Breast Feeding after Breast Reduction (BFAR)– One mama’s journey through the first 6 months

BFAR – My Journey through 6 Months

Photo credit: Render Photography

Photo credit: Render Photography

When I became pregnant with my son, George, I knew I wanted to breastfeed him.  There were a lot of reasons that this was important to me: nursing him would be better for his health, for my health, and it just felt like it was the natural thing to do.  Every time I learned another thing about breastfeeding, I was amazed.  
 
I read so many horror stories on the internet, from bleeding nipples, to low milk supply, to oversupply.  In fact, my mom hadn’t been able to nurse me due to recurring mastitis, and she never even tried with my brother.  I knew that nursing could be really hard – it could be impossible.  And that was from women who had never had breast surgery.  
 
When I was 17, I had a breast reduction.  It was not a tough decision to make.  I was told that there was a chance I wouldn’t be able to breastfeed, but I was 17 and not thinking that far down the line.  I had the surgery the summer I graduated from high school, and I felt so much more confident.  Although I had the scars to remind me, it became a distant memory.
 
Fourteen years later as I prepared to give birth, I started researching as much about breastfeeding after breast reduction as possible.  I read Diana West’s book, Defining Your Own Success: Breastfeeding after Breast Reduction Surgery.  In it were many stories about women who had varied amount of success with breastfeeding.  I felt like the book prepared me to fail, to be mentally OK with the idea that exclusive breastfeeding was not the only option.  
 
I called my plastic surgeon to ask his office which type of surgery I’d had (inferior pedicle).  That method was known to have the best success rate for nursing because it leaves the nipple intact.  I was relieved.
 
I read and read and googled everything I could on the internet.  I think I found one success story on a blog but for the most part success stories were few and far between, especially for first time moms.
 
Perhaps the best thing I did was read Ina May’s Guide to Childbirth.  Her book helped shape my whole birth plan.  Instead of giving birth in a hospital, I chose to have my baby in a freestanding birth center.  Although her book did not directly discuss breastfeeding after a breast reduction, it did offer many suggestions applicable to all women attempting to breastfeed – skin to skin contact immediately after the birth of the baby, rooming in with the baby, initiating breastfeeding as soon as possible after the birth, limiting the use of drugs and other modern interventions so that baby is wide eyed and awake after birth, no pacifiers, bottles, supplementing, etc.  I felt that having a natural birth, without any medical intervention (no pitocin, no pain medications, etc) would set me up for the best breastfeeding journey.  Additionally, the birth center released its patients just 5 hours after the birth of the baby.  I’d recover in my own bed, with my husband and mom caring for me, instead of nurses I didn’t know, which was one of my biggest fears about a hospital setting.
 
BabyGeorgeI’m not sure if I would have been as successful breastfeeding had my birth story been different, but I am so thankful that I had an uncomplicated labor and delivery, and I was home in my own bed the night that George was born, snuggling with my sweet baby.  
 
My milk came in within 48 hours of having George.  George was born 2 weeks late at 9 lbs, 6.5 oz.  I think he got down to about 8 lbs 12 oz, and was back to 9 lbs 1 oz by day 6.  He nursed like a champ!  He was hungry ALL the time and those first couple of weeks my nipples were SO sore, but no one, myself included, ever asked if he was getting enough milk.  There was never a doubt in my mind.
 
I wanted to wait we had really settled into a routine to write about my experience.  It was so wonderful, I didn’t want to jinx it.  
 
RockingchairI exclusively nursed George until he was just 5 days shy of 6 months old.  We then started introducing solid foods via baby led weaning.
 
I think that there are a couple of things that really helped us to have a successful nursing relationship.  One: a birth team and husband who knew a lot about breastfeeding and who were 100% supportive.  Two: a ton of education while pregnant.  The birth center offered a one on one consultation with a lactation consultant during one of the last visits; one of the Bradley Method classes was dedicated to breastfeeding; in addition, I had the chance to do lots of research on sites like kellymom.com, which I bookmarked for questions that arose after George was born.
 
milkdrunkgeorgeNursing my son might be the coolest thing I’ve ever done.  It’s definitely the most beautiful thing my body has ever done, in addition to growing this tiny, perfect human.  I hope and pray that every woman who wants to breastfeed has the opportunity to do so, and that my story can help offer some hope to women who have chosen breast reduction surgery.
 
