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My Suggestions for Keeping Babies safe During Hot Weather:
1.) Offer the breast more frequently. 2.) Keep yourself very hydrated. 3.) Offer a bit of extra water to infants that are solid food eating age, but no water for exclusively breastfeeding infants. 4.) Cover any waterproof mattress covers with cotton or absorbent sheets. 5.) Put your baby down for naps in just a diaper. 6.) Try to make trips outside during the cooler parts of the day. 7.) Use a shade on a car window to protect your baby from direct sunlight. Emergency heat levels: Use a fan or AC. Don't put the fan directly on the baby, just direct it close by to circulate the air. If you have no AC then use damp hand towels to keep baby cool, but not cold. DON'TS for Hot Weather: Do not thin down formula or breastmilk bottles. Do not leave your baby in a car for any amount of time unattended, not matter the temperature. Do not leave your baby in a stroller for prolonged times. Do not cover the stroller with a blanket, that can reduce hot air circulation. Do not use fluffy mattresses/blankets that baby can sink into. Serena Meyer RN IBCLC
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Bay Area Breastfeeding Support
Serena Meyer, RN, IBCLC, RLC IBCLC-reg. 11113721 RN- reg.95048954 (510) 612-4000 Fax 510 275-0331 RE: Lactation Accommodation To Whom it May Concern, It is common and standard clinician practice to recommend that breastfeeding parents express milk a minimum of every three hours to maintain a full supply of breastmilk. This generally is covered during the two breaks offered during an 8 hour shift and a full 30 minutes during lunch. Many mother's pump at 9am, 12, and 3pm. The accommodation part of this conversation is that a ten minute break is not long enough to fully empty out a breast during pumping. Offering an additional ten minutes on the regularly scheduled break time (20 total, twice a day) is reasonable, and allows for cleaning, wiping down surfaces and storing breastmilk. This additional time, on top of normal breaks is not required to be paid. All breastfeeding people in California are afforded the same protection of our laws that outline the basics of reasonable accommodation. In California reasonable accommodation has to do with offering pumping breaks, a private area to pump with a door (not a bathroom stall), and a clean place for lactating individuals to express breastmilk. The current American Academy of Pediatrics has extended the minimum requirement for breastfeeding to age two years: "The AAP outlines its recommendations and evidence of significant health benefits to infant and mother within an updated policy statement and technical report, both titled, “Breastfeeding and the Use of Human Milk” Published in the July 2022 issue of Pediatrics and available online June 27. The updates include a recommendation to support parents who choose to breastfeed their infant to age 2 and beyond." Full article here: https://www.aap.org/en/patient-care/breastfeeding/policies-on-breastfeeding/ The CDC outlines supporting a minimum of 2 years of breastmilk. That can be found here: https://www.cdc.gov/breastfeeding/faq/index.htm Thus support for lactation needs to continue until the time of weaning. The Academy of Breastfeeding Protocol 7: https://www.bfmed.org/protocols "Recommendations Model maternity policy supportive of breastfeeding Policy. 1. This institution promotes breastfeeding considering that it is the biological norm for the human mother and infant (dyad) and that artificial feeding and early weaning carries considerable maternal and infant health risks1–5,7–14 (1).6" Workplace actions that fail to support breastfeeding mothers also by virtue of decreased pumping options necessitate the use of formula which increases the health risks to infants. The full protections of California Laws regarding Lactation are listed here in full: https://www.dir.ca.gov/dlse/Lactation_Accommodation.htm#:~:text=Does%20my%20employer%20have%20to,are%20expressing%20milk%20in%20private. Quotes below. "Does my employer have to provide me with a place to express breast milk? A. Yes, your employer must provide you with the use of a room or other location, other than a bathroom, in close proximity to your work area, shielded from view, and free from intrusion while you are expressing milk in private. This may include the place where the employee normally works if it otherwise meets the requirements. The lactation room or location must be safe, clean, and free from hazardous materials, as defined in Labor Code section 6382, contain a surface to place a breast pump and personal items, contain a place to sit and have access to electricity or alternative devices, including but not limited to, extension cords or charging stations needed to operate an electric or battery-powered breast pump. Access to a sink with running water and a refrigerator suitable for storing milk, in close proximity to the employee’s workspace must also be provided by the employer." "5. Q. What happens if my employer does not provide me with the opportunity to take a break for lactation purposes? A. If you feel your employer is not providing you with adequate break time and/or a place to express milk as provided for in Labor Code section 1030, you may file a wage claim to recover one hour of premium pay at the employee’s regular rate of pay for each violation. See https://www.dir.ca.gov/dlse/HowToFileWageClaim.htm " Additionally, a mother may also file a report/claim with the Labor Commissioner’s Bureau of Field Enforcement (BOFE) at the BOFE office nearest her place of employment should a workplace be unwilling to offer legal accommodation requests. http://www.dir.ca.gov/dlse/HowToReportViolationtoBOFE.htm "The Labor Commissioner’s Office may, after an inspection, issue to an employer who violates any provision of this chapter, a civil citation ($100.00 for each day an employee is denied a break or adequate space to express milk) that may be contested in accordance with the procedure outlined in Labor Code Section 1197.1 (Labor Code Section 1033)" In addition, any employee who is a victim of retaliation for either asserting or attempting to assert a right to lactation accommodation or for complaining to the Labor Commissioner about the failure of an employer to provide this accommodation may file a retaliation claim pursuant to Labor Code Section 98.7. An employee must file a retaliation claim with the Labor Commissioner’s Office within a year of the retaliation. See here: https://www.dir.ca.gov/dlse/HowToFileRetaliationComplaint Serena Meyer RN IBCLC Whether this is your first child or second child, I want to take a moment to welcome you here to this space. Some of you may access this article before your infant arrives, and some of you after. Learning about breastfeeding and how to create a smooth feeding relationship is important at any stage.
