Birth Hand Expression Galactagogues
Transcription
Birth Hand Expression Galactagogues
J A N U A R Y | 2 015 | ISSUE 27 Today Birth Galactagogues The Power of llli.org Hand Expression 01 TABLE OF CONTENTS To day 4 8 10 12 What Joyce Taught Me About Birth 18 Mom To Mom: LET GO! The Power of Hand Expression Mother's Stories: •High Heels and Lipstick •Was It Worth It? •Ripples on a Pond 22 24 Galactagogues Keeping Fit and Well What’s Cooking ? Raising Healthy Eaters. Lessons Learned from Breastfeeding llli.org llli online magazine Our Mission is to help mothers To day order printed copy text version pdf version past issues L i ke u s o n Fa c e b o o k ! worldwide to LLLI Annual Supporting Membership breastfeed SUPPORTING MEMBERSHIP INCLUDES: through mother- • 10% savings on items purchased in the LLLI online store to-mother support, encouragement, information, and education, and to promote a better • Special offers on LLLI store items. • Breastfeeding Today, our global online publication with breastfeeding research, articles, resources, and products. 1 year supporting membership • Advance notices for new products and materials. • mother-to-mother breastfeeding support Find breastfeeding help online: • 10% savings on most items in our online store • special offers on many items • free subscription to Breastfeeding Today, our global online publication understanding of breastfeeding as an important element in the healthy development of the baby and mother. local groups helpful resources parenting forums for more information call 800-LALECHE online store 03 EDITOR’S NOTE To day Issue 27 | 2014 | Volume 12 | Number 27 © 2014, La Leche League International, Inc. Managing Editor | Barbara Higham A New Beginning Contributing Editors | Review Board | Lydia de Raad, Gwen Gotsch, Carol Kolar, Kathleen Whitfield, Lisa Hassan Scott, Johanna Rhys Davies, Johanna Horton Art Director | Josh Dobbs Cover Photo | belleverdiglionephotography.com.au Photo Credits | pg4&6 belleverdiglionephotography.com.au, pg8 Meave Haughey, pg12 Jess Wimpenny, pg13 Emma & Josiah, Photographer Lisa Scott, pg14 www. istockphoto.com/claudiad, pg18 Shutterstock. com, pg20 Shutterstock.com, Laura Brown by jvcphotography, pg23 Monica Duke, pg24&26 Katja Leccisi Advertising Manager | Barbara Higham Web Development | Dave Davis, Shelly Stanley Acceptance of paid advertisements does not constitute an LLLI endorsement of the product advertised. LLLI does not require advertisers to carry product liability insurance. How appropriate to start our first issue of the new year with an article about birth! Teresa Pitman writes about natural birth and the influential role her mother and doctor played in helping her achieve normal births without the need for medical intervention. Teresa’s story resonates with me because I have fond memories of giving birth unhurriedly in the comfort of my own home. My nine-year-old daughter loves to hear and recount the story of her own gentle birth in water. I hope my happy story will stay with her as she matures and encourage her to have a positive approach when she embarks on a pregnancy of her own. Another article that is suited to the January fresh start is Lisa Hassan Scott’s “Keeping Fit and Well” in which she examines how mothers looking after small children can incorporate caring for their own important needs for fitness and well-being into the day to day. In our “What’s Cooking?” column, instead of recipes this time, we have an article from a dietitian about the lessons we learn from breastfeeding that teach us how to raise healthy eaters. What is a galactagogue? Philippa Pearson-Glaze explains with herbal and medicinal examples. And Diana West examines the power of hand expression. We have mothers’ stories and letters from new moms to grandmothers and the whole magazine is beautifully illustrated. Please send me your stories and photos for publication to editorbt@llli. org and join us on Facebook, Twitter and Google+. Happy New Year! Mailing Lists: LLLI sometimes makes its mailing list of members available to reputable outside groups. If you prefer not to receive these mailings, notify LLLI at cs@llli.org. La Leche League International fully supports the WHO (World Health Organization) International Code of Marketing of Breastmilk Substitutes. LLLI Board of Directors, (2009, 2010) Barbara editorbt@llli.org (Photos for publication need to be well lit, at around 300dpi, and have no photo modifications such as borders/frames, textures, wording or titles, or filters such as sepia tone.) Barbara Higham has been a La Leche League Leader since 2004 and is the managing editor of Breastfeeding Today. She lives in the spa town of Ilkley, West Yorkshire, in the north of England with Simon and their children, Felix (16), Edgar (13) and Amelia (9). Visit and “like” us on Facebook: www.facebook.com/BreastfeedingToday and at www.breastfeeding.today Breastfeeding Today is published by La Leche League International Inc., 957 N. Plum Grove Road, Schaumburg, IL. 60173 USA. Telephone 847-519-7730 cs@llli.org (9 AM to 5 PM U.S. Central Time). Visit our Website at llli.org. Canadian subscribers should contact LLL Canada at PO Box 700, Winchester, ON K0C 2K0, Canada, or go to www.lalecheleaguecanada.ca with any questions about subscriptions. Follow us on Twitter: https://twitter.com/BreastfeedingT1 llli.org | 2015 • JANUARY • To day 04 belleverdiglionephotography.com.au What Joyce Taught Me About Birth My My dear friend Joyce Barrett died of cancer in January of 2014. We had been friends for a long time, although when we first met she was just the new family doctor who had been recommended to me. I immediately loved her warmth and down-to-earth style, and it was into her hands that my next two children were born. Over the years, our doctor-patient relationship became a true friendship, and eventually we wrote a book together. By then, Joyce had stopped being a general practice doctor and was specializing in caring for women during pregnancy and birth—her true passion. Unlike most of her North American peers, my mother had no medication. She loved to tell me the story of her labor—how she walked around the garden paths with her own mother at her side—and the birth, where her mother supported one leg and a midwife supported the other as I was born. The midwife then laid me on my mother’s chest and when I headed straight for the nipple told my mother, “Well, she knows what she’s doing!” So I went into pregnancy with that story in my mind. If my mother had given birth without drugs and found it a positive When I had my first baby (in 1977) I was experience—one she liked to share with lucky. I had been born in England: my us—why couldn’t I? mother had gone to a local birth center, where I was delivered by a midwife. To day • JANUARY • 2015 | llli.org The doctor I was seeing at the time, however, had different ideas. He had his own method of managing labor, one that was popular with other doctors in our community at the time. I would be given a narcotic as soon as I arrived at the hospital and then an epidural as the time for the birth approached. He’d delivered lots of babies, so he knew this was the best way to do it. I hadn’t even given birth to one, so he felt I couldn’t possibly know what I was talking about. Maybe I was inexperienced, but I knew I came from a long line of women—as we all have—who had given birth without narcotics and epidurals. I decided to find another doctor, one who was willing to support me in my plans. My 8 lb 15 oz baby ” Teresa Pitman boy was born at 42 weeks and two days gestation, into the hands of my new doctor. No narcotics, no epidural. He nursed right away. for example) are actually making things more dangerous, not safer. The “safe side” when it comes to birth is the side with the fewest interventions. The seven women who founded La Leche League were being pretty radical for their time when they wrote that “Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.” In the 1950s, most women were medicated during labor and birth and most had no memory of the experience afterwards. Joyce pointed out to me as we reviewed study after study that anything that stresses the mother is a risk factor. I should have known that: I grew up on a farm, and it was very apparent that animals under stress slow down or stop their labors. I remember waiting much of the afternoon with my sisters for one of our horses to give birth, hanging around the stall as the mare moved restlessly and contractions tightened her belly. Finally my mother insisted we come in for a bite to eat. We hurriedly ate our supper then ran back to the barn, where the mare was already licking clean her newborn filly. Over the next few decades, a revolution began to take shape. Women were asking for “natural childbirth.” As the Founders of LLLI suggested, they wanted to be aware and involved in labor and birth. They were concerned about the possible effects of labor medications on themselves and their For some women, moving to the hospital babies. They started writing birth plans and is stressful. For others, staying at home hiring doulas. I was one of these women. would be. Having the right people with you matters too. When Joyce sat with me during The doctor I had found who let me have