Posts Tagged ‘Breastfeeding’
Friday, October 14th, 2011
 Fountain at Schönbrunn Gardens Vienna, Austria Breast cancer is the most commonly diagnosed cancer in women, aside from skin cancer. Approximately one out of eight, or 12% of all women will develop breast cancer in the United States. Next to lung cancer, breast cancer death rates are higher than any other cancer for women.
A new research report from the American Association of Cancer Research has revealed that breast milk may give reliable insight into a woman’s future risk of breast cancer.
Breast feeding women have been found to release abundant sloughed epithelial cells into their breast milk. Samples can be obtained easily from both breasts painlessly. These epithelial cells can be tested for cancer markers. Approximately 80% of all women will give birth at some point in their lives, making these cells readily available from a majority of women for testing in determining relative risk of the developing breast cancer. Ordinarily, in women who are not breastfeeding, would require aspiration of fluid from breast tissue which is both costly, painful and has a very low yield of cells.
The tumor marker that is being studied is the addition of certain ‘methyl groups’ onto specific genes in the DNA of these epithelial cells. It has been noted that the addition of these methyl groups disrupts normal cell function. Women who have increased risk of developing breast cancer have a high amount of methylation in these epithelial cells.
Also of extreme importance is the fact that the methylation of cells is possibly reversible. This would make it highly desirable to obtain early detection and possible treatment for women that have excessive amounts of these type of cells. Women who have excessive methylation can be followed more closely since breast cancer risk increases with age. The possibility of developing routine breast cancer screening tests for all women after they give birth may be a real possibility for the future since trials from the University of Massachusetts at Amherst, by Dr. Arcaro have demonstrated a safe, accurate and inexpensive way of obtaining this extremely valuable information.
Beaute de Maman has recognized the importance of breast feeding to both the baby and now to mom. Previous blogs on our website www.beautedemaman.com have discussed how breastfeeding can reduce the risk of breast cancer, ovarian cancer, osteoporosis and heart disease in women.
Beaute de Maman’s goal is to provide better and more effective high quality products to enable more women to breast-feed successfully and for longer periods of time, thus improving the health of their infants as well as their own well being. Our nipple gel has incorporated a natural, herbal, anti-bacterial and anti-fungal herb into the product that has antiseptic and anti-inflammatory properties, with the intention of preventing mastitis.
The base of our gel is a natural, omega 3 fatty acid which has been found to be important for brain and eye development in infants. The gel is easy to apply and can be left on the nipple until the next feeding. Beaute de Maman’s nipple gel contains no lanolin, no animal products and is kosher certified. Our aim has always been to raise the bar on available products for pregnant and breastfeeding women.
Tags: breast cancer, breast cancer detection, breast feeding, breast milk, Breastfeeding, breastfeeding women, breastmilk, early cancer detection, lactating, lactating women, nipple gel
Posted in Breastfeeding, Conditions & Diseases | 3 Comments »
Monday, July 18th, 2011
 One of our previous blogs “Just Do It” discussed sexuality both during pregnancy and the postpartum period. It was mentioned that it is not unusual for women to have decreased sex drive postpartum due to emotional and physical changes that occur after delivery. However, for those that feel up to the big event, avoiding unwanted pregnancy soon after delivering is highly desirable. Ovulation may occur as early as 25 days after delivery, but may take as many as 42 days after delivery. Because of the irregularity in bleeding both in breastfeeding and nonbreastfeeding women, using reliable contraception is even more critical in avoiding an unwanted pregnancy. I thought this would be a great opportunity to discuss with my readers the brand new “hot off the press ” guidelines published by the CDC on July 8, 2011 concerning the revised recommendations for the use of contraception immediately following delivery.
Is the pill safe to use immediately after delivery?
New recommendations by the CDC (Center of Disease Control and Prevention) are that women less than 21 days postpartum not use combined hormonal contraceptives, combined hormonal patch, or combined hormonal vaginal ring. Barring other medical risk factors it is deemed safe to use these methods after this time frame.
What are the risks for using hormonal contraception immediately postpartum?
Oral contraceptives normally cause a slight increased risk of venous thrombosis regardless of pregnancy status.
Postpartum women carry an additional risk of DVT of 22 to 84 fold higher compared to women that were not pregnant in the exact same age group. This added risk is greatest immediately after delivery and declines after 21 days but reaches baseline only after 42 days. This increased risk is probably related to the increase in coagulation factors due to elevated hormone levels. In addition, women that are obese, immobilized due to a cesarean section, age over 35, previous history of blood clots, have had postpartum hemorrhage, preeclampsia, smoking, or previous history of a clotting disorder (thrombophilia) adds even greater risk to the formula.
Does risk of venous thrombosis change depending on whether you are breastfeeding or not?
No, regardless of breastfeeding status, combined oral contraception should not be used within the first 3 weeks after delivering.
Are there other forms of contraception that can be used safely?
Progesterone only pills, progesterone shots, contraceptive implants, intrauterine devices (IUD’S), and condoms can be used safely immediately after delivery.
IUD’s are not recommended in any woman who developed infection after childbirth. IUD’s, both copper-bearing and hormone releasing, can be inserted within 10 min or later after delivery of the placenta.
The cervical cap or the diaphragm can be used generally within 6 weeks of delivery when the cervix has returned to its original configuration.
What are the effects of combined oral contraceptives on breastfeeding moms?
