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Breastfeeding Report Card By State
Breastfeeding A Baby With Hypotonia
What Is A Certified Breastfeeding Educator (CBE) ?
Breastfeeding With Fibromyalgia, Yes It's Possible
Amyotrophic Lateral Sclerosis (ALS) And Breastfeeding


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Breastfeeding Report Card By State

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Here is the latest statistics on breastfeeding and exclusively
breastfeeding by state.  This list was compiled by The Center For Disease Control And Prevention National Immunization Survey.(2011)  Statistics.  It is based on phone calls, land line and telephone samples, dual frame sample.

The World Health Organization says that babies should be breastfed for at least six months.  The American Academy of Pediatrics also believe that babies should be breastfed exclusively for the first six months.  Then food should be introduced and breastfeeding continued up to 12 months old.

Vermont is the best state for good breastfeeding rates.

States          Breastfeeding 6 months       Breastfeeding 12 months
Alabama      32.1                                     11.8
Alaska         64.3                                     42.5
Arizona        47.8                                     23.9
Arkansas     32.3                                     13.5
California     63.1                                     38.4
Colorado     55.2                                     29.3
Connecticut   51.4                                    27.5
Delaware       34.4                                   16.8
District of Columbia     53.1                     30.0
Florida                         48.7                     26.9
Georgia                        40.1                     20.7
Hawaii                         61.5                     36.5
Idaho                           56.8                     30.5
Illinois                           47.0                    26.1
Indiana                          38.6                    21.5
Iowa                             51.6                    28.9
Kansas                          40.3                    22.5
Kentucky                       31.5                    22.8
Louisiana                       30.3                    12.6
Maine                             50.5                   29.2
Maryland                        60.1                   29.4
Massachusetts                 53.7                  24.9
Michigan                         46.6                  23.3
Minnesota                       59.2                  34.6
Mississippi                       28.9                 10.0
Missouri                          42.1                  20.2
Montana                         50.7                   25.5
Nebraska                        46.1                   25.8
Nevada                           45.3                   22.7
New Hampshire              57.6                   30.9
New Jersey                     56.2                   28.3
New York                       55.8                   31.3
North Carolina                48.3                   24.5
Ohio                                42.1                  21.6
Oklahoma                       38.4                   22.6
Oregon                           64.4                   40.2
Pennsylvania                   45.7                   26.1
Rhode Island                  47.0                   22.2
South Carolina               56.2                    30.9
South Dakota                 45.6                    18.3
Tennessee                       40.7                    20.9
Texas                              42.9                    20.9
Utah                               63.1                    40.7
Vermont                          66.5                    45.3
Virginia                           53.7                    27.4
Washington                     64.2                    35.3
West Virginia                   29.3                   15.9
Wisconsin                        54.9                   26.2
Wyoming                         56.6                   30.0