UPDATE:
George is now 9 months old are we are still enjoying nursing – maybe more than ever!  It calms him if he’s upset, it helps him sleep if he’s tired, and it’s so easy now that he can more actively participate.  I’m planning to let George self-wean, and I definitely don’t see that happening anytime soon.
TracyGeorge
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Summer Mocktails

Given that it is the season of picnics, BBQs, outdoor gatherings and trips up North, we thought it would fun to share some alcohol-free yet-fun cold beverages for our mamas.  Kids (of all ages) may also love these!

Watermelon Aquas Frescas

Mocktails for pregnancyIngredients

  • 2 cups watermelon, sliced into 1-inch cubes
  • ¼ cup fresh lime juice
  • 10 drops stevia (you can find this as a liquid at the co-op, Trader Joes, or Whole Foods)
  • ice, enough for your preference of cold

Directions:

  1. Place watermelon, lime juice and stevia in a high powered blender and puree on highest setting until liquefied
  2. Fill two large glasses to the top with ice
  3. Pour watermelon mixture over ice
  4. Enjoy

Ginger Lime Mocktails

Ingredients:

  • ¼ cup fresh lime juice
  • 1 teaspoon zested ginger (great for nausea!)
  • 12 drops stevia
  • 18 ounces plain sparkling water

Directions:

  1. Combine all ingredients in a jar and stir
  2. Pour over ice into 2 cocktail glasses
  3. Garnish with lime wedges, if desired
  4. Enjoy

 

Iced Ginger Chai (caffeine free!)

This one is great any time of day!  The ginger and the fennel are great for digestion.  All of these are warming spices too, which are good in pregnancy.  Rooibos has many vitamins, minerals, and antioxidants beneficial in pregnancy.   Note that this recipe doesn’t take long but does involve and overnight steep, so plan ahead!

Ingredients

  • 8 cups water
  • ½ cup finely chopped fresh ginger (you can leave the skin on)
  • 10  cardamonpods
  • 5 whole cloves
  • 10 whole peppercorns
  • ½ teaspoon fennel seed
  • ¼ cup organic loose rooibos tea

Directions:

  1. Place all ingredients in a pot and bring to boil
  2. Reduce and leave pot on stove with mixture at a rolling simmer for 30 minutes
  3. Turn off heat; allow mixture to remain in pot overnight to continue steeping without heat
  4. Strain mixture into a 1 quart mason jar –you will have between 3-4 cups of chai concentrate
  5. Fill a glass with ice, 1 cup chai concentrate and ¼ cup almond milk (or any milk of your choice)
  6. Add stevia, agave, or honey to taste, if desired
  7. Enjoy

THANK YOU!

Dear Readers,

For our 100th post on the blog, we wanted to extend a sincere thank you to all of our readers and our families for supporting us, and choosing us for your care and as an information resource during such an important time in your lives.  We feel fortunate that we have been able to extend our reach to those all over the world– we’ve had almost half a million views on our blog (over 80,000 on a single day alone!) since we began less than a year and a half ago.

We would like to continue to make this blog relevant and valuable to you!  We welcome your topic suggestions ANYTIME.  We are always accepting birth stories and photos or any stories you want to share from pregnancy or parenting.  If you have something you would like to share please don’t hesitate to email jaime [at] health-foundations.com.

Thank you for your support and your readership, we are honored to be able to serve others and feel so grateful that we are able to help women and their families make informed and empowered decisions about their care, their health, and their birthing experiences.

Here’s to another 100 posts that serve you, our dear readers.