my my second labor, her calm and reassuring first baby without drugs moved away by the presence gave me confidence. As I time I was pregnant the second time. My struggled through the intense contractions hunt for a new caregiver led me to Joyce. I of the transition stage, she said: “Hurts had lucked out again. like hell, doesn’t it?” Yes, it did. Then she added, “But you can get through it.” She Joyce had a sign in her office that said, was right about that, too. “Remember, I could be wrong.” She expected her patients to call her by her first Knowing that interventions have risks name. And she believed that pregnancy doesn’t mean they should never be used. and birth were normal, natural processes. As an experienced doctor, Joyce had been at births where a cesarean section saved While that belief was the basis of her the life of the baby or the mother, or where approach, Joyce also believed very strongly an epidural relieved pain that was beyond in the importance of high-quality research. that which the mother could cope with. When we wrote our book on pregnancy Her message was that we should always and birth, it was based on the Cochrane keep the risks and benefits in mind, so Reviews—carefully analyzed analyses of that interventions are not used without published research studies. due consideration. I’d read plenty of research before. But as we worked through the process, going through study after study, I was actually surprised to realize something that should have been obvious: every intervention has risks. All of them. Even an intervention that seems as simple as putting a mother on bed rest has risks for mother and baby. For example, if a mother is going to have an epidural, what can be put in place to help the baby get going with breastfeeding once it is born, since the epidural can affect his sucking abilities? If a mother has a cesarean, who will be available to teach her how to breastfeed while protecting her incision? How will we respond to reduce the risks? 05 Joyce’s great gift to me—and to the thousands of other women she walked through labor with—was her confidence in a mother’s ability to give birth. Many of the young women I know today are afraid of birth. They know only that it’s painful and difficult and they expect to need medication to get through it. Joyce would look puzzled if you told her you felt that way. She’d remind you of the generations of women in your ancestry who had birthed without medication or interventions beyond perhaps the encouragement of a midwife. She’d remind you of everything your body had already done for you in creating and growing a baby. She’d encourage you to give your body every possible chance to do its job of getting the baby out. And she’d promise to be with you throughout the process. If my mother had given birth without drugs and found it a positive experience—one she liked to share with us—why couldn’t I? In labor, she’d encourage you to listen to your body for every signal, and she’d tell you about the research that shows how women who move freely in labor naturally walk or sit or stand in ways that help the baby move into a better position for birth. She never coached you to push, but reminded you that the research showed women who began pushing only when they felt the urge were less likely to have tears in their perineum or babies with low oxygen levels. Joyce retired from practice early. I’m glad she had those extra years with family and friends because in her late 60s she was diagnosed with cancer. Even as her health Many things people do to “just to be on the safe side” (having a fetal monitor in place, llli.org | 2015 • JANUARY • To day 06 The Birth-Breastfeeding Connection, Excerpted from The Womanly Art of Breastfeeding 8th edition Issue 18 http:// viewer.zmags.com/publication/33d8f1e8#/3 3d8f1e8/22 I Want a Natural Birth Issue 24 http://viewer. zmags.com/publication/7792b368#/7 792b368/10 My Emergency Cesarean Issue 23 http:// viewer.zmags.com/publication/29d112e6#/ 29d112e6/12 Books Dick-Read, G, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, 2013, 4th edition. belleverdiglionephotography.com.au deteriorated, she still loved to talk about Further reading birth and babies and share information from What Your Baby Knows About the most current research. Breastfeeding Issue 20 http://viewer.zmags. com/publication/ed9fb378#/ed9fb378/6 I miss Joyce every day. She made a profound difference to me and to so many Birth and Breastfeeding Issue 19 http:// other women. I am so grateful to have had viewer.zmags.com/publication/fd9eb27c#/ her as a friend, and to have been able to fd9eb27c/6 learn about birth from her. Teresa Pitman has been a La Leche League Leader for 35 years. She is one of the coauthors of the LLLI books The Womanly Art of Breastfeeding and Sweet Sleep and is the author of Preparing to Breastfeed: A Pregnant Woman's Guide, plus 15 other books. Her book with Dr. Joyce Barrett, Pregnancy and Birth, is now out of print. Teresa is the mother of four grown children and the grandmother of six. Teresa came across this article shortly after writing hers and thought its author was saying the same things she was. http://m.theatlantic.com/health/ archive/2012/03/the -most- scientificbirth-is - often-the -least-technologicalbirth/254420/?single_page=true To day • JANUARY • 2015 | llli.org Gaskin, Ina May Birth Matters. A midwife’s manifesta, 2011, Pinter and Martin. Goer, H. The Thinking Women's Guide to Better Birth, 1999, Penguin. Pitman, T. Preparing to Breastfeed. A Pregnant Woman’s Guide, 2013, Hale. www.ibreastfeeding.com/books/ preparing-to-breastfeed-a-pregnantwoman39s-guide-333.html 07 Natural Support for Breastfeeding Moms Milkies Milk-Saver Save every drop Use every drop Collects up to 2 ounces from your non-nursing side during each breastfeeding session Milkies Freeze Easy to clean, dishwasher safe BPA Free Organic & Lanolin Free Nipple Nurture Balm Use coupon code “BFToday” for 15% off order Phone: 800.367.2837 info@fairhavenhealth.com www.mymilkies.com llli.org | 2015 • JANUARY Affiliated with: • To day Mom to Mom 08 MOTHER’S SITUATION LET GO! My nine-month-old son will only fall asleep if I am breastfeeding him, day and night. For daytime naps, I have to lie down with him, and if I try to get up he immediately awakens and starts to fuss until I lie down with him again. At night it is the same story, and we spend three-quarters of the night in the same bed. Breastfeeding has been going well for us, and he is mostly a happy, healthy boy, but I am exhausted by his constant need for physical contact. How can I ever put my baby down to rest without his needing me to be there? Do other mothers find this problematic? My mother-in-law tells me I have “spoiled” him and that I should let him cry it out, but that is not an option I am prepared to consider. I am feeling “touched out” and would appreciate hearing from other mothers who have dealt with similar feelings. Response Both of my children have been like this at different phases in their first years of life. Settling in with a smart phone or a book helps to pass the time until they are soundly asleep (or done napping). I wore my son in the sling for his nap and I could keep up with my preschooler at the same time. Using a sidecar crib has helped. It helps with nighttime feedings because I have the comfort of my own bed and do not have to get up to nurse him. Most important for me is to remember that this is a season and does pass. Each child and the length of time are different but I consider it an investment in helping my children be secure and confident as they grow. It is helpful to make some alone ‘me time.’ Find and enjoy To day • JANUARY something renewing. It might just be 15 minutes a day or a couple of hours every few weeks. Find what refreshes your spirit and make time for it. Alina Mattson Pohm, Montgomery, Alabama, USA Response I remember being that touched out. I read that it takes a baby longer to reach a deep cycle of sleep during a daytime nap. I would lie down with my baby on the bed, in such a position that we were only attached at the breast and not touching at any other point. Then when she was really asleep, I would slide a finger into her mouth, to detach her, and roll away. Initially I had a 50% success rate that went up to 85%, thwarted by trying to move before she was fully asleep. Having a good book by the • 2015 | llli.org Meave Haughey bed helped as did accepting my baby’s needs were just that, needs. To a baby, if you’re not there, you’re gone forever and it’s panic stations. I would try to listen for her stirring, so I was there when she woke up. Mastering back carries with my wrap sling, so she could nap on my back was a help. I would let her feed to sleep, transfer her from front to back, tie her on, and get on with what I wanted to do. Sometimes she would go to sleep on my back without nursing, which was great. Nighttimes, well that’s a hard one. At nine months we tried to get our baby to settle in the cot so she would sleep on her own. For about a week, I would nurse her to sleep, try to put her down, only to have those eyes shoot open and the crying start. After a week of really bad nights we decided to go back to co-sleeping fully, but with the cot by the bed at the same