Breastfeeding A Baby With Hypotonia

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     Breastfeeding is best for your body.  It has all the nutritious ingredients needed to keep your baby healthy.  In fact, any breast milk you give your baby is better then none.  However, sometimes special care is needed to help breastfeed a baby with special needs. 
     Hypotonia babies have a weak muscle tone movement, which may involve the brain, nerves, muscles and spinal cord.  Causes may include:  brain damage, encephalopathy due to lack of Oxygen.  Sometimes disorders affect the nerves that supply muscle to our body.  In rare cases, an infant can’t process food into energy.
     How can a mom help breastfeed a baby with Hypotonia?  A baby with Hypotonia has a weak suck, and ineffective tongue.  Therefore, the baby needs help positioning on mom’s breast for breastfeeding.  Many Hypotonia babies have a hard time with the coordination of sucking, swallowing and breathing.  Therefore, a baby with Hypotonia needs additional support. 
     The Dancer Position is used, where a mom rounds her hand underneath her breast while stabilizing her baby’s jaw.  Sometimes, the Hypotonia baby, does not have a sucking reflex or has a decreased one. In fact, some of these babies facial muscles are also weak, therefore making it hard to suck well.  Occasionally, a nipple shield is needed for this baby. You need to make sure your baby gets a deep and good latch.  If these signs are not recognized early on, these babies can lose too much weight.  However, it has been noted that, after working with these babies, their sucking efficiency continues to improve over the first year.  Some of these babies may require a little intervention such as supplementation, pumping, more frequent nursing etc……  Take short breaks in between breastfeeding.  Use a supplemental feeding system at your breast if needed. 
     One example of Hypotonia is Down Syndrome.  Down Syndrome is a disorder caused by Trisomy of Chromosome 21.  Breastfeeding may actually help with normal mouth and tongue coordination.  Additionally, many Hypotonia babies suffer from Cleft Palates. Other Hypotonia babies may suffer from Pierre Robin Sequence, where a baby has a smaller then normal jaw, high arched palate, a jaw that is far back close to the throat and the tongue is large.  Sometimes, teeth even appear at birth.  Other babies may suffer from Choanal Atresia, where the anterior skull has a blockage which narrows the nasal airway.  Sometimes surgery is required to correct this situation. 
     It is a good idea for a  Lactation Consultant to help assess your baby’s ability to latch, suck and transfer milk.  In fact, a Lactation Consultant will recommend you to hold your baby skin to skin because this helps with increasing you milk supply.  Ask your pediatrician to refer you to a Specialist, who can help you with your baby’s sucking coordination, probably a pediatric Occupational Therapist.  I have seen many come to the NICU to help preemies. 
      Ankloglossia or Tongue Tie is very common in babies suffering from Hypotonia.  They may have a short Ligual Frenulum, difficulty lifting their tongue and going to side to side with their tongue.  These babies need to see a special Ear Nose and Throat, ENT, Doctor.  I send many of my patients to ENT, for a proper evaluation. A Frenotomy, Tongue Clip may be preformed by the ENT, if necessary.
     You can use a hospital grade pump to double pump your breast.  It’s important to continue to evaluate and monitor your infant.  You can go to a pediatric neurologist, a geneticists for more testing, you can get diagnostic testing done and evaluate your baby’s decreased muscle tone and floppyness of your baby’s body and head.
     In conclusion, I am so proud of each new mom that attempts to breastfeed a baby.  Having a baby with Hypotonia is an even bigger challenge.  However, with patience and love, you will learn to breastfeed your baby well.  Remember, human milk is the best for your baby.  Keep your baby skin to skin when possible.  Breastfeed as often as you can.  This will help improve coordination associated with Hypotonia.  Support your baby’s mouth and jaw with your hand if needed. Take extra care when lifting your baby up. Good luck.  I hope breastfeeding works out for all of you.  It is a special bond that will last forever.  If you know someone who has a child with Hypotonia, encourage them and be supportive of their choice to breastfeed.  Keep telling them what a wonderful job they are doing.

What Is A Certified Breastfeeding Educator (CBE) ?

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     Certified Breastfeeding Educators help breastfeeding families in many ways. Many of them are nurses on the health care team promoting and assisting new moms with breastfeeding problems. In 1987, Dr. Debi Leslie Bocar, created the Breastfeeding Educator Program.  It has been revised through the years over 120 times.
Certified Breastfeeding Educators take a very short five day course.
In fact, Certified Breastfeeding Educators are not qualified to represent themselves as lactation consultants. Therefore, there is a big difference when a person represents themselves as a Lactation Consultant or as a Certified Breastfeeding Educator.
The title Certified Breastfeeding Educator means that you have attended and participated in a Breastfeeding Educator Program.
Additionally, you have role play activities which may
include positioning, latch-on and mom breastfeeding, and oral discussion of the management of selected breastfeeding challenges during the week you are at your conference.
There is a 50 question exam that you need to get an 80% in order to pass.
Participants are awarded a certificate documenting their successful completion of the certification process and will be entitled to use the designation Certified Breastfeeding Educator™ for a period of five years.
Recertification is needed every five years.