With gratitude,

Health Foundations Family Health and Birth Center

Health Foundations Birth Center

Vitamin D in pregnancy and breastfeeding

There has been a lot of buzz around Vitamin D in the last few years, and with good reason.  Evidence continues to mount about the importance of getting enough of this vitamin.  While getting enough vitamin D is a concern for everyone, sufficient Vitamin D is especially important during pregnancy, while breastfeeding, and for babies.

Because the body produces Vitamin D via sun exposure, we in the North—with our months of underexposure to sunlight—need to be particularly vigilant about getting enough vitamin D through diet and supplementation.  Foods such as oily fish and eggs provide some vitamin D, though it is not always enough to eat these foods.  Supplementation is often necessary.

We offer blood testing at the center to check for levels of Vitamin D in the blood; and, from this, we are able to recommend an appropriate dosage of D3 supplementation.  We also carry vitamin D supplements at the center.

What is Vitamin D?

Vitamin D promotes calcium absorption in the gut and maintains adequate calcium and phosphate levels to enable healthy bone mineralization and to prevent disease. It is also needed for bone growth and bone remodeling.  Without sufficient vitamin D, bones can become thin, brittle, or deformed. Getting enough Vitamin D prevents rickets in children and a condition called osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.

Vitamin D in foods

Very few foods naturally contain vitamin D. The flesh of fatty fish such as salmon, tuna, and mackerel, as well as fish liver oils, are among the best sources.  Of course in pregnancy, it is important to be mindful of safe fish intake to limit mercury exposure.

Small amounts of vitamin D are also found in beef liver, cheese, and egg yolks.  Other foods in the American diet are fortified with vitamin D, such as milk and cereal.

Research on the importance of Vitamin D in pregnancy

Vitamin D and preeclampsia

Women who are deficient in vitamin D in the first 26 weeks of their pregnancy may be at risk of developing severe preeclampsia, a potentially life-threatening disorder diagnosed by an increase in blood pressure and protein in the urine, according to research by the University of Pittsburgh Graduate School of Public Health.  This study found women with Vitamin D sufficiency at a 40% lower risk of severe pre-eclampsia.

Vitamin D and infant brain development

Emerging studies show a strong correlation between mom’s intake of Vitamin D and baby’s physical and cognitive development.  Fetuses use vitamin D in the womb for many important processes including regulation of the metabolism of neurotropic factors and neurotoxins, signaling neuronal differentiation, and protecting the brain from inflammation.

A recent study in Spain showed that the 14-month old children of women with sufficient Vitamin D in pregnancy scored higher on mental and motor skills evaluations, which can be predictive of IQ later in life, compared to babies whose mothers were deficient in Vitamin D during pregnancy.

Other studies have linked insufficient levels of vitamin D during pregnancy with language impairment in children at 5 and 10 years of age.

Prenatal Vitamin D may prevent autism

Researchers are also beginning to understand the link between prenatal Vitamin D levels and autism in children.  This study discusses this link further and mentions high rates of autism among Somali children in Minneapolis whose mothers were deficient in Vitamin D prenatally.

Vitamin D in pregnancy helps baby’s muscle strength

One UK study found that mothers who had high levels of vitamin D had children with a much higher grip strength compared with the children of mothers who had low vitamin D levels.

Dr. Harvey, a researcher in this study, explains:  “Muscle strength peaks in young adulthood before declining in older age and low grip strength in adulthood has been associated with poor health outcomes including diabetes, falls and fractures.

It is likely that the greater muscle strength observed at 4 years of age in children born to mothers with higher vitamin D levels will track into adulthood, and so potentially help to reduce the burden of illness associated with loss of muscle mass in old age.”

Postpartum Depression and Vitamin D

Other studies have found that sufficient Vitamin D intake can reduce the risk of postpartum depression.

Getting enough Vitamin D

It is important for all women in the childbearing cycle from conception planning to postpartum to get enough Vitamin D.  Studies have shown that women who take 4,000 International Units (IUs) of Vitamin D every day have the lowest risks of preterm labor, premature infants, and infection.

