“One tip we want expecting parents to know and how Little Nursing Company can help!”

TIP 1: Don’t expect breastfeeding to come easily or “naturally”!

No matter what you see from social media, movies, moms at the mall, your friends and family- breastfeeding is generally a learned skill.  It takes practice and usually requires assistance. Put money aside prenatally to hire a private International Board-Certified Lactation Consultant (an IBCLC has the highest level of knowledge with breastfeeding issues). Or ask for gift cards to a private IBCLC from grandparents, family or friends.

If you do not have the resources, there is free breastfeeding help. Edmonton has a few publicly funded breastfeeding clinics plus the La Leche League.  Most likely you will need your family doctor to refer you for a free breastfeeding clinic, and unfortunately the wait time can be weeks to months.  In our experience, breastfeeding concerns need immediate attention.  When you do go to your appointment, you need to pack up and drive, haul the carseat and sometimes wait in a waiting room. Based on the allotted time for the appointment, you may or may not get to show the Lactation consultant or Doctor a full feed, especially if you had to feed while waiting.  The space is not what you are used to. A different chair, maybe no breastfeeding pillow, distractions for your baby. Your setup and environment play a big part in your and your baby’s comfort.

With Little Nursing Company, we come to you. In any room that you are comfortable feeding in. Sometimes we are in bed with you, sometimes we are in the living room and sometimes in the nursery. We go where you are comfortable.  We watch an entire feed and suggest different positions or latch techniques. We do a pre/post feed weight to see what the baby transferred from you (so many minds find confidence in numbers!).  We have specific training in oral restrictions/tongue/lip ties and do assessments on all babies. If we do see something concerning we refer you to other professionals for proper care and revision. Being in the home we get to see where the baby sleeps (we’ll discuss safe sleep) and we see breast pump parts (which leads to discussing pumping) and we get to talk about it all without the rush!! Any questions you have! You can easily book on our website and we can guarantee you will see us within 24-48 hours of booking. If you have insurance through Sun Life and Blue Cross you can submit our receipts for reimbursement. When you book a package with us we keep in touch with you through text, which most moms find the most helpful! Check out our Google Reviews

We look forward to meeting you and easing your transition into breastfeeding

Can my stress affect lactation?

Simply said, stress and breastfeeding don’t mix well.

When you are scared, stressed or anxious, the adrenaline release by your system can inhibit oxytocin. And since oxytocin is what causes your milk to “let down” that adrenaline messes with your milk flowing freely from your breasts. 

“Let down” or the “Milk Ejection Reflex” (MER), is governed mostly by the hormone oxytocin.  When the mothers nipple is stimulated, smooth muscles surrounding the alveoli contract and milk is then ejected. Moms usually have more than one MER in a feeding.  Some moms are aware of their MER, some are not.  Most moms seem to be aware of a MER when their breasts are fuller.  

In the infant, you’ll notice a change in rate of suckling.  Going from more frequent little sucks to a pattern of longer, slower, more rhythmic sucks followed by swallowing. In the mother, sometimes she’ll experience breast tingling or a “pins and needles” sensation, dripping from the other breast, sense of calm and tranquility, relaxation, drowsiness and thirst!! (always have a big glass of water near you before you sit down to feed!)

So now what? 

Most new, dare I say ALL mothers have some stress…

Here are some ways to increase MER

• Drink warm liquids- tea, coffee, hot toddy..(just kidding)

• Use warm moist heat directly on the breasts- warm washcloth, warm packs (2 to 3 minutes) have a shower/bath

• Warm the flange of the breast pump before applying 

• Before your baby is ready for a feed, get yourself comfortable.  Find your most relaxing place in the house- warm up the room,  dim the lights, light candles,  find your favourite essential oil, your favourite music, look at pictures of relaxing memories or visualize a relaxing place that you visited, meditate.  Have your partner bring you the baby before he/she is starving and screaming!

• Do lots of skin to skin with baby before feeding

• Use the fingertips to massage the breasts toward the nipple to raise oxytocin levels

• There is such a thing as exogenous oxytocin nasal spray out there in the world.  I have never seen it and I'm pretty sure we can’t get it in Canada.  But if you dig deep enough you could probably find it.

• Laugh! Find something that makes you laugh- a movie, something on your phone, a picture, maybe you have a funny husband! Laughter does so much good for our tension!