So when we are thinking about breastfeeding success sometimes our families have other ideas about what that means, and their suggestions may conflict with what you have learned or what your goals are. It’s important for me to assert that surrounding yourself with supportive people who aren’t busy telling you horror stories is critical to success. It’s really sad that your cousin’s friend’s daughter wouldn’t breastfeed and only took formula, but that really has nothing to do with you and your journey. The same goes for your bestfriend’s torn up nipples; not really about you and just serves to increase worry. What’s real versus what’s not real is this: Infants need to eat often and they will yell if that doesn’t happen. Your job as a parent is to offer to breastfeed every time your baby seems hungry whether that is a cluster of feeds that occurs many times over two hours, or on a rhythm of every 2-3 hours, including nights. Scheduling feedings is good for adults but bad for babies. They need to eat way more than you might think. This means when your baby is brand new they communicate their hunger by squirming around, trying to eat their hand, trying to latch to your husbands ear - basically anytime they go poop or pee they made room for more milk. I try to tell people if the infant is awake at all it’s an early feeding opportunity.Babies need to be held and placing them in direct contact with your skin will enhance breastfeeding/feeding behaviors. Immediately after breastfeeding/chestfeeding your baby’s expectation is to be on your body. That doesn’t change much over the next few months. Everyone wants to swaddle a baby and put them down, babies don’t want that though. If there is a layer of clothes between you and your baby while they are feeding, how do they know they are in the right place? Many times they act confused, or don’t open their mouth wide enough. Infants grow and thrive on an exclusive breastmilk diet. Your milk has everything your baby needs, including immune system support! The milk changes to meet the needs of your baby. Studies show that as an infant ages, the components of breastmilk change. For an example as the quantity of milk goes down like when you have a weaning child, the immune properties go up. This absolutely doesn't meant that you should withhold food if you have a low supply. It just means that your labor making milk is important. Formula is a tool and I don't feel like its helpful to demonize it. Breastfeeding has never been solely about breastmilk transfer. It is about meeting the emotional needs of the infant at the breast/chest. Soothing and reassuring your baby. Teaching your baby who they are, in relation to who you are. With breastfeeding/chestfeeding my goal is to help parents build and emotionally intact infant. It can be done many ways and you will have your own version. Breastfeeding doesn’t have to be painful, but you might be a little bit sore for the first few weeks. Real pain with feeding means something is wrong. So when people share that their nipples were bloody at first and then they toughened up what I am hearing is: “I didn’t know what I was doing, but I started to get better, and finally my latching stopped hurting my nipples.” My question to you as a mother/parent is, why not just learn how to do it without the cracked nipples and pain the first time? I know, It’s a good question right? :) Anatomy of the Breast What do you know about your breasts/chest? I have found that most people never really think about the breasts/chest in relation to their biological purpose. They are mostly just with us along for the ride, filling out our clothes with no real purpose until it comes to feeding. During pregnancy the glandular tissue starts to change because of hormones. They become tender, they fill out, and you may see more veins develop on your breasts, and upper chest area. Breast changes at the beginning of pregnancy tend to be glandular and important to function and making milk, breast changes towards the end of pregnancy are mostly padding or fatty tissue. The important part of breast/chest changes is that they are normal and we expect them. It is during this time that you may experience the breast/chest changing position or being lower placed. You might hear friends say that breastfeeding makes breasts sagging but it’s not breastfeeding- its actual pregnancy that does that. The human breast/chest area comes in many sizes and shapes. A small breast can make just as much as a larger one. What we are hopeful to see is breast growth during pregnancy and more veining on the outsides. If you skin is darker you might not notice it. You will notice darkening of the areola, and some women notice more pronounced Montgomery glands. Those help lubricate the outside of the nipple. Some people see the kertin plugs in the breast which look like crusty skin on the tip of the nipple. That’s normal! Here is a picture of the breast. Notice the grape like clusters depicted in the inside of the breast- those are the part of the breast/glandular tissue that make the milk. The pathway to the nipple from the areolar clusters is called a duct. They are small tubes, and carry the milk. There are many convoluted paths to the breast and they weave through the breast. There isn’t a straight pathway to the nipple. Some of the breast is fat, some is the working part of the breast which I like to describe as the engine of the breast! (c) Copyright 2023 Serena Meyer RN IBCLC  Starting Solids
It’s almost time for the next big baby milestone – starting solids! There’s no one right way to do this, and the experience can be totally different from family to family and even baby to baby in the same family. The main things to remember are simple: wait until they’re ready, offer a variety of flavors and textures, follow baby’s cues, and skip choking hazards. Within those guidelines, there exist a multitude of ways to introduce your baby to solid foods. In almost all cultures and societies, eating is a social experience in addition to a source of nutrition. Eat with your baby, include them in family meals, and celebrate the new experience together. History of starting solids In the United States, until about the mid-1900’s, at about the middle of the first year, infants were simply fed soft food, without added spices, from the family’s kitchen table. With the Industrial Revolution and introduction of packaged baby foods, families were taught by doctors and manufacturers that premade baby food was better for baby, and easier, too. Around this same time, babies started tasting their first bites of solids foods at very early ages, as early as six weeks old! Thankfully, we’ve again learned that six-week-old babies are too young for solid foods, and the consensus now is to wait until about six months of age. This message of the convenience of pureed baby food has now become part of our country’s social consciousness, and many of us grew up believing that feeding jarred baby food was a normal part of raising an infant. In many cultures around the world, baby’s first bites of solid foods is symbolic, a ritual that brings the entire family together. Special