We are happy to speak with our clients about optimal Vitamin D supplementation depending on current levels and overall health.  This article also discusses the issue of safe and optimal levels in pregnancy.

Breastfed infants and Vitamin D

The vitamin D content of human milk is related to the mother’s vitamin D status.  The National Instituted of Health recognizes that mothers who supplement with high doses of vitamin D may have correspondingly high levels of this nutrient in their milk.  Generally speaking however, vitamin D requirements cannot ordinarily be met by human milk alone.

While the sun is a potential source of vitamin D for infants, experts caution against direct exposure to sunlight for infants, which reduces their exposure. The American Academy of Pediatrics recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D daily, which is the RDA for this nutrient during infancy.

 

Sources:

http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

http://www.naturalmothermagazine.com/

 

Postpartum nutrition

postpartum nutrition

We talk a lot about nutrition in pregnancy, but eating well is also incredibly important in the postpartum as we heal, undergo many physical and emotional changes, and begin breastfeeding.  It is so important to take care of ourselves at this time.  It is also one of the more challenging times to practice self care, as we are busy caring for our newborns and juggling a whole new set of demands.

For many women, postpartum eating needs to be as simple and quick as possible.  Women are greatly helped in the postpartum when others are able to spend more time preparing and offering her healthy meals and snacks regularly throughout the day.  Preparing meals ahead of time to freeze and make later is a good idea, although we want to take care to choose foods that are going to serve the body best.  Loved ones may also offer to make healthy meals, which can be organized by a close friend or family member or with the help of online services such as Meal Baby, Take them a Meal, Food Tidings, and others you can find via a search for “meal registries.” Check out our post on preparing for the postpartum.

Here are some principles of optimal nutrition for the postpartum.  Our midwives can also talk with you about postpartum nutrition in greater detail during a prenatal or postnatal appointment.

Caloric Intake

During the later months of pregnancy, women need to consume about 200 to 300 more calories than their pre-pregnancy requirements, as a general rule.  Breastfeeding women need even more than this. Women generally need about 500 extra calories to make enough milk to feed baby and to get the nutrients they need.  As we mentioned in a previous post, consuming less than this does not help mamas lose weight, but actually encourages the body to hold on to fat reserves.

Drink lots of water

Most women need 2 to 3 liters of water a day in the postpartum to heal and to make milk.  A new mama’s support team should be aware of her need to stay well hydrated and ensure she has access to water at all times.  Make sure glasses or bottles of water are stashed anywhere in the house where mama and baby spend time throughout the day and night.  New mamas typically get an intense feeling of thirst each time they begin to breastfeed, a cue from our bodies that we really need to drink lots of water during this time.

Snack

To get the recommended additional calories in the postpartum and to avoid hunger, it can be helpful to have little snack stations wherever you plan to breastfeed throughout the day, or bring a basket of snacks around the house with you.  These stations or baskets should include water and easy nutritious foods such as trail mix, dried or fresh fruit, high-quality bars (such as Pure bars), or the like.  (You may also want to include in your stash a book to read and/or your phone…nursing takes time!)

Iron

For many postpartum mamas, getting enough iron is huge.  Pregnancy often depletes a woman’s iron stores and bleeding during and after birth can further deplete her stores, so replenishing iron is important to healing in the postpartum and to preventing anemia.  Ways to increase iron include:

  • Eating red meat, eggs, blackstrap molasses and other good sources of iron
  • Increase vitamin C to help absorb more iron from your food.  Take C with your meals and don’t exceed 3000mg a day, or as directed by your care provider.
  • Avoid black tea, as the tannins in tea decrease iron absorption
  • Cook using cast iron pans and pots, iron from the cookware actually gets into the food you eat while cooking.

Keep taking your prenatal vitamins

Women are encouraged to continue taking their prenatal vitamins until they are done nursing.  This extra nutritional support helps mama and baby.  Extra B vitamins can give you a boost in energy and stamina.

