Breastfeeding / MILC Moment

MILC Moment: Breastfeeding Update 2017

By Rebecca Costello, IBCLC

Twice a year, the WBWC lactation consultants organize a “Breastfeeding Update” for all our midwives, nurse practitioners, and nurses. This spring we covered several topics, one of which was a quality improvement project by our UNC intern, Anna Caudill. Anna pulled data from charts for 6 months of WBWC births, looking at breastfeeding outcomes, specifically whether a baby is at or above birth weight at 2 weeks of age, which is an indicator of whether baby is breastfeeding well/getting enough milk. Her work was an update to a similar assessment conducted 2 years ago, which had enabled us to identify possible early warning signs of breastfeeding issues. As a result of the previous study, WBWC implemented several additional screening measures as part of our routine postpartum care.

Anna’s research showed that over the past 2 years, we cut our rate of babies who were not back to birth weight by 50%! Because our rate 2 years ago was already similar to other comparable populations, this result now means we are doing much better than average. We credit this progress to our focus on early intervention – noticing breastfeeding problems in the first few days of life, and helping fix them quickly. We want to thank the entire WBWC team for making this progress possible, and of course you, our WBWC families, for working so hard with us to make breastfeeding successful for you and your babies.

Anna also looked at the percentage of babies who lost more than 10% of their birth weight in the early days after birth (another sign that breastfeeding is not going well). We found that our rate is consistent with other comparable populations. Our next step is to see whether we can reduce that number as well. We have been in touch with another birth center that successfully reduced its numbers with some baby-friendly changes, like continuous skin-to-skin for 48 hours postpartum. We are interested to pilot some new ideas in the service of happy, healthy moms and babies. Stay tuned!

Image courtesy of Heart in Hands Photography

By |April 26th, 2017|Breastfeeding / MILC Moment|0 Comments

MILC Moment

By |March 29th, 2017|Breastfeeding / MILC Moment|0 Comments

Breastfeeding for Doulas and Birth Professionals

Photo credit: Heart and Hands Doula Services and Photography

Are you a birth or postpartum doula? A childbirth educator or other birth professional? In this class, you’ll supercharge your breastfeeding support skills! Whether you’re starting from scratch or have helped hundreds of babies, you’ll get a grounding in the latest breastfeeding information and learn something new (and customized to the Triangle area!).

We’ll be covering topics including:

Preparing your clients for breastfeeding success

The anatomy and physiology (making milk, letdown, suck)

Baby reflexes, abilities, and cues

Optimal latch and positioning, and helping parents get comfortable

“Protecting the space” immediately postpartum and navigating local hospital protocols

Helping parents catch early signs that something isn’t going right, and navigate to the help they need

Breastfeeding gear: pumping, bottles, and milk storage

Overcoming common obstacles including engorgement, sore nipples, and worries about weight loss and milk supply

Hot topics: understanding tongue tie, and bodywork for breastfeeding challenges

The class will be taught by Rebecca Costello IBCLC CD MPH. Rebecca sees patients full time at Women’s Birth and Wellness Center where she’s the Director of Lactation Services. Before coming to WBWC, she worked at UNC Women’s Hospital as an LC, and was a birth doula for many years prior. She knows the importance of doulas to breastfeeding success, and how helpful it was to have breastfeeding education in her doula role.

Cost: $50

To register call (919)933-3301

http://ncbirthcenter.org/event/breastfeeding-for-doulas/

By |March 29th, 2017|Breastfeeding / MILC Moment, Events & Workshops|0 Comments

A Story of Strength

By Lindsey B. Bickers Bock

On the fourth day after our daughter was born, my husband and I were struggling. We had a distressingly sleepy, jaundiced baby, and we were concerned that my milk wasn’t coming in after dealing with a retained placenta after her delivery. We were exhausted from someone being up with her 24 hours/day to keep her on the biliblanket that was provided as treatment for her jaundice. We were overwhelmed when a suggestion was made that she might need to go to the hospital if we couldn’t get her feeding and regaining weight better. Thankfully, the midwife on call at the Women’s Birth & Wellness Center suggested that we could at least try an appointment with an LC before heading to the hospital. Then, if we still felt like we needed to go, they could at least facilitate our admission, instead of having to go through the ER.

