When The MILC Group first started out we ran a series that we called "JJs Nip Tips." They were named for an adorable chunky baby who we spent a lot of time with. JJ is now a rambunctious preschooler and we wanted to take a moment to pull together a list of our favorite Nip Tips and post an adorable updated pic of our chunky mascot. 

1. Breastfeeding isn't just about food. It is about love and closeness and more!
2. If you have breastfeeding questions, don't wait to ask for help. Have a list of local resources on hand before you deliver your baby.
3. A good latch is a good thing. Wide open relaxed mouth...lips flanged out...chin deeper into the breast than the nose. These are a few quick nip tips.
4. Don't forget that the best way to build your milk supply is to breastfeed your baby frequently. 
5. Breastmilk has a mild laxative effect that helps to prevent constipation. 
6. A supportive bra is one of the most important breastfeeding tools you can buy. Invest in a good one!
7. Breasts come in all shapes and sizes. Yours are perfect for your baby.
8. Remember, when baby is being fussy they are not trying to manipulate they are trying to communicate.
9. Finding a group of breastfeeding friends can be great for you and baby.
10. Make sure to take some time for yourself. A few quiet moments with a lovely cup of something warm can help to relax and rejuvenate you.
11. Nursing in a carrier can make things easier for babies on the go.​

If you need breastfeeding support you can contact The MILC Group here:
www.TheMILCGroup.com
210-960-MILC/210-960-6452

​

Low milk supply seems to be a main concern for today's breastfeeding mother.  I do remember mothers asking, "how will I know that my baby is getting enough?" and, "how much milk does my baby need?" back when my first child was born (19 long years ago).  The difference I suppose was that we were satisfied with the answers we were given and we never pumped to see how much our body was presumably making.  We relied on observing our baby. Today's mother seems to want more answers and to know exactly how much milk she is making.  Here is a brief overview of Low Milk Supply. 

When should we be concerned that our milk supply might be low?  

• Insufficient Weight Gain
  
• Babies are expected to gain approximately one (1) ounce per day for the first two months and then half an (.5) ounce per day until around six months of age.  Remember however that all growth charts are just guidelines to follow.  They were developed to help monitor the growth and development of a large amount of babies especially in poor areas to watch for anything going wrong.  Now we utilize them for every baby but often we put too much stock into those numbers instead of looking at the whole child.
  
• Lack of  bowel movements
  
• The first several days of life a baby's bowel movements are what we call meconium.  Usually by day four, the baby is transitioning to bowel movements that are lighter in color and moving towards yellow or brown and mustardy.  If baby is still having meconium bowel movements at day five, you should contact your health care provider.  During the first few weeks of life, a baby should have frequent bowel movements.  If a newborn baby goes more than 24 hours without a bowel movement, you should contact your health care provider.  After three weeks of age, the bowel movements may space out more.  As long as baby is happy and healthy there is no cause for concern. 
  
• Lethargic Baby
  
• Some babies are very relaxed.  Relaxed and lethargic are quite different.  We want to see a baby being "active and alert" at the breast when feeding.  Your baby should be moving actively, looking around, making noises, etc.  If your baby seems inactive or overly sleepy you may wish to contact your health care provider.
  

What can cause a low milk supply?
Maternal Concerns
*Note that the majority of maternal issues would be present from the onset of the breastfeeding relationship.

• Breast Surgery
  
• Breast reductions and augmentations would be the top of this list however biopsies, injuries and surgeries of other types fall into this category.  If you have had any of the above at any time you should consult with your OB/GYN and an International Board Certified Lactation Consultant (IBCLC) to discuss how these may effect breastfeeding for you and what you can do to improve your chances of being able to provide a full or partial milk supply to your baby.
  
• Insufficient Glandular Tissue (IGT)
  
• These breasts have less milk making tissue and so mothers who have IGT may need to supplement.
  
• Thyroid Problems
  
• Can cause issues with milk release.
  
• Diabetes
  
• Milk production can be affected if insulin requirements are not well managed.  Mothers who are diabetic can reduce their child's risk of developing both type 1 and type 2 diabetes in adulthood by breastfeeding.
  
• Polycystic Ovary Syndrome & Other Fertility Issues
  
• If a mother had issues preventing her from becoming pregnant without assistance these issues may also affect lactation.  
  