     There are different pathways to become an International Board Certified Lactation Consultant or IBCLC.  This is the real degree in the field of Lactation Consulting. For me, it took six and a half years to become an IBCLC.   I am an International Board Certified Lactation Consultant.  I hold a Bachelors Degree in the field of Maternal and Child Health/ Lactation.  I also interned for many hours, months, years to qualify to sit for my boards in 2010. 
     A Certified Breastfeeding Educator has only finished a one week course.  Therefore, you need to be careful who you choose to be your Lactation Consultant.  Ask for our Board Certified Number.  An IBCLC has much more extensive training, and more techniques to better serve you and help you with your breastfeeding problems.  By using someone else, they miss something and you are not going to be guided correctly.  Furthermore, someone may say and represent themselves as Lactation Consultant when in reality, they are not.  Many states are trying to put legislation through to protect new moms.  I feel that it will take a while before this happens in your state or place you live.
     In conclusion, if you can find someone with an IBCLC, behind their name, then we are the real International Board Certified Lactation Consultant.  If you use anyone else, including nurses with the less degree, they will not know all the techniques to help you and your baby.  Choose wisely and carefully.

Breastfeeding With Fibromyalgia, Yes It's Possible

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     Breast milk is best for your baby.  Therefore, every woman should consider breastfeeding.  However, sometimes medical problems may arise and prevent a mom from breastfeeding.  Some women experience breastfeeding and Fibromyaligia.  It becomes a little more challenging where these moms experience constant fatigue, chronic pain, joint disorders and other kinds on medical problems.  Some women with Fibromyalgia feel great during their pregnancy, only to feel worse afterwards while breastfeeding.  Therefore, this makes it hard for women to breastfeed.
     What is Fibromyalgia?  It is a syndrome that is associated with pain all over your body for a long period of time.  It has no age limit therefore, children, men and women can suffer from it.  Possible causes may include:  physical, emotional and mental trauma, abdominal pain response, sleep disturbances, anxiety, depression, injury to the body, sensitivity of light, sound or odors, stiffness when you wake up and get out of bed, sexual dysfunction, muscle trauma, chronic neck or back pain, infectious illness, chronic fatigue, hypothyroid or under active thyroid, or illnesses such as Lyme Disease, Hepititis C or Epstein- Barr Virus.  Additionally, if you have an overactive immune system, this may cause muscle trauma and injury.  Last of all, genetics may play a part in triggering Fibromyalgia. 
     Sometimes, stress can cause Fibromyalgia to flare up.  When that happens, try to find a calm and stress free room to breastfeed.  Use pillows to help support your body during breastfeeding.
     Unfortunately, people with Fibromyalgia experience pain day and night.  Some people seek medications for their symptoms.  At this time, the Food and Drug Administration has approved Lyrica (Pregabalin), to be used for Fibromyalgia patients.  Dr Thomas W. Hale, an expert in the field of medications and breastfeeding, recommends that you watch your baby for sedation, constipation etc…   Furthermore, he continues saying that nursing moms should use precaution when taking this drug. 
     Alternative therapies such as massages, acupuncture or seeing a Chiropractor may help.  Yoga may also be good for you.  These alternative therapies may help mange your Fibromyalgia symptoms better.
     Other symptoms of Fibromyalgia may include:  irritable bowel syndrome, (IBS), having memory loss or having a hard time to concentrate in your daily life, numbness or tingling in your hands or feet.  You may also have a limited ability to perform exercises.  One can even get migraines or tension headaches.  Speak with your doctor if you experience these problems so you can get a proper diagnosis swiftly.
      Fibromyalcia can be debilitating.  These conditions can come in a wide range of symptoms affecting each individual differently.  At the present time, there is no cure.  Doctors focus and concentrate on relieving symptoms and improving your functions.
     In conclusion, breastfeeding should be pain free and enjoyable.  If you have Fibromyalgia, ask your doctor how you can successfully breastfeed.  Position yourself on your bed or in a chair properly.  Try to have a little bit of patients to deal with your problem.  Consult a Lactation Consultant, such as myself, a specialist in the field of breastfeeding for additional assistance.  Speak to your doctor and use prescription medication to help reduce pain if needed.  Try to use alternative therapies for additional comfort.  Try to get as much rest as possible, reduce your stress level, exercise moderately and listen to your body if you are tired, practice methods of relaxation, and improve your diet and overall nutrition.  All these things can help minimize symptoms and help improve your quality of life.