level, so I would follow the same technique as daytime naps, getting her to sleep and then rolling away, with about the same rate of success. Babies seem to have heat sensors, and will roll toward you and end up sleeping under your armpit, even if they start out in their own space on the bed. Every child is different, and my first has a much higher need for physical contact and is much more emotionally sensitive than my second. When my second would happily sleep on her own in the Moses basket, I wondered what was wrong with her! At night she nursed to sleep, but tandem nursing the two of them to sleep left me with nowhere to roll over, so usually I’d make the best of it and sleep too. They do grow out of that intense need for your presence. It takes a while and the intensity comes and goes in phases. Living through it all can be tough. It’s very tiring and other peoples’ expectations can make it more so, but when I look back on it, it went so fast! They still like milk and cuddles to go to sleep, but cuddles with dad or grandma will do, and they need me less in the 09 daytime too. I have sometimes resented that my husband got to watch TV or chat while I was settling the kids, but equally he felt left out and inadequate when they would settle for me, while crying for “mummy milk” when left with him. On the plus side, I get lots of cuddles. asleep! It’s also distressing when you’re having second thoughts yourself, to hear criticism from others that leaves you worrying it might be all your fault! Many moms have been in your situation! Sometimes relaxing helps and accepting that this might There were a couple of books be physically good for you, that helped me particularly, helping to give you the extra Nighttime Parenting: How to rest you need. Meditation, Get Your Baby and Child to breathing exercises, and other Sleep by William Sears and relaxation techniques can all Raising Your Spirited Child: contribute. As unbelievable as A Guide For Parents Whose it sounds right now, your child Child Is More Intense, Sensitive, will outgrow this stage, even if Perceptive, Persistent, you do absolutely nothing! Energetic by Mary Sheedy Cicely Rodal, Cary, North Kurcinka which helped me see Carolina, USA that some children’s needs are just more intense than others, Response not wrong, not right, just differ- My son did the waking up from ent. I also found the LLL meet- a dead sleep when I rolled ings very helpful, as most of away, until we had his food the other mothers were coping sensitivities all figured out. So with the same things. that might be something to consider investigating. Hope this helps you realize Lynn Biberdorf Carter Ofs, you are not alone. Kirksville, MO, USA Mary Baxter, Chilwell, Nottingham, UK Response I remember what it was like Response when my youngest child I love taking the opportunity to wanted to breastfeed almost relax when we nurse to sleep. ceaselessly. I found it hard I bring my phone and catch to devote so much time to up on emails and Facebook, breastfeeding while my two and sniff my little guy’s head older children also needed my a few times even after he’s attention. There were occaasleep. I find that is worth that sions I felt sheer exhaustion extra “staying” time so that he at not being able to break is deeply asleep when I climb away from my daughter. The out of bed. slightest move was enough Tova Ovits, Brooklyn, NY, USA to awaken her or result in her feeding with increased vigor Response while apparently asleep. It can be so draining, feeling as if you are tied to your baby! It got easier when I fought it I remember that antsy feeling, less. What made it easier at when you’re forcing yourself to nighttime was not getting up lie still when all you can think when she awoke because we of is all the stuff that needs shared the same bed for a year. doing or when you’re resenting the fact that you aren’t You are responding to your son's needs and this shows that he is loved rather than “spoiled.” Emer Martin, North London, UK the blanket, so that he still feels that same warm surface against his back and isn’t as likely to startle awake.” A simple and effective technique! Jenny Maguire, Glasgow, Scotland, UK Response I found the most recent book from LLLI Sweet Sleep: Nighttime & Naptime Strategies for the Breastfeeding Family http://www.llli.org/sweetsleepbook full of excellent solutions. On page 71, the suggestion to this difficulty is to wait until your baby has been asleep for a while. You can tell if he is in a deep sleep by gently lifting and dropping his arm. Wait until his arm is totally limp when you let go, then he isn’t as likely to wake up when you “ooze” him away from your breast. Response I empathise! I feel this frustration too when my baby demands so much physical presence. I find I cope best when I let go of my feelings of resentment and try to treat myself in small ways to make up for all the time I no longer get to spend my way. Oh, and your mother-in-law is just plain wrong, because how can you possibly spoil a baby by making him feel loved? You are building his trust in you and helping him develop a sense of his own security. Martha Hansen, Odense, Denmark If you are sitting up and want to lay him down, the authors say, “you might want to start by breastfeeding him with a receiving blanket at his back. Then you ooze him with MOTHER’S NEW SITUATION BONDING WITH DADDY My husband was initially quite supportive about the idea of my breastfeeding our baby, agreeing that it was the healthy choice, but since our son’s birth, two and a half months ago, he has had a change of heart. He seems to resent the time I spend breastfeeding and appears frustrated and jealous that he is unable to calm the baby as easily as I can. Breastfeeding is going quite well but, of course, takes up so much time that my husband perhaps feels excluded. He keeps telling me I should introduce a bottle and that I need to get back to “normal.” I want to continue exclusively breastfeeding until six months and don’t want any one else (not even my husband) to feed my baby. Am I being selfish? How do other fathers of breastfed babies behave in the early months? How can I help him bond with our baby and carry on breastfeeding without causing a rift between us? Please send your responses by January 12th to editorbt@llli.org llli.org | 2015 • JANUARY • To day 10 The Power of Hand Expression By Diana West, BA, IBCLC I was a new mother struggling with low milk production and a baby who wouldn’t nurse when the first effective “consumer grade” breast pumps were invented. I’d been renting a hospital-grade pump to remove my milk, but the idea of owning a good quality pump that was more portable enticed me to buy a double-sided electrical model. It looked so cool! It was in a black bag designed to look like a briefcase so it could be carried to work discreetly. I wasn’t working, but I loved the way it made me feel efficient and smart. I was in the first wave of breastfeeding mothers to flock to this type of pump, and millions have been sold over the years. Knowing what I’ve learned since those days, my heart sinks to think I put such stock in a cool looking pump when my own two hands could have done a better job. But expressing my milk by hand never crossed my mind then. My impression of hand expression in those days was as a last resort when a good pump wasn’t available. My mind has changed quite a bit since then. 11 I now see hand expression as far more powerful than pumping in many ways. Research has shown that it can be more effective at removing milk in the first days after birth when the colostrum is thick and the breasts are swollen. 1 Pumping colostrum leaves only sprays on the side of the bottle that are hard to give to the baby, but hand expression into a spoon saves every drop. Hand expression can also be used as a technique during and after pumping to increase caloric content2 and remove more milk.3 It can be more reliable than a pump when electricity is scarce. It’s quieter than a pump when privacy is needed. It’s certainly less expensive than a pump. But I think the most powerful aspect of hand expression is the way it affects our perception of our breasts and what they can do. breastfeeding confidence, but also how long they breastfed. 