first foods, often cereal or porridge types, are fed to baby. Starting solids is about more than simply nutrition, it’s a sign of familial and societal membership and community. Over the past decade or so, there has been a slight shift back to feeding baby from the family’s meal, a practice often referred to as Baby Led Weaning. This practice is simple: allow baby to eat what the family is eating, provided it is soft and easy to pick up. The goal: by about 12 months old, baby eats healthy family meals. No spoon feeding required. Organization recommendations What do the experts say about starting solids? The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months or longer if you and your baby desire. (healthy children). The World Health Organization recommends exclusive breastfeeding for the first 6 months of life; and introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond. How do you know if it’s finally time to start solids? “By waiting for him to be developmentally ready, he becomes an active participant in eating, rather than merely a passive recipient” (LLL). For the first six months of life, the AAP recommends exclusive breastfeeding if possible. Otherwise, donor milk or formula should be baby’s main diet for the first half of their first year. Studies have shown that “babies who start eating solid food too early are more likely to be overweight or obese in childhood and adulthood.” (AAP). The AAP recommends introducing solids foods around six months of age, exposing baby to a wide variety of healthy foods and a variety of textures. In the first days and weeks, baby may only eat a small amount of food. As they get older, they’ll increase the amount of solid foods, up to three meals a day plus snacks at about 12 months old. However, “your milk remains the single most important food in your baby’s diet until the first birthday”. (LLL). For various reasons, in our culture, “At 9 months, there is a considerable drop in fruit and veggie consumption, and an increase in non-nutritive finger and snack foods.” (AAP). Be aware of this possibility and plan to keep offering fruits and vegetables at almost all of baby’s meals and snacks. Let’s get to the fun part! What to feed to baby? There are lots of options available. Most organizations, including the American Academy of Pediatrics and the World Health Organization, recommend starting solids one food at a time, to allow time to observe any possible reactions to that food. After baby is eating a small variety of foods, “Try giving her a new food once or twice a week along with foods she regularly eats.” Healthy Children. This allows baby to experience new tastes and textures while still having the familiar foods available. Many families have found that “a baby might have to try a new food 10 to 15 times over several months before she’ll eat it” (Healthy Children). Some excellent ideas for first foods include ripe avocados, bananas, baked sweet potatoes, steamed or grated carrots and other vegetables, baked apples, and plums with the seeds and peel removed. Other popular foods are broccoli, cooked beans, flaky fish, and scrambled eggs. Avoid choking hazards like popcorn, nuts, hotdogs, and grapes until baby is older. Honey should also be avoided until after the first birthday. Focus on iron-rich foods, such as meats, poultry, fish, egg, tofu, and legumes, as baby’s iron stores tend to drop in the second half of the first year. So, let’s get started! At the next family mealtime, plop baby in a highchair or hold them on your lap. Put small pieces of your mushy food of choice in front of them and see what they do with it. Watch them explore with all their senses and enjoy the changes you’re seeing in your baby. Don’t forget to take lots of pictures! As baby gets older and more mature, “gradually increase food consistency and variety” (WHO), while “allowing baby to control the amount he eats” (LLL). Purees – easy to make and easy to find. Should I feed my baby some of these, too? Many foods can be made into a puree at home, with nothing more than a fork. Other foods need a little more work to make into a puree, but it can be done with a blender. Of course, it’s easy to find pureed baby food in jars at the store, in a variety of flavors and flavor mixes. However, baby has a hard time feeding themselves with these, and generally must be fed by a parent, which takes away opportunities to experience textures and work on fine motor skills. In addition, some commercially made baby foods have added ingredients, and there are many flavor mixes available that adults simply wouldn’t eat. Few rules exist for baby led weaning. Healthy Children gives the following recommendations: Sitting with little support, having good head control, trying to grab your food, and turning away from the breast or bottle when not hungry. It is not necessary for teeth to have erupted. “Babies are encouraged to use spoons and fingers to feed themselves” (AAP). Don’t put food in their mouth for them. Foods should be soft and squishy, and mushy enough to squish between their fingers. Babies don’t need added salt or sugar, they’ll enjoy the new tastes and textures just as they are. Finally, eating is a social experience, so eat your meals with your baby! “Never leave a baby or young child alone with food in case they begin to choke” (LLL). Don’t forget to take lots of pictures – starting solids can be messy but make for some excellent photo opportunities! Because starting solids can cause a change in bowel habits for almost all infants, “Babies are encouraged to drink from a cup starting at 6 months of age” (AAP). A sippy cup set out with the solids provides another opportunity for exploring textures and allows baby to drink to thirst. If they have troubles figuring out how to drink from it, try removing the valve inside the cup. Potential for a bigger mess, but easier for baby to learn. “The key difference between BLW and traditional weaning, when you think about it, is in the order that children learn to eat. With a puree, they learn to swallow first and then chew, which works fine until they meet a lump. With BLW, the babies learn to chew first and swallowing might come some time later.” (Babyledweaning.com). What about infant cereals? They seem so common! Many families start their solids journey with the infant cereals marketed directly to new parents. These are often nothing more than processed grains, with added vitamins. They are hard for baby to digest, typically cause constipation, won’t help baby sleep longer, and baby can’t absorb the artificial additives anyway. Baby cereal is a bland gelatinous mess, it’s something baby won’t ever eat again in their lifetime and isn’t something an adult would particularly enjoy eating. Giving baby real foods is much better way to get needed calories and nutrients into your baby. A common old wives tale suggests putting cereal into baby’s bottle, to help them sleep longer. Many desperate parents, wanting a few more minutes of sleep, have tried this with little success. “Putting cereal in your baby’s bottle will not help her sleep through the night.” Healthy Children and adds extra empty