Amyotrophic Lateral Sclerosis (ALS) And Breastfeeding

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       What is Amyotrophic Lateral Sclerosis or ALS?   Amyotrophic gets its name as follows:  A stands for no, Myo refers to muscle and Trophic means nourishment., therefore, no muscle nourishment.  When a muscle has no nourishment, it atrophies or wastes away.  Lateral identifies the area in the human’s body, their spinal cord, where a portion of the nerve cells that signals and controls the muscles are located.  As this area degenerates, it starts to scar and harden, sclerosis, in the region.  Sometimes ALS is called Lou Gehrig’s Disease. Unfortunately, it is a rapidly progressive disease, a fatal neurological disease that attacks the neurons or nerve cells which are responsible for controlling our voluntary muscles movement.  These muscles may include the arms, legs, or face.  In fact, it can gradually destroy our motor neurons and can be fatal.  That is why The Ice Bucket Challenge is a blessing to many who suffer or who have family members who are suffering from this disease because from all this money has come awareness of this disease and a possible road to a cure.
     The drug Riluzole (Rilutek) is the only drug approved by the FDA for ALS.  It slows the disease down.  Speak to your doctor if you are breastfeeding because this drug passes through into the human milk.  Additionally, this drug can lower your white blood cells and increase your chances of getting an infection.  Additionally, animals, especially rodents, treated with this drug, have shown significant improvement in their motor scores.
     There are no adequate studies at this time done on Riluzole and breastfeeding. Together with your doctor, you can make an informed decision weighing the benefits of taking this drug as opposed to the potential risks it may have on you and your baby while breastfeeding.  Many feel that a mom should not breastfeed while taking this drug.
     There are side affects to this drug Riluzole.  Some of the side effects are:  pneumonia, abdominal pain, drowsiness, dizziness, decreased liver function, nausea, rash, itching, swelling, vertigo, vomiting and diarrhea.  There are many clinical trials underway testing new drugs and hoping to find a way for people to live a better quality life.  There are tests being done on especially rodents to test drug like compounds, gene therapy, antibodies and cell based therapies.  Clinical trials offer hope for people to help further our study on ALS. 
     In conclusion, always contact your doctor when you want to breastfeed and you are taking medications. Discuss with your doctor the risk and benefit of the drug, Riluzole.  It is unknown if this drug passes into breast milk.  Therefore, consult with your doctor before breastfeeding.  I hope in our lifetime we will see a cure for ALS and be able to figure out what causes this disease and how we can prevent and help people live a more productive life with it.  I am happy we have had The Ice Bucket Challenge and now the world is more aware of ALS.  I hope with the money received, we will find a cure.
Where can I get information?
ALS Association
1275 K Street, N.W.
Suite 1050
Washington, D.C. 20005
tel:  202-407-8580
fax:  202-289-6801

Antipileptic Drugs and Breastfeeding

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     Can breastfeeding moms use of Antiepileptic Drugs (AEDs)? Now that you have given birth, you probably have concerns whether you can breastfeed while taking epilepsy drugs.  It is important to  encourage breastfeeding moms to  take  careful precautions and evaluate possible side-effects on their baby caused by the indirect exposure to AEDs via breast milk.
     In this blog, I have tried to explain how safe each drug is while breastfeeding In fact,  for each AEDs, I collected all retrievable data from Hale’s “Medications and Mother Milk” (2012).  I will summarize each drug according to Dr. Thomas W. Hale’s opinion.  Additionally, older AEDs, such as Carbamazepine, Valproic Acid, Phenytoin, Phenobarbital, Primidone are considered to have a good level of safety during lactation. However, there are fewer data available on the use of the new AEDs on the market today.   Therefore, Gabapentin, Lamotrigine, Oxcarbazepine, Vigabatrin, Tiagabine, Pregabalin, Leviracetam and Topiramate are compatible with breastfeeding with a less documented safety profile. Ethosuximide, Zonisamide and the continue use of Clonazepam and Diazepam are contraindicated during breastfeeding. More testing is needed on these drugs and hopefully in the near future, more doctors, healthcare professionals and scientists will take interest in this subject and future their studies on these drugs,