That afternoon, we spent nearly two hours talking with the LC, learning more about ways to keep a tired baby awake to feed, strategies to maximize the energy our daughter did have, and a game plan until we met again. We walked away with clear written notes about what to do, what to be concerned about, and when to come back again. Over the next ten days, we returned to the Birth Center 5 or 6 times for additional LC visits and weight checks. When our daughter checked in at her birth weight after 15 days and we got the okay to stop an exhausting schedule of pumping and feeding every two hours, we cheered…but only long enough to gear up for outpatient surgery that I had to put off while being pregnant. Again, the LCs were an amazing help, assisting us with putting together a new game plan that would ensure our little one continued to be fed breastmilk on demand around my surgery and follow-up care.

Five weeks after she was born, I was delighted to “graduate” up to the local La Leche League meeting, where I was able to share and troubleshoot more routine challenges of breastfeeding with other mothers, as well as celebrate milestones along our nursing journey. After those difficult early weeks, I knew how valuable the support of others could be in reaching my breastfeeding and parenting goals. I have been exceedingly thankful to have an awesome local evening meeting with lots of other working moms.

Our first breastfed for 20 months, when the upcoming arrival of her sister brought an end to her nursing journey. As we were expecting our second, the staff at the WBWC, our prenatal care group, and my LLL crew were so valuable in helping us think through the things we could do in order to avoid some of the challenges from our first go round.  We weren’t lucky enough to avoid another jaundiced baby, but we were much better prepared, so we got through it much calmer and quicker. Now, twenty-seven months later, we’re nearly to the end of our second breastfeeding journey. I’m so glad to have had the opportunity to breastfeed both girls, and so very thankful to have had such a support team that helped make it possible.

By |March 1st, 2017|Breastfeeding / MILC Moment, Stories of Strength|0 Comments

March 1 is IBCLC Day!

In honor of IBCLC Day, we’re celebrating our wonderful Lactation Consultants! Nancy Albrecht, Ellen Chetwynd, Rebecca Costello, Elley Schopler, and Deborah Adler work tirelessly to make sure every mother has the best available breastfeeding assitance.  Here are some of the ways they’ve helped women navigate the sometimes difficult world of breastfeeding:

We are a few days away from our 6-month nursing anniversary. We would not be here without Ellen. By the time I saw Ellen, my daughter was one month old and the nursing struggles had left me an emotional mess. Ellen was so kind and invested so much time into figuring out what was going on – after a few visits and a tongue tie clip, we have not looked back and breastfeeding became a wonderful, pain-free experience. I treasure my time nursing Zoya, because it helps me connect with her, and I would not have this opportunity if we hadn’t met Ellen. Her attentiveness and thoughtfulness are something I will always remember.” – Haniya Mir 

 

 

The wonderful IBCLCs, especially Rebecca since that’s who I saw mostly, always helped to ease my worries. They made me feel like I was doing an awesome job nourishing my baby, as I pushed my way through diet restrictions, constant nursing, pumping at work, and low supply. The best advice I got from Rebecca was that breastfeeding is not all or nothing. That statement helped to normalize how hard breastfeeding was for me at times and made me feel better about having to use donor milk.” – Sarah Jackson 

“Sometimes I worry Rebecca will think I’m a total creep for the amount of praise I give her. I was probably at my most vulnerable after Rowan’s birth when I went to see her. He was born at 31 weeks due to severe pre-eclampsia. Nothing had gone right, or even right-adjacent. We were finally home from the hospital (I was inpatient for three weeks, owan for almost six), and he was really struggling to nurse. He was not transferring much milk and was choking every time he ate. I was falling apart emotionally from the trauma mixed with sleep deprivation from trying to pump, nurse, and bottle feed.

