“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.

Guest Blog Article

By Dr. James Thomas, DDS, MS
Founder of the ​health:latch circle​ and the ​health:latch clinic

Dr. James Thomas, DDS, MS

Dear Moms,

We know how painful it can be, both physically and emotionally, if you and your baby are struggling with breastfeeding.

You may have heard about tongue tie and are wondering whether an oral restriction could be at the root of your breastfeeding challenges.

As a pediatric dentist who specializes in diagnosing and releasing oral restrictions in babies, I have had the honor of collaborating with amazing lactation consultants to support thousands of mothers and infants on their breastfeeding journeys.

This article will help you understand the basics of ​oral restrictions​ such as ​tongue tie​, how they can impact ​breastfeeding​, and ​what to do next​ if you suspect your baby could have an oral restriction.

What is an oral restriction?
Tongue tie is the common term for a medical condition called ​ankyloglossia​ that restricts the tongue’s range of motion. The most common types of oral restrictions are ​tongue tie, lip tie, and buccal tie. These conditions are conditions present at birth and impact the normal movement and function of the tongue and mouth​.

●  A ​tongue tie​ is when the band of tissue connecting the tongue to the bottom of the mouth is too short, too thick, or too tight, restricting the tongue’s normal range of motion.

●  A ​lip tie ​is when the tissue connecting the upper lip to the gum is too stiff or too thick, preventing the upper lip from moving freely.

●  A​ buccal tie ​refers to tissues that attach the inside of the cheeks to the gums, restricting normal movement.

How can an oral restriction affect breastfeeding?

Many oral restrictions are discovered and diagnosed due to difficulties with breastfeeding. An oral restriction can impair a baby’s ability to properly latch, suck, and swallow. If you are having issues such as mastitis, decreasing milk supply, or clogged ducts, or if your baby is having difficulty latching or losing weight, it is a great idea to check if your infant has an oral restriction.

What signs should I look for?

An oral restriction can hamper your baby’s ability to breastfeed, leading to important symptoms for both you and your baby.

You may notice that your baby is:

• acting irritable or fussy during or after feeding

• experiencing gassiness or frequently spitting up

• having difficulty creating a secure latch during nursing

• losing weight or having poor weight gain

• falling off the breast frequently during nursing

• frequent feedings without feeling “satisfied”

If you are nursing your baby, you may notice:

• breast pain

• plugged milk ducts (which can lead to mastitis)

• engorgement

•  cracked or blistered nipples

•  a feeling that your baby is chewing or biting on the breast

• recurrent thrush or infections

Of course, not all breastfeeding issues are related to an oral restriction. Your lactation consultant can help you find solutions to issues such as milk supply, positioning, shallow latch, inverted or flat nipples etc.

What does tongue tie look like in a baby?

When it comes to oral restrictions, there’s no “one size fits all” presentation. Oral restrictions are diverse in their appearance, which is why it is important to seek care from a healthcare professional who is knowledgeable about this condition.

How common is tongue tie?

It’s hard to say for sure because more research and better statistics are needed. Some research indicates that up to 10 percent of babies are born with an oral restriction and up to 25 percent of nursing infants can be affected by shallow latch caused by this condition. Many oral restrictions go undiagnosed even into adulthood, mainly because of the lack of education among healthcare professionals about this condition.

What is the treatment for an oral restriction?

Oral restrictions can be treated​ with a quick outpatient procedure to release the tie, sometimes referred to as a tongue tie surgery.

A release procedure known as ​frenectomy​ is usually done with a laser and may completely eliminate (“ablate”) the tissue restricting the tongue or lip. This differs from a ​frenotomy​, which is usually done with sterile scissors and involves “clipping” or “snipping” the tissue.

What types of healthcare professionals can help my tongue tied baby?

Lactation consultants are often the first to notice breastfeeding-related symptoms that could point to an oral restriction. Although they cannot diagnose, your lactation consultant can help you by referring you to a Proceduralist who can identify and treat the condition.

Proceduralists​ are trained and licensed to diagnose oral restrictions and perform the release procedure. They include dentists, doctors, naturopaths, nurse practitioners, and oral surgeons.

When is the best time to diagnose and treat an oral restriction?

As soon as possible! In the best of circumstances, a tongue tied baby can be diagnosed and treated shortly after birth. The longer we wait, the more problems can arise. For example, if a baby’s oral muscles are restricted and they compensate by using other muscles not intended for suck and swallow, the brain quickly memorizes these dysfunctional patterns. Thankfully, with the right support from healthcare professionals, after a release procedure babies can learn healthy suck and swallow patterns. Lactation consultants can provide critical support after a release procedure by helping you adjust your feeding plan and breastfeeding technique.

What causes oral restrictions?

As a fetus develops in the womb, tissue forms to anchor the tongue to the base of the mouth. Usually, this tissue dissolves naturally over time. At around the 12th week of pregnancy all that is left is a small, flexible tether. For reasons that have yet to be fully understood, in some fetuses, this tissue does not dissolve. These babies are born with an oral tether that is especially short, tight or thick.

Although much research is needed to better understand what causes oral restrictions, some evidence points to a genetic mutation known as MTHFR (​methylenetetrahydrofolate reductase)​.

Oral restrictions:

•  are conditions present at birth

•  appear to be hereditary

•  are common in babies who are born prematurely

• are common in babies who are born with other mid-line traits like “stork bite” birthmarks

What are the possible long-term effects of tongue tie?

Even small components (such as the tiny tether under your tongue) can affect the entire body over time. Oral restrictions can be indirectly related to a cascade of developmental issues in the mouth and even in the rest of the body.