#1 Most Important thing to do: PROTECT YOUR MILK SUPPLY

Empty those breasts! 8 to 12 times in 24 hours (depending on your baby’s age). Full breasts don’t make milk. Your milk supply is driven by supply and demand. 

Check out this video:

How To Increase Milk Supply - Relaxing Breastfeeding Meditation

Resource

Marie Biancuzzo. Breastfeeding the Newborn Clinical Strategies for Nurses. Second Edition. 2001

Is My Baby Getting Enough Breast Milk?!

There are so many amazing things about a woman's body. Mainly the intense, miraculous, overwhelming, amazing world of reproduction. We get pregnant, we anticipate for 9(+) months, we manage to gently ease these little angels into the world (eye-roll, maniacal laughter, sarcastic snort here- your choice) and then the “dot, dot, dot”. 

The story of how we got from there to here is as individual as snowflakes but I’m pretty sure I can say all of us, not long after having those little bundles of joy, start the never ending question period that is, AM I DOING THIS RIGHT??? 

We read books, look up websites, we talk to our mothers, sisters, (dare to even ask the mother in law?!) we cry with friends and snap at our partners and we stress! We didn't have a lot of control during that incubation time but now we are in the driver's seat and it is scary! But we do it, one day at a time, one NIGHT at a time, one feed at a time. And with those feeds, while we sit and “relax” we think, how, on Earth, do I know if this little lovey is getting what he/she needs from me? IS MY BABY GETTING ENOUGH MILK? Well mama, let us tell you a few signs to watch for to ease your mind and help those shoulders come down a notch.

The 3 main areas to pay attention to are weight gain, feeding technique and behaviour, and output/diapers.

During a postpartum visit with your doctor or midwife, they will weigh your baby and compare it to the birth weight. Now there is a bit of number play here but the general idea is that your baby will lose a bit of weight (5-7-10% depending on who you talk to) in the first 4 days after birth. By day 5, your baby should be gaining weight (20-35 grams/day) instead of losing and have regained that lost weight by 10 days to 2 weeks of age.  After 2 weeks, your baby will gain 120-240grams/week. 

Personal story, my third and heaviest baby did not regain her birth weight back by two weeks and I felt like a failure. It was my job to do this “one” main thing. So I started drinking the suggested teas and took a shot of something that tasted terrible every day (don't ask what, I have no clue what it was now) and I pumped and bottle fed just so I could see how much she was getting then I supplemented with formula (I just had to know she was getting enough!) and fed any time I thought she might be hungry and I stressed. This was my third, I should know what to do, right?! Then her chiropractor asked me how I was during a visit, as I complained about my tea, and she said, “Do you think there is a problem?” and I frustratingly replied “No! She looks fine and acts fine and I'm spraying her in the face for goodness sake!” She said, “Stop with the tea, you are doing a great job.”. For whatever reason I needed permission to listen to my gut and from then on her weight wasn't a problem. Which brings me to feeding.

Once you have established a good latch, there are a few things to look for that show your baby is getting enough milk. At the start of the feed your baby's eyes should be open and  baby alert. During the suck their mouth should be wide and have slower periods with intermittent  pauses while the milk is going in. The longer the pause, the more milk is going in, so fast “open, close” sucks are taking in less milk. It is drinking vs sucking (or sipping!). Imagine chugging through a straw and what happens in your mouth. That’s a bit difficult to put into words but there are great videos on youtube. Here’s one of them:  Good Drinking At Breast

During the first 2-3 days pauses are difficult to detect as they are quite short due to colostrum having less volume than milk. Feeding times should be approximately less than 30 minutes (can vary) and end with softer breasts and a content baby. Baby may be gently falling asleep and have limp hands or an unworried expression, this is that “milk drunk” state we all love and miss!   MINIMUM breastfeeds are 8x in 24 hours but in the first few weeks it is more like 10-12x/24hrs.  Don’t forget those very important night time feeds-at least 2-3x.  Babies have tiny tummies that hold a small volume and breastmilk is easily digested - which is why they feed ALOT! And that is normal.   