calories to your baby’s diet, when they should be getting breastmilk or real solids. If baby does happen to sleep more after getting cereal in their bottle, it may mean his body is diverting energy resources from growing to digestion. Not a great thing. Some families prefer to use expressed milk in their baby’s foods. It can be added to baked goods or added to other recipes in place of water or milk. Great in pancakes, muffins and more. You can even make a batch of muffins or pancakes, freezing most of them for baby’s later use. This can be a good way to use up an aging freezer stash and can turn an already delicious recipe into an excellent recipe baby will love! For leftovers, follow general food safety guidelines. Use cooked foods within four days and use leftovers that include fresh milk within 24 hours. If baby’s mouth has touched the food, bottle, or even the spoon that goes in the food, use the leftovers at the next feeding. Defrosted foods or milk cannot be re-frozen, they must be used or discarded. At about a year, many professional organizations recommend that toddlers transition from breastfeeding or drinking formula to drinking whole fat milk. For nursing toddlers, this may not be necessary. Calcium and calorie needs can be met by breastfeeding and offering a variety of whole foods like yogurt, cheeses, broccoli, and kale, among other things. If your toddler is nursing often, you may not need to offer milk at all! If you choose to offer milk to your toddler, stay with whole fat milk products until at least the second birthday. Growing toddler brains need the fat content. If your little one is rejecting whole milk, try mixing it with expressed breast milk until they become accustomed to the flavor and texture. Don’t let baby fall asleep with a sippy cup in their mouth, as milk can drip from the cup and pool in their mouth, raising the risk of cavities. Special Circumstances If your baby was born prematurely, more than 37 weeks early, starting solids brings more questions, and requires a little extra vigilance. Solids should not be started before four months actual age, or three months corrected age. Often, this means starting solids somewhere around five to seven months actual age. As with other infants, continue nursing first, then offering solids after. Breastfeeding should still be baby’s primary source of nutrition until about a year old. For premature infants, choosing when to start solids is more about development than age. Baby should be able to sit unsupported, show interest in others eating, put toys and fingers in their mouth, and lean towards food and open their mouth. Because these infants often miss out on extra iron stores gained at the end of pregnancy, it’s important to focus on iron-rich foods when starting solids. Continue any supplements as recommended by baby’s doctor, especially iron supplements. Baby led weaning is an excellent option for these infants, as it helps reinforce motor skills. Occasionally, infants aren’t quite gaining weight as fast as expected. For these infants, starting solids can be a time to finally gain some weight. Even in these cases, solids should not be started before six months, except when working closely with medical professionals. As we’ve mentioned before, continue nursing first, then offering solids after. Focus on high fat foods in baby’s diet – avocados, butter or oil on almost everything, nutrient dense foods of all types. Skip the empty calories of baby cereals and juice. If baby food recipes call for water, use expressed milk for the extra calories. Increase the frequency of solids relatively quickly, still giving baby time to get used to new foods yet adding in extra calories and fat where possible. Allergies Do allergies run in your family? Heard some horror story about allergies? The good news is that most children do not have allergies to foods. It’s simply not that common. However, everyone should know what to watch for, in case they think a potential allergic reaction is occurring. The top eight allergens in the United States are milk, egg, peanuts, tree nuts, fish, shellfish, soy, and wheat. Possible mild symptoms of an allergic reaction include a rash on the face or around the anus, or a suddenly runny nose. More serious reactions include trouble breathing, wheezing, swelling of the lips or face, or even severe vomiting or diarrhea. For mild reactions, rinse with cool water any skin touched by the food and eliminate the food until you can talk to the child’s doctor. For severe reactions, immediately call 911 for assistance. “If there is a family history of food allergy, consult your doctor or allergist for advice on when to start your baby on foods that tend to be more allergenic as it may differ from recommendations for babies without allergic history.” (LLL). Unless you’ve already seen baby react to the food in question, there is no need to avoid feeding baby certain foods. Start the solids journey with less allergenic foods, and once those are established, add in small amounts of the more allergenic foods one at a time. If there’s no reaction, continue exposing baby to that food regularly. If you’re feeling extra worried, try rubbing a small amount of the food inside baby’s lip, and watch for a reaction. Offer new foods during the daytime, so you can watch for a reaction. A few final words Like many other milestones in baby’s life, starting solids is highly anticipated by parents and caregivers, and often extensive thought goes into that first bite of solids. Relax, enjoy the moment, take some pictures. Your family is entering a new adventure, and by following some basic safety guidelines, it can be a very enjoyable adventure indeed. Not intended as medical advice. By Shannon Heindel 2023 References: American Academy of Pediatrics. (2018). Infant Food and Feeding. Retrieved November 18, 2018 from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx. Australasian Society of Clinical Immunology and Allergy. (2018). Allergy Prevention. Retrieved November 18, 2018 from https://allergy.org.au/patients/allergy-prevention. Baby Led Weaning. (2011). Getting Started. Retrieved November 19, 2018 from http://www.babyledweaning.com/some-tips-to-get-you-started/. HealthyChildren.org. (2018). Food and Feeding. Retrieved November 18, 2018 from https://www.healthychildren.org/English/healthy-living/growing-healthy/Pages/baby-food-and-feeding.aspx#none. La Leche League International. (2017). Starting Solids. Retrieved November 19, 2018 from https://www.llli.org/breastfeeding-info/starting-solids/. United States Department of Agriculture. (2015). Basics for Handling Food Safely. Retrieved November 18, 2018 from https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling/basics-for-handling-food-safely/ct_index. World Health Organization. (2018). Infant and young child feeding. Retrieved November 18, 2018 from http://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding.  During heatwaves many babies need just a little bit more milk. This means offering more frequently. Watch that you are paying attention to your own hydration levels, if you get dehydrated milk production falls a bit!
