Brilliant Breastfeeding Fact #485: Breastfeeding when you're sick I have spent the last ten days or so languishing feverishly in bed with a doozy of a flu. To my amusement, the Fitbit misinterpreted the 45bpm increase in my resting heartrate to be the result of 14 hours and 47 minutes of exercising daily in the "Fatburn" zone, and awarded me a celebratory badge. How cute. We never got prizes for deranged vitals in nursing school. Anyway, the enforced rest has given me a lot of time to reflect upon the remarkable immune properties of breast milk. Many mothers are concerned that if they are unwell, it is better for their babies if they switch to formula and “pump and dump” until they recover. In almost all situations, it is much better for your baby – and you! - to continue breastfeeding. By the time you start feeling unwell, the virus will have already been in your body for some days – how long depends on which one it is. In any case, your baby will also have been exposed before you become symptomatic, so putting a halt to breastfeeding now is not going to prevent your baby’s contact with the virus. If you think about the social precautions adults take in preventing the spread of illness, these usually include not shaking hands, keeping distance from others, and using hand gel. Have you ever tried explaining to a baby why the cuddles and suckles have been temporarily suspended? Short of putting up a glass wall between you and your bubba (which I’m not suggesting you do!), just take it as a given that your baby is determined to be snuggled up with you, even if your head is pounding, your temperature soaring, and you’re ploughing through the tissues like there’s no tomorrow. And if you’re feeling as dreadful as all that, it’s a lot less work to put your baby to the breast than to get up to sterilise bottles, cool boiled water, scoop out powder, mix up, repeat, and also express to prevent losing your supply. You might not be feeling up to much, but a quiet suckle with your baby in bed is usually manageable. There’s also another very excellent reason to continue breastfeeding when you’re ill. While the “superfood” label is applied by advertisers to everything from acai berries to chia seeds to spirulina, there’s really only one source of nutrition that truly deserves the title, and that’s breastmilk. What other food is tailored specifically to the needs of the person who is going to be consuming it, right down to giving immune protection against the bugs they are currently being exposed to? Breastmilk contains an immense range of immunoactive components, including bifidus, interferon, immunoglobulins, lactoferrin, lysozyme, leukocyte enzymes, antiviral factors, and antibodies. The amazing thing is that breastmilk is constantly changing according to which viruses and bacteria the mother is exposed to. While you’re sick, your immune system makes antibodies to fight off the disease. These antibodies also go into your breastmilk, which reduces the risk and severity of your baby becoming unwell. The last thing you want to do is deprive your little one of this immune protection when he has inevitably already been exposed to the same bug as you. While I have now emerged from the sweaty chrysalis of my flu-ridden sickbed, my own little breastfed Infant Ninja (just about to turn one), has sailed through with nothing more than a bit of a runny nose. Incidentally, if your baby attends daycare, it’s a good habit to breastfeed at the daycare centre if you can: by spending the time exposing yourself to whatever the latest bug the kids are all into, your body will produce antibodies specific to your baby’s needs. This immune boost can help reduce the severity and duration of any illness your baby experiences. Of course, I do need to advise you of some exceptions and caveats. Conditions that cause lesions on the breast needed to be assessed by your doctor and lactation consultant. If you are feeding a premature infant, additional precautions may be necessary – please take advice from the neonatologist in these situations. There are some maternal diseases where it is NOT safe to breastfeed, and most of these are rare in this part of the world. These include haemorrhagic diseases (eg Ebola, Marburg, Yellow fever, Junin); human T-leukaemia viruses; tuberculosis; and rabies. Breastfeeding with HIV is generally discouraged. There is not enough data available on breastfeeding and Zika. But if you’re down with a cold or flu, just keep on feeding. * Please note - this information is for general interest and education only, and should not substitute for personalised advice from your LC, midwife, doctor, or health professional. Dial-A-Midwife endorses the Australian Immunisation Schedule for the health of mothers and babies, especially the pregnancy dose against Pertussis (whooping cough). If you would like to discuss your own baby's feeding, please contact Dial-A-Midwife 04-818-4-MDWF (0481 846 393) to book a Milk By Mama appointment with an International Board Certified Lactation Consultant.

