Thankful for Breastfeeding

Thankful for baby bliss.

Thankful for baby bliss.

Recently a client sent me a nice note with a generous check. She had been feeling gratitude for the help she received to breastfeed her son. There were multiple lactation consultations in her home, a frenotomy (the procedure to release a tongue tie) and body work for baby. There were many up-front costs–some of which were not covered by insurance. Here’s what she wrote: Continue reading

Choosing and Preparing Formula for your Newborn

DSCN1955You may be wondering… why is a lactation consultant writing about formula? Because in my world of breastfeeding difficulties including chronic low milk supply, mothers often find they need to supplement breastfeeding with another source of nutrition. Sometimes that’s donor milk from another mother, sometimes banked human milk. But most often it is commercially available formula.

All formulas are not created equal. There are pros and cons to various brands. There are milk-based formulas, soy formulas, organic, non-organic and special formulas. But the most important distinction in my mind is liquid vs powder. Why is this so important?

It turns out that powdered infant formula (PIF) is not sterile. The manufacturing process does not allow for elimination of all germs. In addition, preparation of the product in the home can lead to further contamination. The most concerning bacteria found in PIF is called Cronobacter bacteria.

Cronobacter bacteria is an organism that thrives in dry conditions and it’s very prevalent. The bacteria is found in dry herbs and spices, herbal teas, dry milk manufacturing facilities and household vacuum cleaners. It has also been found in waste water. It can thrive on plastics, rubber and silicone bottle nipples. Clearly it is difficult to avoid this little beast.

Becoming sick from Cronobacter is a rare event, but it can be deadly in young infants. Premature babies and infants younger than 2 months are most vulnerable to Cronobacter illness. Cronobacter illness can lead to blood infections or meningitis. According to The Center for Disease Control (CDC) there are about 4-6 reported cases of Cronobacter illness in infants per year, but it may be under-reported. Recently more awareness has led to higher reported numbers. There were 13 known cases in 2011.

Breastfeeding is the best protection against Cronobacter infection. If possible, provide your baby with breast milk—especially for the first 2 months. “Almost no cases of Cronobacter infection have been reported among infants who were being exclusively breastfed.” (Center for Disease Control and Prevention website).

If your baby uses formula, choose formula that is sold as a liquid. Liquid formula is sterile so is less likely to transmit the bacteria. This is especially important for very young or premature babies.

If you choose to use powdered formula, please do so safely with good hygiene in mind.

  • Always wash your hands prior to preparing formula.
  • Use clean tongs to fish the scoop out of the container. Wash the scoop after every use.
  • Clean bottles in hot dishwasher or hot soapy water plus sterilization.
  • Use only clean work surfaces when preparing the bottles.
  • Use hot water to prepare the powdered formula—at least 158 degrees F(70 degrees C) This temperature is necessary to kill the bacteria. Cool to room temperature before feeding to baby by placing closed bottle in ice bath.
  • If you make the formula ahead of time, refrigerate it immediately and use it within 24 hours.

The Center for Disease Control and Prevention: has more information on this topic. The World Health Organization (WHO) has created a PDF in several different languages that includes guidelines regarding formula and breastfeeding.

Baby Poop: A Story of Getting To Normal

Happy little guy!

Happy little guy!

Lactation consultants are not only interested in what goes into your baby; we’re also interested in what comes out! We like to see very frequent stooling that is yellowish in color with lots of chunky white curds. That is normal breastfed baby poop. If baby is not pooping frequently, or poop is a different color, that is not normal and we want to know why. Continue reading

The Lactation Consultation: What to Expect

This article was written in collaboration with Lyla Wolfenstein, B.S., IBCLC. Lyla is a lactation consultant in Portland, OR.

DSC9909-LA thorough lactation evaluation will probably be different than any other health-related visit you’ve experienced. It is time intensive, multi-dimensional, intuitive, experiential and often includes a bit of detective work. The International Board Certified Lactation Consultant (IBCLC) is the only health care professional that has the expertise and training required to perform such a specialized evaluation.

She (Lyla) is patient with new moms and has an ability to detect problems. She has creative solutions and never gives up on a client.

Continue reading

Finding a Lactation Consultant: How do you Choose?

This article was written in collaboration with my colleague, Lyla Wolfenstein, BS, IBCLC. Lyla is a lactation consultant in Portland, OR. 

I_DSC9271n an ideal world, every mother-baby dyad would have access to thorough, accurate, compassionate lactation support from the prenatal period through weaning. Sadly, this is not the case, and sometimes the “support” new families receive is fraught with error– informed by poor (or no) training. Continue reading