If left untreated​, oral restrictions may affect your child’s:

• airway development

• breathing

• eating

• sleeping

• chewing

• tooth and jaw development

• oral hygiene

Much research needed to understand the long term effects of oral restrictions. Some specialists suspect that oral restrictions could play a role in serious, chronic conditions in adulthood such as sleep apnea, asthma and heart problems.

Trust your instincts

It is very common for parents to be dismissed, have their concerns be minimized, or told their baby is not tongue tied because their practitioner lacked specific training and experience in diagnosing oral restrictions.

At the ​health:latch circle​ ​we are advocates for parents and patients. We believe you know your body and your baby better than anyone. Listen to your gut and continue to ask questions until you are satisfied with the answers.

Next steps

As soon as you suspect that tongue tie is a possibility, or even better, if you just want a preventative evaluation - it's time to gather together resources and prepare for the decisions that you will have to make.

You need caring, kind, and knowledgeable professionals who can guide and advise you through the sometimes bumpy road of education, examination, diagnosis, treatment, and follow-up therapy.

Creating your circle of support

We created the health:latch circle as a place for parents like you to surround yourself with support and for providers to connect with parents.

The ​health:latch circle​ is a radically kind, community-based online platform that allows interested parents and professionals to learn together and connect to trusted professionals who are committed to helping families thrive.

Learn more about the health:latch circle and create your free parent account ​here.

Today we are delighted to talk about breastfeeding, formula feeding and sleep. We all love our sleep, right!? Probably the hardest thing about becoming a new parent is losing sleep and having to function the next day….and this can go on for weeks, months or even years! It’s no surprise that parents are desperate to find ways to increase the amount of their little ones sleep.

Parents often ask us the question, “if I give my baby formula, will they sleep through the night?”. They get advice from their formula feeding friends, grandparents and other relatives that they should “give them formula; they’ll sleep longer.” And if you do a google search you can find plenty of people backing this belief up. This results in many sleep deprived, desperate parents prematurely giving up breastfeeding or night weaning altogether, just in the hope of more sleep. So is this advice accurate - does formula feeding mean more sleep? This article aims to give you the facts so that you can make an informed choice that is right for you and your family. 

Firstly, let’s look at what biologically normal  sleep looks like. All children, and adults, sleep in cycles, and as they enter the light phase at the end of each cycle they may partially or fully wake. So no-one actually ‘sleeps through the night’ ever! As adults if we have a need then we can attend to it ourselves - but if a baby is hungry or thirsty (or has any other need) then they will signal to an adult to help them. And so until a baby is able to sustain a full nights sleep without needing food, they will wake and signal to their parent. The point at which this is varies from child to child, but the evidence suggests that many babies need food at night up to 18 months old. And so if your child is waking up and feeding several times a night, whether via breast or bottle, they are behaving completely normally, and you are not creating bad habits by feeding them.

So next let’s look at whether giving formula will mean that babies will wake less.  Formula fed babies can often take larger volumes per feed than breastfed babies, and this milk also takes longer to digest than breast milk . For this reason, some formula-fed babies do sleep for slightly longer stretches than breastfed babies. However, research confirms that although breastfed babies wake more frequently, breastfeeding mothers actually get more overall sleep. This is because of a combination of factors. Firstly, breast milk is full or hormones that help a baby feel both satisfied and tired - it is basically mother nature’s amazing tool to get babies back to sleep quickly and easily. Secondly, making up bottles is a bigger job for the mother - they have to get out of bed, go downstairs, make the bottle etc. This means that it often takes longer, and wakes the mother and baby more, than breastfeeding, which, as we’ve said can be very quick and easy. 

Remember also that babies wake for more reasons than just hunger - feeling cold, needing a diaper change, needing a cuddle - so even if you are bottle feeding, it doesn’t not necessarily mean they will sleep longer as if they have another need they will still wake up. 

Here are some other interesting points about breastmilk and sleep:

* Tryptophan is in breast milk and helps develop a babies’ circadian rhythm. This will help your newborn learn day from night. 

* Breastfed infants have more Non-Rapid Eye Movement (NREM) sleep than formula fed infants. NREM sleep, known as lighter sleep, is thought to protect infants from Sudden Infant Death Syndrome (SIDS). 

* Night feeds, in the early weeks, are especially important to build milk supply. 

* In cultures where co-sleeping is the norm, babies feed lots at night. Sometimes up to 4 times per night; taking in almost half of their daily amount of milk.  

So, in the end, if your baby is breastfeeding and this is working for you then, adding a bottle of formula isn’t guaranteed to help her or you sleep any better, in fact it can sometimes make things harder. But ultimately the decision as to how to feed your baby is yours, and you should do what is right for your family given the facts. Never feel pressured into giving up breastfeeding before you are ready, instead work on establishing good, healthy sleep habits with your baby.

Melissa Alexander RN, IBCLC

Sarah Mabbutt | Baby Sleep Well Program

Helping you reach success on your breastfeeding journey

We are all about creating confident, happy mothers here at Little Nursing Company. If you want to learn more about breastfeeding and babies you’ve come to the right place.

Our hope is to empower women through education and support. We want to be your village! Your tribe! A place you can come to be encouraged and feel proud of yourself!

• Are you a grandmother looking to support the new mother/grandchild in your life;

• Are you are a new mother;

• Are you are an experienced mother;

• Are you the partner of a breastfeeding mother;

• Are you are a healthcare provider wanting to support your clients;

• Are you a best friend who bottle-fed your own babies and are unsure how to support your friend.

Whatever the case, I hope this blog keeps you informed so you can be the best support possible.

Mychelle and I feel the best chance of success is through education. I hope you enjoy what we post. Learn more Prenatal Breastfeeding Basics.

“I'm not telling you it's going to be easy - I'm telling you it's going to be worth it.” ― Art Williams

Melissa Alexander RN, IBCLC

We’re excited you’re here!