12 Famous Moms Who Couldn't Care Less If Their Bodies 'Bounce Back'

In honour of World Breastfeeding Week, Dial-A-Midwife is sharing a series of Remarkable Breastfeeding Trivia. Without further ado, here is #673: Twinning during lactation Twins hold a special social fascination, and theories abound regarding how and why they come into the world. It's important to differentiate between dizygotic (fraternal) and monozygotic (identical) twins. DZ twins are the result of two eggs being released and fertilised. About two-thirds of all twins are DZ. They can be same- or opposite-sex, and are genetically as similar as any other siblings. These are the twins that run in families - from a woman's tendency to release more than one egg at a time (most women just pop out one per month). Having a set of DZ twins doubles your odds of having another set down the track. There is also an ethic predisposition to DZ twins: they are most prevalent for parents of African background (16 in 1000), and least common for parents of Asian extraction (4 in 1000). Caucasians run at about 8 in 1000. MZ twins are genetically identical, and occurs more commonly in girls than boys (ratio of 3:2). MZ twinning occurs shortly after conception. They zygote (fertilised egg, not yet advanced enough to be called and embryo) splits between days 2 and 8. The exact timing of the divide affects implantation and placental development. MZ twinning is a random event that occurs in about 4 in 1000 births. The trigger for MZ twinning is unknown, however a study led by Dr Gary Steinman noted a remarkable correlation of MZ twinning in women who were breastfeeding at the time of conception. The study found that the odds were 9 times higher for breastfeeding mothers than those in the general population. The hypothesis was that alterations in the calcium levels in lactating women affected embryonic intercellular bonding. Astonishing! Brought to you by Dial-A-Midwife, Your Call Bell at Home. Postnatal homecare for mothers and babies in Hobart and Southern Tasmania. Bookings available at www.dial-a-midwife.com or phone 04-818-4-MDWF (0481 846 393). Reference: Steinman, G 2001, 'Mechanisms of twinning. IV. Sex preference and lactation', Journal of Reproductive Medicine, vol.46, no. 11, pp. 1003-7.

Breast-Feeding the Microbiome - The New Yorker

Wow. The marvels of milk. http://www.newyorker.com/tech/elements/breast-feeding-the-microbiome

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"Is this normal?!?!" #417: Baby rashes Babies enjoy a reputation for fabulously beautiful skin. However, many tots experience a dizzying array of dots, bumps, and rashes which can cause anxiety in their loving parents. “Baby acne” can occur anytime from birth to 3 months of age, notable for its red bumps on the chin, cheeks, and forehead. You might also see “milia” or “milk spots”, which look like whiteheads. Milia are not acne, they are dead skin cells caught in small pockets just below the surface. They sometimes crop up inside the mouth, and are called Epstein’s pearls. All of these are quite harmless and will subside without any intervention. These rashes are hormonal, a legacy of exposure to your pregnancy hormones. Don’t be tempted to treat them as you might adolescent or adult acne. No soaps, lotions, potions, cleansers, detergents, pinching, or popping. Just wash your baby’s face one to three times daily with warm water, and pat dry. It usually resolves by 4 to 6 months of age, but if it persists, please see your doctor about other treatments.

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So you know that moment when your hand luggage is going through the x-ray at the airport and the guy stops the conveyor belt and scrutinises your stuff and asks what that possibly incendiary device is and you find yourself explaining that it's a breast pump and he looks at you with a mix of major embarrassment and mild disbelief and has his female colleague dust it for explosives? Or is it just me?