Carbamazepine -Moms treated with Carbamazepine (CBZ), should be carefully monitored during breastfeeding.  Probably this drug is safe to use.
Ethosuximide-A large amount of this drug is transferred into the baby.  Watch your baby for sedation, poor sucking and excitability. This not the preferred choice.

Gabapentin- Levels are low in milk.
Lamotrigine- lamotrigine is considered moderately safe during breastfeeding .

Levetiracetam- Levetiracetam is a new AED;  keppra, is usually added to other drugs in case of inadequate control of seizures. It passes into breast milk however, it is still thought to be safe levels.  It is the growing choice of a drug to use.

Oxcarbazepine- Oxcarbazepine (OXC) or  Trileptal is used to treat partial seizures.   Reports of its use while breastfeeding are limited. Phenobarbital-  Phenobarbital or Laminal or Barbilixir, is widely used in both adults and children.  The main, yet rare, side-effect attributed to phenobarbital is sedation, In premature babies or in infants with drowsiness, difficulty in sucking or poor weight gain, it is recommended to monitor its plasma levels.

Phenytoin or Dilantin or Nova-Phenytoin At this time, there is no study on the passage of pregabalin into human milk. The absence of binding to plasma proteins and its excellent oral bioavailability suggest that it can pass into the mother’s milk and into the circulation of the breastfeeding baby. Numerous side effects such as dizziness, drowsiness, impaired vision have been observed in adults. It is rated as moderately safe during breastfeeding  

Primidone- Mysoline, Apo-Primidone, Sertan, These types of drugs have a significant affect and causes sedation in a baby. It should be used with caution during breastfeeding Tiagabine- Tiagabine oral absorption is almost complete and it is highly bound to plasma proteins. There are no studies on its use during breastfeeding, leading to possibly prefer other antiepileptic drugs. If this drug is taken by the breastfeeding mother, the baby should be monitored.

Topiramate or Topamax is increasingly prescribed, being effective and well-tolerated by epileptic patients. It is rapidly absorbed, it has a low plasma protein binding, a relatively long half-life and a significant excretion into breast milk.  Close observation for sedation is advised.

Valproate- Patients taking valproate may develop hepatotoxicity, thrombocytopenia and anemia. The limited passage of valproate into breast milk (the drug is almost completely bound to plasma proteins) make it safe in lactation.

Vigabatrin- Vigabatrin is commonly used for multi-resistant epilepsy.  There are no precise data about its passage into breast milk. Since no information is available about its use during lactation, the breastfeeding infants should be monitored.

Zonisamide-  Zonisamide –It is a sulfonamide. It easily passes into breast milk.  Caution is recommended with this drug.

         When evaluating a drug, certain things should be taken into considerations.  Discussion toxicity in breastfed infants is reported. AEDs are expected to determine in the breastfeeding baby  a series of symptoms related to their pharmacological effects on the central nervous system, sleep patterns, poor sucking and possibly poor growth.  Another variable is how well an infant and mom metabolizes the drug in their systems.
        Breastfeeding mothers should be provided with concise and clear information on the lactation risk on every prescribed medications they take. Nevertheless, breastfeeding mothers taking AEDs happen to receive inconsistent and sometimes conflicting advices on whether or not to breastfeed from different clinicians (general physician, neurologist, pediatrician, obstetrician, etc.).  Therefore, don’t be afraid to ask questions when you are in doubt of what medications you are on and how will it affect your baby.
        In conclusion,  breastfeed babies should be carefully monitored and, if required, the infant drug plasma-level should be tested.  Although the current available advice on the use of AEDs during breastfeeding present some contradictions, most AEDs can be considered safe according to our review.  We need to keep encouraging women to breastfeed.  Moms taking epileptic drugs need to be well informed and speak directly to their doctor and together make an informed decision to breastfeed her baby. Good luck and I hope you all have a successfully and enjoyable breastfeeding journey.