5 Experimenting slowly with hand expression to figure out what it takes to get drops of milk can be empowering, especially during pregnancy before there’s any pressure to express milk for the baby. In my experience, there’s no one right way to hand express. When I was nursing my first baby almost 20 years ago, I remember being taught the Marmet Method of Milk Expression, which was developed by Chele Marmet, one of the pioneers of the lactation consultation field. Over the years, there have been several other official methods, many of which are now demonstrated on YouTube. But I think hand expression methods are best used as a starting point to figuring out what works best on your own individual breasts. We’re all different, and Many young women have an uncomfortable what works for you might be different than relationship with their breasts before they what works for me. The one movement become mothers. They’re usually aware of that I find helps no matter what else you do the sexual aspects of their breasts before is to move the skin over the breast tissue they think about their ability to make milk. instead of sliding your fingers over the skin. As an erogenous zone, women often feel You’ll also almost always get milk to spray it’s more appropriate for their partners to by compressing just behind the areola handle their breasts than to touch them where there’s a sort of “sweet spot.” themselves. There can be a delicate balance between breasts as sexual power Getting to know the landscape of your and targets of sexual vulnerability. breasts and the way they work can help you start to think of them as your breasts. You may feel a slowly growing pride as you see that they can feed and soothe your baby. You’ll start to appreciate their superpower. After a few days of nursing, you may realize that your breasts are your connection to this baby with whom you are falling so deeply in love. That’s the power of hand expression. ” I think hand expression methods are best used as a starting point to figuring out what works best on your own individual breasts. Many women have discovered that learning how to hand express during pregnancy helps them feel more comfortable touching and handling their breasts. I jokingly call this “making friends with the girls” when I suggest the idea to a client. That usually makes her laugh and lightens the mood, but there’s some real truth to it. One study found that learning hand expression during pregnancy increased mothers’ confidence and readiness for breastfeeding.4 Another study found that it increased not only Footnotes 1 Ohyama M, Watabe H, Hayasaka Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int. 2010 Feb;52(1):39-43. 2 Morton, J., et al. "Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants." Journal of Perinatology 32.10 (2012): 791-796. 3 Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology 29.11 (2009): 757-764. 4 Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial. Midwifery. 2011 Apr;27(2):209-14. 5 Flaherman VJ, Gay B, Scott C, Avins A, Lee KA, Newman TB. Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly. Arch Dis Child Fetal Neonatal Ed. 2012;97:F18-23. Resources See http://newborns.stanford.edu/Breastfeeding/ HandExpression.html for a demonstration video. Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC: http://bfmedneo.com/BreastmassageVideo.aspx Diana West is a La Leche League Leader and The Womanly Art of Breastfeeding 8th edition, 292–293 an International Board Certified Lactation Consultant in private practice. She is the co- http://www.llli.org/thewomanlyartofbreastfeeding author of three La Leche League International Tear-Sheet Toolkit: http://www.llli.org/toolkit books: Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, The Womanly Art of Breastfeeding, 8th edition, and Defining Your Own Success: Breastfeeding After Breast Reduction Surgery. She is also the co-author of The Breastfeeding Mother's Guide to Making More Milk. She lives with her husband and three teenage sons in the picturesque mountains of western New Jersey in the United States. llli.org | 2015 • JANUARY • To day tories S others’ M12 Emma & Josiah, Photographer Lisa Scott High Heels and Lipstick Rachel O’Leary, Cambridge, UK Clickety-clack, clickety-clack. Must be ten o’clock. There goes Carol from up the road in her high heels, lipstick bright, hair neat, covers on the pram spotless. I twitch the curtain so she can’t see me – still in my dressinggown, hair all over the place, house covered in laundry – and sit on the stairs to feed the baby… again. How does she do it? Why can’t I be like that—organized? Am I “coping”? Doesn’t feel like it. Sometimes it’s blissful, when the baby relaxes in my arms and falls asleep at the breast. Often it’s stressful—when she To day • JANUARY • 2015 | screams and I can’t understand why and don’t know what to do about it… Somehow, we got through those days, and nights, and sometimes I even made it out of the front door—to a La Leche League meeting on good days! (I was always late, but they didn’t seem to mind). to get out of the door, and the high heels and lipstick were to make me feel as if I was “coping” when I wasn’t at all!’ I wished I’d known; we could have had a laugh about it when we needed to. I wish I hadn’t assumed I was the only one drowning in isolation. I wish I’d got to know her better, and allowed her to know me Years later I met Carol at work, when our with all my failings. I wish women could children were teenagers. With a wry smile, I help each other more and compete less. told her how I’d been so impressed by her, all those years ago. She chuckled and said, From Musings on Mothering (Mother’s ‘That’s the only way I could stay halfway Milk Books, 2012) store.llli.org/public/ sane! I was falling to bits at home, I just had profile/671 llli.org Mothers’ Stories 13 Jess Wimpenny providing one-to-one support, information and encouragement. I have one Leader in particular to thank: Jo, you were fantastic, being there for me when I needed you the most. How can I ever repay your knowledge, care and kindness? When you came to my home to watch me feed and offer help—that was special, beyond words. It’s no coincidence you have the digits 999 in your phone number—you are the fourth emergency service! Thank you to my supportive boyfriend Adam for being with me every step of the way, providing encouragement whenever I needed it. Thanks mum and dad for being there for me, to my sister Natalie for her advice when I didn't know which way to turn and to Sue for taking time off work to help look after Isabella while I attended my doctor’s appointments. ” Was It Worth It? Jessica Wimpenny, Silsden, West Yorkshire, UK Prior to my baby’s birth I decided to opt for breastfeeding her. This decision was based on the apparent ease of it as a feeding method, the knowledge that I could be anywhere at any time and be able to feed my baby. I remember shopping with my sister and looking for clothes that would be suitable for feeding in and my sister saying that not everyone is able to breastfeed, so not to spend loads of money on special clothes in case I didn’t manage to do it. Before I actually came to try breastfeeding, I imagined you just put your baby to your breast and he would suck away. The first challenging eight weeks were proof this was not necessarily the case. The demands of motherhood soon became reality. My breasts were extremely full of milk, making a good latch very difficult. Then a dreadful fever set in. We had a Sunday evening trip to Accident & Emergency at the hospital, where the doctor confirmed I had mastitis and prescribed a course of antibiotics. Mastitis was very persistent and I was on antibiotics for a total of five weeks, which led to my immune system being A recent LLL meeting I went to had the theme “Was it worth it?” Any mother who has experienced that incredible feeling of sorely tested. Then I gained a burning the warm connection with her baby, the sensation in my nipples and sat in bed best cuddle ever, will know that even with with tears streaming down my face. The all the struggles and tears, breastfeeding is pain was unbearable. At another trip to an definitely the best thing to have mastered. out-of-hours clinic, the doctor diagnosed thrush. After this cleared up, my breasts I have continued to attend the monthly LLL began to feel lumpy, so I booked another meetings, as they are a great way to make doctor’s appointment. I was referred to new friends, share experiences, and chat hospital and after various doctors prodded with like-minded people. and poked me, I was told I had cysts caused by blocked ducts. The cysts were drained. I I hope my story provides others who are had to attend a breast clinic weekly to have struggling with comfort that there is light this unpleasant procedure carried out. at the end of the tunnel. You can be tested to the limit yet overcome such problems to The final feeding issue I had to overcome reach your breastfeeding goal. was an overproduction of milk, which was tricky to get under control, but necessary to prevent Isabella from choking on the fast flow of my milk. And my clothes were continually drenched in milk! When you have recently given birth to a baby, you want most of all to be at home having cuddles, getting to know your new family member. Instead, I found myself on a roller coaster journey having to overcome all the challenges thrown at me. I had never felt more pain, emotion and exhaustion. At the same time, I had never felt such drive, determination and passion. La Leche League mothers were amazing in Before I actually came to try breastfeeding, I imagined you just put your baby to your breast and he would suck away. llli.org | 2015 • JANUARY • To day 14 Ripples on a Pond Kathy Dettwyler, Newark, Delaware, USA To day • JANUARY • 2015 | llli.org www.istockphoto.com/claudiad ” Mothe rs’ St 15o In October last, one of the Founders of La Leche League died at the age of 87. Mary Ann Cahill was one of the original seven women who nearly six decades ago were sitting around in Franklin Park, Illinois, talking about how to support each other in their mothering journey through breastfeeding and how to extend that support to other women. Today, La Leche League International is a