Breastfeeding Kickstarter Tip #257: Antenatal expressing If you’re expecting a baby, you may be making plans for a warm, loving, breastfeeding relationship when he arrives. You might even have thought so far ahead as to how you’ll keep breastfeeding after returning to work or study. But have you considered expressing before your baby arrives? Is that even a thing, and why would I want to do that? Plenty of reasons! Breast milk production varies tremendously from one woman to another, but it’s not uncommon to notice a few golden drops of colostrum – the nutrient dense early milk – from about 28 weeks’ gestation. Some women notice it even sooner than this. Your body is getting ready so that even if your baby arrives very early, there’s already some food available. This early colostrum secretion is called Lactogenesis I. It’s one of those remarkable things that your body does, although if you’re not expecting it, it can be a bit of a headspin. But I thought milk didn’t come in for a few days after the birth. Generally speaking, your body starts making transitional milk about 48 to 72 hours after your baby arrives. This milk is thinner and paler than colostrum, and there’s a lot more of it. This happens regardless of how you give birth (vaginally or by C-section), and even when you give birth (on time, prematurely, or late). There’s a huge cascade of hormones involved in Lactogenesis II. This sounds like a Sci-Fi sequel, but it just means that your body has realised that there’s a hungry baby (or two, or three) out in the wide world, and it’s time to crank up the dairy. Contrary to popular belief, it’s not actually the birth of the baby that triggers this process – it’s the departure of the placenta that’s the crucial factor. Placental hormones suppress the action of prolactin, so once it’s gone, your breasts get the message to start making milk. Meanwhile, the frequent suckling of your baby releases oxytocin, resulting in the “let-down” (milk ejection reflex). This gives your body the necessary feedback to work out how much milk to make - after all, twins will need a lot more than a singleton! It can take some time for your body to figure this out though – some women will have an oversupply, and others will take longer to build up to the levels needed for their tot(s). Antenatal expressing promotes prompt, plentiful supply in the first days after birth. But even more importantly, having a stockpile prepared beforehand means that there is less likelihood that your baby will need artificial formula at any time. Are you saying my baby will be given formula in hospital? No, not without a clinical reason, and never without your written consent. However, there are some situations where babies are more likely to need supplemental nutrition, and your midwives and doctors would absolutely prefer that it came from you. That’s why having some frozen colostrum on standby is a great idea. Antenatal expressing is recommended if: • You have diabetes - babies sometimes need extra feeds in the first hours of life to stabilise their blood sugars. • You had challenges with low supply or delayed milk production with a previous baby. • You have had limited breast growth and change during your pregnancy. • You have had breast surgery in the past. • You have been unwell during your pregnancy, as some illnesses and medications can affect your ability to feed in the first days after birth. • Your baby has been diagnosed with a condition that may affect early feeding, such as a cleft lip or palate. Even without these concerns, some mamas like to have some frozen colostrum on standby as “insurance”, just in case breastfeeding does not click at the start. If it’s such a good idea, why isn’t everyone doing it? Can’t it trigger labour? You may have heard that nipple stimulation can be used to induce labour. There is some truth to it, but it doesn’t work if your body is not ready for birth. Plenty of women at 38 weeks or even 41 weeks have diligently tweaked and rotated their nipples in an effort to get things going, with no results whatsoever. For most women, it is perfectly safe to begin expressing from 34 weeks’ gestation. It can be very reassuring to know that you’ve got extra milk good to go. I encourage many women to express late in pregnancy, but there are some circumstances where you should DEFINITELY NOT. Women who have previously had premature babies or who are identified as being at risk of premature labour should NEVER express antenatally. If you’ve been diagnosed with cervical shortening or need a cervical stitch, antenatal expressing is not for you. Anything else I need to know? Use hand expression only, save the pump for after baby’s arrival. Don’t expect buckets of milk to begin with – 0.5mL is an excellent start! If you feel contractions, abdominal tightening, or pain, stop expressing and contact your doctor or midwife. * Please note - this information is for general interest and education only, and should not substitute for personalised advice from your doctor, midwife, or healthcare professional. For information on how to hand express colostrum, and how to store it in preparation for your baby’s birth, please email hello@dial-a-midwife for a fact sheet. If you would like a pre-baby breastfeeding consultation, Dial-A-Midwife offers Milk By Mama home visits or virtual appointments with an International Board Certified Lactation Consultant. Book online at www.dial-a-midwife.com or phone 04-818-4-MDWF (0481 846 393).

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Meanwhile, in Hobart...

