, my supply will settle down soon…’

I put up a ten month breastfeeding blinkie.  Wow, ten months!  Crazy!  The last few months of breastfeeding have been a breeze, especially compared to the first few.  Eleanor still has her moments of not being the nicest nurser – especially when she can’t breath because of a cold, poor thing – but for the most part she knows exactly what she’s doing now and how to do it without hurting me.  Even with her seven teeth, she very rarely does something that hurts me.  The only time she comes close to biting is when she gets distracted by a sudden noise or something.  I was so worried about breastfeeding a baby with teeth, and now I’m a little surprised that more moms don’t talk about how easy it really is!  I guess that’s probably partly because few women even breastfeed this long these days, and the majority of ten month olds don’t have seven teeth.  Haha!  Hopefully a few moms out there can learn from my experience.  I always enjoy learning from other people’s successes and mistakes before embarking on my own journeys!

Last night was the best night for sleeping that we’ve had in this house in I don’t know how long.  Eleanor was up only once to eat!  She gave us a six hour stretch of sleep.  To give you an idea of how rare that is: I woke up engorged and leaking! I never leak anymore, at night or during the day, unless I’m nursing her on the other side.  I hope my body gets the chance to adjust to this.  I know it will in a few days, if Eleanor just keeps this up!

As you can probably tell I’m in a very good mood today!  A little sleep can work wonders.  : )

Paris bat t’as pensé (son ventre plein), à mettre de l’eau scolaire ? rentrée littéraire Y vont rafler romans déjà morts, prix des cartables-fleurs, trous chrysanthèmes d’éditeurs, du cul d’auteurs inconnus encore nains ‘taing t’as vu ça même la phnaque et librairies la place arnaque la pile fuck ! Devant ! Toujours allouée les ! – un style à couper le souffle – évidemment pfff Angot, mêmes Rentrées Pfff chaque mot-année après année ! concurrentielle rentrée ! saleté misère mise en place impitoyable marché Gynecoco (le méchant des armées), et l’autre amant, là, y’en a que pour avec son – Premier Roman – j’hallucine et moi-nous-si-loins ? Tous ces pousse-toi moi moi c’est pas vrai 676 (seulement !) tu te rends compte, pavé érudit ? Attachée de presse purée lundi oui Millet et bronzés, se va pavaner la nana à Saint-Chatte, là (Germain, derrière) de toute façon d’art content comptant les Prix pour rien Prix Prix Prix ! Moi Moi Moi quel 676 tu veux me dire ! Non la liste – à lire de toute urgence ! – la première jalousie Femina, Lacrimosa, Tralala, Charabia, (pleure pas, Régis) 676 Goncourt brothers et machin Intersaucisse, gosses de réseau, signature signe ! Chez Taddeï et si blogosphère il y a la télé-bousculade. Aucun piston riche, rien, jeune prodige – une écriture ciselée, aïe ! –, chance site de Prix B bébé Wrath rate, mal digéré ça change rien la haine. Z’ont raison (Révolution !) édition numéricon va bientôt et ma thune alors enculé??? Et Possibilité mort netocratique de rire d’une île Houellebecq ! ha ha ha wannabe la FIAC aussi wannabe soon ! t’as vu écrivain mystère m’étonne à peine son Scheer gourou chien formatique ! étrange film les salauds, bon M@nuscrits (quoi quoi quoi ?) et deux bières alternatives à boire de novembre à Versailles – immense – s’il vous que du cul-cul (encore du) ! The Flore Rabbit expérience se prend pour Dieu-fiction t’as les blogs-laboratoires avec renvoi d’ascenceur Koons (charge max: 100′000 kg) ; critique j’achète l’interview tique — moi aussi je t’aime, baby — y lent (non, si rapide) restera quoi après la Fashion week, de tout ça ? Hic ! Brooh ! Quoi dis-moi ?

Here we are one week later, and so far I have managed to avoid getting engorged. Yay!! I would do a happy dance if I wasn’t so darn tired. Now there have been some very full moments, but nothing like the extreme pain and discomfort I suffered with my second daughter.

So what’s different this time around? I have a few theories as to why things are running more smoothly with DD#3.

1. Correct Allignment: With DD#2 I forgot that you have line the newborn baby’s body with her belly against yours (at least in cradle and cross-cradle positions) in order for her to latch on correctly. For if they do not latch on correctly then your nipples start to crack and hurt really bad, really quickly. This makes one hesitant to nurse regularly or even at all.

2. Positiong, Positioning, Positioning: Even though I lined up DD#3 correctly, I did start getting a really sore spot on my left side. So that’s when I started using the football/clutch position on that side. It’s not the most comfortable on my back and wrist, but it certainly helped keep that side from getting any worse so it could heal. Sometimes I go ahead and use football/clutch position on the right side to just to drain it differently. I’ve also been doing some side-by-side position, especially at night.