The easy remedy is to ensure that our own body is well nourished and hydrated! Are you hot or feeling a bit sick from the summer heat? Likely time to retreated to a cooling center, a friend's house with AC, or the shade indoors. Your urine should be clear and light colored as an indicator that you are drinking enough. As you get dehydrated your urine takes on a darker tone, and there is less of it. Drinking regular water is enough to stay hydrated, but some people like flavored sports drinks which are also fine. Breastfeeding infants do not need extra water, they need you (the breastfeeding/chestfeeding parent) to be hydrated. Once they are over 6 months and eating solids they should have access to as much water as they like during solid food meals. With older babies you can offer a small amount of water after breastfeeding if absolutely necessary. Formula supplements should not be thinned out when you make them because you think its too hot. That can lead to electrolyte imbalances. The real action is to keep baby's away from direct light and too much heat. WHAT TO OBSERVE FOR in Dehydrated Infants: Behavioral red flags: children and babies can get more fussy, they seem cranky for no reason, or they can start to look unwell. "Unwell" in an infant is dry skin, a dry mouth, loose or floppy tone, not responding appropriately to contact or stimulation. They may refuse to nurse (older children may refuse to drink). Infants may get a sunken fontanelle (the soft spot). If you see these things and you baby has not had a wet diaper in 6 hours or urine is getting darker please go to urgent care. Smaller children, toddlers do not show typical signs of dehydration. In the heat they can lose a lot of fluids through sweating. They need to drink regularly, and wear loose fitting light clothes and stay out of the heat. My Suggestions for Keeping Babies safe During hot Weather: 1.) Offer the breast more frequently. 2.) Keep yourself very hydrated. 3.) Offer a bit of extra water to infants that are solid food eating age, but no water for exclusively breastfeeding infants. 4.) Cover any waterproof mattress covers with cotton or absorbent sheets. 5.) Put your baby down for naps in just a diaper. 6.) Try to make trips outside during the cooler parts of the day. 7.) Use a shade on a car window to protect your baby from direct sunlight. Emergency heat levels: Use a fan or AC. Don't put the fan directly on the baby, just direct it close by to circulate the air. If you have no AC then use damp handtowels to keep baby cool, but not cold. DON'TS for Hot Weather: Do not thin down formula or breastmilk bottles. Do not leave your baby in a car for any amount of time unattended, not matter the temperature. Do not leave your baby in a stroller for prolonged times. Do not cover the stroller with a blanket, that can reduce hot air circulation. Do not use fluffy mattresses/blankets that baby can sink into. -Serena Meyer RN IBCLC A transmom's GuestpostWhen my husband and I married in 2015, I was not certain of what the future would have in store for us. Would we have a child or not? It was an open question. For many people this is very much a deal breaker before marriage but I felt it was acceptable in my situation. As a transsexual woman marrying a cis-man I knew that having children the normal way was not possible for us. But by the time 2018 rolled around, we had decided that our journey of life would be more complete by raising a child together. We then needed a plan to make that happen, and we were able to partner with a surrogate mother and an egg donor to help create our child.
I had read about non-birthing mothers breastfeeding their babies in recent years- mostly the non birthing partner in lesbian couples; but also a few scattered accounts from transsexual women. The emotional bonding and attachment development provided by breastfeeding seemed to be something that would benefit our child immensely and something I wanted to develop with our son. Additionally the health benefits of antibodies in breast milk were a big positive. So after doing research into the Newman-Goldfarb protocols, I began the journey to breastfeed our soon to be born son. With a due date in January 2020 I began a hormone and galactagogue regime in June of 2019. I was taking 20mg Domperidone 4 times a day, 200mg Progesterone twice a day, and 2mg estradiol twice a day. After a referral from a friend I began consulting with Lactation Consultant Serena Meyer RN IBCLC in September 2019. Based on her advice I purchased a Spectra breast pump and began pumping 4 times a day 10 minutes at a time. I also increased my domperidone dosage to 30mg 4 times a day, my progesterone to 200mg twice a day, and my estradiol to 2mg 4 times a day. At first I pumped very little, about 8.5ml on average each day for the first week, and 13.4 ml on average a day for the second week. By week 6 I was averaging 82.8ml a day. Again based on advice from Serena I moved to “power pumping” in week 7 – pumping 4 times a day still but each pumping consisted of 10 minutes followed by 5 mins rest, another 10 mins, another 5 mins rest and a final 10 minutes. Within two weeks of that I was averaging 152.8ml a day. I then increased my pumping to 5 or 6 times a day. I'm not going to lie – holding down a full time job and getting all this pumping done was hard! But I wanted to share this special bond with our child, and I knew that it would all be worth it if I was successful. By week 13 (and three weeks before the expected due date) I was pumping 310ml a day. At that point, per the Dr. Jack Newman protocols, I stopped the progesterone and cut the estradiol back to 4mg a day. I also increased my pumps to 7 or 8 times a day. The week before the baby was born I was pumping 385.5 ml a day. The day before our son was born I pumped 454ml. Our son was born at 1pm on Jan 5th. The birth mother healed well and we were able to visit with her a number of times in the days and weeks following the birth. We look forward to having a lifelong friendship with her and her family, and it's important for us that our son knows her and understands how he came to be in the world. After our son was cleaned up and tested he was given to me. I had informed the hospital I intended to breastfeed. With some tips from our lactation consultant our son latched easily. Everything seemed to be going well the first few days and I was exclusively breastfeeding. Weighted feeds showed he was taking the appropriate amount of milk when he fed. A big stressor was maintaining supply as a newborn does not eat much. So I pumped as often as I could while still caring for our newborn. Heading to the pump and leaving our