"Is this normal?!?" #397: Pink pee Having a new baby is a massive learning curve. While you're flooded with a cocktail of hormones the likes of which you've never encountered before, you're also sleep deprived, and in charge of a small person who looks to you for guidance and worldly wisdom while taking extraordinary liberties with your most delicate bits and pieces. Welcome to motherhood, an adventure that is fabulous, bewildering, frustrating, exciting, joyous, funny, and guilt-inducing in ways you never dreamed possible. While falling in love with your baby, he will reward your devotion with a technicolor spectrum of nappy output. In the first days of life, as you're getting to grips with Parentcraft 101, high-fiving each other for rocking the whole bathing thing, you might undo the nipper's nappy to find a red stain to the urine. Before you hit the emergency call bell, take a deep breath. It's almost certainly urate crystals, and it's nothing to worry about. Urates are a dark pink or red pigment that babies commonly pass in the first couple of days. It's a sign of mild dehydration, which can be normal as a breastfeeding mother starts building her supply. Once the colostrum (thick, rich, golden, early milk that is nutrient dense, but low in volume) transitions to milk (whiter, less viscous, and much higher in volume), the baby hydrates, flushes out the urates, and urine becomes a pale straw colour. If your baby is peeing pink, do let your midwife know, so she can make a note, and keep an eye on your bubba's progress. She may ask you about your baby's feeding duration and frequency, and signs such as lethargy, decreased saliva, dry lips, and long stretches (6hrs+) without a wet nappy. If she is concerned, she will refer to the paediatrician. Urates may be accompanied by jaundice, which is the yellowing of skin and the whites of the eyes. It's also known by the impressive name "hyperbilirubinaemia". Bilirubin is the byproduct of the body's normal breakdown of red blood cells. This process happens in the liver, and newborns sometimes have an excess of red blood cells to sort out, so it takes a bit longer. The pigment lingers in their bodies, making the skin yellow as the liver catches up. The potential risk is that the rising bilirubin level makes babies sleepy, and therefore less likely to feed well. This can exacerbate dehydration and urates. Up to a certain point, jaundice is okay and self-limiting, but beyond that, it requires treatment. If you're still in hospital, the midwives will be checking your baby for jaundice every shift. If you think your baby is looking a bit yellow, let the midwife know. She may check your baby with a space-age looking tool called a bilirubinometer. This is a non-invasive device that gives an estimate of your baby's circulating bilirubin levels. A blood test, called an SBR (serum bilirubin) gives a definitive figure, and will determine whether treatment is needed. Any jaundice concerns will be referred by the midwife to a paediatrician for review. Continued breastfeeding is the best way to tackle dehydration, urates, and mild jaundice. However, if your milk supply is low or delayed, or if there are other issues, this warrants immediate investigation. Urates persisting more than a few days are a more serious sign of dehydration. If your baby develops jaundice after you go home, or if jaundice becomes more severe and your baby is lethargic, medical attention is needed. As a treatment, your paediatrician may order phototherapy. This is not baby's first Instagram account - it's an ultraviolet light therapy that helps break down and flush out the bilirubin. Good hydration through breastfeeding and building your supply is a key part of this approach. Treating jaundice early is usually straightforward and non-invasive (other than small blood samples to check SBR levels). If in doubt, ask your doctor for an assessment of your baby. .* Please note - this information is for general interest and education only, and should not substitute for personalised advice from your doctor. If you would like to discuss ways to manage breastfeeding and increase your supply, please contact Dial-A-Midwife 04-818-4-MDWF (0481 846 393) to book a Milk By Mama appointment with an International Board Certified Lactation Consultant.

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The original comfort food. Get your breastfeeding relationship off to a flying start with a Milk By Mama consultation. Dial-A-Midwife: Your call bell at home. www.dial-a-midwife.com 04-818-4-MDWF (0481 845 393) Photo by Arwen Dyer - Photographer.

Boobie Newbie FAQ #412: What is cluster feeding? In the early months, a lot of babies are superfussy of an evening, and just want to suckle, suckle, suckle. Having your baby latched firmly at the breast for hours at a time, with howls of protest if you even think about removing him, can seem like a routine that will never end! But most babies outgrow this by about 3 to 4 months. New babies breastfeed between 8 and 12 times per 24 hours, but since they don’t wear watches, their hungry times are not spaced at regular intervals. Cluster feeding is when babies have frequent feeds sometimes, and have longer gaps at others. While having a baby at the breast from 6 til 10pm can feel like an endless marathon, the good news is that they typically have a longer sleep for several hours after. But not always! (Sorry!) Cluster feeding usually coincides with your baby’s Fussy O’Clock (sometimes called the witching hour or arsenic hour). Your little one may feed for a bit, pull away, cry, feed some more, pull off, wail, feed, repeat. For hours. This can be extremely frustrating, and new mothers often despair that the baby isn’t getting enough, or wonder if something she ate might be disagreeing with the tot. It can be very demoralising, and a lot of mamas start to doubt themselves. Even more distressing is when your partner, mother, mother-in-law, or friend asks what’s wrong, and helpfully offers a bottle of formula. You are doing fine. You’re a great mother. It's unlikely that there is anything wrong with your milk, or your baby. This behaviour is totally normal. If your baby is a sunny little blossom the rest of the day, and doesn’t seem to be in pain, just soothe him, keep feeding, and don’t give yourself a hard time. Let bubba suckle as long as he needs to. If your partner / mother / MIL want to help and give you support, the best thing they can do is keep you fed, watered, calm, and comfortable. Above all, they need to be your cheerleaders, encouraging you in your decision to breastfeed. (But maybe my baby really needs a bottle…?) Rely on your body. Just keep feeding. Breastmilk production is about supply and demand. Your body is working out how much to make, and your baby is growing rapidly. Emptying your breasts signals your body to make more milk. Supplementing with a bottle tells your body you don’t need to make as much milk, so your supply goes down. And then you get a hungry baby. It’s also worth noting that artificially fed babies also have crankypants time in the evenings, so switching to formula is not a lasting solution. For many babies, fussiness is characterised by wanting small amounts of milk frequently, interspersed with plenty of cuddles, rocking, and nurturing. So how can you provide this while keeping yourself calm? • Wear bubba in a sling or carrier, freeing up your hands. This makes it easier to attend to other tasks, as well as saving your back. • Dance! Rocking motion might just send bubba to sleep, and make you happier, too! • Hand your little one to someone else for some cuddle time. Your partner will welcome the chance to share the parenting load. • Sing! Give your baby some sound and vibration. This can be very soothing. If you don’t fancy being the source of the tunes, play music or white noise. Believe it or not, radio static can calm fussy babies remarkably well. There are also lots of apps that play gentle nature sounds, like rain or birdsong. • Or try the real thing, and go for a walk outside. The fresh air can clear your head and calm down bubba too. • If you’ve reached the end of the evening and just need everyone to settle down to sleep, sit quietly in a dim room. If you’ve got a rocking chair, so much the better. No matter what techniques you try, just remember that this will pass. And you are a fabulous mother. * Please note - this information is for general interest and education only, and should not substitute for personalised advice from your LC, midwife, doctor, or health professional. If you would like to discuss your own baby's feeding habits, please contact Dial-A-Midwife 04-818-4-MDWF (0481 846 393) to book a Milk By Mama appointment with an International Board Certified Lactation Consultant.