If what goes up must come down, we know what goes in must come out! Since we can't visualize the precise volume the baby is taking in, we monitor their diapers. After the meconium (sticky tarry first poops) have cleared the baby's system, usually around day 3-4,  the colour and consistency changes to a seedy yellow/brown stool. See below. To tell if the amount in each stool is adequate we use the “O-K” method, as in make the O-K 👌🏼👌🏾👌🏿 sign with your hand and the amount in the “O” (forefinger to thumb) is considered one good poop! This amount is what you watch for during the first month. Now it's difficult to monitor wet diapers amongst all of this colourful solid waste but ample stools generally translate to ample milk and also wet diapers, see below. Very concentrated urine during the first few days of life can contain urate crystals (uric acid crystals). These urate crystals can cause a pink, red, or orange-colored, powdery stain in your baby's diaper called brick dust. Tell your care provider as this is a sign of not enough milk and find someone to help you with breastfeeding/formula feeding, like an IBCLC! 

Day 1- 1 Wet/ At least 1-2 black or dark green poops

Day 2- 2 Wets/ 1-2 black or dark green poops

Day 3- 3 Wets/ 2-3 brown, green or yellow poops

Day 4- 4 Wets/2-3 brown, green or yellow poops

Day 5-7- At least 5 wets/ 2-3 soft and seedy, yellow poops

2 weeks on- 6 wets/2-3 soft, seedy, yellow poops

Breastfeeding My Baby Guide is a helpful guide of “How do I know if my baby is getting enough breast milk?”

The first 24 hrs are different for all babies. Give yourself time to snuggle and celebrate and rest. Have a water bottle handy because you will be thirsty with all of this milk making! 

TIP: From day 1- Keep a very simple log: one column for pees, one column for poops, checks when you change!” If you have more questions or comments, let us know!

Get some extra “milk drunk” cuddles in for us! 

Here is a list of some of our favourite links:

Is Baby Getting Enough Milk? • KellyMom.com

Attaching Your Baby at the Breast

Resources

La Leche League International. The Womanly Art of Breastfeeding 8th Edition. 2010

Dr Jack Newman & Teresa Pitman. Dr. Jack Newmans Guide to Breastfeeding Revised Edition. 2014.

British Columbia Ministry of Health. Breastfeeding my Baby.

Hey all you lovely ladies,

It’s Melissa from Little Nursing Company. How is everyone? I hope you are all staying healthy and safe. Wow, what a time we are living in right now! So much uncertainty it’s overwhelming. I’ve been watching Frozen 2, on repeat, with my girls and the song “Into the Unknown” is SO relevant for 2020 thus far.  Mychelle and I are still working at an Edmonton labour and delivery hospital and are experiencing first hand the demands of this virus! 

I’ve been wanting to write for a while now but have been struggling to prioritize what is worth reading during these stressful times! I considered writing a blog on how breastmilk is the best choice for your baby, as it gives immune protection. Who doesn’t want the best immune protection right now?!!   But why “beat a dead horse?” Everyone is aware of that and now is not the time to make any mama feel unsupported for choices made. I thought of writing specifically about HMOs (human milk oligosaccharides) found in breastmilk. There is fascinating new research about how HMOs keep your baby healthy. But that didn’t seem right either.  How about tips on how to help a mother relactate…. Some moms who have stopped breastfeeding might want to start up again during these uncertain times?   

I had all these topics on my mind but just couldn’t sit down and write.  Until a good friend of mine said “keep it short and supportive- less is more right now.”-LA

So all I have for you this month is a couple self care tips, that don’t even involve breastfeeding. Just surviving as humans :)

1. Go outside! Go for a walk or if it's warm enough, just sit outside with a coffee. The Vitamin D on your face is guaranteed to lighten your day

2. FaceTime friends and loved ones to combat loneliness

3. Do the thing that has been on your “when I have time” list: binge watching a series, cleaning out the fridge, organizing photos

4. Spend “quality” time with your kids/family- bring out the puzzles/games/books/movies. And genuinely take the time to enjoy being together

5. Have a relaxing bath

6. Allow and release all the feelings during this time; with yourself and your kids, so it doesn’t remain in the body

7. Do nothing! And don’t feel guilty about it! 

These self care tips are as much a reminder for you as they are for me. 

Somehow I managed to get out of my “slump” and had a pretty good day, the best one so far! The kids and I baked cinnamon buns, started a puzzle and I enjoyed the best coffee & Bailey’s on the deck in the warm sun.

Please let us know if you would like more infant feeding and/or breastfeeding information on the topics mentioned above. 

Thanks for reading, you’ve got this and you are not as alone as you might feel!