• Retained Placental Fragments
  
• Can occur even after cesarean birth. 
  
• Breastfeeding Mismanagement
• Most often IBCLCs find that milk supply has been reduced due to what we call breastfeeding mismanagement.  This can mean that either baby was not being put to the breast often enough (early scheduling or sleep training) or baby was at the breast but with poor positioning and thus unable to nurse effectively.

Infant Concerns

• Prematurity
  
• Premature babies may be smaller or have weaker jaws and may need assistance transferring milk in the beginning.  Usually these babies will become more efficient as they grow.
  
• Oral Concerns
  
• Tongue Tie and/or Lip Tie are the most common however there are other oral irregularities that can affect breastfeeding. Congenital malformations such as Cleft Palate and/or Cleft Lip can also make breastfeeding challenging and cause mom's supply to drop if baby is unable to nurse effectively.
  
• Muscle and Neurological Issues
  
• As with prematurity these babies may need help until they are able to develop their oral muscles more or may need continued assistance but can transfer a portion of their food at the breast.  Remember that breastfeeding is more than food.  The closeness and comfort for many babies will help them to grow and develop and provide comfort to both mom and baby.
  
• Chromosomal Disorders
  
• Down's Syndrome is among the most common.  Many Down's Syndrome children are able to breastfeed with little assistance but perseverance from their amazing mothers. 
  
• Heart Conditions or other illness
  
• These babies may be too weak to transfer milk effectively.  
  

What can we do?
With any of these concerns the first step would be to work with an experienced Health Care Provider (HCP).  This can be your OB/GYN, Pediatrician and/or an International Board Certified Lactation Consultant (IBCLC).  Who you work with depends on which issue you are dealing with.  While seeking out a professional who can assist you and working on a care plan you will want to:

1. Make sure baby is being fed.
   
2. Make sure you are protecting your milk supply by pumping and/or hand expressing in addition to breastfeeding.

Ways to Increase Milk Supply

• Increasing Milk Removal
  
• Breastfeeding more frequently, pumping more frequently and in general increasing the removal of milk from the breast.  Breast compressions may also assist with this.
  
• Assist Baby in Gaining Oral Strength/Developing Orally
  
• Working with an IBCLC you can develop a care plan to work with Pediatric Dentists, Pediatric Ear, Nose and Throat Doctors, Speech Therapists, Occupational or Physical Therapists, Chiropractors and/or Cranio Sacral Therapists to aid baby in gaining oral strength and function.  By doing this you will find baby is able to stimulate your breasts to make more milk.
  
• Bring Mother's Health into Balance
  
• Your OB/GYN or other HCP can work with you to check maternal hormone levels, thyroid function, etc. to bring mother's health into balance to assist her body in being able to produce more breastmilk.  This includes checking for retained placental fragments which must be removed.
  
• Utilizing Galactagogues
  
• Galactagogues are any substance that increases milk production.  These include herbs, foods and prescription medications.  A list of common galactagogues is below.   
  

Common Galactagogues

• Goat's Rue - Often used for IGT and Breast Surgery situations
  
• Shatavari - Often used for hormonal support
  
• Fennel - Often used for milk release problems
  
• Alfalfa
  
• Fenugreek
  
• Barley
  
• Brown Rice
  
• Oatmeal
  
• Domperidone (Motilium) - Often used to increase Prolactin
  
• Metoclopramide (Reglan, Maxeran) - Often used to increase Prolactin
  
• Metformin (Glucophage) - Often used to stabilize blood sugar
  

There are many great Low Milk Supply Resources.  Following is a list of just a few:
http://www.mobimotherhood.org/
http://www.lowmilksupply.org/
http://kellymom.com/hot-topics/low-supply/
http://www.llli.org/nb/nbmilksupplyissues.html

If you have questions or concerns about your milk supply we will be happy to meet and discuss those concerns with you either prenatally or after baby arrives.  www.TheMILCGroup.com  210-960-MILC/210-960-6452

Last summer Ginger and I had the pleasure of attending a wonderful workshop at the Texas La Leche League Conference.  We attended the daytime session led by Jaye Simpson, IBCLC and thoroughly enjoyed hearing in-depth information on "Structure and Function" as it relates to the anatomy of the infant and what could be contributing to breastfeeding difficulty.  That evening we attended a hands-on clinical session where we observed techniques and put them to work evaluating an infant.  We attended many other wonderful sessions in lactation education; however, the sessions taught by Jaye had the most impact on our work.  I would say that this information was so empowering and helped us to become even more confident in our evaluations of infants during our lactation consultations.  