newborn with my husband after an hour-long feeding session was hard, but I was very paranoid about not making enough milk for our child. On day 4 we discovered he was approaching too much weight loss (about 5% off his healthy birth weight) and I began to panic. In inducing lactation, my baby’s well being was always paramount in my thinking and to imagine I may have caused him too much weight loss devastated me. To me there was one cause - I was not making enough milk. Looking back I think I was going about the feeding all wrong – I was obsessed with intervals between feeds, and even if he was still hungry, I was taking him off the breast before he was done as I thought my breasts were empty, or avoiding putting him back on until I thought I was ready. I realize now that this is exactly the wrong thing to do! But at the time it's what we did. We had plenty of expressed milk frozen so we began supplementing with that. His weight stabilized and started to climb. Out of an abundance of caution we also began to mostly skip breastfeeding in favor of me pumping and then bottle feeding him the expressed milk. It provided my very anxious self a sense of control that was otherwise lacking to know exactly how much he was eating. We also supplemented with frozen breastmilk and formula. In the early weeks, still believing I wasn’t making enough, I started to use more and more formula, and I started to hate pumping more and more. I was nervous for each breastfeeding session thinking “would this be the last time” our son would latch. When our son was 5 weeks old my husband was set to go back to work and I prepared to begin taking care of my son alone during the work day. The prospect of trying to pump while taking care of a 6 week old seemed overwhelming - any time I could put him down I wanted a break not to pump! I consulted again with Serena Meyer RN IBCLC about how to pump less and breastfeed more. She encouraged me to just try breastfeeding only for one day and see what happens. If he loses weight you know you need to supplement, if he doesn't then you can just breastfeed. So I breastfed for a day without supplementing and the next day he gained about 10 grams. So a little low on weight gain. We decided to supplement with a bottle or two of formula a day (also this gave me breaks so my husband could take some feedings!). I stopped pumping completely and happily. Our son was steadily gaining weight and was hitting developmental milestones early. Over the following weeks my husband began to have more and more trouble with the bottle and it became a battle for him! Often my husband would bring the baby to me to calm him down and breastfeed him. Also our son started going to sleep earlier without that last night feeding. Eventually we just gave up giving him the bottle and starting at about week 9 he became exclusively breastfed again. I thought I might list some of the challenges as well – my libido was greatly reduced since I started pumping regularly and has become non-existent since my son was born. The domperidone exacerbated the IBS like symptoms I experience, but it has been manageable. Being the only person who can feed the baby is a lot of stress. It was amazing having a 2-3 hour break when my husband could still watch the baby and feed him bottles. I don't get that now. But the baby sleeps longer at night, so that's a plus. As of week 15 he is steadily gaining weight and looks to be on pace to double his birth weight by the end of Month 4. He is a happy smiling little fellow with good neck control and the ability to roll from belly to back. He also loves making eye contact – the special smiles and eye contact we share when he's on the pillow and about to latch are absolutely the most love I have ever felt in my life. I'm so thankful to be able to breastfeed and I'm in debt to our lactation consultant Serena Meyer and the doctors I have worked with. And of course we are also in debt to the surrogate mother and egg donor without whom our son would not exist. LC Addendum: Any medical information in this article does not constitute advice, you should always contact your own Dr about any medications and before you adjust your hormone therapy yourself. -Serena Meyer RN IBCLC 8/7/2019 Breastfeeding encourage-ment in its sweetest form delivered for world breastfeeding weekRead Now Bay Area Breastfeeding Support Cookies The major theme for World Breastfeeding Week 2019 is empowerment. To me, this means providing the support, protection, and encouragement necessary for parents to reach their personal breastfeeding goals. World Breastfeeding Week can bring up some very deep feelings, especially when breastfeeding does not turn out as one expected or hoped. It is important for families I support to know that there is no one right way to feed and nurture a baby, and every drop of breastmilk matters. Aside from all of the practical aspects of breastfeeding support such as parental leave, community support, and hands-on help, one of the most important ways we support parents is by simply being present and providing a non-judgmental, willing ear. I like to call this the "warm fuzzies" of breastfeeding support. warm fuzzies: plural. noun. :feelings of happiness, contentment, or sentimentality :the warm, pleasant sensations one feels in their center when emotionally moved by an act of goodwill or love  Warm fuzzies delivered by Allie In the spirit of World Breastfeeding Week, we did a little supporting, promoting, encouraging, and empowering breastfeeding this week. One of our activities included delivering batches of special cookies to a number of healthcare providers in the San Francisco Bay area. The cookies featured breast-themed designs representative of a variety of skin tones and the Bay Area Breastfeeding Support logo. This logo is special to me because it represents not only the birth of a baby, but the birth of parents. It's about all families being sacred and beautiful. No matter how one births, feeds, or parents; it is a miracle every moment. These delectable delights were made with love (and very skilled hands) by Iced Crystals in San Ramon CA and delivered by our friend, Allie Lewenilovo.  A different kind of warm fuzzy World Breastfeeding Week may be over, but the promotion of breastfeeding will continue all month long! August is National Breastfeeding Awareness Month. It culminates with Black Breastfeeding Week, which aims to bring awareness to the racial disparities that exist not only in the rates of breastfeeding, but the related issues of infant mortality and higher rates of diet-related disease. Bay Area Breastfeeding Support will be supporting the local event scheduled in Berkeley.
