Tag Archives : Breastfeeding


Momblog: when your breasts don’t work & low supply

breastfeeding_symbolIt is estimated that 95% of women who conceived naturally are physiologically able to breastfeed.  This means that, so long as the mothers nurse the baby(ies) on cue, their bodies will be able to produce the right amount of milk.   But this means that 5% of women cannot physiologically produce milk, cannot produce enough milk, or can produce milk but something impedes the milk from reaching the baby.   That’s 5 women out of every 100 who cannot nourish their babies 100%, no matter how much determination they have and no matter their desire to breastfeed.

The reasons are myriad, but reasons are both maternal and neonatal.  Let’s focus on the maternal side.  For the birth mother, they include long words such as:

  1. mammary hypoplasia
  2. insufficient glandular tissue
  3. breast reduction or augmentation
  4. breast injury damaging glandular tissue
  5. breast removal (mastectomy)
  6. thyroid or other hormonal imbalances
  7. PCOS or other auto-immune issues
  8. retained placental fragments
  9. late onset lactogenesis
  10. more…

When these mothers hear “I stopped breastfeeding because I didn’t have enough milk”, their hearts often break.   They may have tried and tried and tried.  But their bodies just didn’t produce or wasn’t able to provide what their baby needed.   And by no fault of their own. With accurate diagnosis, whether or not a mother is able to provide 100% of the baby’s needs for milk, even with intervention, cannot be estimated, each mother and each set of circumstances play a role.

For those who cannot feed 100%, they can seek out donor milk or use formula.  This milk can be offered in bottles using paced-feeding methods or in supplemental nursers such as the SNS or Lact-Aid.   The latter is particularly appealing to mothers as it promotes the intimacy of breastfeeding as the supplement is given at the breast.  In fact, with supplemental nursers, it’s even possible to “breastfeed” 100% of the time, even if you do not feed human milk 100% of the time.

No matter the method to offer supplements, many times these mothers are judged when they are seen to not be breastfeeding their children.  No mother should be judged.  Most mothers try the best they can with the information they have at the time. It’s especially hurtful, however, when the mother wanted to nurse but could not.

Low Supply & the Mother

In my work as a breastfeeding counsellor, I’ve met many women who said “I didn’t have enough”.   And probably 5% of these women had one of the above issues.   The other 95% had either “perceived low supply” or actual low supply, but low supply not based on a physiological inability to produce milk.   It was another issue.  Let me explain.

Perceived low supply often manifests itself from lack of confidence in one’s ability to nourish a child, from misinformation about normal infant behaviour & nursing patterns (see this blog about the 3-8 week crisis), and/or from cultural booby traps that set mothers up for failure, before they have even given birth.   In these cases, the mother’s supply is often fine, but circumstances lead her to believe she doesn’t have enough milk.  Without receiving accurate information & support at this time, parents often supplement their babies, the supplementation then reducing the baby’s time breastfeeding, thus interfering with supply & demand, ultimately resulting in actual low production and eventually early cessation of breastfeeding.

In other cases, breastfeeding gets off to a rocky start and low supply ensues due to misinformation or poor support.  For example, many parents have been taught that babies breastfeed every 4 hours, this idea repeated by family & friends (feeding “again”?) and even by health care professionals.  So they try to feed every four hours, even though they hear their babies asking for more before that time period (often forcing themselves to ignore their maternal instincts, which can dull that instinct long term).  Infants, however, don’t read watches.   If we try to manage breastfeeding by limiting a baby’s access to the breast (his all-in-one source of water, food, antibodies, comfort & love), the mother’s body will react by producing less.  And the fewer times baby nurses, the less milk the mother’s body will make.   If there is very early management of breastfeeding, the mother’s body may not reach its full production potential.

Low Supply & the Baby

Sometimes the baby isn’t able to “transfer milk” effectively, either due to an easily corrected latch or due to a physiologic issue, such as a high palate, tongue-tie, and/or lip tie.   If the latch isn’t fixed or the baby’s issue not corrected (with a tongue or lip tie release or cranial sacral therapy to work on the palate), the milk that is there won’t reach the baby, meaning the mother’s body will think the baby does not need the milk, so will respond by producing less, ultimately leading to low supply as well.