vibrant organization with information and support available for women all over the world, in many languages, and through many different media. I have only had the good fortune to meet two of the Founders in person, Edwina Froehlich and Marian Tompson, but the importance of all seven of these women to my life— both my career as an anthropologist and my experiences as a mother—cannot be overstated. I owe them a debt of gratitude that I can never repay directly: I can only try to pay it forward, extending the ripples they started on a pond when I was just a nursing infant myself. Growing up, I was the youngest of three girls. I had only babysat for other people on a handful of occasions, and neither of my older sisters had children. I had never given a moment’s thought to having children, or to how I would feed them, how I would care for them, or where they would sleep. I had no knowledge, and no opinions, about child care. Fortunately for me, Martha Toomey came into my life in 1977, when I left California and headed off to graduate school. Along with her husband Ron, and my soon-to-be-husband Steven, Martha had moved to Bloomington, Indiana, and had given birth to her son Brian in the summer of 1979. My own journey as a mother began on a fall day that year. I had just found out I was pregnant, and after telling the fatherto-be, I next went to see my friend Martha, who had a four-month-old son. When I told her the good news, she gave me a hug and said, “Oh, that’s great! You’ll have to come to a La Leche League meeting with me.” I responded, “What’s La Leche League?” And the rest, as they say, is history. La Leche League philosophies of mothering through breastfeeding, along with baby wearing and co-sleeping, just made sense to me. I met a variety of women from all walks of life who were truly enjoying their infants and toddlers, and who were friendly, supportive, and just all-round wonderful people. I embraced LLL and never looked back. My daughter Miranda was born in 1980 and we nursed without any problems. When she was ten months old, we traveled with her throughout Europe, and then to Egypt. Eventually we ended up in Mali, when she was 15 months old, and I devoted my ethnographic field research to breastfeeding, weaning beliefs and practices and the growth and health of children among the Bambara people of Mali. I wasn’t really surprised to note how much of Bambara child-rearing philosophy reflected what I had learned in LLL meetings. I was pleasantly surprised to spend two years in a culture where everyone breastfed for several years, where nursing problems were virtually unknown, and where children seldom cried or fussed. It was, of course, sobering to see children who were malnourished, or who suffered from polio, or who died from measles, diphtheria, and malaria. Why couldn’t we create a world where all children got to breastfeed for several years, where every mother knew how to prevent or solve common problems, but also where vaccines, antibiotics and sufficient highquality foods were available to all? As I had more children, and my career unfolded, I pursued various avenues of research related to breastfeeding and weaning, and the impact of La Leche League has only grown. Through my writings (books, scholarly articles, popular articles, and website), my lectures at conferences (for physicians, lactation consultants, health departments, and LLL groups), and my university classroom teaching (I manage to work this material into every class, no matter what the official topic might be), I have been able to pass along the lessons I learned from LLL to ries thousands of people, who in turn have passed them along. My daughter Miranda has continued the legacy, giving talks on breastfeeding to a variety of groups and through the example of her own mothering of my two breastfed grandchildren, Henry and Eleanor. I expect my son Alexander and his wife Shenin to continue the legacy in the years to come. As I had more children, and my career unfolded, I pursued various avenues of research related to breastfeeding and weaning, and the impact of La Leche League has only grown. The seven founding mothers of La Leche League sent out the first ripples in a tiny pond. Those ripples have reached far beyond their wildest imaginings. I am honored to have served as an amplifier of their original ripples, which continue on into the future, indefinitely. Dr. Katherine A. Dettwyler is an anthropology professor at the University of Delaware, Newark, DE. She is the author of Dancing Skeletons: Life and Death in West Africa 1993, and the coeditor of Breastfeeding: Biocultural Perspectives (1995), which includes her chapters “Beauty and the Breast: The Cultural Context of Breastfeeding in the United States,” and “A Time to Wean: The Hominid Blueprint for a Natural Age of Weaning in Modern Human Populations.” See some of her scholarly peer reviewed publications here: http://kathydettwyler.weebly.com llli.org | 2015 • JANUARY • To day 16 Quality Healthcare Begins with Breastfeeding Support the Mission of LLLI Today! During the month of December, generous LLLI donors, Sue Ann Kendall and her husband, Ernest Lee Bruns, will match your gift dollar-for-dollar up to $10,000. Combined with our current matching gift offer, your gift will be matched $2 for every $1 you give to LLLI today! “We support La Leche League International, because the organization has helped Sue Ann and so many of her friends breastfeed their children. We also are committed to the organization, because the LLL philosophy has helped us and so many others become better parents. We want the organization to continue to help future generations and be there when our children have their own babies to love. It’s especially important to help LLLI now, as it enters a new era with an even stronger focus on the mission and commitment to openness in all its operations. We are proud of the work being done by LLLI today.” Donate online or by check made out to LLLI at 957 N. Plum Grove Road, Schaumburg, IL 60173 Your support will have triple the impact in helping mothers and babies! Credit Card PayPal Pay by credit card using the LLLI online donation form or by PayPal LLLI Recognized by the Better Business Bureau Wise Giving Alliance LLLI is proud to be recognized in the recent issue of USA Today by the Better Business Bureau Wise Giving Alliance as a national Accredited Charity Seal Holder having met rigorous standards for charity accountability. Click here for a pdf version. The BBB Wise Giving Alliance is a national charity watchdog affiliated with the Better Business Bureau system. Unlike other charity monitoring groups that focus solely on charity finances, the Alliance completes comprehensive, in-depth evaluations of the charity’s governance, fundraising practices, solicitations and informational materials, as well as how it spends its money. As voluntary standards, they go beyond the requirements of local, state, and federal laws and regulations. This accreditation demonstrates the continued commitment of La Leche League International to strengthen our position as a viable charitable organization. To day • JANUARY • 2015 | llli.org 17 17 llli.org | 2015 • JANUARY • To day 18 a l a G s e u g o ctag earso Philippa P What is a galactagogue? A galactagogue is something that increases the production of breastmilk such as certain herbs, foods, and a few prescription medicines. Most mothers won’t need galactagogues (from the Greek “galacta” which means milk) as there are several ways to increase or maintain a milk supply without using herbs or medicines. If you are worried about your milk supply and whether your baby is getting enough milk, see an LLL Leader or IBCLC for a full assessment. Laura Brown by jvcphotography To day ds, UK e, Midlan tourbridg n-Glaze, S • JANUARY • 2015 | llli.org 19 Do I need a galcatagogue? If your milk supply is still not responding with skin-to-skin contact, breast compression, good positioning, frequent feeds, and pumping—then it might be a good time to try a galactagogue alongside. However, using a galactagogue on its own won’t normally increase your milk supply without efficient milk removal by your baby or a pump. The Womanly Art of Breastfeeding, p 355 provides: “One option to speed things along is to use a galactagogue, an herb or medication that increases milk production. It is important to take these ONLY after you’re nursing or pumping regularly to remove the milk that they will help create. When it comes to building a supply, galactagogues are the frosting on the milk removal cake. They never substitute for milk removal itself. Many mothers have been successful in increasing their milk by nursing and expressing alone, so it is worth trying this before you go to galactagogues.” Milk production is usually a robust process. Not only will most mothers not need a galactagogue, many mothers have induced lactation for adopted babies or relactated for their own baby by pumping and supplementing their baby at the breast— their hormones respond to demand by producing milk. Telling your medical professional is particularly important for pregnant mothers considering a galactagogue. Sheila Humphrey, author of The Nursing Mother's Herbal suggests avoiding most herbs during pregnancy