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

​

Your baby has arrived and you are having problems breastfeeding. What should you do? Some of your knowledgeable friends suggest that you should see an IBCLC (International Board Certified Lactation Consultant). That sounds okay, but you want to know what to expect during a meeting with one. Here is what to expect if you choose to meet with an IBCLC from The MILC Group.

• The Lactation Consult  lasts about 1.5 - 2 hours whether in our office or in your home. 
• ​We make every effort to arrive on time and call or text you if we are running behind.
• We bring a high quality baby scale which we use to weigh your little one. 
• If we make a housecall,  we set up our scale on a flat surface (kitchen counter tops work great), otherwise we always have a scale in our office.
• We wash our hands thoroughly before we touch you or your baby and we also use non-latex gloves during our exam.
• We  ask you to fill in a brief intake sheet which can be found ahead of time on our website, but we always have them available to fill out in person.
• If baby is hungry, we skip ahead and weigh the baby so you can start to feed them. If baby is sleeping, we complete the paperwork before waking the baby to feed.
• We take a health history, talk about your birth and your breastfeeding experience so far and we ask some possibly odd seeming questions (we will always explain their purpose). We get a lot of insight into issues during this part of the meeting.
• We weigh your baby in a diaper only. We always ask you to put a clean diaper on your baby before the weight which stays the entire time for the most exact pre and post feed weight possible.
• The MILC Group IBCLC performs an examination of the baby including an oral assessment. We explain what we are doing as we do it so that you feel completely comfortable as well as to point out what we observe along the way.
• Getting you comfortable before nursing is important so we in your home we set up in whichever space you feel most at ease and in our office, you choose your spot and which pillows you want to use (or not use).
• We assist your baby in latching as needed and watch and listen as your baby feeds at the breast. We correct positioning as needed during the nursing session and make any other adjustments. 
• After the nursing session, we again weigh the baby to get an idea of how much baby has transferred at the breast. 
• All of this information will go into our assessment of what issues you may be having and we will write up a care plan for you to refer back to and to share with your care providers. 
• The MILC Group provides you with a Superbill for your insurance company to be reimbursed for our services.
• We take payment at the time that services are rendered. We accept cash, checks or credit cards. 
• It is extremely important to The MILC Group IBCLCs that all of your questions and concerns are addressed so we do not rush you through the appointment and we make sure along the way that you have time to ask questions. Feel free to have a list ready for our appointment :) 

We hope that this answered your questions about what to expect if you schedule a Lactation Consultation with The MILC Group. We look forward to meeting with you and your family!

​We can be reached by phone at 210-960-MILC/210-960-6452.

The topic of increasing iron intake for toddlers comes up often in our Support Groups. This recipe for a yummy quick bread was mentioned so I typed up the recipe for everyone to have. One tbsp. of blackstrap molasses provides 3.5 mg of iron. This provides half of the recommended daily intake for toddlers, and 13 percent of the recommended daily intake for pregnant women.

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!

What is the role of your Doula in supporting your breastfeeding relationship?  

I was reading a Facebook post recently about a mother's first birth/breastfeeding experience.  She made a comment similar to, "I did everything right.  I hired a doula, had a natural unmedicated birth, etc. and still had breastfeeding issues."  I thought to myself...what do mothers expect from their doulas in regards to breastfeeding support? 

Doulas are Childbirth Professionals which doesn't actually mean that they are Breastfeeding Professionals.  In San Antonio I am currently the only Doula that is also an International Board Certified Lactation Consultant (IBCLC).  Many of my fellow Doulas have made the effort to obtain additional breastfeeding education which is something I applaud them for and support them in doing.  I love being a resource for my fellow Doulas who come to me asking which programs I recommend or ask for guidance on their road to becoming more breastfeeding proficient.  

Two weekends ago my business partner Ginger and I taught a class to a group of newly trained Doulas on Breastfeeding.  We loved working with these new Doulas and we loved putting together the class.  Here is some of what we shared with those Doulas regarding the Role of the Doula in regards to Breastfeeding:

At your prenatal visits your Doula should...

• Discuss breastfeeding basics, skin-to-skin and how your birth can affect your breastfeeding relationship.
  
• Provide you with resources for local breastfeeding classes and support groups.
  
• Suggest breastfeeding books, dvds, etc. that would be helpful to you.
  
• Discuss your plans to go back to work and how that will affect breastfeeding.
  

At your birth your Doula should....

• Assist you with latching your baby.
  
• Make you comfortable and take care of any needs that you have while you are nursing.
  
• Ask the medical staff for assistance if you need it and she is unable to provide it.
  

At your postpartum visits your Doula should....

• Make sure that breastfeeding is going well.
  
• Make sure that you are taking care of yourself so that you can take good care of your baby.  Hydration, nutrition and rest are important to successful breastfeeding.
  
• Provide resources for lactation professionals if you need additional support outside of her knowledge.
  

What your Doula should NOT do....

• Provide assistance out of their Scope of Practice.  For example,  a Doula should not be doing an oral assessment on a baby unless she is a trained lactation professional and is working under that scope.
  
• Your Doula should not be in the way during your initial breastfeeding and should make sure that your partner is able to see what baby is doing so that they can assist you when no one else is around.  
  
• Your Doula should not be holding your baby for long periods of time.  Your baby needs to bond with you and your Partner.  Your baby should be learning your scents and tastes not anyone else's.  The Doula should never be center stage at a birth especially during early bonding.
  

Make sure that your Doula is covering the topics that we suggested and that they are not working outside of their Scope of Practice.  Working with babies is a delicate thing.  A newborn baby can start to go downhill pretty quickly if they are having issues with milk transfer or if you are having issues with your milk supply.  You should always consult with your Health Care Provider as well as with an IBCLC when you are experiencing breastfeeding difficulties.