Melissa, RN, IBCLC

“Taking care of yourself is part of taking care of your kids”- Unknown Source

One of the top concerns of breastfeeding moms is latching pain! It is also one of the biggest reasons Edmonton mothers quit breastfeeding and rightfully so, it hurts! No one wants extra pain when you are already so exhausted with a new baby. 

So let’s talk about it for a bit...What does “latching on” mean?  Does a traumatic or difficult birth affect latching on? What could you do if the baby doesn’t latch?  What is a good latch anyway? We can help if you want to ask these questions directly to an Alberta registered nurse. Contact Us.

“Latching on” simply means the baby taking the breast into his or her mouth. However, sometimes it's not this simple!  Not all babies are the same; not all breasts are the same; not all nipples are the same.  Sometimes the baby prefers one position on one breast and another position for the other; sometimes the baby prefers only one breast and not the other and sometimes the mother prefers one position over the other. The baby could be tongue tied or extra sleepy or have a tiny mouth.  There are so many reasons why latching can be difficult.

A good latch for a breastfeeding baby is taking a large mouthful of nipple and areola, bringing the nipple to the very back of their mouth and massaging the areola with the tongue.

A good latch is not only pain free but it also means the baby is getting more milk.  A mother might have an abundant milk supply and her baby is growing but overtime a poor latch can lead to decreased milk supply.  A poor latch might also result in nipple pain and damage, long feeds with low weight gain or long term low milk supply.

This can have a traumatic or difficult birth experience can definitely have an effect on bonding and breastfeeding.  Being able to recognize this is a huge step in the right direction. Also, forgive yourself! You have been through a lot too!   

Many babies won’t latch after a difficult birth and you may not want them too. Here are some ideas to help with bonding:

• Remain skin to skin for as long as possible.  Smell, touch and enjoy each other!

• If you are home, take a warm bath together alone.  Enjoy the time together.

• Limit visitors or simply tell them you need time with your baby. If he/she won’t latch, be patient. Try not to get upset or frustrated. 

Three “MUST-DO’S” if baby won’t latch:

• Hand express colostrum! By removing colostrum from your breasts it is telling your body to produce more now and also to continue making milk for the future.  In the first 1-2 days you’ll want to hand express every 2-3 hours around the clock. If your “milk” is in on day 3 you can choose to continue hand expressing or try pumping. Continue with breast massage and breast compression to encourage more milk. 

• Feed your baby! In the early days, this can be with a spoon, a medicine cup or a syringe. 

• Stay skin to skin! Direct skin to skin contact helps with bonding and keeps your baby warm. It also keeps their heartbeat and breathing steady while his/her food source is close by! It feels amazing!

Tips to achieve a good latch 

• Your nipple level to baby’s nose

• Ensure the neck is extended so the chin touches the breast first

• Tickle the babe’s top lip with your nipple 

• Be patient and wait for the wide open mouth

• Once opened like a yawn, bring your baby in extra close and seal the latch. Picture your nipple at the back and roof of your baby’s mouth

• Top and bottom lip should be flanged out, not tucked in

• Do not hold the back of the head.  Your hand can go at the shoulder blades for stability

Getting support with your latch is very important. Ask your nurses/midwives/doctors for help while you are in the hospital.  Sometimes hospitals will have a lactation consultant on staff. Don’t be afraid to ask for help as many times as you need. There are community supports such as Le Leche League and private practice lactation consultants to contact once you are home.  

Check out youtube videos such as:

How to Breastfeed - Deep Latch Technique

Global Health Media- Attaching Your Baby at the Breast

International Breastfeeding Centre- Breastfeeding Videos

Melissa Alexander RN, IBCLC, Mychelle Gagne RN, IBCLC

Edited by: Lindy Akins RN & mother of 3 breastfed babes

References

Biancuzzo, M. (2003). Breastfeeding the newborn: clinical strategies for nurses. St. Louis, MO: Mosby.

Brown, A. B. (2018). The positive breastfeeding book: everything you need to feed your baby with confidence. London: Pinter & Martin.

Newman, J., & Pitman, T. (2014). Dr. Jack Newmans guide to breastfeeding. London: Pinter & Martin.

Wiessinger, D., West, D., & Pitman, T. (2011). The womanly art of breastfeeding. London, England: Pinter & Martin.