This knowledge coupled with our years of additional training and experience would lead me to say that here in San Antonio we may be the lactation consultants doing the most thorough examinations of babies and catching oral and physical issues that other practitioners miss. This may be because they are either rushed through visits (often not by choice when the practitioner works in a hospital with limited time resources) or because they lack the extensive training that we have received.  Ginger and I continue to seek out courses that further our education and we are excited to team up with other lactation professionals in Central Texas to educate ourselves more fully on how different practitioners working together can get a baby nursing more effectively, gaining weight better and nipping (no pun intended) oral or physical issues in the bud before they effect a baby's later development.  

On our website www.TheMILCGroup.com we have compiled a short list of wonderful resources for parents who are seeking information regarding a possible tongue tie, lip tie or other oral issue in their baby.  We include practitioners who our clients have found helpful as we want all of our clients to have the best possible experiences.  We do suggest that parents seek out the guidance of a lactation professional to help them to decide what kind of practitioner will best serve their needs.  

If you suspect that your baby has an oral issue and would like to meet with us for a full evaluation you can contact us by phone at 210-960-MILC/210-960-6452.

For those parents not located in San Antonio, South Texas or the surrounding areas, we suggest that you seek out the support of your local La Leche League Leader or IBCLC to find resources to assist you with your breastfeeding issues.  We are always happy to support families who are not located near to us in finding the support that they need.

Human milk sharing has been around most likely since the beginning of time.  When women died in childbirth another woman would step in to breastfeed her child.  When one woman was away from her child another would breastfeed that baby in a sort of informal shared parenting agreement.  There were no bottles or breastpumps.  Other cultures still share breastmilk with each other as a way to survive.  Even here in the United States situations can arise where mothers are unable to provide breastmilk to their baby themselves but wish for their baby to receive the nutrition of breastmilk and so they enter into some sort of human milk sharing.

There are two basic types of human milk sharing.  Those are formal and informal milk sharing.  

• Formal milk sharing is done by utilizing milk obtained from a Milk Bank.  Milk Banks are facilities that collect human milk donations, batch process the milk and pasteurize it before sending it to families in need.
  
• Informal milk sharing is the sharing of breastmilk from one mother to another.  There are websites set up for milk sharing but often it is done via word of mouth or local area mothering groups.

Here at The MILC Group we as International Board Certified Lactation Consultants (IBCLCs) uphold very strict health standards.  We promote breastfeeding and support mothers in reaching their breastfeeding goals.  We provide information and resources. However, we do not facilitate milk sharing or act as a go between for mothers. There are risks to milk sharing. A great discussion of these risks can be found in this article, Milk sharing and formula feeding: Infant feeding risks in comparative perspective? by Karleen D. Gribble and Bernice L. Hausman.

Nipple shields....are they good or a bad?  There is so much conflicting information out there for moms so we thought we might try to clarify it.

Nipple shields have been used in one form or another for over 500 years!  Early nipple shield were made of:

• Silver - Can you imagine your baby latching on to a silver nipple cover??
  
• Wood - Ouch...watch for splinters!
  
• Lead - We all now know the dangers of this material to brain development.  
  
• Pewter - Similar in texture to the silver and must have tasted terrible.
  
• Animal skins - Probably the softest and maybe the most helpful.
  
• Ivory - Very high class but very rigid and I wonder how hard they must have been to make.  Poor elephants!
  

Fast forward to the 20th Century and we started to make nipple shields from rubber, latex and now silicone.  They have come a long way for baby and are much thinner now than ever before.  

We hear a lot about the possibility of nipple shield use reducing milk transfer.  This most likely comes from a 1980 study which had this finding.  The thing is that the nipple shields being used in 1980 and those being used today are quite different.  The much thinner silicone shield allows for much more feeling for mother and thus less reduction in milk transfer and production.  Some shields also have a cut out for the babies nose and this tends to aid in that touch component.  