It is also a good idea to regularly eat low-mercury fish (the most bioavailable forms of DHA are found in coldwater fish and algae) and/or take an Omega-3 fatty acid supplement with a higher DHA to EPA ratio (taking a supplement is a reliable way to make sure you are getting enough).  Studies have found that infants benefit neurologically when moms supplement during pregnancy and throughout the breastfeeding relationship.  These healthy fats also benefit mamas by helping them heal and by replenishing the nervous and reproductive systems.

Ideal foods

In general, whole, organic, protein-rich, nutrient-dense, warm and nourishing foods are ideal in the postpartum.  It is best to avoid cold, processed and high-sugar foods as well as dairy, and peanut butter (at least for the first few days as these latter two are hard to digest).  You may also want to avoid foods two which babies can be sensitive (a topic for another post!

Good postpartum foods include:

  • Warm soups
  • Warm/Hot foods (avoid cold)
  • Soups, stews and braised dishes (can be made ahead and frozen or prepared in a crock pot)
  • Ginger
  • Whole grains
  • Fermented foods, such as yogurt, kefir, and sauerkraut. These foods promote “good” gut flora in mama and baby and may help prevent colic and the development of allergies in babies.
  • Beans, such as kidney beans, black beans, black soya bean
  • Meats, such as beef, lamb, offal
  • Nuts, such as walnut and almond
  • Eggs
  • Fruits, especially black grapes, plums, cherries, cooked raisins
  • Veggies such as tomatoes, beets, yams, spinach, sweet potatoes, winter squash, leafy greens, avocado
  • Plain Greek yogurt with honey, nuts, fruit, and/or seeds
  • Milk supply supporting foods

Breakfast sausage

In pregnancy, getting enough protein is paramount.  To get the necessary amount each day, it is good to incorporate protein sources into each meal and snack, beginning with breakfast.  There are many good sources of protein among common breakfast foods, such as yogurt and eggs.  Sometimes, however, we get stuck in a rut after having the same food again and again every day for breakfast.  It can be nice to find new recipes and new foods to enjoy during pregnancy.  This one is of the meat variety…and it is tasty and easy to make.  You can enjoy with eggs, frittata, veggies, fruit, topped with salsa, or all by themselves!

Ingredients:

breakfast sausage

1 1/2 pounds of lean organic ground turkey or chicken or pork

1-2 T of minced fresh sage

1 T of minced fresh rosemary

1 t of fresh cracked black pepper

1 1/2 t of sea salt

1 T of honey

1 T of extra virgin olive oil or coconut oil

Directions:

1.  In a large bowl, combine all of the ingredients except for the olive oil.  Use your hands or a spoon/fork to mix thoroughly.

2.  Divide the mix into about 8 portions and make into patties that are a little over 2 inches in diameter.

3.  In a skillet, heat the olive oil over medium low heat and cook the patties, turning once and gently pressing the second side into the pan.  Each side will take about 5 to 8 minutes and will turn golden brown when done.

4.  Transfer the cooked patties to a paper towel lined plate and serve.  You may also wish to save some for future meals or snacks!

Enjoy!

Essential Oils in Pregnancy

essential oilsEssential oils are growing in popularity both in the mainstream wellness and pregnancy and childbirth communities.  Essential oils are subtle, aromatic volatile liquids distilled from shrubs, flowers, trees, roots, bushes, barks, leaves, and seeds.  While we often associate essential oils with scent, there is much more to these oils than meets the nose. Essential oils contain chemical components that can greatly support and enhance our health.

 Essential Oils in pregnancy

Many essential oils can be used during pregnancy to assist with common conditions such as nausea, itching, stretch marks, heartburn, headaches, and more.  They can also prepare the body and mind for and during labor and childbirth.  Additionally, they can be used in place of stronger chemicals that are contraindicated for pregnancy (such as standard bug sprays and immune support).