Brilliant Breastfeeding Fact #329: Breastfeeding and weight loss. You've probably heard that breastfeeding helps shed the baby weight, but you might be wondering how much, how soon, and how it works. There are normal ranges of weight gain during pregnancy, which vary according to your pre-pregnancy BMI. That's the subject of a whole other post, but in essence, nature wants to make sure that if there's a famine when your baby arrives, your little one will survive - and so will you. In the Western world, we are faced with an abundance of food, not all of which is nutritionally beneficial. However, we also live in a culture that is obsessed with the body beautiful, and there is a disturbing trend of models and actors posting selfies as they progress through pregnancy, showing off their rice-and-kale diet-induced, fatless physiques, with barely a baby bump on display at 36 weeks. That, ladies, is NOT healthy. Fact: Eating nutritious foods in sufficient amounts during pregnancy will cause you to gain weight. Breastfeeding or pumping milk will nourish your baby from your body stores and your continued healthy eating program after your baby arrives. So how much energy is in breastmilk, and how much does it take to produce? Peak milk production is usually reached about two weeks after baby's birth, and is maintained as long as you are exclusively breastfeeding. This is usually between 750-1100mL per baby, per day. The amount is variable, especially if your baby is premature, and the components of breastmilk vary according to your baby's gestation, current age, frequency and exclusivity of feeding. As a rule of thumb, though, every 100mL of breastmilk contains about 67 Cal (280kJ), at 80% efficiency - this is the amount of energy your body uses to make the milk. So the amount expended per 100mL of milk is about 84 Cal (350kJ). If you make 750-1100mL per day, this means your body burns up 630-925 Cal (2635-3865kJ). Put into perspective, a 60 minute, high impact aerobic class such as Body Combat burns about 550 Cal (2300kJ). You can see why breastfeeding helps get you back to your pre-pregnancy weight! While some of the energy used in making breastmilk will come from the stores laid down during pregnancy, your ongoing, healthy food intake should contribute about 400-500 Cal per day (1675-2090kJ) for milk production (i.e. in addition to a normal, non-pregnant, caloric intake for a woman of your height and weight). So breastfeed your baby with joy! Not only are you giving him the best nutritional start in life, you are also improving your own health by lowering your risk of obesity, diabetes, and heart disease. For once, sitting quietly and cuddling up is the best way to lose weight. Plus you can enjoy all the warm baby love. The gym can wait a while. * Please note - this information is for general interest and education only, and should not substitute for personalised advice from your doctor, midwife, or other health professional. It is important to note that you should NOT attempt to lose weight too quickly after you give birth - this can compromise your milk production and your own health. Nor should you return to high impact exercise until at least 3 months postnatally, or when you have clearance from your obstetrician or midwife. The damage that can be done to your pelvic floor if you return to heavy physical training too soon is VERY serious. If you would like to discuss your own nutritional health and wellbeing during pregnancy and after birth, please contact Dial-A-Midwife to make an appointment.