3. Making Nursing the #1 Priority: With my second daughter I think I tried to do too much too soon. I would get busy cleaning up something or trying to make my first born feel like she was still special and put off nursing. It is so important, though, to keep draining your breasts before they get over-full. Otherwise you find yourself soaking your breasts in a hot bath tub at two in the morning in hopes of expelling enough milk and lessening your swelling so that your baby can actually latch on. So this time around the house is just going to hell, and thankfully my older girls have each other to play with.

4. Drainage: Often at night I will go ahead and open my nursing bra on whichever side I am sleeping on, stick a cheap cloth diaper under that breast, and let gravity relieve some of the pressure. Sometimes I have also been letting one side leak into a cloth diaper while the baby nurses on the other. They both want to let down milk, anyway, so I may as well let them drain as much as possible. It keeps everything much more comfortable.

No one could ever accuse me of having milk production issues. I tend to produce a ton and it tends to have a very high fat content; I call it high-octane. My babies start out small (this latest one being my biggest at 6 lbs and 14 oz) and fatten up really fast. This new baby does not seem to be an exception. She’s probably put on close to a pound in her first week and is right on the cusp of moving up to size 1 disposable diapers.

I am just glad that I don’t look like Hagrid misused an engorgio charm on my chest. Although since my belly has gone down, I probably could pass for a Playboy model…if it wasn’t for all those pregnancy skin tags and that very unsexy baby that is constantly attached to one of my completely real breasts. Oh, and my skin isn’t so tanned that I look orange. And my teeth aren’t whitened to the point of glowing in the dark. Ok, so maybe I couldn’t pass for a Playboy model…maybe an early model Barbie doll instead.

Autant clarifier tout de suite : ce billet n’est pas un débat pour savoir jusqu’à quand allaiter. C’est l’affaire personnelle de chacune et ce n’est pas à moi de m’en mêler. Il s’agit juste de donner quelques pistes à celles qui souhaitent arrêter avant le sevrage “naturel”, pour aider à la transition.

D’abord -si c’est possible- il vaut mieux éviter que le sevrage soit concomitant avec un autre changement important dans la vie du poussin (au hasard : maman retourne au travail). Il est aussi préférable pour tout le monde de prévoir un peu de temps (pour passer d’un allaitement exclusif au 100% biberon compter au moins une semaine et idéalement deux voire trois). Et plus le poussin est diversifié (moins il tète), plus c’est facile. Enfin, la physiologie de la lactation fait que c’est plus simple de sevrer après 2-3 mois qu’avant, quand on a encore des montées de lait.

D’autre part, il peut être judicieux de commencer par introduire le biberon avec du lait maternel, histoire de faire une découverte à la fois. Cela peut être fait dès que l’allaitement est bien installé sans le compromettre. Certains poussins refusent totalement le biberon, même avec du lait maternel. Mieux vaut que ce ne soit pas la mère qui donne le premier biberon (volontaire désigné : au hasard, le père), car l’enfant risque de ne pas comprendre pourquoi elle ne lui propose pas son sein préféré. Il peut même être préférable qu’elle quitte la pièce. Comme toute nouveauté alimentaire, le premier bib est plus facilement accepté si vous n’attendez pas que le bébé hurle de faim. Mieux vaut lui proposer quand il est à peu près de bonne humeur, quitte à ce qu’il n’en prenne qu’un petit peu la première fois. Si il refuse totalement, n’insistez pas sur le coup et reproposez plus tard. Il faut savoir que certains bébés sont très difficiles sur la tétine ; parfois essayer une autre marque peut s’avérer payant.

A propos de tétine, il vaut mieux en choisir une à faible débit (pour nouveau-né, deux trous maximum), même si votre poussin est plus âgé. Ainsi vous optimiserez vos chances qu’il continue à prendre le sein pour les autres tétées.

Autre petit problème technique : quelle quantité de lait préparer ? Au sein on n’a pas la moindre idée du volume ingurgité, et même s’il a déjà pris des biberons de lait maternel, il n’est pas dit qu’il lui faille les mêmes quantités de lait artificiel. Un truc simple est de proposer le volume suggéré sur la boîte de lait pour l’âge de l’enfant. S’il en laisse, c’est qu’il a eu assez. Par contre s’il le siffle en entier, vous pouvez rajouter 30 ml au prochain. Personnellement, je préfère en préparer juste un peu plus pour être sûre que le poussin ait assez.