or discussing their use with a herbalist midwife or knowledgeable obstetrician. On page 237 she says: “I recommend caution when using herbs during pregnancy, particularly the first and early second trimester. Many of the herbs used to increase milk supply (fenugreek and blessed thistle, for example) are also uterine stimulants; they may have strong enough actions to cause a miscarriage.” ” Which herbs increase human milk? There are over 30 herbs that are thought to increase human milk. Great resources that cover them in more detail include The Nursing Mother's Herbal and also The Breastfeeding Mother's Guide to Making More Milk by Diana West and Lisa Marasco. Experienced breastfeeding experts suggest choosing a herb that has a dual role of stimulating mammary growth, and giving hormonal support in some way. (See the list of popular herbs below.) Which foods can help my milk supply? Herbal galactagogues Herbs have been used to help milk supply for thousands of years. And while there isn’t much scientific research on their effects, many mothers who have taken them, felt that their milk supply improved. Many of the herbs and foods used to help milk supply today were recorded in a book some 2000 years ago by a Greek physician Dioscorides. They included medicinals for increasing milk, “bringing down” the milk, keeping the milk “fresh,” helping mastitis, engorgement, weaning, and even relactation. So while using herbs is not a new idea, how effective they are is not certain. Discuss with your doctor The quality of herbal products can vary a great deal, so it is important to buy them from a good reputable source. Many herbs can have side effects, so it’s important to know how they work, what dose to take, and which ones might be more suitable for you. Seek the advice of someone knowledgeable. The Womanly Art of Breastfeeding, p 397–8: “If you choose to use a galactagogue, it’s important to tell your doctor, even if she or he disagrees with your use of it, because there is always the possibility that it can interfere with other medications or cause reactions. Avoid herbs that can decrease your supply, such as parsley, sage, and peppermint (in large quantities), and medications such as pseudoephedrine, hormonal birth control (especially when introduced before four months postpartum), bromocriptine, ergotamine, and Methergine.” Many authors covering the topic of nutrition for breastfeeding mothers give the impression that you can have quite a poor diet and still make perfectly good breastmilk. They may mention a passing caution that the type of fats in human milk will differ depending on your diet, but it’s never made into a big deal. And up until the 1990s many experts thought dietary galactagogues worked by a placebo effect (mind over matter). Yet special milk-promoting foods have been eaten by newly breastfeeding mothers for more than 2000 years across history and all cultures. These women held a strong belief in the connection of diet and quality and abundance of breastmilk. “When it comes to building a supply, galactagogues are the frosting on the milk removal cake. They never substitute for milk removal itself.” llli.org | 2015 • JANUARY • To day 20 Popular herbs in the breastfeeding literature include: Goat’s rue belongs to the legume family with alfalfa and fenugreek and is often suggested for insufficient glandular tissue and breast surgery situations. It is widely used as a galactagogue across the world. Wild asparagus is often used for hormonal support and stomach problems and is widely used for increasing milk in India (called shatavari). It is a different plant species from the asparagus commonly used as a food. Fennel is often used for milk release (let-down) problems. Fennel seed is said to increase milk supply and improve mother's digestion. In Mother Food Hilary Jacobson suggests a baby’s digestion may also be improved through her mother’s milk. Alfalfa leaf is a very nutritious herb full of minerals, numerous vitamins, and essential and non-essential amino acids. Alfalfa is said to have many medicinal uses such as reducing inflammation. However, alfalfa is linked with triggering auto-immune disease so take in moderation and avoid it if you suffer from lupus or another auto-immune disorder. Fenugreek is one of the best known and most popular galactagogues. It is a common middle-eastern spice and one of the oldest medicinal herbs known. It can be used in conjunction with blessed thistle. Blessed thistle is recommended by Canadian pediatrician and breastfeeding specialist Jack Newman as a galactagogue to be tried in conjunction with fenugreek. It is traditionally used for indigestion and loss of appetite. There is sometimes confusion between blessed thistle and milk thistle. They are not the same herb, but they are both members of the Asteraceae family and both are said to be galactagogues. Milk thistle has traditionally been used as a food (peeled, tender shoots). Nettle has a long history as a powerful galactagogue along with various other medicinal uses. It contains all the essential nutrients and this may be how it supports lactation. In Mother Food, Hilary Jacobson looks at different cultures’ traditional milk-making (lactogenic) foods through history. She believes there is a connection between a very poor diet and breastmilk supply and composition. And if you are one of the mothers who has a low supply it is important to know what you can do to help it. As the composition of fats in breastmilk can alter depending on mother’s diet, it might well be that eating the right essential fatty acids (EFAs) could potentially change mothers’ milk from skimmed to fuller fat. In Mother Food, p 277 Jacobson says: “Many mothers find that supplementing with EFAs, such as borage seed oil, evening primrose seed oil, black currant seed oil, or flax seed oil, increases their milk production. These oils contain hormonal precursors which may influence the chemistry of lactation.” In The Breastfeeding Mother's Guide to Making More Milk, p172 many foods are mentioned that support good milk production, for example almonds, coconut, sesame seeds, millet, rice, anise, fennel, dill, barley, oats, chickpeas, and many more. Laura Brown by jvcphotography To day • JANUARY • 2015 | llli.org 21 Which medicines can increase breastmilk? There are no drugs specifically licensed as galactagogues or for “making more milk.” However there are a few drugs which are known for causing extra or spontaneous milk flow (known as galactorrhea) as a side effect of their intended medical use. For example, domperidone and metoclopramide are usually prescribed for stomach problems such as sickness or reflux but can influence milk supply. How can I find out more about the effects of herbs and medicines on me and my breastmilk? There is more information about each of these herbs and medications online at Diana West and Lisa Marasco's website: www.lowmilksupply.org, at e-lactancia http://e-lactancia.org/en/ and on the Lactmed website http://toxnet.nlm.nih.gov/newtoxnet/ lactmed.htm Which one shall I choose? How do they work? Most of the medications that can help milk supply work by indirectly increasing prolactin levels in the body (a hormone important in producing breastmilk) for example, domperidone, metoclopramide, and sulpiride. These drugs are available on prescription only. Discuss with your health professional whether they might be suitable for your specific situation and medical history. Domperidone (Motilium). This drug has historically been used for controlling indigestion, nausea and reflux but recent changes recommend it only to be prescribed for nausea in future. It is not available in the U.S. Canadian pediatrician Jack Newman has comprehensive information about the safety of domperidone and how it may help milk supply on his website. Maternal side effects may include dry mouth, itching, headache, and abdominal cramps. Rated L1 'Safest' limited data—compatible with breastfeeding by Thomas Hale’s Medications and Mothers’ Milk. Metoclopramide (Maxolon, Maxeran, Reglan). This drug has several uses but mainly it is used for patients with reflux. Maternal side effects may include gastric cramping, diarrhea, tremors, slurred speech, anxiety, and severe depression. Rated L2 'Safer' significant data—compatible with breastfeeding by Hale’s Medications and Mothers’ Milk. Metformin (Glucophage). This drug stabilises blood sugar in noninsulin dependent diabetics and is used to treat polycystic ovary syndrome (PCOS). Metformin can help improve milk supply for some PCOS mothers. Maternal side effects may include headache, dizziness, nausea, abdominal pain, hypoglycaemia, and vitamin B12 deficiency. Rated L1 'Safest' limited data—compatible with breastfeeding by Hale’s Medications and Mothers’ Milk. Sulpiride (Eglonyl, Equemote, Dolmatil, Sulpor). This drug is primarily an anti-depressant and antipsychotic but may increase human milk production during breastfeeding as a side effect. Sulpiride is used to help lactation in Zimbabwe, South Africa and Chile, but is almost never used in the U.S., Europe or Australia. Maternal side effects may include physical symptoms such as tremors, slurred speech, feeling restless or anxious, and sedation. Rated L2 'Safer' limited data - probably