We recently asked a group of moms why they used a nipple shield and these were some of their responses (paraphrased):

• We used it for a few days when baby wouldn't latch.  I think it kept baby at the breast.
  
• My baby was premature and it helped him to latch.  We then found a tongue tie once he was bigger.  We were able to stop using the shield once it was clipped.
  
• We tried the nipple shield due to a tongue tie but my baby didn't like it.
  
• I used a nipple shield because my nipples were flat/inverted at first.  We weaned off around 3 months.  I wish we had tried sooner.
  
• I had flat nipples and the shield helped my baby to latch.
  
• My nipples were very damaged and the shield helped my nipples to finally heal.  We used the shield for several months but now have weaned from it.  
  

Why Use a Nipple Shield?
Nipple shields can be a great tool if used with common sense. Good reasons include:

• Flat or Inverted Nipples - Many moms have no clue that their nipples are flat or inverted until they have a baby.  A shield can assist with early latching.  Note:  Some babies have no trouble with latching on a flat or inverted nipple!
  
• Premature Baby - Nipple shields are commonly used for these babies who struggle to latch.  The shield is often the only way that these babies can maintain suction.  They can be a tool that saves this breastfeeding relationship.
  
• Babies who prefer the bottle - When baby has been given a bottle in the hospital and is sent home not nursing a nipple shield can feel closer to a bottle nipple in baby's mouth and can help to transition baby back to the breast.
  
• Damaged Nipples - Some mommas have nipples that really take a beating in the early days of breastfeeding.  A nipple shield can be just enough of a barrier to help mom heal her nipples for a few days to get baby back to directly nursing.
  
• Tongue Tie - Some families choose not to revise a tongue tie.  A nipple shield can be the only way that baby will nurse until their mouth gets larger/stronger or until their  tongue does stretch a bit.  (There are lots of schools of thought here.  Not offering an opinion just a reason for the shield use).
  

Ultimately, there are usually underlying circumstances for which a nipple shield is being used.  It  is imperative that families visit with a trained lactation professional to figure out what is going on and to make sure that we take care of those issues.  Long term nipple shield use may be a challenge.  Often babies will not take a nipple shield as they get older.  Carrying a nipple shield with you at all times can be stressful and putting one  on with ease before latching baby in public can also cause mom undue stress.  

Helpful Links:

• To find a qualified lactation professional, you can visit the International Lactation Consultant Association website.
  
• When using a nipple shield, it is important to make sure you are offering lots of skin to skin time for baby.  
  
• Make sure you are attempting to latch baby directly at the breast often.  Here is a helpful video on latch.
  

This week I  had the pleasure of meeting with a local San Antonio pediatrician.  Her office had contacted us and asked for a meeting.  We were pleased that they had reached out but also wondered what they would want to chat about.  

Since we started The MILC Group late last year we have worked hard to market the business to local health care providers as well as the families that we serve.  We strive to have professional integrity and we want the families that we work with to know that we represent them and not the interests of any particular care providers.  We LOVE that our location is not affiliated with any particular medical practice and we don't pander to any certain medical practices.  When asked if we can recommend a pediatrician we give out several names often based on location but always based on our knowledge of how supportive those doctors are of breastfeeding.

Our chat with the local pediatrician went really well!  Ginger was not able to make it because it was smack dab in the middle of her busy time of day shuttling her kiddos around.  I was rushing that day from one thing to the next and came directly from the elementary school track meet so I was sweaty and feeling sunburned...lol.  At first it seemed like it might be a short chat and she asked me a few pointed questions.  We then started a more casual conversation about birth, her own breastfeeding experience, her own children's oral issues (or maybe what I thought they might be from hearing her descriptions of nursing issues), her desires for her patients, etc.  It turns out we are very much on the same page.  Bottom line...we both care about the health of our client's children.  We both feel that breastfeeding is extremely important in the development of that good health.  We both want to make sure that babies are being fed adequately.  I explained what we do during a consult and how we strive to educate our client's on the importance of the baby transferring milk well and what factors can impede that.  I talked about our desire to keep baby at the breast while still providing the baby with the proper amount of nutrition and if supplementation is necessary then supplementing with their own breastmilk is our first choice.  It was refreshing to hear a health care provider express such a clear interest in the care of her patients beyond the hot topics like vaccines, etc.  Our chat led me to want to write this little post and stress the importance of finding a supportive health care provider for your baby.  