Essential Oils Generally Considered Safe in Pregnancy

  • Lavender: Lavender can be exceptional for calming, promoting a good night’s rest, treating cuts, scrapes and burns, and taming allergies.  It assists the body in times of stress or imbalance, including anxiety and depression.  May help with stretch marks.
  • Peppermint: Peppermint can help ease nausea, stomachaches, constipation, headaches, heartburn, and other pregnancy discomforts.  It also supports liver  and respiratory systems. Peppermint is energizing.  It is an antibacterial and antioxidant.  (Peppermint should be used with caution when nursing as it can affect milk supply).
  • Lemon: Great for coughs, supporting the immune system, ph balancing, and uplifting the mood.  It is full of antioxidants and is revitalizing.  Also good for digestion and can help with heartburn.
  • Frankincense: valued for its skin healing properties, it would make a great addition to a belly cream or other lotion. It also supports the respiratory system.
  • Ginger: can help with morning sickness

Other oils considered safe and beneficial in pregnancy include:

  • Roman chamomile
  • Geranium
  • Tangerine
  • Grapefruit
  • Orange
  • Rose
  • Marjoram
  • Cedarwood
  • Jasmine
  • Melaleuca alternafolia (tea tree oil)
  • Sandalwood
  • Rosewood
  • Thyme
  • Ylang Ylang

Essential Oil Blends for pregnancy

There are also blends that can be useful in pregnancy.  These include the following (the names in parentheses are the names of the blends offered by Young Living, which is a high quality reputable brand).

  • Antimicrobial blend (Thieves)—good for warding off flus and colds; great alternative to antimicrobial soaps and gels;
  • Pain relief blend (Panaway)—great for muscle aches and pains
  • Relaxing Blend (Peace & Calming, or Gentle Baby)—add these to your bath at the end of a long day; Gentle Baby is great for stretch marks
  • Balancing blend (Valor): this is great for back labor and courage, strength, and confidence in labor.  It helps move us toward a state of balance and alignment.  It can calm our nerves.
  • Purifying blend (Purification)—good for cleansing; can be used in natural homemade cleaning products; can help ward off cold and flu.

Safety of Essential Oils

Safety of any kind of therapeutic remedies is always a consideration, especially during pregnancy.  For this reason, it is important to use high-quality therapeutic grade essential oils that do not contain peptides, amino acids, or other allergens.  The method of contact with essential oils can also make a difference.  Different schools of thought promote different avenues of application.  For example, one model favors inhalation and dilution of the oils.  Another concentrates on external application on the skin, particularly in bodywork.  Yet another incorporates topical application, inhalation and oral ingestion.

As a general rule, it is best to avoid all unnecessary medications and supplements during the first trimester.  Some experts recommend that in the last trimester, essential oils only be applied to the feet, as some oils applied to the belly can cause a baby to change position.  Some oils have been shown to help baby’s turn to ideal position, but that is beyond this general discussion and should be done under the close supervision of your care provider.

How to Use Essential Oils

Aromatherapy:  The safest method of use is thought to be diffusing essential oils into the air using a diffuser.  You can also place a few drops of oil into a pot of gently boiling water and inhale the steam (carefully!) to derive benefits.  Most simply, you can also just take a deep whiff of the oil straight from the bottle to derive benefits.

Topical Application:  External application on the skin (undiluted is called “neat”) is also an option with many oils, but these may cause irritation, so it’s important to learn about what oils are considered safe for the skin.  Many people blend essential oils with carrier oils (such as olive or coconut oil) before skin application, and this can often mitigate any potential sensitivity.  Massage using oils containing essential oils can be wonderful for many expectant mamas.

Internal Use:  Internal ingestion is thought to be appropriate for some oils though it may or may not be the preferred route in pregnancy.  You may want to check with someone very experienced with essential oils and your care provider before ingesting oils (though many are considered very safe for consumption).

It’s important to remember (or it may be the biggest thing on your mind!) that pregnant women can be especially sensitive to smells and oils during pregnancy and even postpartum.

If you are looking for a way to purchase essential oils or need assistance deciding what is best, we can connect you with resources that can help.  Just ask at the front desk.