compatible with breastfeeding by Hale's Medications and Mothers' Milk. The choice of herbs, foods, and medications that can help a milk supply, not to mention ideas about pumping and breast compression, can be quite confusing. Bear in mind that herbs and medications are not a substitute for careful evaluation by a breastfeeding specialist as their safety and efficiency have not been proven in reliable randomized control trials. Working with your LLL Leader or IBCLC is recommended to find the best combination of ideas to increase your breastmilk while the safety of galactagogues can be discussed with your health professional. Have a look at Making more milk for self-help ideas. Philippa Pearson-Glaze lives in the West Midlands of England in the UK and has four children. She is an LLL Leader, International Board Certified Lactation Consultant and graphic designer. philippa.pearsonglaze@blueyonder.co.uk Resources Hale, T. Medications and Mothers’ Milk, 16th edition, 2014. http://www. ibreastfeeding.com/books/2014-medications-and-mothers39-milk-345.html Humphrey, S. The Nursing Mother's Herbal, 2003, Fairview Press. Jacobson, H. Mother Food: A Breastfeeding Diet Guide with Lactogenic Foods and Herbs for a Mom and Baby's Best Health, 2007, Rosalind Press. LLLI, The Womanly Art of Breastfeeding, 8th edition. Schaumburg, IL: La Leche League International, 2010. West, D. & Marasco, L. The Breastfeeding Mother's Guide to Making More Milk, 2008, McGraw Hill. ABM Protocol Committee. Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion http://www.bfmed.org/Media/Files/Protocols/Protocol%209%20-%20English%20 1st%20Rev.%20Jan%202011.pdf Anderson, P. The Galactagogue Bandwagon J Hum Lact 2013 29:7 http://jhl.sagepub. com/content/29/1/7.full.pdf+html Gribble, K. Breastfeeding the Adopted Child. https://www.breastfeeding.asn.au/bfinfo/ adoption.html Jacobson, H. Motherhood International. Lactogenic Foods and Herbs http://www. mobimotherhood.org/lactogenic-foods-and-herbs.html Zuppa, A, Sindico, P, Orchi, C et al. Safety and Efficacy of Galactogogues: Substances that Induce, Maintain and Increase Breast Milk Production J Pharm Pharm Sci, 13 (2): 162-174, 2010. http://ejournals.library.ualberta.ca/index.php/JPPS/article/view/6663 llli.org | 2015 • JANUARY • To day 22 Keeping Fit and Well Lisa Hassan Scott, Wales, UK Monica Duke A baby changes everything. A mother’s daily routines change completely, her nights may be restless and old habits necessarily have to alter to work around the newest, neediest member of the household. Self-care and keeping fit often drop off the to-do list altogether. But for a mother’s well-being, and for the benefit of her whole family, it’s worth taking small steps to try to fit a well-being practice into the day, even for just a few minutes. I led a fairly active life before having children. Cycling, hill-walking, yoga and swimming were my favorite ways to keep fit and clear my head. Like many people, I took it for granted that I could just nip out for a swim for a few hours. When my first child was born, I found myself struggling with poor latch and a baby who needed to be held almost constantly. “Nipping out” were words I no longer uttered. Just getting out the door was a military-style operation, and when I got out into the wintry cold I’d often find that in my focus on the baby, I’d completely forgotten to wear a coat! To day • JANUARY • 2015 | If I couldn’t even remember to wear a coat in a snowstorm, how on earth could I look after my own needs for fitness and well-being? Running/jogging is the most efficient form of exercise around. Even a 15–30 minute-run a couple of times a week can confer awesome benefits. If your baby has a reliably sound nap and you have a caring Over the years of mothering, and realizing helper, consider a short run right from your that my self-care was essential to the front door. Or, take your baby with you! happiness of my entire family, I have found Jogging strollers can be expensive, but several ways of fitting in a well-being used ones often come up on online auction practice to keep myself feeling fit and sites or through local connections. calm, while still attending to the needs of my babies. Here are a few ideas that might 2. Start the habit of an at-home practice. work for you. In inclement weather, or if you have several children’s needs to attend to, 1. Try going for a walk and consider a short, frequent at-home practice can progressing to a run. Getting out reap rewards. The market is awash with of the house, with baby in a sling or fitness DVDs and podcasts, including pushchair, and having a brisk walk can aerobics and yoga. I have some great be a great way of staying close but memories of my children bouncing also getting time for yourself. There around the living room with me, trying is something so invigorating about to imitate the lycra-clad instructor on a fast walk in the sun or crunching the screen. The belly laughs we had over autumn leaves. Time outdoors made me feel good and once I got into will clear your head, offer a change a daily habit of serving their breakfast, of scenery, and may even help a napthen doing my exercise, they came to resistant baby doze off. accept that “this is what mummy does” and I’d be free in a few minutes. I have even practiced gentle yoga with my llli.org 23 baby in a wrap sling, relishing a chance to breathe with awareness and stretch my body.* 3. Walk or cycle as much as possible. If you can, ditch the car for short trips. Walk to the bank, cycle to the store. It takes a little extra planning and time, but building a habit of using your body to get you around can help you feel really good. And walking with a toddler or young child, there is so much to discover: sycamore seed ‘helicopters’ to throw in the air, autumn leaves to jump in, snow to crunch through, puddles to splash in. If cycling is more your speed, or your distances are greater, there are baby bike-seats and trailers and some amazing cargo bikes on the market. I have a friend who cycles her six children around her city every day! Even if you live in a place ” If I couldn’t even remember to wear a coat in a snowstorm, how on earth could I look after my own needs for fitness and well-being? Monica Duke where you need to use your car for most trips, try parking a little farther away from the store entrance, walking from errand to errand, or simply make a stop along the way at a local park, field, nature reserve or woodland for some outside time. spite of what celebrity magazines might tell us, it is natural for a mother’s body to change when she has a baby, and it will take time for you to return to your former fitness. It’s important to take it slowly, make sure you have the go-ahead from your health care practitioner and give your body credit where it’s due: it’s carried and birthed your 4. Step outside and breathe. Sometimes beautiful baby and you continue to nourish none of these ideas will work for you. him with your body. You are amazing! Maybe the weather is terrible, your child is ill, your mobility is limited, or * Do take advice from an experienced you have older relatives to care for. yoga teacher if you are considering Maybe you just have a really busy practicing yoga with your baby. You may life, juggling working, pumping and also find helpful books at your local library, motherhood. If you do only one thing or information about a local parent and to contribute to your overall well-being, child class. make it this one: step outside, even for just a few minutes, and breathe. Take Lisa Hassan Scott is an LLL Leader, writer and your morning coffee outside, stand yoga teacher living in Wales, UK with her outside your door, and notice what husband and three children. is happening around you. The moon, the rising sun, birds going about their business, the feeling of the wind or rain Further reading on your cheek, the stillness of falling snow—all of these are events we so Keep Fit http://viewer.zmags.com/publicatio often overlook, but can bring us right n/5f3b8aed#/5f3b8aed/6 back to a sense of calm. Every day, try to get outside and just notice. Marathon Mother http://viewer.zmags.com/ publication/ed9fb378#/ed9fb378/14 One of the most important things to recognize is that a baby’s needs change Triathlete Breastfeeding Mom http:// over time. He won’t be this needy forever, viewer.zmags.com/publication/a8e5de2a#/ and gradually you may find that you have a8e5de2a/12 more and more time to give to your own wellness. When your baby is very young, Outdoors Baby and Family http://viewer. it’s okay to focus on his needs and allow z m a g s . c o m / p u b l i c a t i o n / f 8 0 c f 6 6 f # / yourself time to adjust to motherhood. In f80cf66f/20 llli.org | 2015 • JANUARY • To day What’s Cooking ? 