There is no effect on infant weight between breastfeeding mothers using oral contraceptives and those who do not. No adverse effects have been demonstrated on infants exposed to combined oral contraceptives through breast milk although there are few very good, reputable studies. There may be some variation in milk production in women who breast feed and use oral contraceptives.
Summary:
Use of combined oral contraceptive pill within the first 21 days postpartum is not recommended due to the increased risk of venous thrombosis and the unlikely possibility of pregnancy risk at this time.
Women with additional risk factors (under 35 and smoking, postpartum hemorrhage, postpartum transfusion) use of oral contraceptives returns to baseline only after 42 days postpartum and initiation of therapy should wait beyond the 3 weeks. Mothers with a history of pulmonary embolism, cardiomyopathy postpartum, thrombogenic mutations, and previous DVT should not use oral contraceptives postpartum altogether.
Tags: birth control after birth, birth control after delivery, birth control after pregnancy, birth control pill safe after delivery, birth control pill safe while breastfeeding, Breastfeeding, contraception, contraception after birth, contraception after delivery, contraception after pregnancy, contraceptives after birth, contraceptives after delivery, IUD, IUD safe after delivery, oral contraceptives, post partum, sex, sex after pregnancy, sex drive after pregnancy
Posted in Miscellaneous, contraception | No Comments »
Sunday, September 26th, 2010
NEWS RELEASE
Abbott Laboratories has voluntarily recalled up to 5 million containers of its popular powdered Similac infant formula after finding evidence that beetles had possibly contaminated it. The U.S. Food and Drug Administration cautioned that tiny insect parts could irritate babies delicate digestive tracts, and might make them refuse to eat. Dr. Brown, founder of Beaute de Maman, is sharing this information with all her web OB readers who might be using this product or are considering switching from breast milk to this product.
“So far, no major repercussions have been reported for infants drinking the contaminated formula, but we wanted to pass this information along to all our readers as quickly as we could,” said Dr. Brown.
For more information on how to look up the particular lot numbers that are involved or how to return a product, readers can view www.similac.com/recall.
The powder was sold throughout the United States, Puerto Rico, Guam, and certain Caribbean countries.
Dr. Michele Brown, OB/GYN, is the founder of Beauté de Maman, a leading personal care products company for pregnant women and new mothers. For more information about Dr. Brown or Beauté de Maman, visit http://www.beautedemaman.com/web-ob/
Tags: baby feeding problems, baby formula contamination, Breastfeeding, contaminated baby formula, formula recall, infant safety, similac recall, voluntary recall
Posted in Infant & Pregnancy Safety | 2 Comments »
Tuesday, August 31st, 2010
 As an OB, my patients ask me just as many questions about breastfeeding as they ask about pregnancy itself. I don’t mind at all because it is such an important topic. Over the years, I have scribbled many of these questions in my notebook so that I could research the most current information for new mothers eager to learn how to feed their babies the natural way.
 Now, these questions are the basis for this week’s blog which is written just for you, with a completely different mindset and format than all my previous articles. Before writing however, I decided to interview the head lactation consultant, Ms. Renate Abstoss at Stamford Hospital in Connecticut, to get a second opinion and gather her responses. Ms. Abstoss sat for the first International Board Exam for Lactation Consultants in 1985 and has continuously worked in the field since that time in California, New York, Germany, Austria, Switzerland, and Connecticut. She was the first lactation consultant appointed as State Certified Teacher for Bavarian Midwifery schools.
There are probably many variations of responses to these questions so please consider this information helpful, but not absolute. I welcome any additional “pearls” from other lactation consultants or experienced moms so we can share the knowledge and promote the best nutritional health for babies everywhere.
- What are the most common problems that women encounter when pumping?
Dwindling milk supply is probably the foremost problem that women encounter when pumping milk. This can be attributed to many different factors.
- Infrequent pumping
A working woman should try and pump every 3 hours for 10 to 15 minutes or at least for every missed feeding.
- Inefficient pumping
Pump being used may have inadequate pressure or not enough cycles per minute causing a decrease in the milk supply.
- Lack of breast feeding
Even when mom is home from work, she should try and breast feed the baby to stimulate milk production. For convenience, babies may be bottle fed too frequently.
- Painful nipples
This can be due to a bad pump due to excessive suction pressure, pumping for too long a period of time, or poor latch when the baby does breast feed.
- Fatigue and exhaustion
The stress of taking care of a newborn along with pressure from work and home can result in exhaustion and fatigue which can decrease the milk supply.
- How do I increase my milk supply?
There are several medications and herbal products available to help with increasing the milk supply. To increase an existing milk supply, one can take two herbal supplements in combination fenugreek and blessed thistle, both of which are available in health food stores and have no known contraindications.
The two most commonly used prescription drugs are Metoclopramide and Domperidone both of which were designed as stomach medications but were found to increase prolactin production in the brain. The medication Domperidone, (Motlium) is not approved for use in the United States and the FDA has issued warnings against the use of this drug as a galactagogue because in higher dosages, when given intravenously, Domperidone it was associated with cardiac arrhythmias and cardiac arrest. However, the small dosages that are used when given orally to increase lactation (30–40 mg/day) and for the short duration of three to six weeks does not seem to be a great concern. Patients generally obtain this medication from Canadian pharmacies or from Mexico and Europe where it is over the counter. Studies are now being conducted by ILCA (International Lactation Consultant Association) regarding the safety of domperidone.