How did you celebrate World Breastfeeding Week this year? Tell me in the comments. If you are in the Bay Area and you need breastfeeding information or support, please contact me!  World Breastfeeding Week is marked by a steady stream of promotional and informational messages on ways to support breastfeeding families to reach their goals. The messaging is centered around why breastfeeding makes a difference in the health and well-being of individuals and the global population. World Breastfeeding Week (WBW) is an annual celebration that is held every year from August 1-7 in more than 120 countries across the globe. WBW was founded by the World Alliance for Breastfeeding Action (WABA) and was first celebrated in 1992 in commemoration of the Innocenti Declaration. Global organizations such as UNICEF and WHO participate, as do thousands of other healthcare organizations, governmental agencies, and individuals. It is the first week of National Breastfeeding Month in the USA, where the month-long promotion of breastfeeding culminates with the celebration of Black Breastfeeding Week (stay tuned for an upcoming event in Berkley!). August 1-7 has also become synonymous with messages that breastfeeding isn’t important at all and there is too much pressure to being placed on birthing parents. Competing “anti” messages are shared in the media and make their way across social networks in the form of memes, and in some cases, horror stories. In this way, breastfeeding becomes a political issue rather than a health and parenting issue. How individuals feel about breastfeeding is personal, as it should be. Together we must look for ways to separate feelings from facts, as facts are not judgmental. If everyone knows breastfeeding is the biologically normal way to feed human infants, why do we still need World Breastfeeding Week? We have to continue promoting breastfeeding because parents need support including parental leave, guaranteed breaktime, government funding for programs that support breastfeeding families, and ongoing research and education. Breastfeeding promotion is not about shaming families who cannot or chose not to breastfeed. Promotion ensures the people who need to hFear the message know that breastfeeding matters and it helps limit the undermining of breastfeeding by people who stand to profit when parents do not breastfeed. Promotion and support make a difference both on the individual and population levels. Yes, breastfeeding matters. The ideal that World Breastfeeding Week aims to promote is exclusive breastfeeding for the first 6 months of life. The research shows that the protection breastfeeding provides against respiratory illnesses, gastrointestinal illnesses, middle ear infections, and allergy in babies and in heart, metabolic, and reproductive health in mothers is compounded when babies are breastfed exclusively for about the first six months of life. We should continue promoting exclusive breastfeeding while also recognizing the problems parents face in achieving this goal, and providing support to help them overcome challenges that may prevent them from breastfeeding as long as they would like. All of this said, in our promotion of breastfeeding, we must be careful not to minimize or ignore the experiences of parents who, for whatever reason, were unable to meet their own personal breastfeeding goals. For someone who wanted so desperately to provide their baby(ies) with their own milk, it can be hurtful to hear about the importance of breastfeeding on a population level and it can sting to hear of the success of others. In our messaging, we must make clear that every drop counts and some breastfeeding, even once, is beneficial. There’s no one right way to breastfeed and the individual way parents define their own success is something to be celebrated. So, enjoy the week that celebrates breastfeeding, ensuring you internally filter the messaging as good, bad, or ugly. It is okay to take what works for you and leave the rest. Share with family and friends what inspires you. Lift someone else up who may be struggling. We all can play a role in improving maternal and child health, and in many ways, that all begins with breastfeeding. This year’s theme is empowering parents to breastfeed, and together, we can do just that. If you are facing breastfeeding challenges and you live in the San Francisco Bay area, reach out to me through my webpage to book an appointment! Securing Insurance coverage for lactation Care TIPS FOR GETTING REIMBURSED BY ANTHEM FOR LACTATION CARE
From Serena Meyer of Bay Area Breastfeeding Support If you are having problems breastfeeding did you know that your insurance HAS to pay for lactation care? Its mandated coverage as preventive health care and you are entitled to it. Certain insurance covers certain codes but they all have to cover part of it. 1.) Call Anthem’s member phone number and ask for a list of in-network lactation consultants in your area. They may give you the run-around or turn it around on you and ask YOU to provide THEM the names of the consultants you want to see -- only to tell you that those consultants are not in-network. If they do this, insist again that they provide a list of in-network lactation consultants. If they try to give you the run-around again, insist yet again that they provide a list of in-network lactation consultants and, if they can't, make sure they clearly tell you that they can't. 2.) If they can't provide you a list of in-network lactation consultants within a 75-mile radius of where you live, you are entitled to open an in-for-out case. This allows you to get your out-of-network claims processed at the in-network level, so you would only be responsible for the total beyond the in-network total allowed. These cases are handled by a nurse case manager on your insurance company's medical management team. You call the same member phone number but you choose the option for pre-approval or pre-certification and ask to make an in-for-out request. 3.) WARNING: The wait for this particular team is LONG. It can be over an hour before someone picks up. So when you call, be ready with all of the information you need because you don't want to waste your time. You'll need: the CPT/procedure and diagnosis codes that would be used during your visits; your phone number; your full name and date of birth; your baby's name and date of birth; your home address; how many visits you are seeking and which codes your consultant will use for each visit; your consultant's name; your consultant's business's name; your consultant's NPI number; and your consultant's EIN number. You may also need to tell them whether the visits will be at your home or at your consultant's office. IMPORTANT: Make sure the person opens your case in YOUR name and not your baby's. Also make sure the case includes a date range that will cover ALL of your visits. The representative will give you a reference case number and a fax number that your consultant will use to send what they call a clinical. Here is the info they will ask you for: CPT codes: 99204 for an initial consult and 99404 for preventive health teaching at the same time 99214 for a follow up and 99404 for preventive health teaching at the same time ICD10 code: Z39.1, care of the lactating mother Modifier codes: 33 and 25 Serena Meyer RN IBCLC Business Name Bay Area Breastfeeding Support NPI 1306113881 EIN 45-3915267 CA RN license 95048954 IBCLC number 1113721 Phone number 925-257-4023 Fax number 510- 275-0331 Email [email protected] 4.) As soon as you have the reference case number, ask your consultant to send a “clinical” to your insurance company with your reference case number on the cover letter. Nothing else should be on the cover letter, especially no personal health information. The clinical should outline what your plan for treatment is. The nurse reviewing your case will use the clinical to make a determination. 5.) The nurse has 15 calendar days from the time a clinical is received to respond to you. They'll likely call with a determination, but they'll follow up with a letter. In my experience, calling every day to check in on the case doesn't help or speed up the time of a response. 