How Critically IIl Babies Benefit Most From Breastfeeding

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     Breast milk is the most nutritional food you can feed your baby in the NICU.  It is filled with nutrients, vitamins and antibodies that can help a NICU baby get stronger and healthier.  “The immunological and anti inflammatory properties of human milk are especially important for the critically ill, infants in our intensive care units,”  said Diane L. Spitz, nurse researcher and director of the Lactation Program at the Children’s Hospital of Philadelphia, CHOP.  Some babies will be able to breastfeed during their stay in the NICU while other babies will need breast milk fed to them through their feeding tubes or bottle.  I have had the experience of having two sons who were in the NICU. 
     I remember going home and pumping my breast milk every three hours at home and sending the bottles with my husband for our baby in the NICU and they fed it to him through his feeding tube.  One of our sons spent four weeks in the NICU.  I had to teach him how to breastfeed when I came home. 
     If you need to pump for a while for your NICU baby, I highly recommend a hospital grade pump or a good electric pump.  Many insurance companies are now paying for you to get a pump through the Affordable Care Act.  After you give birth, call your insurance company and see if you can get one.  Some of them are worth close to three hundred dollars, well worth the call.
     Try to pump in a comfortable place, eat and drink well, find time to rest.  This will all help your milk production.  What ever you pump for your baby is so important to bring to the hospital because this breast milk is especially designed for babies in the NICU.  It has more infection fighting substances in the milk.
     Ask a Lactation Consultant for help in the hospital while your baby is in the NICU.  Once you come home, you may want to call a Lactation Consultant, such as myself, at least one time to help you breastfeed.  A Lactation Consultant may recommend you use a nipple shield, a soft silicone nipple placed over the mother’s nipple sometimes used to help premature babies.  Additionally, a Lactation Consultant can help weigh your baby before and after to see how much your baby is eating.  Your pediatrician may recommend supplementation for a while.  As the baby gets stronger and bigger, supplementation will be decreased and possibly be discontinued. 
     A Lactation Consultant can also go over Kangaroo Care, placing your baby on your chest skin to skin.  This will help warm the baby and be comfortable by hearing mom’s familiar heartbeat and breathing.
     In conclusion, don’t expect breastfeeding to be perfect at first.  Your baby has spent time in the NICU and there needs to be a period of adjustment for both of you when the baby comes home.  Your baby will benefit from any amount of breast milk you can produce.  Breastfeeding is a personal decision.  You need to make the right decision for you and your baby.