Metoclopramide (commonly known as Reglan), used to treat severe nausea in pregnancy, has been known to have a side effect of depression so its use has to be carefully monitored in the postpartum mother. The drug can be detected in breast milk and the long term side effects to infants is unknown.
- How do I treat plugged milk ducts?
Milk ducts that do not drain can cause the milk to back up resulting in a plugged milk duct. Often the the surrounding breast tissue becomes hardened and inflamed. This area can eventually become infected resulting in a mastitis requiring antibiotic therapy. Plugged ducts often occur when:
- Mom misses feedings
- Mom fails to pump frequently
- The breast fails to empty
- Nursing more frequently
- Changing positioning
- Improving the latch of the baby (sometimes a shield is necessary). A lactation consultant would be very instructive in this situation.
- This can be a result of incorrect positioning, inadequate pressure from a pump, or restriction of milk flow from poorly fitting bras or any kind of breast trauma that damages the duct. Fatigue, stress, or failure of the baby to latch on properly can also contribute to this problem.
- Standard Treatment consists of moist heat beforehand for approximately 5 minutes, empty breast as much as possible, cool compresses afterwards, and reduce swelling in between feedings. Massaging the duct towards the nipple may also be helpful. If the plug comes out, it may look like dried milk in a string. One should continue to nurse to fully clear the plug. Apply cold compresses via an ice pack or a plastic bag of frozen peas for approximately 15 to 20 minutes. Fresh cabbage leaves to the area is another herbal remedy that can be used in between feedings to help with engorgement. Cabbage leaves can be left in the bra for approximately one hour until it wilts. It is important to avoid the nipple area when applying the cabbage leaf because the cabbage is caustic and can cause irritation.
- Other helpful treatments include:
- What do I do if the baby does not latch on?
Latch problems can depend upon the situation causing them:
- It may be due to a newborn who is just learning how to latch.
Assistance from a lactation consultant can be very helpful in making sure the baby is latched deeply with a mouth very wide to get all the breast tissue. The baby should be latched well beyond the tip of the nipple. Often latching problems occur because the baby fails to flare the bottom lip.
- Is it due to flat or inverted nipples?
If the problem is due to flat or inverted nipples, a suction device, pump, or nipple shield may be used to avoid engorgement by expressing the milk. This will avoid a lowered or disappearing milk supply. Different lactation consultants and hospitals may prefer one modality over another, however all agree that care has to be taken when using any device that serious trauma or damage does not occur to the nipple.
Once the baby is “educated” that the breast is his or her “food supply”, generally the baby will nurse fine. It is helpful to try and get beyond the first few days when only colostrum is present, until the milk comes in. Try and avoid avoid artificial nipples at the very beginning.
- Is the baby not hungry at this time?
- Is there a nursing strike?
A “nursing strike” can occur if a well nursing baby, beyond the newborn period suddenly refuses to nurse. This can occur often after 4 months of age when a mother will state “my seven month old baby just suddenly weaned herself.” These babies are not weaning but are actually facing a situation where nursing has become unpleasant, boring, or painful. Often these infants need to be taught to return to a functional breastfeeding pattern with increased skin to skin contact, trying to nurse in a quiet, calm environment without distractions, such as nursing at night in bed. Bottles should be avoided but spoon or cup feeding with expressed milk is acceptable. If the underlying cause is treated, most babies will happily go back to their normal nursing pattern.
- Is the baby getting sick?
Causes of poor latch can be an undiagnosed ear infection, a urinary tract infection, or an upper respiratory infection. Check with your pediatrician to be sure an illness is not being missed. Maternal stress can also cause this problem.
Regardless of the problem, it is important to remove the milk as efficiently as possible if an established supply exists to avoid engorgement which will lower or cause the milk supply to disappear.
If the baby is not latching, it is important to stimulate the establishment of milk production through use of a pump.
- How do I wean the baby when I have decided to transfer to a bottle?
Weaning is the time the baby transitions away from the breast. Time frames for weaning can vary from weeks to months.
Slow weaning is always more optimal. Some mothers will use the pump for weaning and stop breastfeeding entirely. One option for weaning would be to reduce the time per pumping, ie instead of pumping for 15 minutes, reduce it to 10 minutes. This can gradually be dropped down to 2 to 3 minutes per session. An alternative way to wean is to increase the interval between pumping sessions, ie from every 3 hours to every 4, 6 or even 8 hours. If desired, one can use ice packs after pumping for comfort. Also, Motrin can be used for anti-inflammatory pain relief. A comfortable, tight bra can also help with support and relief. Nursing pads can be used to prevent excess leakage. A recommended herbal remedy can be drinking 3 cups of sage tea which is available in health food stores. It has a strong and astringent taste so adding honey makes it more palatable. Do not use this if currently pregnant since it has abortive action.
On occasion, sudden weaning becomes necessary. Discomfort is generally greater since the breast continues to make milk and the breast remains engorged. Nursing can be replaced with pumping but only pump the breast to allow comfort and not to completely drain. Increase time frame between pumpings.
Three days of Sudafed can help dry up the milk production. The milk supply decreases as you feed less. The milk quality also changes becoming more salty and colostrum-like which many babies do not like. Consequently, this also helps diminish the nursing.