So what’s the point of this blog?   There are several:

  • Breastfeeding isn’t just about the milk!
  • Learn about breastfeeding & infant behaviour BEFORE the baby is born.   The production of milk is innate, the act of breastfeeding & babycare is learned.
    If you learn BEFORE (by reading and by attending mother’s groups where you can SEE mothers breastfeeding), when baby is here you’ll have a better idea of what’s normal & what’s not.  If something’s “not normal” you can get early help.
  • Get to know your body and breasts/nipples!
    Did your breasts grow during pregnancy?  Do you have hormonal issues?  PCOS? Thyroid?   Knowing about these things in advance mean that you can be prepared for a possible effect on supply.  You may also be able to act DURING pregnancy.
  • If you feel like you have low supply but wish to continue breastfeeding ASK a breastfeeding counsellor or lactation consultant or both!  They can help you figure things out and can suggest tips to up low supply IF this is the issue.
  • Some mothers truly cannot breastfeed 100%.  Know that paced-bottled feeding & supplemental nursers are an option.
  • If you want to stop breastfeeding as it’s not working for you (for whatever reason), think about how you talk about this choice.  Instead of perpetuating the idea that many mothers are not able to produce enough milk by saying “I couldn’t make enough” take ownership of your choice and give the true answer.

Comments?   Experience with low supply?   We’d love your comments below.

Need support?   Follow the facebook page “Supportive Community when breastfeeding doesn’t work out

 


Healthblog: Maternity Services in Switzerland – Postpartum Support

As mentioned in our post about Pregnancy & Birth in Western Switzerland, moving abroad whilst pregnant, or starting a family abroad, whether or not you speak the local language, is difficult and raises several questions about what to expect in terms of prenatal and postpartum support.

Living abroad, far away from family, the question “what support is available once baby is here” is usually a big one.  The Swiss healthcare system offers quite a lot in terms of medical support and it is possible to apply for practical help at home too.  Postpartum doulas are also available to offer emotional, informational, practical and other support around your home — which is especially helpful to expatriate families (and can be reassuring to Dads/Partners who return to work quickly after a baby’s birth).

To help you understand what is available, we’ve put together this post outlining the basics for Western Switzerland (i.e. between Geneva and Lausanne).  We also offer consultations to anyone who would like to discuss his/her specific family-dynamics or family history.   We can also help families figure out what THEY need and how they might go about finding such support.   We can also offer a prenatal consultation to any family who is considering hiring a postpartum doulas.

HEALTHCARE IN WESTERN SWITZERLAND AFTER BABY IS BORN
For Birth in Hospital or in a Private Clinic

The hospital’s midwives are responsible for your care whilst you are admitted.  Your doctor will normally visit at least once after the baby is born, as will your chosen paediatrician (if he/she does hospital visits, if not, it will be the paediatrician on call).  If, whist in hospital, you are having difficulties with breastfeeding, you can ask to see an IBCLC (International Board Certified Lactation Consultant) who can provide evidence-based and up-to-date breastfeeding advice.  Breastfeeding is a learned skill (lactation is innate), so don’t expect it to just “happen”, both you and your baby have to learn what to do.

Baby Nurseries (pouponnieres) are still common, though BFHI hospitals do not have them (they have neonatal observation rooms).  Rooming-in is standard in BFHI hospitals and available at other institutions but not necessarily promoted.  If you want your baby with you at all times, let the staff know.  Rooming-in helps the motherbaby dyad in various ways, including helping you get additional rest, which is why it has become standard in many maternity wards worldwide.

Returning home
You can stay in hospital up to five days (longer after cesarean births or in case of complications) or leave right away.  No matter when you decide to leave, once at home, your immediate postpartum care, and monitoring of your baby, will be the responsibility of an independent nurse-midwife (i.e. does not work within a hospital or clinic).   Your midwife will come to your home.  Your baby’s care is also followed by your chosen paediatrician or family-doctor.   The first visit to the doctor’s office is usually around one month.