Skin to Skin After A Cesarean Section

     Skin to skin is an amazing time to bond with your new baby.  There are so many benefits for a mom to hold her baby close to her skin.  In fact, early skin-to-skin care (also called kangaroo care) is a natural process that involves placing a naked newborn chest down on the mother’s bare chest and covering the infant with blankets to keep it dry and warm.  Ideally, skin-to-skin care starts immediately after birth or shortly after birth, with the baby remaining on the mom’s chest until at least the end of the first breastfeeding session (Moore, Anderson et al. 2012.)  Therefore, hospitals need to be well informed of the importance of skin to skin.  Early skin to skin can done right after delivery, as soon as possible or within the first twenty four hours.  If a mom cannot hold her baby right away, dad can do skin to skin.
     Sadly, in the United States, Cesarean births are on the rise.  Importantly, the rate of Cesarean births has increased significantly in the U.S. and currently averages around 32%– or 1.4 million American babies born by Cesarean (Menacker and Hamilton, 2010.) Many of my patients have had Cesarean births.  I tell them to breastfeed their baby as soon as possible after delivery.
     Skin to skin helps babies in so many ways including in their development physically, emotionally, mentally and socially. In fact, preemie babies benefit in so many ways with skin to skin.  There are so many benefits for both mom and baby during skin to skin time.  Some of them are:  baby blood sugar level stays good, mom gets less engorgement in the first few days, mom is less anxious because she is holding her baby in her arms.  Furthermore, the baby cries less.  The baby has a better heart rate and temperature level because he is skin to skin with his mom.
     Sometimes barriers get in the way and the mom is not able to hold her baby right away.  Some barriers may be mom is too nauseas after giving birth.  Additionally, mom may have to wait until her anesthesia wears off and she can feel her arms so she can hold her baby.  Her IV, oxygen monitor or heart monitor stickers have to be placed so she can pick up the baby.  Routine procedures for the baby such as getting the baby’s Apgar score, weighing and checking the babies, may delay skin to skin.  One of the main perceived barriers to implementing skin-to-skin care after a C-section is because hypothermia (low temperature) in babies is more common after a C-section. Babies who are born via Cesarean are at higher risk of hypothermia because the operating room temperature is kept quite cold, mothers undergoing a Cesarean may have a lower body temperature, and babies were exposed in utero to drugs that may affect their temperature (Moore, Anderson et al., 2012).  Some of these barriers need to be broken and different protocols need to be put into place to allow the family to experience a once in a lifetime moment of beginning life holding their baby skin to skin.
     Hospital policies usually control whether the baby can be with you in the recovery room.  Talk to your nurse and doctor before you go into the operating room and express your wishes to do skin to skin and breastfeed as soon as possible immediately after delivery. 
     In conclusion, skin to skin early on is safe and beneficial.  Hopefully, hospitals will see the importance of skin to skin in the first hour and help women who have had a Cesarean hold their baby.  It is a great start for both mom and baby.  I hope hospitals around the world will encourage women to do skin to skin after they have had a Cesarean Section.  This way, the baby will be in the warm, loving arms of their mom and feel safe, nurtured, protected and loved.

Pregnancy, Breastfeeding and Arthritis

     There are many health benefits to breastfeeding your baby. Moms with Arthritis may face special challenges while breastfeeding their baby.  You can help assist these moms by giving them words of encouragement, helping them find good ways to hold their baby etc…
     Some women have Arthritis before they conceive or breastfeed.  What are the types of Arthritis? Osteoarthritis is the most common form.  It usually puts wear and tear on your joints.  Usually it occurs where you have injured a joint or in the elderly.  Inflammatory Arthritis covers over 120 different diseases.  Not only does this disease affect the joints, it also affects other body parts.  Some types of Arthritis include Rheumatoid Arthritis, RA Systemic Lupus Erythematosus, SLE or Lupus, Systemic Sclerosis.  They can range from mild to severe.  RA is an autoimmune disease, a condition that causes pain and swelling in the joints.  It can affect the hand, feet or wrists as well as other parts of the body can also be affected.  Fibromyalgia is a chronic pain syndrome sometimes also called arthritis of the muscles. 
     More then half of pregnancies in the world are unplanned.  The American Academy of Rheumatology, ACR, recommends that a woman’s Arthritis be controlled six months before conceiving.  Some women with Arthritis often feel better during pregnancy.  However, after delivery often doctors recommend moms to have someone help them because Arthritis may flare up where their shoulders, wrist and elbows hurt making it hard to position the baby for breastfeeding.  This is where I come in as a Lactation Consultant and help them position their baby in a more comfortable way.
     Evaluating medications a patient is taking is top priority.  Here is a list of drugs harmful during pregnancy and breastfeeding for Arthritis.  This list was developed by a group of OB-GYN doctors, Rheumatologists and Internists placed on the ACR website. 
Drugs that are good while pregnant and breastfeeding are:
Anti-tumor necrosis factor(anti-TNF) drugs
Azathioprine(Imuran) (probably OK during breastfeeding but check with your doctor)
Cyclosporine  (ask you doctor if OK  during breastfeeding)
NSAIDS ( avoid after 32 weeks)
Sulfasalazine (Azulfidine)
These drugs should not be taken during pregnancy or breastfeeding
Cyclophosphamide (Cytoxan)
Methotrxate (Rheumatrex, Trexall)
Mycophenolate (Cellcept, Myfortic)
Waefarin ( OK after first trimester and breastfeeding)
The ACR goes further and recommends men should speak to their doctors who are on drugs for RA three months before conceiving because some drugs such as Methotrexate and Cyclophosphamide (Cytoxan) can affect sperm cells.
     There are other important facts about Arthritis.Yeast Infections are sometimes more common because moms may be more susceptible during her medication use.  Furthermore, if she gets cracked nipples, she could develop thrush.  Another interesting fact is that many cases of Arthritis are believed to result from an interaction of genetic as well as environmental factors.  Women tend to suffer more then men.  Raynaud’s Phenomenon is another possible symptom of Fibromyalgia.  Raynaud’s involves constriction of blood vessels in the hands and veins that they blanch or turn blue.  It can also turn red as the blood rushes back. 
     Fatigue and sleep deprivation can occur with moms who suffer from Arthritis.  In fact, a mom with Arthritis may be at a greater risk of postpartum depression.  Antidepressents may have to be used to not only control Arthritis but help with sleep.  Consult with your doctor before using any drug while breastfeeding.
     In conclusion, further research needs to be done with Arthritis, pregnancy and breastfeeding.  Moms with Arthritis need to be given accurate information so that they can make informed decisions on their condition.  Helping moms use proper pillows and positioning moms right while breastfeeding will help ease joint pain.  Help the mom get her pain under control so she will have a good night sleep and feel rested.  Make sure she is taking the right and safe drug while she breastfeeds.   Enjoy breastfeeding.  It is a beautiful time to bond with one another.