Une fois ce premier contact établi, vous allez pouvoir remplacer une tétée par un biberon. Mieux vaut éviter de commencer par la tétée du matin ou par celle du soir, l’idéal étant celle de la fin d’après-midi où la lactation est généralement plus faible. Si vous sentez un peu de tension dans les seins, n’hésitez pas à tirer un peu de lait pour éviter un engorgement. Si nécessaire, vous pourrez tirer un peu moins de lait chaque jour jusqu’à ce que vos seins s’habituent à moins produire. Ensuite il faut éviter de supprimer deux tétées consécutives, et attendre deux-trois jours entre deux suppressions de tétées. Notez que le temps d’ajustement du corps n’est pas forcément linéaire : personnellement il m’a fallu une semaine pour ne plus avoir les seins tendus après avoir supprimé une tétée, alors que pour les autres en 24 heures c’était plié.

Si le poussin tète encore la nuit (et que vous aimeriez qu’il arrête…), vous pouvez assez rapidement proposer un biberon à la place. Certes il faut se lever, allumer la lumière et tout, mais : 1. le papa peut s’en occuper pendant que vous dormez du sommeil du juste et 2. si le repas de la nuit est la seule tétée qu’il reste au bébé, sa valeur affective risque de vite dépasser sa valeur nutritive. Ne vous méprenez pas, j’adore faire des câlins à mon poussin, mais la nuit honnêtement je préfère dormir.

De fil en aiguille, vous arrivez généralement à la situation suivante : il vous reste une tétée le matin et une tétée le soir, situation merveilleusement compatible avec votre reprise du travail, généralement connue sous le nom d’allaitement mixte. Cette situation est-elle pérenne ? Je n’en suis pas sûre, et je ne suis pas la seule : encore un bel article de Co-naître, L’allaitement mixte, est-ce possible ? du Dr Claire Laurent. D’abord, pour certaines femmes la lactation peut rapidement se tarir, et n’être relancée que par un allaitement exclusif, ce qui n’est pas le but du schmilblick si on ne veut plus allaiter. Ensuite, certains bébés préfèrent le biberon et se désintéressent totalement du sein. Enfin, même si -comme votre amie la poule pondeuse- vous avez une lactation généreuse et un poussin totalement bilingue sein-biberon, ça risque de ne pas suffire malgré tout. Ainsi, j’avais fini par supprimer la dernière tétée (du soir) car au bout de 45 minutes de tétée intensive le poussin ne semblait toujours pas vraiment rassasié. Et pourtant il y avait toujours du lait à la fin de la tétée, mais le débit ne suivait pas. Donc remplacement par un biberon. Je dois dire que j’ai toujours considéré l’allaitement surtout du point de vue nutritionnel, mais je sais que pour certaines c’est le côté affectif qui prévaut (ce que je respecte bien sûr entièrement). Dans ce cas je pense qu’il est possible de garder une tétée “câlin” par ci par là pendant longtemps. Mais sinon ne vous leurrez pas : l’allaitement mixte est dans la grande majorité des cas la transition vers le sevrage total.

(image : http://www.villiard.com/images/bebes/boire-biberon.jpg)

I pumped twice overnight and got only 5mL between both pumping sessions, which was disheartening.  That’s about what I was getting in single sessions yesterday.  Then I took a two hour nap this morning with Nora on my chest, and woke up with engorged breasts!  I pumped and got 22mL – about 2/3 of an oz!!  Holy milky!  That’s the maximum amount Nora has taken in a single feeding (either of formula alone or combined formula and colostrum), so she’ll get at least one milk-only meal today.  Woo-hoo!  We have her first pediatrician’s appt this afternoon, and I’m so glad we worked all of this out before the appt.  I hope she’s gained a bit of weight since yesterday.  : )  

Suite à mes promesses d’hier, voici quelques pistes concernant l’engorgement et ses copines, mastite et lymphangite. Concrètement, de quoi s’agit-il ? Vous sentez une tension désagréable dans une partie du sein, qui peut devenir rouge et gonflée (oui, encore plus que le reste, c’est possible !). Cette tension ne disparaît pas après la tétée (peut s’atténuer puis revenir). C’est généralement un (ou plusieurs) canal lactifère qui est bouché et par lequel le lait ne peut plus s’écouler. Dans certains cas, le bébé n’arrive même pas à faire sortir de lait du sein concerné. Et si vous ne faites rien, ça risque de dégénérer en infection, plus communément appelée mastite ou lymphangite, avec fièvre et autres joyeusetés. C’est surtout fréquent dans les deux-trois premiers mois, quand l’allaitement n’est pas bien régulé, mais ça peut aussi arriver aux vieilles routières.