6.) Once you've been approved, schedule your visits. You'll need to pay for the visits up front. Before your visits, ask your insurance company which claim form you must submit for reimbursement. Print out the claim form and bring it to your visit so you and your consultant can fill it out together. Submit your claim form to request reimbursement as soon as your visit is over. Your insurance company may allow you to submit it electronically via a member portal. That will save you the time of sending it via snail mail. Other tips: Write down the name of EVERY person you speak to about your case. That way, there is always a trail and someone held accountable. This will come in handy countless times, I PROMISE. Keep track of every conversation you have related to your case and document exactly what was said and what information you provided during each one. Lastly, be aggressive and don't give up -- because that's what they're hoping you'll do. It's not nearly as difficult as it sounds to track down all the information you need. It just sounds difficult because of the alphabet soup they drown you in. Keep your head up and persevere!! Additional resources: California Network Adequacy standards: https://www.dhcs.ca.gov/formsandpubs/Documents/FinalRuleNAFinalProposal.pdf Anthem CA Member Claim Form: https://www.anthem.com/docs/24066CAMENABC.pdf National Women’s Law Center Toolkit New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care LawF Sample appeal letter for lactation coverage on page 11. https://www.nwlc.org/sites/default/files/pdfs/final_nwlcbreastfeedingtoolkit2014_edit.pdf?fbclid=I wAR0eRLpFAbeJUaSJwaiOvz9Npg8Y8suTIMTsKjzkqQFA2zUAAaffeQhoLjg  A Short Introduction on Infant Growth Many families are worried about breastfeeding successfully and having a baby that flourishes and grows well. It can feel very overwhelming to have a small person so completely dependant on your care ( and breast), and it's common for parents to be concerned about weight gain as a sign of health. New parents often confuse frequent feeding as a sign that the baby is not being fed enough or well. In some instances the baby is simply having a growth spurt, in other situations the baby is truly not getting enough to eat, and the baby needs to be supplemented while breastmilk production is pulled upwards. In this post I’ll be talking about why it is important to be able to tell the difference between a healthy baby and a baby not getting enough milk. I will also provide 8 suggestions to correct the problem if your milk production is low. What is normal weight gain for breastfeeding infants in the first place? The average term infant will take about 10-14 days to get back to birth weight. This can be complicated by excessive weight loss in the first 3 days of life, jaundice ( sleepy nursing) and preterm infant feeding ( more sleepiness). If the baby has lost 10% or more from original birth weight, then it is reasonable that it might take the full 14 days or a few days longer to regain the weight. After 2 weeks of life my expectation is that the baby should be able to gain 6-7oz (180-210 grams) per week if they have access to a full supply of breastmilk. If your baby is not gaining weight regularly, losing weight in a prolonged fashion ( still losing on day 5, or still under birth weight at 17 days of life) it’s important to figure out why, and correct the issue. Older babies may gain weight a little slower than infants in their first 8 weeks, but they should still be able to stay on their growth curve without falling off of it. How to Tell if Your Baby is Gaining Enough Weight A baby that is gaining weight normally, will stay on their growth curve and grow accordingly. It is also important to watch head circumference as an indication that the baby is healthy and getting enough to eat. Their are percentile for head circumference growth, as well as a separate chart weight. If your baby is gradually dropping weight percentiles and has dropped two weight chart growth curves downwards; it’s time for corrective action. Important to early weight gain tracking is that infants in their first 5-8 weeks should be stooling at least twice a day to indicate that they are eating enough volume of breastmilk. You can’t count weight gain if the baby isn’t stooling appropriately, it might just be a backup of waste material vs real weight changes. A well hydrated infant will have 5-6 wets and 2-3 poops in a 24 hour period, after the age of 5 days old. How Milk Production Works Milk production is dependant on the signal to make more, which is effective removal from the breast. Breast emptiness triggers a faster speed of milk production, while staying full over a long period of time slows milk production through the mechanism of the “Off Switch”. The off switch in milk production is called the Feedback Inhibitor of lactation, a small protein that we call FIL for short. Its build up signals a slow down in milk production. This is why pumping after breastfeeding to get very empty helps drive up supply. An emptier breast makes milk faster! The first 5 weeks or so of breastfeeding, the milk is produced in a way that is offset by hormones. Between weeks 5-8 or so, the production of milk is slowly changed over to mechanical milk removal. This means that the baby has to be able to do the work if supply is going to stay up. For women that have oversupply it might be closer to around week 8-12 before they notice a drop in infant weight gain due to tongue tie. Why Isn’t the Baby Gaining Weight? Babies that are failing to gain correctly will often have a structural reason for the issue; meaning possible tongue tie or lip tie. Sometimes tongue tie is assessed for by unknowledgeable healthcare providers and it is missed or dismissed, or a parent is told that the tongue tie is “little” or “unlikely to cause any problems”, and then the baby simply can’t get the milk out and no one can figure out why. Once this occurs, the mother’s body responds to the decreased mechanical milk removal, by making less milk. Milk production is dependant on milk removal. Supply follows the demand at the breast, so if the demand is not effective, supply goes down. In general, a baby is not gaining weight well if the baby isn’t getting enough calories. Instead of focusing on the real reason some HCP will tell women that their milk is watery, low calorie or some other nonsense. When reviewed, there is little evidence to support such claims, and what can be seen is that a mother’s milk is perfectly made for her baby each time. The quantity that the baby is receiving is the usual issue. Slow Weight Gain Without Infant Tongue Tie If the baby has been assessed by an International Board Certified Lactation Consult already and it has been determined that the baby has normal tongue and lip function, this section is for you. There is evidence that other health conditions in the mother may influence milk production, such as PCOS, breast hypoplasia, breast augmentation, breast surgery, hypothyroid, anemia, low prolactin levels, postpartum hemorrhage, and diabetes. For those with a low supply that refuses to increase despite these tips, please look into visiting a lactation consultant to make a custom plan of action to pull up milk production. You may also need specific lab work to rule out health problems; your LC can help you figure out what is the best choice for you. What You can Do to Correct Weight Gain
Reaching out for Help When Your Baby Isn’t Gaining Weight Right It’s really hard to have your feelings that something isn’t quite right listened to or validated. Well meaning family may dismiss your worry about your baby as first time mother’s nerves. If you know something isn’t right or you think your healthcare team should be paying more attention, you are probably right. In the field of medicine we are quick to dismiss what we don’t totally understand or agree with. If your baby has not been gaining any weight, or is losing weight its time to start looking for a Lactation Consultant. Before you add in a supplement, please take a moment to really make sure one is needed. Please talk your options over with your Lactation Consultant! If you are not sure how to find one, I wrote another blog post on finding a Lactation Consultant near you that might help you find one! Meeting Serena Meyer RN IBCLC for an Appointment If you have given some thought about your situation and you live in the San Francisco Bay Area you can reach out to me through my webpage to book an appt: https://www.bayareabreastfeedingsupport.com/contact-me.html |
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