The first thing Rebecca did was give me permission to skip the nursing part during the middle of the night. She spotted the same tongue and lip ties that I had suspected, but been told not to worry about by the NICU. She wrote her “prescriptions” down on pieces of notebook paper for me. Not just ways to change the way we nursed, but ways to slow down the bottles. I believe one note said to make bottles ‘tortuously slow.’

After a few visits and a tongue/lip tie clipping, everything started to fall together. When my insurance refused to cover the visits, she worked so hard to try to fix it. Rowan will be two in April and is still nursing. And I am 100% sure that would not be the case without the WBWC IBCLCs.” –Rhiannon Giles

“I am so thankful to Rebecca! She helped out many times: teaching me new positions, reassuring a new
mom, getting rid of a milk bleb that I couldn’t do myself, and establishing this amazing group for us. Thank you Rebecca!!”  Jenae Delayen

I can’t say enough about the IBCLCs at WBWC. Between my two babies, I’ve seen all of them at least once. My first was a traumatic delivery which resulted in pituitary damage and delayed/insufficient milk supply, and by the time we realized there was a problem, my daughter had lost over a pound and had forgotten how to eat. We sat on Ellen’s couch, often sobbing, at least once or twice a week until Ada was about 12 weeks old. Ellen reassured me that we were doing everything “right,” that it was more important that my baby was fully fed than that her food came completely from me, and that my worth as a mother wasn’t measured in ounces of milk – all of which I desperately needed to hear at the time. We also saw each of the other LCs with my daughter (incidentally, I think she might have been the first birth center client that Rebecca saw! If not THE first, certainly on her first day there), and they were all wonderfully supportive and helped us figure out how to maximize my supply while re-teaching my kiddo how to nurse. I should add that this was at a time when many folks, even lactation specialists, didn’t believe that low supply was real. We got a LOT of inaccurate information from well-meaning supporters of breastfeeding, but the WBWC IBCLCs never questioned that what I was experiencing was real, or that it was devastating. My daughter nursed until she was 28 months old even though I never achieved a full supply (and would have gone longer, but I was pregnant and had to stop her because my pituitary condition precludes nursing while pregnant), and I’m positive that would never have happened without the support we received in the beginning – I didn’t think we’d make it to six weeks at first.

My second is a completely different story, but we’ve received just as much support this time, mostly from Rebecca. Simon was born via a dramatic VBAC, so no trauma or damage this time, but my milk still was delayed (not surprising, given my history). So we had a prenatal appointment with Ellen to make a plan and saw Rebecca on day 3 to assess his latch and transfer – he had lost almost 10% of his body weight, so we began donor milk immediately. It wasn’t enough to prevent a readmission to UNC for jaundice, but he never forgot how to eat, and we realized very early that he was tongue tied. Our weekly visits to Rebecca from the very beginning have gotten our nursing relationship off to the best possible start – he’s got a fantastic latch, we addressed my supply concerns very quickly, got his tongue tie revised, and this baby is a committed and enthusiastic nurser. He has gained four pounds since he was born… and he hasn’t gotten any donor milk in over a month! More sobbing on the couch this time, but now it has been happy tears as we’ve celebrated the completely different path that this journey is taking. Rebecca finally told me this week that it’s silly for me to keep making appointments when the baby is consistently gaining over an ounce per day. It has been a lovely security blanket, but I’m excited to be out on my own, just feeding my baby the way that I’d hoped I’d be able to. The phrase ‘EBF’ is not something I take at all for granted, and again, I’m sure that I wouldn’t be here if not for the support and guidance that I’ve gotten from the amazing MILC IBCLCs.” – Sarah Stokes 