Tags: Bavarian Midwifery school, bfeeding, bottle feeding, breast engorgement, breast engorgment, breast feeding, breast milk, breast pump, Breastfeeding, breastfeeding FAQ, cracked nipples, doctor answers questions on breastfeeding, Domperidone, drug can be detected in breast milk, engorged breasts, galactagogue, healthy baby, increase lactation, International Board Exam for Lactation Consultants, International Lactation Consultant Association, is the baby latching, la leche league, lactation, lactation consultant, latching on breast, Metoclopramide, Motlium, Ms. Renate Abstoss, nipple gel, nursing an infant, nursing mother, painful nipples, pumping milk, questions on breastfeeding, Reglan, sore nipples, Stamford Hospital, weaning the baby
Posted in Breastfeeding | 4 Comments »
Monday, August 23rd, 2010
 Let’s face it. A breast pump is not the most romantic, or glamorous, piece of equipment ever invented. They can be bulky and uncomfortable, hard to clean and very expensive. Even worse, when lifted out of their boxes, they may seem extremely intimidating to use on something as delicate as our breasts. Personally, I would rather spend this kind of money on a cute Kate Spade purse, or a nice pair of Gucci pumps… not a breast pump!
Does a breastfeeding woman really need one of these things?
The answer is maybe…
It’s a well known fact that breast feeding has significant benefits to both mother and baby. (Breast Feeding Experts Weigh in on SIDS)(Breastfeeding Cuts Breast Cancer Risk)(Breast Feeding Can Reduce the Risk of Heart Disease) Previous blogs discussed how over 60% of the 4 million pregnant women in America are currently employed and the majority will want to return to the workforce soon after delivery. (Is Pregnancy a Disability?)( Breastfeeding and the Law) This should not be a deterrent for breastfeeding and therefore, it becomes extremely important for women to be encouraged to continue to breastfeed their newborns in a safe, efficient, and effective way while still carrying on their daily work lives. Since women are not available for demand feeding, it becomes vital to know how to use a breast pump so another caregiver can provide milk for the newborn. The blog this week will deal with the nuances of choosing the correct breast pump.
Who should use a breast pump?
Learning how to use a pump is important in the following situations:
- Women returning to work and not available for feeding.
- Premature infants lacking a good suck reflex can benefit from breast milk that is pumped making it easier for them to feed.
- Mom is unable to breastfeed due to sickness.
- Infants having difficulty removing milk from the breast due to anatomy when other techniques to correct fail (flat or inverted nipples of the mom or a facial abnormality in the infant).
How does the breast pump work?
Pumping milk from the breast has its origins from the dairy industry in the 1950”s by Einar Egnell. Pumps have been designed to simulate the sucking action of a nursing infant by mimicking both the suction pressure and the frequency of a baby’s suckling. Pumps are designed so that the amount of pressure and the cycle frequency can be regulated by the mother.
The volume of expressed milk with a breast pump is higher compared to manual expression.
Pressure
The pump has to have enough pressure to extract milk from the breast but not so high that it causes pain and skin trauma. The pump relies on the physics of a fluid moving from an area of higher pressure to an area of of lower pressure. The breast pump creates a pressure differential with negative pressure on the breast reducing the resistance to the outflow of milk from the milk ducts of the mother, which is at a higher pressure. Babies breast feed with a suction pressure of 50–220 mm Hg so the pumps are designed to suck at maximum negative pressures at about 220–250 mm Hg. Levels at less that 150 mm Hg are ineffective in emptying the breast and pressures greater than 220 mm Hg cause nipple pain which will result in the mother terminating her breast feeding.
Pumps can vary in the configuration of the flange (cup applied to the breast). The smaller the cup, the more pressure is exerted over a smaller area of space.
Frequency
The other important factor is the length of time the vacuum is applied. Babies suck at a frequency of between 40 and 126 sucks per minute and pumps are designed to mimic the breast by pumping at 40–60 cycles per minute.
How do you select the proper breast pump?
There are so many pumps available today with countless cycle and suction settings, different sizes, power sources, single vs. double set-ups and varying prices that it becomes a great enigma in choosing the right one for an individual. Important considerations in choosing a breast pump include baby’s age, mother’s work needs (full time or part time), support from the mother’s work environment, mother’s finances,and family’s health insurance. Price differences can be based on the durability of the motor, length of the manufacturers warranty, style of packaging, personal amenities, and have single or double set-ups.
Talking with a lactation consultant before you leave the hospital can help you sort through the morass of information. Many pumps are generally not refundable once used so trialing in the hospital or through a lactation consultant may be a good idea. Here are some of the factors to consider when deciding .
Price
The cost of a breast pump is approximately 1,500 dollars for a hospital grade variety to about 150–350 dollars for a personal use style. Prices will increase depending upon the accessories that are packaged with it. Pumps can also be rented for from 30 to 75 dollars per month. but mothers will need to buy all the accessories which include bottles, tubing, and breast flanges for about 50 dollars. If plans are to pump for several months, it may be more valuable to purchase one. Personal breast pumps in the long run are cheaper than formula which can run over 2,000 dollars a year.
Single vs. double pumping
Bilateral pumping is quicker and use more powerful machines with greater cycles per minute and use more pressure to express a greater amount of milk in less time.
For women that use a single pump, the breast should be switched every 5 minutes. It may take 15 to 20 minutes as opposed to 10 minutes with a double pump.
Power source
Electric pumps produce the most milk, followed by battery operated pumps and finally hand pumps. Some pumps have car adapters. For a non-working mother who does occasional pumping, a hand pump or small battery operated pump can work well. Try to make sure the pump has a one year warranty on the motor.