Questions to ask when looking for a breastfeeding-supportive Pediatrician/Health Care Provider:
1.  What are your thoughts about breastfeeding?
2.  What are your thoughts about breastfeeding beyond 6 months? beyond a year?
3.  Do you have referrals to offer if I am in need of breastfeeding assistance? or are you an IBCLC?
4.  Do you have a list of local breastfeeding support groups that you could give me?
5.  If my baby needed to be supplemented would you go first to breastmilk or formula as a supplement?
6.  What percentage of your patients are breastfeeding exclusively at 1 month? 

How to know if a Pediatrician/Health Care Provider is NOT breastfeeding friendly:
1.  If they give you formula samples when you meet with them.
2.  If they tell you that breastfeeding and bottlefeeding are the same.
3.  If they advise you to stop breastfeeding because baby is sick or if they give outdated information about breastfeeding.
4.  If they act shocked that you are "still" breastfeeding at six months.
5.  If they tell you not to allow baby to fall asleep at the breast or if they push rigid sleep scheduling early on.
6.  If YOU ARE NOT ALLOWED TO BREASTFEED IN THEIR OFFICE OR WAITING ROOM.....RUN THE OTHER WAY!!

We are so happy to have many supportive health care providers here in San Antonio but are always looking for more.  If you have a great one, let us know!

In the last few days I have been answering lots of questions on the La Leche League USA Facebook page as well as my local LLL of San Antonio Facebook group.  It seems the majority of the questions are centered around milk supply.  Not a big shocker really.  It seems in this day and age mamas are always concerned about their milk supply.  Their baby can be super chunky, having a pee diaper every couple of hours and pooping up a storm, yet they are still worried.  

The modern nemesis of all lactation support people is.....the lactation cookie!  I see posts all the time on IBCLC and La Leche League Leader pages venting their frustration that the answer to every breastfeeding malady seems to be the lactation cookie.  I am right there with them.

• My baby isn't gaining weight well and my doctor wants me to supplement.....just eat some lactation cookies and your supply will skyrocket.  (Do we know why baby isn't gaining weight?)
  
• I was only able to pump three ounces at my last sitting what can I do?......just eat some lactation cookies and your supply will skyrocket.  (No mention that three ounces is a great amount to have pumped and a full feeding for a breastfed baby is two to four ounces.)
  
• My breasts don't feel as full as they used to......just eat some lactation cookies and you will instantly feel fuller.  (No mention that all mamas stop feeling "overly full" after their supply is established around three months for most mothers.)
  
• My baby has a tongue tie and I don't want to get it revised but I want to increase my supply.....just eat some lactation cookies and it will all be better.  (If that baby has a tongue tie and is unable to nurse effectively, increasing her supply will only lead to plugged ducts and mastitis since baby can't empty breast effectively.)  

Do you see what I'm saying?  The lactation cookie can only do just so much.  How can you increase your milk supply for real?

• Breastfeeding your baby frequently with a proper latch is the best way to increase your supply.  Look at how often you are feeding baby.  If you are scheduling feeds, consider allowing baby to feed on demand or decreasing the time between feedings.
  
• If baby's latch is not great, getting some help to work on that will make things much better.  So many mamas don't go back to their hospital lactation center after baby is born, but a visit there could make a world of difference.  
  
• Learning more about lactation such as how your breasts work, how much to bottle feed a breastfed baby, how much and how often to pump, etc. will relieve many of your fears.  
  
• Stop stressing.  Stress can decrease your supply.
  
• Stop listening to well-meaning family and friends that are making your doubt your milk supply.  
  