D’abord, comment éviter une situation somme toute assez pénible ? Tout simplement en évitant le trop-plein : bien alterner les deux seins, et si le bébé saute une tétée, ne pas hésiter à tirer un peu de lait (manuellement ou au tire-lait) si les seins sont tendus. Pas forcément l’équivalent d’une tétée entière, juste de quoi soulager la tension. Evitez aussi de porter des soutien-gorges trop serrés qui vous scient le sein en deux (plus facile à dire qu’à faire quand on fait soudainement du 95 I, je suis bien d’accord). Si vous décidez de sevrer votre poussin, allez-y progressivement (attendez plusieurs jours avant de supprimer une autre tétée) et évitez de supprimer deux tétées consécutives.

Dès que vous sentez les premiers symptômes, prenez immédiatement les choses en main. N’arrêtez surtout pas de faire téter l’enfant, bien au contraire, et ne négligez pas l’autre sein pour autant. Sachez que la zone la plus stimulée du sein est celle au-dessus de laquelle se trouve le menton du poussin. Donc à vous de faire votre propre kama-sutra de l’allaitement pour favoriser le drainage de la zone. Et c’est en tout début de tétée que la stimulation est la plus forte. Vous pouvez “accompagner” en massant la zone douloureuse pendant la tétée.

Entre deux, pour diminuer l’inflammation, appliquez du froid ou du chaud (selon ce qui vous soulage le mieux), et glissez (attention minute glamour) une feuille de chou dans votre ravissant soutien-gorge d’allaitement. Vous pouvez aussi appliquer une pommade du style Osmogel mais à nettoyer soigneusement avant la tétée car pas top pour le poussin. C’est aussi une excuse en or pour vous vautrer dans le canapé pendant que Chéri fait la vaisselle, car le repos est fortement recommandé par la faculté.

Si les symptômes persistent, voire s’aggravent, consultez au plus vite, mais pas n’importe qui. Beaucoup de médecins sont encore hélas peu au fait des subtilités de l’allaitement, et on risque de vous prescrire d’arrêter l’allaitement, ce qui serait dommage et n’arrangerait pas vraiment votre problème. Donc visez plutôt votre maternité ou une sage-femme libérale ; peut-être une consultante en lactation, mais ne les ayant pas fréquentées je préfère ne pas me prononcer sur le sujet. Lorsque cela m’est arrivé, une gentille sage-femme est venue chez moi pour me traire faire un massage drainant. Ça n’est pas très agréable, mais c’est souverain.

(image : http://www.smtc90.fr/upload/smtc/embouteillage.jpg)

Eviter la pression, n’importe où, n’importe quand…

J’allaitais depuis trois bons mois. Tout se passait bien et nous devions aller en famille à un repas. Un peu de route, je m’installe à l’arrière de la voiture pour dormir un peu. Comme il y avait la nacelle de mon bébé, je m’y appuie pour dormir. Mais à peine une demi heure après, j’avais très mal au sein qui était en contact avec la nacelle.

Lors de la monté de lait (ce qui arrive à peu près tout le temps quand le bébé ne tete pas), il faut éviter toute pression sur le sein. Je le savais mais je ne pensais pas que ça l’était à ce point… Trop tard! Que faire?

Poursuivre l’allaitement en ciblant la zone engorgée

Je me suis souvenue des conseils d’une amie qui me disait d’allaiter du côté endolori pour réduire au maximum l’engorgement. Et de mettre le bas de la lèvre du nourrisson (si possible) du côté le plus rouge du sein. C’est ce que j’ai fait.

Le lendemain, le sein était déjà beaucoup plus souple et je n’avais plus autant mal. Par précaution, je suis allée voir le médecin. Il m’a simplement donné une crème Osmogel mais je l’ai à peine utilisée.

Voir le médecin quand même…

J’ai quand même passé toute la soirée (qui était celle de Noël dans ma belle famille bien sûr ) avec de la fièvre et une atroce douleur… Cette nuit là fut un peu difficile mais j’ai volontairement laissé mon cher mari et ma famille pour me reposer au maximum les nuits suivantes. En quelques jours (deux ou trois) tout est revenu de nouveau à la normale. Ouf! Voilà ce que c’est que de vouloir se reposer en voiture !

Autres astuces de maman : le choux!

Si l’allaitement intensif ne suffit pas à remettre le sein sur “pieds”, mon amie m’avait également conseillé d’envelopper le sein pendant la nuit avec une feuille de choux vert écrasée au rouleau de cuisine. Je n’ai pas eu besoin de ce remède malheureusement (ou heureusement), je ne peux donc pas en parler d’expérience… Je ne doute pas qu’il fonctionne puisque je l’ai vu à maintes reprises sur forums et astuces pour allaitement.