Other factors to consider
Noise level, ease of use and assembly, and difficulty in cleaning are also variables that must be considered when choosing a breast pump. Also ease of obtaining spare parts is a consideration.
Other accessories
Some pumps have more discreet carrying cases to make for easy transport. Also some packages contain gel or ice packs to keep the milk cool.
Different Categories of Pumps
Hand pumps
Two different types exist:
 Milk can be pumped from many kinds of mothers. This one has four spigots instead of two.
- Cylinder pump—Has a double cylinder set-up with suction created by pushing and pulling one cylinder inside the other.
The main problem can be the gasket inside which may need replacement because of shrinkage or its inability to maintain a seal after continued use. The gasket can also harbor bacteria.
- Hand squeeze pump— Suction is created with a hand lever that is squeezed and released.
The advantage is that it is portable, easy to use, quick to assemble, no need for electricity, and is inexpensive.
The disadvantage is the difficulty in obtaining a good milk supply due to difficulty in cycling at baby’s normal suck reflex. Many have a poor suction or excessive suction. Women can also fatigue easily with continued use, especially those with wrist problems or carpal tunnel syndrome (very common in pregnancy.)
Semi-automatic pumps
These pumps can be used manually, with a battery or with an electric adapter. The motor is generally small and not meant for frequent use.
The advantage is that they are portable, lightweight, small and do not require electricity. They can be double and often come with a cooler case.
The disadvantage is that they are not meant for heavy use and are not very durable. The short battery life can be expensive. The cycle frequency slows as the battery wears down. Some can also be noisy.
Personal use electric double pumps
These are automatic, light weight, durable, portable, and double-pump with controls to regulate the pressure and frequency for comfort. They generally include chill packs and storage compartments. They are run by electricity but can have battery and adapters included.
Hospital grade rentals
These are the most powerful and effective with different control settings for suction and frequency. They are the most expensive. Physically, they are large and heavy, and not meant to be portable. Therefore, there is no carrying case and no compartments for storing milk. They run on electricity. They are designed to be multi-user and you must supply your own collection kit which generally must match the pump brand.
Are there FDA standards for breast pumps?
In the United States, there are currently no standards for breast pumps to ensure the safety and quality of the products. However, the FDA does consider personal (not industrial) pumps to be used by one person only. Unfortunately certain pumps are impossible to clean and can produce high bacterial counts making a woman more prone to infection which is a reason not to buy or share a used personal pump.
Summary:
Choosing the right breast pump depends upon the individual needs of each mother. Factors to consider include the home and work situation, the amount of use, and cost factors. The assistance of a qualified lactation consultant is indispensable in guiding a new mom in choosing what works best for each given situation.
Tags: breast feeding, breast milk, breast pump, Breastfeeding, cracked nipples, healthy baby, nursing mother, working mothers
Posted in Breastfeeding | 3 Comments »
Tuesday, August 3rd, 2010
Renate Abstoss IBCLC
 While life does sometimes becomes a juggling act, most of us have learned how to keep all the balls in the air. For a new mother with a job outside the home, however, the simple desire to continue breastfeeding her baby may seem impossible.
Don’t give up!
It’s a well known fact that breast feeding has significant benefits to both mother and baby. I have written several previous blogs addressing these benefits. Just last week I wrote about how 60% of the 4 million pregnant women in America are currently employed and that the majority of these new mothers will want to return to the workforce soon after delivery. This should not be a deterrent for promoting optimal infant health and therefore, it becomes extremely important for women to be encouraged to continue to breast-feed their newborns in a convenient way while still carrying on their daily work lives. Since women are not available for demand feeding, it is vital they know how to use a breast pump and how to store milk so that another caregiver can provide milk for the newborn. The blog this week will deal with the proper way to store breast milk.
What is the length of time that I can store milk?
Breast milk storage follows the rule of 3:
- Freshly pumped breast milk at room temperature (77 degree F or 25 degree C) should be used within 3 hours.
- Freshly pumped breast milk that is refrigerated (39 degree F or 4 degree C) should be covered and used within 3 days.
- Freshly pumped breast milk can be frozen (4 degree F or -16 degree C) for up to 3 months. (Check your home freezer for temperature—freezers may run as low as 0 degrees F and deep freezes may run at -10 degrees F.)
Can I refrigerate or freeze milk after it has been sitting out for the 3 hours?
No. One cannot follow one step after the other. The milk is at the end of its shelf life after one of the above 3 steps is followed. However, if small amounts of milk are pumped at a sitting, it is possible to put the freshly pumped milk in the refrigerator to cool and then immediately add it to frozen milk in order to obtain the accumulated 4 oz. feeding. The milk will often freeze in layers and needs to be shaken before use. Shelf life is determined by the older milk in the container. Some sources suggest using the milk for longer periods of time, but often the taste of the milk deteriorates due to breakdown of flavonoids, which may cause the baby to reject the milk. The taste deterioration occurs before the milk becomes contaminated due to elevated bacterial counts.
What guidelines should I follow for freezing milk?
Similar to the way food stock is rotated in a supermarket, the newest milk should be placed in the back of the freezer where it is colder and older milk moved to the front, as a reminder to use it first. Dates should be placed on the container. If frozen for storage in a day care center, place the baby’s name on the container. Freezing in small allotments of 2 to 4 oz. is recommended since it takes less time to defrost and less is wasted if the baby is unable to finish the feeding. Leave room at the top of the container when freezing since liquid expands when frozen.