If you do all of the above and still want to eat some lactation cookies, go ahead.  Enjoy a cookie :)

The other night I sat down after teaching my Bradley Class and was relaxing in front of the tv.  It's my routine after talking for two straight hours to sit quietly and just veg out.  I opened up my Facebook and was glancing through notifications when I saw something so upsetting.  Literally my heart sank.  A "friend" from high school apparently was having a bad night and she decided that something in my Facebook feed pissed her off.  This is what I saw:

"And while I'm at it...can I bitch about how breast feeding nazis are up there with politicians, etc... hey, been there done that but you don't need to shove it down everyone's throats!! ‪#‎thatsallyoupostabout‬!!!‪#‎sickandtiredofseeingtitts‬!!!
‪#‎itspersonalandyourtakingawaythebeautyofit‬!!!‪#‎thisiswhyiunfreind‬#thisiswhyiavoidfacebook!‪#‎bythewayinever‬####!!!"


Now do you see why my heart sank?  I was so sad.  I have spent the last 16 years of my life trying to build women up.  Working to empower them in their choices as mothers and working with partners to aid in that empowerment.  I hope that I can support the family as it grows and changes.  I LOVE what I do.  I have worked with thousands of families in my roles as a La Leche League Leader, Birth Doula, Childbirth Instructor and Lactation Consultant.  This is my life.  

Why did I choose to do this work?  Quite simply because of the impact that those who worked with me had on my choices and the way that I have parented.  Our Bradley Instructor in Austin, Chan McDermott taught us to be proactive, intuitive, involved and informed.  My La Leche League Leaders, Beverly and Laurie Ann, showed me how to be gentle in my parenting.  I learned so much about breastfeeding but more so I learned so much about myself.  I still to this day quote things that they said to me.  I can not thank them enough.  Over the years there have been others who have influenced and assisted me in this journey.  I enjoy being the supportive educator to the young families that I now work with.  

I want to encourage everyone who knows me to happily unfriend me if I offend you.  If my posts are bothersome you do not have to be my friend on Facebook.  It will not hurt my feelings.  I am so blessed to have friends who support my career and passion.  I get so many positive comments from old friends.  Surprisingly my most supportive friends are often men who I have known since high school.  My own partner Matthew often sends me articles, etc. on topics related to breastfeeding, childbirth, etc. that he sees on BBC online.

Oh and just for the record....I support each and every one of you in the choices that you have made in parenting/mothering/fathering.  I do not like you any less because you chose not to breastfeed or you asked for an elective cesarean or you considered your epidural the best decision you ever made.  You don't have to defend those choices to me.  Those choices were yours and as long as you made them after being given good evidence-based information, I truly don't care.  I made my choices for me and not for anyone else and expect the same of you.  

How to handle breastfeeding during the Holiday Season....

This past week The MILC Group asked this question of our Facebook community.  We figured that we should go to the source (the moms)  for the best answers.  We gathered together their responses for this week's blog post.  The following are some ways that our MILC Moms dealt with the Thanksgiving Day preparation.  These tips could be applied to all of your upcoming Holiday Gatherings.

• Cook as much of the food ahead of time that you can.
  
• Take cooking shifts with your husband so that you can sit down to breastfeed baby while hubbie takes over.
  
• Go potluck!  Instead of taking on all of the responsibility this year spread the jobs out and do a potluck meal.
  
• Crock pot some of the Holiday meal.  Lots of things can be cooked in a crock pot.  Borrow a few extra crock pots if you need to.
  
• Let someone else host the gathering this year.  Give yourself a much needed break!
  
• If you are doing the cooking then make sure that you take frequent breaks to nurse the baby and to hydrate yourself.
  
• If you are dairy-free due to baby's food intolerances then plan ahead changing up ingredients and host the party so that you can be in control of the food.
  
• Lastly....let your family cook for you.  You can always host the party then sit back and watch everyone else work.
  

The Holidays can be a challenging time for a breastfeeding mother.  Feeling the need to "get everything done" while also meeting the needs of a baby can be quite stressful.  We want to encourage you to take care of yourself so that you can take care of your baby.  We often use the oxygen mask analogy.  On an airplane you are told to put your own oxygen mask on first so that you can then put an oxygen mask on your child.  This is done so that you are able to care for your child in that emergency situation.  In life we encourage you to do the same.  Your health and well-being are of paramount importance to your children.  Make sure that you are hydrating, resting, eating well and getting lots of snuggle time with your babies.  

If you have any questions about breastfeeding during the Holidays feel free to stop by and see us at our Breastfeeding Center.  We are always happy to help!