Just like you select a paediatrician or family-doctor before the birth, it is also possible to select an independent midwife before the birth.  Expatriates often contact different midwives ahead of time, ensuring they find one who is available around their EDD, has similar cultural and parenting philosophies, and/or who speaks one of their languages.  If you haven’t talked to someone ahead of time, the hospital/clinic will arrange a midwife for you.

Within the first ten days of your baby’s birth, visits by your assigned/chosen midwife are covered by basic insurance.   As mentioned above, the midwife will come to your home (you do not need to go to your midwife’s practice or your OB/GYN’s office, unless of course the midwife has detected a problem).  If you are having problems with breastfeeding (which may manifest itself in baby not gaining weight), a visit by a lactation consultant (IBCLC) in the first ten days postpartum is ALSO covered by basic health insurance.  After the first 10 days postpartum, additional visits by an independent midwife or IBCLC are covered if accompanied by a prescription “ordonnance” (or if you have complementary insurance).  The level of coverage is dependent upon your insurer.

For Birth at Home or at a birth house/centre
If you chose a home birth or birth house/centre birth, your independent homebirth midwife will continue to be responsible for your care.   The care at the birth house or at home is covered by basic insurance (additional charges for lodging, etc. may apply).  After baby is born, your midwife will come to your home (once again, you do not need to go anywhere unless of course the midwife has detected a problem).  As above, if you are having problems with breastfeeding (which may manifest itself in baby not gaining weight), a visit by a lactation consultant (IBCLC) in the first ten days postpartum is ALSO covered by basic health insurance.  Telephone consultations with our breastfeeding counsellors is also available free of charge (though visits are charged and are not covered by insurance). You can call us or LLL for a list of English-speaking IBCLCs.

After the first 10 days postpartum, additional visits by an independent midwife or IBCLC are covered if accompanied by a prescription “ordonnance” (or if you have complementary insurance).  The level of coverage is dependent upon your insurer.

ADDITIONAL POSTPARTUM SUPPORT

Practical Help
If you think you need additional help at home following the birth of your baby, you can ask your doctor to prescribe “home help” (Services d’aide et de soutien à domicile).   To be claimed against your Swiss insurance,  you would contact either the AVASAD (in Vaud) or the IMAD in Geneva.  Help at home is especially worthwhile after caesarean surgery or with multiple-births.

Postpartum Doulas & Breastfeeding Counsellors
If you want a more tailored postpartum service, you may consider hiring a private postpartum doula who can offer help at home in the immediate days/weeks/months following the birth of your baby.  A postpartum doula’s role is to help the family adapt to life with a baby and become independent, confident parents, as such the services they provide are diverse.  They also usually work short shifts over a few days or weeks.  Postpartum doulas are especially helpful to expatriates who do not have local family support as they can provide the help traditionally offered by extended family, with additional help navigating parenthood in a foreign country & culture.

Breastfeeding counsellors can also be contacted for breastfeeding information and support.   They offer telephone support, support groups & workshops, and/or private consultations in your home.  Postpartum doulas and breastfeeding counsellors can often also help you navigate the Swiss maternity system and even translate documentation.

Baby Nannies / Baby Nurses
Families who are welcoming twins or multiples may want to consider not only a postpartum doula, but also a baby nanny or baby nurse.  Baby Nurses/Nannies help you take care of the baby (rather than the household) and when you are juggling two or three, it’s nice to have an extra set of hands (especially if one parent travels or is returning to work soon after the birth).

Parents’ Groups
Becoming a parent is a monumental life-changing event and it is very easy, especially for expatriates, to feel lonely or overwhelmed by the changes a baby brings.  To limit the feelings of isolation, there are many Groups, Clubs, Playgroups, and baby classes in Geneva, Vaud & Neighbouring France for mothers and fathers.  Sign up before the baby arrives so that you’ll have a group of parents to turn to once baby has arrived.