Disposable bags with freezer ties are fine to use since they take up less refrigerator space. Less expensive generic bags are just as good as brand name bags. It is a good idea to double bag the milk to eliminate and risk of contamination due to leakage. Several smaller bags can be placed in a larger zip lock bag. Plastic or glass storage containers can also be used, but there is risk of breakage. Avoid containers that have BPA.
How do I reheat the refrigerated or frozen breast milk?
Milk that has been frozen or refrigerated can be reheated to room temperature by putting it in a cup of hot water or in a bottle warmer. Refrigerated milk may take about 5 minutes to reheat and frozen milk may take about 20 minutes. Frozen milk left in the refrigerator to thaw takes approximately 12 hours. Never microwave frozen or refrigerated breast milk. This will destroy some of the beneficial properties of the milk. In addition, microwaved milk may be unevenly heated which could be potentially dangerous to the newborn. Milk that has been defrosted may appear layered due to the fact that the fat content will rise to the top. You may want to mix the milk by shaking before feeding to the baby.
Where do I get further information on storing pumped milk?
The La Leche League has a website that reviews storage guidelines. Guidelines may vary depending upon the lactation consultant. Also, the Human Milk Banking Association of North America (HMBANA) is a non-profit organization that sets standards and operates human milk banks in Canada, Mexico, and the United States. They provide information to the medical community on the storage of human milk and also serve as a resource for both potential milk donors and recipients for mothers that are unable to provide breast milk. We must keep in mind that there are new mothers who for one reason or another are not able to breast feed (gender, medications, illness, decreased supply, adoption/surrogate birth, etc.) and want the best nutrition and immunity protection for their baby.
Renate Abstoss IBCLC
Born and educated in Austria, Renate sat for the first International Board Exam for Lactation Consultants in 1985 and has been continuously certified and worked in the field since that time. She is currently the Lactation Consultant at The Stamford Hospital, a position she has held since 1997.
Tags: baby, breast feeding, breast milk, Breastfeeding, cracked nipples, health, nipple gel, nursing mother, pregnancy
Posted in Breastfeeding | 3 Comments »
Tuesday, June 22nd, 2010
 We all love to watch an adorable baby sucking on a bottle, but breast fed babies, although less likely to develop cavities compared to formula fed babies, can develop baby bottle syndrome when feeding is done on demand. Until recently, a child would only visit the dentist after dental disease occurs. Sadly, some children with decay developed pain, infections, abscesses, chewing difficulties, malnutrition and low self esteem. Others experienced malocclusion, poor growth, difficulty in speech, bruxism (grinding) and decay of the permanent teeth. Delayed treatment was expensive and often children required general anesthesia and/or frightening restraint for needed repairs.
As if these outcomes were not terrible enough, many people have had to endure mouthful’s of fillings, crown’s and bridges later in life as the conditions worsened over time. I suppose this all may seem better than the infamous wooden teeth of the George Washington era, but honestly, not by much.
Now that dentistry has, thankfully, shifted to prevention of cavities by proper oral hygiene and treatment with antibacterial and tooth protecting substances, I thought it would be important to write an article focused on oral care guidelines for the newborn infant. This very new information, based upon many years of research, will crown my series of blogs focused on dental guidelines focused on pregnant mothers (and how to avoid gingivitis and periodontal disease and their possible associations of poor obstetrical outcomes). Now it’s time to turn to the babies.
But my baby has no teeth yet!
Not true! Although a baby is born without visible teeth, development of two sets of teeth has begun in earnest by the 6th week of gestation. By the time the baby is born, both the primary and permanent teeth are present below the gums in an early developmental stage.
Now that you understand that all your baby’s teeth are “in there”, it’s clear why early preventative care will help prevent traumatic dental care issues from cropping up any time during life.
What will a good dentist do?
Believe it or not, children should be visiting the dentist by 1 year of age and be seen twice a year after that. Dentists should discuss diet, provide oral hygiene instructions and detailed directions for fluoride intake. They should also offer behavioral recommendations including the use of pacifiers, the ramifications of thumb sucking and the prevention of baby bottle syndrome.
Will my baby’s diet affect her teeth?
Nutrition continues to play an important role in prevention of tooth decay. Cariogenic foods such as crackers, teething biscuits, fruits and fruit juices, sweetened and acidic soft drinks should be limited. Carbohydrates, broken down by the enzymes in saliva along with bacteria in the mouth leave acid residue that dissolves the tooth enamel. Gums and newly erupted teeth should be cleaned after eating these types of foods. Dairy foods, especially aged cheese, can be protective.
Is flouride good or bad for my baby?
Fluoride use, which prevents tooth decay by increasing the density of the enamel, helps the teeth resist acid dissolution and is recommended after birth to limit cavities (caries).
Fluoride content of water should be tested and fluoride given by 6 months of age if the water is not supplemented or if the supplementation is less than .6 parts per million. Excessive intake of fluoride is not recommended because it produces mild dental fluorosis. This can also occur when children swallow large amounts of toothpaste that is supplemented with fluoride.
Fluoride use during pregnancy is controversial, with broadly divergent opinions.