24 Katja Leccisi Katja Leccisi Raising Healthy Eaters Lessons Learned from Breastfeeding Katja Leccisi MS RDN, Mont-Tremblant, Quebec, Canada To day • JANUARY • 2015 | llli.org As parents, we try to do what’s right when feeding our children. Unfortunately, that’s no easy task with so much confusion about what that is exactly. Nutritional advice is forever changing. Foods that were supposedly healthy one month are apparently off the list the next. In my experience as a dietitian and lactation consultant, I have seen many wellmeaning parents get so caught up in the do’s and don’ts of what is good and what is bad, that the simple pleasure of eating disappears. Mealtimes become stressful when parents worry about all this and whether their child is eating enough or too much, and what to do about it. The happy family meal around the table seems a thing of the past. My focus is on helping children develop a healthy relationship with food and eating. The goal is for our children to become adults who listen to their signals of hunger and satiety, who like to discover and try new foods, and who take pleasure in eating. How can we make this happen? Let’s look at what we learn from breastfeeding that instils healthy eating habits in our children. 25 As children grow up, things may get more confusing. How many of us have heard or said, “Just eat two more bites,” “You can have dessert when you finish that plate of food,” or “You can’t be hungry, you only just ate,” or “No second helpings!” Children grow at different rates, and it is normal for their hunger levels to vary enormously, from week to week and even from day to day. Remember that growth spurt at two months, when you breastfed round the clock to satisfy your baby? Well, that could be happening in your preschooler too, not to mention your teen. Internationally renowned food author Ellyn Satter says that parents are responsible for what, when and where food is offered (providing regular meals and snacks), while children are responsible for how much and whether they eat. Trust your child! 2. Try, try again. 1. Eat when hungry, stop when satisfied. As a breastfeeding mom, you are giving your child a great start. A baby is born knowing when he is hungry and when he has had enough to eat. You respect these signals of hunger and satiety. Your baby can eat when she’s hungry, and when she’s had enough she will stop. Can you imagine making your child keep breastfeeding once he’s had enough? Or purposely refusing to nurse even though your baby is giving you all the signs that he’s hungry again? So why do we feel we can make a five-year-old eat more when she says she’s full? Trust in your child, just as you did when she was a baby. Respecting signals of hunger and satiety is fundamental in the development of healthy and normal attitudes toward food and eating. You didn’t give up the first time you had difficulty breastfeeding, so don’t give up the first time your child looks at a new food and says no! A child may be exposed to a new food as many as ten or twelve times before he accepts it. Children will eventually eat what their parents eat, so it is important for you to sit down at the table with them and eat what they are eating. In my experience, it’s very easy for parents to give up too quickly, or turn mealtime into a battle or power struggle, when a child refuses a food. 3. Keep mealtimes pleasant and eat together. Remember how well a breastfeeding session went when you were calm and unhurried, when you kept your cool even though your baby was tired and cranky? And, of course, you are always with your baby when you are breastfeeding! Can you imagine its having been a good feed if you were telling your baby to hurry up, latch on and get done? And it would be impossible to feed your baby if he were not cuddled close to you. Let’s bring these concepts forward in time. How can you expect your toddler to eat those peas if you are disappointed that he won’t? Or your teen to finish her meatloaf if others are arguing at the table? Mealtimes should be a time to put hot topics aside and stick to something pleasant. With young children, talk about the food you are eating, where it comes from or grows, how it tastes, feels, smells. With all ages, it is a perfect time to catch up on each other’s day, to stay involved with that active teenager you hardly see around the house any more. Mealtime should be a positive time, one that brings love, attention and energy. From young childhood onward, socialization is learned at the table, in the company of others. Relationships that develop while eating with others build a sense of community and belonging. Eat together whenever possible. Research repeatedly shows that children, and teens who eat meals with their families Children have little control over many on a regular basis fare better socially, things in their lives but what they eat is one academically, and nutritionally. Sitting in of them. Let them explore, keep offering front of the television, or wolfing down new foods, show them that you enjoy them, something while standing at the counter and eventually they will join you. In the just cannot compare to conversation and meantime, teach them to politely say, “No togetherness around the table. thank you” to something they don’t care for, which is much more acceptable than 4. Remember that eating is a joyful and “Yuck!” and give them the option of quietly sensual experience. spitting the food out into a napkin if they don’t want to swallow it. Try serving at least No one knows this more than your one food that you know they like at each breastfeeding baby! She gazes up at you, meal, so they have a fall back option. Be or softly closes her eyes as she suckles, creative, and have fun with food. Let them she holds on to you or gently kneads your help you shop for it, prepare it, and serve it skin, her toes curl, and she is delighted. in attractive ways—they will be more likely Moving ahead, as a toddler, she explores to try something if they were involved with by rubbing food in her hair, squishing it getting it to the table. through her fingers, and by seeing what llli.org | 2015 • JANUARY • To day 26 happens when she smells it, licks it, and bites it. Why does the pleasure have to go away as our children age? Ellyn Satter says, “When the joy goes out of eating, nutrition suffers.” Eating is not just about filling up our stomach, or even about getting the right amounts and kinds of nutrients. Eating is about taking good care of ourselves and our children. It’s about pleasure, socialization, identity. Think about the difference between “eat and run” and “dine and savor.” As a breastfeeding mom, you are giving your child a great start. A baby is born knowing when he is hungry and when he has had enough to eat. You respect these signals of hunger and satiety. Your 5. Eat whole, fresh and varied food. baby can eat when she’s A mother’s milk is a complete food for her We know it contains everything he hungry, and when she’s baby. needs to grow and thrive. It has a variety of depending on what mom eats, and its had enough she will stop. tastes nutrient composition varies over the course of each feed, over the day, over the months As your child grows, help her to keep hold and years. What a wonderful, whole, fresh of the joy of eating. Encourage her to eat and varied diet, an excellent model on slowly, sitting at the table, taking in the which to base your child’s diet as he grows. whole experience—how the food looks, What is it in human milk that makes it so smells, tastes. Certainly there will be days healthy? Scientists keep on discovering when you all have to speed through the new and important components, the meal to make an appointment on time, interaction of which are impossible to or you may even have to eat in the car. replicate in manufactured products (see But, we all need to slow down sometime. The “Science of Mother’s Milk” http://www. Remember how wonderful it felt to finally sit llli.org/nb/nbiss3-09p28.html). still and breastfeed your baby, with nothing but the present moment on your mind? It Teach your child to see food as FOOD, not won’t take any longer, but if you change some package on the shelf. Good nutrition your attitude about the preparation of the means eating a well-balanced and varied meal, setting the table, even the cleanup, diet of foods in as close to their natural you may find that it becomes another time state as possible. Offer him a colorful, to savor with your family. varied, interesting range of foods, and you won’t need to worry so much about whether he is getting too much of this or not enough of that. To day • JANUARY • 2015 | llli.org 6. Every baby is unique and you know your baby best. Perhaps your first child nursed around the clock for months, while your second slept for long stretches after a few weeks. One needed to be burped every feed or she spat up, the other was a voracious feeder and never lost a drop. As a mother, you learned and adapted your parenting to best meet YOUR baby’s needs. There are no absolute rules that suit all babies. The same goes for feeding your child as she grows. He may need a lot of encouragement to try a new food, or she will happily devour anything put in front of her. Mothers, trust in yourselves and your children. If you follow the principles you’ve learned from breastfeeding, then you won’t need to worry so much that what you are doing is right. Katja Leccisi is a registered dietitian/nutritionist in the USA and Canada, a former International Board Certified Lactation Consultant, and a La Leche League Leader with over 20 years of experience working in public health centers, daycares, schools, and the community. 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