Breastfeeding A Three Year Old Child

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     The World Health Organization reports that the world average for breastfeeding is 4.2 years and they recommend that all children be breastfed for at least 2 years.  Most children around the world are breastfed 3-5 years or longer.  In the United States, few moms are still breastfeeding at one years old.
     There are emotional benefits of a mom breastfeeding longer.  In fact, people feel that kids are more attached to their moms who breastfeed longer but, in reality, they are not.  Furthermore, our lives are so hectic and busy these days, that breastfeeding gives moms the opportunity to slow down and relax and enjoy their baby.
     Chances are if you are still breastfeeding your 3 year old son, your family, friends, and strangers are making negative comments about it.  It is sad because is no harm in breastfeeding your toddler.  As a matter of fact, it is still beneficial.
     Multiple studies show that breastfeeding is beneficial for both mom and her baby.  It contains amazing antibodies and nutrients designed especially for your baby.  In fact, the more a child is breastfed, the lower their rates are for diseases.  Breastfeeding can also lower rates for ear infections, eczema, diarrhea, sudden infant death syndrome, obesity, leukemia and childhood diabetes. Breast milk has nutritional components even when a child is 3 years old. Additionally, breast milk contains long chains of polyunsaturated fatty acids that build brain tissue.  It has been proven that mothers who have breastfed also have lowered their chances for breast and ovarian cancer. 
     Time Magazine, a few years ago, put on their front cover page a mom who was breastfeeding her three year old child.  This magazine article fueled many nursing debates all over the world.  The Time Magazine article had mixed reviews.  The story centered on “attachment parenting.”  The woman on the cover was Jamie Lynne Graumet.  She did not understand what was the big deal that she was still breastfeeding her 3 year old.  Mayim Bialik, an actress and mom, is a proud advocate of attachment parenting.
     Here are the 8 suggestions for the idea of attachment parenting principles:
  1. Make sure you prepare for parenting and birth
  2. lovingly feed your child when hungry
  3. react with sensitivity
  4.  nurture them with touch
  5.  provide for good safe sleep
  6.  provide consistent and loving care
  7.  discipline positively
  8. strive for balance in personal family life
     In conclusion, unfortunately, there is so much negative attitude about breastfeeding an older child.  Just do what you feel is right for you and your baby.  Don’t listen to what anyone else says.  This is your choice and if you feel it is the right thing to breastfeed your three year old son, then do it.