The opinions range from “absolutely not” to “absolutely, positively yes” based on studies, some of which are interpreted to find that there is great benefit provided by the use of fluoride supplements during the pregnancy, to commencing fluoride use with the eruption of the infant’s teeth, to those who express the greatest concern about the generation of fluorosis and other undesirable or even dangerous conditions. Please consult your physician and your dentist for the recommendation in your individual case. Be sure to tell those you ask whether you live an an area that has a fluoridated water supply or well water.
Pacifiers and Thumb Sucking
Pacifiers have both advantages and disadvantages. Pacifiers, which exert less abnormal pressure on the teeth than a thumb or other fingers, might prevent thumb sucking and thereby reduce the risk of developing severe malocclusion (overbite) and abnormal growth patterns of the structures that support the teeth (the maxilla and the mandible). If thumb sucking continues after the permanent teeth have erupted, it has an even higher probability of causing permanent damage. Pacifier use can be controlled in a child in contrast to an appendage such as a thumb. Pacifiers have also been associated with a reduced incidence of SIDS.
It has been shown that long term use of pacifiers can cause dental problems. Misalignment of the teeth or malocclusions have been reported when infants use them beyond the age of 4. There is also a higher risk of otitis media with their continuing use. Limiting the use of pacifiers to the first 6 months or limiting their use to sleep times is recommended. Continuous use of pacifiers may also stunt speech development.
There is little evidence that orthodontic pacifiers are any better than conventional ones.
Choose pacifiers made of a more durable substance like silicon rather than latex, and be sure that the pacifier is made in one piece to avoid smaller parts from being detached and swallowed.
Pacifiers have not been associated with cavities but pacifiers should not be coated with sweets. Contrary to popular belief, pacifiers do not shorten the duration of breast feeding.
What is Baby Bottle Syndrome?
This syndrome that results from excessive baby bottle use is characterized by the development of severe tooth decay with pain and infection leading to extractions and extensive dental treatment. Bacteria in the mouth use milk and other sweetened beverages for metabolism and create an acidic environment in the mouth causing the destruction of tooth enamel and creating cavities. Children suffering from baby bottle syndrome feed poorly and often fail to thrive. The damage initially appears as white lesions on the teeth and then later progresses to brown or black discoloration. When the damage is severe, the crowns break down and permanent teeth may also be damaged. Malnutrition, with deficiencies in calcium and Vitamin D, may also lead to tooth enamel defects which predisposes the teeth to caries. The overall incidence of baby bottle syndrome varies from 3% to 6% in the general population but can go up to 72% depending upon the population. The teeth most affected are the maximally and mandibular primary incisors followed by the primary molars.
Breast fed babies, although less likely to develop cavities compared to formula fed babies, can develop baby bottle syndrome when feeding is done on demand. Breast milk does not support the growth of bacteria, doesn’t lower the acidity in the mouth and is therefore not as destructive. This is another reason why all mothers should be encouraged to breast feed their infants. Proper use of nipple gels, such as the Beauté de Maman Nipple Gel, will heal the chapped, sore breasts that often prevent women from continuing breast feeding.
Summary of DOs and DON’Ts of Proper Infant Dental Care
Things to Do
- Mouth cleaning in infancy should be part of a daily routine.
- Clean gums, newly erupted teeth, (after 6 months of age) and tongue, with clean washcloth, piece of gauze, or very soft moist toothbrush after feedings and before bed.
- Clean mouth with toothbrush or washcloth after giving sweetened medications.
- Introduce solid foods after 6 months of age and avoid cariogenic foods.
- Bottles should only contain plain water if being given for naps, bed or pacifier.
- Schedule first dental visit after the first year of life.
- Encourage breast feeding, especially for the first 6 months of life when fluoride is not recommended.
Things NOT to Do
- Do not allow the infant to sleep or nap with a bottle filled with juice or milk.
- Do not dip pacifiers in sweet or sweetened foods such as honey, sugar, or juice—sugars will feed bacteria in the gums, causing tooth decay even before teeth have erupted. Do not give fluoride supplementation till 6 months of age-the American Dental Association does not advocate use of fluoride at this age because there is an increase of fluorosis (white spots on the teeth) in infants who are supplemented.
Like so much about having a new infant in the house, dental care may seem daunting. My advice to new parents is to find yourself a reputable dental professional, carefully follow the advice given, and then watch your baby’s teeth arrive sparkling, white and pain free.
Tags: Breastfeeding, cracked nipples, dental care, gingivitis, healthy baby, nipple gel, nursing mother, periodontal disease, teeth
Posted in Oral Hygiene | 2 Comments »
Monday, August 3rd, 2009
Allow me to inform you about the current state of most nipple gels on the market. Currently, most breastfeeding women are given a lanolin based product to help relieve their sore, cracked nipples. As you may know already, lanolin is an animal based product—100% cholesterol—
 Contains no pesticides (more…)
Tags: beaute de maman, breast feeding, Breastfeeding, cracked nipples, is lanolin safe for baby?, lanolin and pesticides, lanolin based products and breastfeeding, nipple gel, nipple products for nursing mothers should not contain lanolin, pesticides, products for breastfeeding mothers
Posted in Breastfeeding | 6 Comments »
Wednesday, May 13th, 2009
Important update just in from the State of Connecticut Department of Health
Exclusive breastfeeding is protective because of antibody transmission. If a woman is combination feeding, it should be encouraged to increase the amount of breastfeeding or try and express breast milk with a pump if an infant is too sick to feed from the breast.