I’m very grateful for the support and care I got from Rebecca and Elley with my son Mason. Since I had had some difficulties with early latching and mastitis with my first baby, we scheduled an early (day 2) lactation visit for Mason. When I arrived, Rebecca immediately noticed that Mason’s color was off; she helped me me positioning and latch then called the midwives in to check on him. Sure enough, his bilirubin levels were super high and we needed a direct admit to UNC. Her acute observation, outside of strictly breastfeeding, got him into the hospital quickly. He was barely under the level at which he would have been put in the NICU for a blood transfusion. On the second day of our stay at UNC, Mason was improving, and I was desperate to get home. Elley came for an LC visit and really listened and validated my distress about being in the hospital and unable to care for my postpartum needs. She suggested we do a weighted feed, which Mason passed with flying colors, so she then helped advocate for me to be able to be discharged that day rather than staying another night. Both Elley and Rebecca’s help with breastfeeding was great, but it was their care and attention to me and Mason’s health as a whole which made an immense difference for us, and I’m extremely grateful.” –Sarah Marsh 

I was an emotional wreck in week 2 postpartum as the result of 1) being on my own for the first time after all guests left and 2) reading very unhelpful not breastfeeding-friendly resources in my panic. Rebecca reassured me and turned my panic completely around! Did the weigh-in before and after feeding and turned out my baby was getting everything she needed, told me to throw out those unhelpful resources, and gave me better things to read instead. Left visit so grateful and 180 degrees different than when I came in. Thank God! And thank you, Rebecca !!!!!!!!” – Nancy

By |March 1st, 2017|Breastfeeding / MILC Moment, Staff Spotlights|0 Comments

MILC Moment: The Truth About Pumping & Dumping

By Rebecca Costello, IBCLC


Pumping and dumping: not being able to nurse, and pouring your milk down the drain, is NOT a fun experience! Mothers are often told to stop breastfeeding and/or “pump and dump” because they are on medications, or needed to have a scan or test (like an MRI). This seems to be widespread – we hear about this advice being given by everyone from dentists to urgent care doctors to pediatricians. And yet so often, when we look up the medication or test, it is perfectly safe for breastfeeding to continue. You poured your milk down the drain for nothing! Moms may pump and dump for hours or days before finding out they could have breastfed all along. Why does this happen?


Which book or website your health care provider uses to look up medication or test safety can make a big difference. One study used a list of 14 drugs that were commonly prescribed to breastfeeding mothers, and looked how many were considered safe in frequently consulted resources. Several resources said NONE of the medications were safe. Others said about 50% were. It turns out, 85% were fine! Many health care providers don’t get any education about which resources are most accurate.


So where should you turn for advice about medication safety and breastfeeding? One option, of course, is WBWC! We often take calls with questions like “I had a CT scan today – they told me I couldn’t breastfeed for 24 hours, is that true?” or “I’m having a dental procedure next week – which pain meds are safe?” Our most frequently used accurate resource is the book Medications & Mother’s Milk, one of the “bibles” of breastfeeding and medication safety. It’s on the shelf in almost every office!


An even more accessible reference we sometimes use – and that you can use from anywhere with an internet connection – is Lactmed, a free website from the National Library of Medicine. They provide information on thousands of medications, herbal supplements, contrast used for scans (try typing “CT contrast” into the search box), and even specific procedures (try “MRI” or “X-ray”). Often the information makes it very clear that it’s safe to keep breastfeeding. If you have questions or concerns about what you read, please give us a call; we are happy to help you sort through it. We want you to continue nursing or pumping with confidence, knowing that you’re continuing to provide the best you can for your baby!


By |January 26th, 2017|Breastfeeding / MILC Moment|0 Comments

MILC Moment: How to make breastfeeding successful – before you even give birth!

By Rebecca Costello, IBCLC



Our lactation consultants work with a lot of families – over a third of the moms who give birth with WBWC end up seeing one (or more!) of our LCs. We also see many moms and babies who birthed elsewhere – often they say we were recommended to them by a friend or family member who came to WBWC for their birth/and or breastfeeding help. (Thank you, and we are honored!)


     Working with so many new families, we get a chance to see up close what types of resources help new parents. Many people take childbirth classes, but we really notice a difference when first-time parents were also able to do some preparation for what happens after birth! They tend to be calmer, more confident, and adjust more easily to life with a newborn. All of this affects breastfeeding – big time! (Especially when challenges arise.)