1. Feed Early and Often

Attempt to feed your baby within the first 2 hours of delivery. The best way for this to be successful is to keep baby skin to skin with it’s mother until a feed has taken place. Direct skin to skin contact; no blanket, bras or clothes in between. The mother has colostrum after delivery up until around day 2-3 postpartum. Colostrum has been given the nickname “liquid gold” because it is rich in vitamins, minerals, disease-fighting proteins and so much more. Evidence indicates that early breastfeeding increases the likelihood of EXCLUSIVE breastfeeding for the first four months of life and overall duration of breastfeeding.

Unfortunately labour and delivery does not always go as planned. Don’t fret if you miss out on the early feed or the skin to skin- do it as soon as you can! If you are separated from your infant, hand expression is very useful in these times so that the baby can receive your milk. If possible, hand express as often as your newborn would feed or at least every 2-3 hours in the first couple days. Remember most babies will feed 10-12 times in a 24 hour period at this time. This is a great way to be able to provide colostrum and protect your milk supply. Consult with a Little Nursing Co Lactation Consultant if you are having difficulties and need some help. We are registered nurses and lactation consultants.

2. Night Feeds

Prolactin (pro meaning “for” and actin meaning “milk”) is the hormone that is necessary for the production of breastmilk. Prolactin levels DOUBLE when the your baby is suckling. And baseline levels are higher at night. So, higher levels + suckling= more milk production overall. Therefore, telling your body to MAKE MORE MILK!!

I know it’s exhausting to be up around the clock but feeding your baby at night is vital to your long term milk supply (and also help reduce engorgement). It is understandable that you want a good night’s rest, however it is unrealistic in the newborn period. Newborns should be waking to feed in the night, that is NORMAL! To make night time feeds easier, try to rest during the day and keep your baby close enough to you in the night that you aren’t fully waking to feed. In the early days avoid going longer than 3 hours between feeds. Those night feeds will pay off I promise! In the coming weeks you’ll have an abundant milk supply and your baby will be satisfied and growing.

3. Feeding on Demand

So, what does feeding “on demand” mean? It means, let your baby breastfeed until he/she is satisfied. Try not to watch the clock for length of feed or the interval between feeds. Watch your baby for signs of satiety which include: cessation of audible swallowing, increased “comfort sucking;” coming off or falling asleep at the breast; disappearance of hunger cues; arms and legs relaxed. Breastfeeding “on demand” leads to successful lactation and better infant appetite control. That is they don’t overeat.

Watch for those EARLY hunger cues! Did you know that crying is a LATE sign of hunger? Early signs are rooting, sucking motions, sticking out the tongue, hands to mouth. This is the optimal time for latching and feeding. It also gives you a chance to get that perfect latch while your newborn is not too hungry. High demands from your baby + increased supply from mom = more milk produced! The is how the supply and demand cycle works.

4. Hand Expression and Breast Compression

What is hand expression? Basically, it is expressing milk from your breasts with your hands. You may feel uncomfortable at first, as many of us don’t spend much time touching our breasts. There is no right or wrong way and don’t worry if you don’t get much milk out at first. That is normal with colostrum. Once you get your rhythm, milk will come easier and quicker. Every woman should learn how to hand express, just in case you need it! It is free and requires no equipment. Some women even prefer it to pumping. Hand expression can be done prior to, during and following the breastfeed. When milk is removed more often, your breasts feel soft and comfortable and produce milk faster. Frequent milk removal is the key to maintaining milk production whether you are breastfeeding or expressing. Here is a great Stanford video on Hand Expression of Breastmilk

What is breast compression? Breast compression can encourage your baby to keep actively feeding when their sucking has slowed down. Compressions are useful for sleepy babies, babies that don’t have a strong suck due to illness or cleft palate, or for babies who are not gaining enough weight. With your fingers underneath and your thumb on top, cup your breast using a C shape. Make sure all fingers are positioned away from your areola. You can go as far back as close to the chest wall. Gently squeeze your breast and this will give a little extra milk to encourage your infant to continue to feed. Move your hand around your breast to empty all the milk ducts until your breasts feel soft and you are comfortable. So many times I have seen mothers tickling their babies feet or stroking their head to wake them up to finish a feed. Teaching mothers breast compression and watching it work is so exciting! Breast compression can also be done during hand expression to increase your output. Visit Canadian Breastfeeding Foundation for more information on breast compression.

Melissa Alexander RN, IBCLC, Mychelle Gagne RN, IBCLC

View fullsize