Tags: antibodies and swine flu, Breastfeeding, safe, swine flu
Posted in Breastfeeding, Sickness During Pregnancy | 2 Comments »
Wednesday, May 13th, 2009
It has been well known that breast feeding has significant health benefits to the baby. Recently it has been found to afford benefits to the mother as well. This short review will summarize the existing information and present some of the new studies.
(more…)
Tags: Beauté de Maman, Breastfeeding, colostrum, healthy baby, heart disease, immunity, nursing mother
Posted in Breastfeeding | 1 Comment »
Tuesday, May 12th, 2009
- What exactly is swine flu?
Swine flu (the proper name is H1N1 flu) is caused by a new type of influenza virus. This virus belongs to the type A influenza family that originated in pigs and changed to its present form allowing it to infect humans. Humans contract the disease from one another and not from pigs or from pork meat.
 Beauté de Maman Pregnancy Skin Care Combo Pack The epidemic was first detected in Mexico where it caused over 100 deaths. From there it spread rapidly to the U.S. and has been detected in over 20 states. It appears as if the U.S. form of the flu is not as virulent as the one in Mexico. Swine flu has now been detected in other countries but the bulk of the infections are still in North America. Domestic and international travel has facilitated the spread of the flu.
- Are pregnant women more susceptible to H1N1 flu? Pregnant women (and also very young children—under the age of 5) are at increased risk of complications from getting infected with swine flu, as judged from previous epidemics. This is probably due to the fact that the pregnant woman’s immune system is somewhat suppressed. Reports have shown a higher rate of influenza associated deaths in pregnant women and also increased rates of spontaneous abortion and preterm birth, especially with women that acquired pneumonia. Fetal distress associated with maternal illness and delivery complications have also been reported in the past.
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- What are the symptoms associated with swine flu? Most symptoms include typical flu-like symptoms such as fever, cough, muscle aches and pains, headache, runny nose, and in some instances gastrointestinal symptoms. The majority of women have an uncomplicated course. However, some women have developed a secondary bacterial infection leading to pneumonia. Pneumonia is the leading cause of death from influenza.
- What is the length of time a person is considered infectious? The incubation time of swine flu (the time from exposure to the development of symptoms) is only a few days. Once symptoms develop the person is highly contagious and continues to be so for the duration of their symptoms or at least for 7 days after the onset of symptoms.
- What precautions should I take to prevent swine flu? Take the following precautions with ANY flu virus;
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- Good hand washing with an antibacterial soap, especially after coughing or sneezing.
- Cover the nose and mouth when you cough or sneeze and discard used tissues.
- Stay home from work if you are sick and avoid contact with others that are sick. If close contact is necessary, wear a surgical mask. Avoid crowded places if influenza has been reported your community.
- How is the diagnosis made?
 The laboratory should test pregnant women with suspicion of infection. A nasopharyngeal swab/aspirate or nasal wash/aspirate or combination of the two should be collected using special swabs with a synthetic tip and an aluminum or plastic shaft. (Swabs with cotton tips and wooden shafts are not recommended) and placed in viral media and sent for rapid influenza testing. Those specimens positive for influenza A are then sent to the state for sub typing. The real-time (RT-PCR) for influenza A, B, H1, and H3 is the standard test. This test picks up small amounts of the viral gene. It is very sensitive and gives rapid results so treatment can begin quickly. If testing is highly positive, confirmation at the CDC is obtained. Viral cultures can also be done but the results take much longer.
- Treatment in Pregnancy
Pregnant women with confirmed, probable, or suspected infection as well as those who are in close contacts with other individuals with suspected, probable, or confirmed cases, should receive antiviral treatment. The recommended drugs are two antiviral agents zanamivir (Relenza) and oseltamivir (Tamiflu). Fever should be treated with acetaminophen (Tylenol).
Treatment should be start immediately after the onset of symptoms and continued for five days.
Prevention treatment is for 10 days. The safety of both drugs has not been established in pregnancy and they are therefore classified as Category C. Even though clinical studies have not proven the safety of the drugs in pregnancy, to date no adverse outcomes in pregnant women have been reported when given in therapeutic doses. These recommendations may change as more data in pregnancy becomes available.
Tamiflu is the preferred drug if symptoms are already present and Relenza may be preferable drug if prevention is the goal because of its limited absorption into the blood stream. Potential benefits must outweigh the risks for treatment to be initiated.
Herbal treatments like echinacea which have been used to prevent colds and stimulate the immune system have not been shown to cause toxicity in the limited studies that have been done.
- Are anti-viral drugs safe while breast feeding? Women who breast feed can continue taking the antiviral medications. If a mother is ill, all precautions should be taken to prevent newborn infection including hand washing and use of a mask. Transmission of virus through breast milk is unknown.
- Will the flu vaccination protect me against the swine flu? There is a good possibility that there is some measure of protection that the current vaccine has because of cross-reactivity but it may not be sufficient to prevent illness. Vaccines have to be changed nearly every year because of the ability of the influenza virus to mutate. Availability of a new vaccine specifically for this strain of the swine flu will probably be available within the next 6 months.
Pregnant women (and also very young children under the age of 5) are at increased risk of complications from getting infected with swine flu, as judged from previous epidemics. This is probably due to the fact that the pregnant woman’s immune system is somewhat suppressed.
Tags: antibodies and swine flu, Breastfeeding, safe, swine flu
Posted in Sickness During Pregnancy | 3 Comments »
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