     How can you prepare for your baby to arrive? Spend some time asking your friends who are parents about what life with a newborn is like, and their best tips for a smooth transition! Get some books on baby care and breastfeeding – read them, and get your partner to read them too! No friends with kids? Not into reading? WBWC offers classes on Breastfeeding Basics and Newborn Care to help you get ready. Our classes are fun, interactive, and taught by experienced lactation consultants and nurses! Not able to make it to the WBWC classes? Many local childbirth educators, doulas, and other professionals offer baby care and breastfeeding classes. We encourage all first-time parents to sign up and study up! We think you’ll be more likely to have a successful experience breastfeeding, and be happier, more confident parents all around.

By |November 21st, 2016|Breastfeeding / MILC Moment|0 Comments

MILC Moment

A lot of things go pink in October for Breast Cancer Awareness Month. We talk about early detection of breast cancer, supporting breast cancer patients and survivors, and finding better treatments for breast cancer. But let’s also talk about breast cancer prevention – and part of that is breastfeeding!


So much of the discussion of breastfeeding focuses on benefits for the baby. But we know that there are big benefits for mom as well. When we get pregnant and give birth, there’s a complicated interplay of hormonal and physiological changes that prepare the body for breastfeeding. Our bodies expect it to be part of our reproductive life cycle. When our society doesn’t support mothers to breastfeed, we are disrupting this cycle and placing them at increased risk for a number of issues later in life: osteoporosis, heart disease, hypertension, diabetes, and ovarian and breast cancer.


The longer you breastfeed, the stronger the “dose” of prevention against getting breast cancer later in life. For each 12-month period a woman breastfeeds, one study calculated a 4.3% reduction in relative risk of getting breast cancer later in life, compared with women who didn’t breastfeed. So a mother who breastfeeds 3 children for 2 years each would reduce her relative risk by over 25%! There is also growing evidence that breastfeeding specifically reduces the risk of particular aggressive types of breast cancer, which are more common in African-American women.


Does this mean someone who breastfeeds is totally protected against breast cancer, and someone who doesn’t breastfeed will definitely get it? Nope! This is just about changes in risk – sadly, there is no way to know exactly who will get breast cancer. But we know that by supporting all moms to breastfeed, some cases of breast cancer will be avoided. And the next time someone tells you your baby is “too old to breastfeed”, smile and say “Oh, we need at least another 12 months! We’re reducing my risk of breast cancer!”


Your MILC LCs,

Rebecca, Ellen, Deborah, Elley, and Nancy

By |October 25th, 2016|Breastfeeding / MILC Moment|0 Comments

WBWC Officially Part of First Breastfeeding Family Friendly Community




by Rebecca Costello, IBCLC


One year ago, the mayors of Chapel Hill and Carrboro partnered with members of Rotary, Chamber of Commerce, health departments, faith communities, and UNC-Chapel Hill on an initiative to become the first Breastfeeding Family Friendly Cities in the country. One important step is for businesses throughout the community to welcome and support breastfeeding families. They just have to follow 4 simple practices:


1.      Breastfeeding mothers are always welcome and respected. They will never be treated poorly, asked to stop breastfeeding, or asked to cover up or move.
2.      All lactating employees are allowed breaks to express milk or nurse their children, and access to a private space for expressing milk or nursing that is not a bathroom. The space is lockable and shielded from view, includes an electrical outlet, and has hand hygiene available
3.      Business does not advertise infant formula or related products.
4.      Business will post the “Breastfeeding Welcome Here” window cling.
WBWC definitely qualified on all counts, and we were excited to join the other local businesses that have signed up – everything from physical therapy to boutiques to optical shops to restaurants! Above is a photo of Kathleen Anderson, from the Carolina Global Breastfeeding Institute at UNC, with our executive director Maureen Darcey and with our new window cling. Do you know other businesses in Carrboro/Chapel Hill that might be interested in signing up? Or do you own a business and want to complete a quick and easy application? You can e-mail klanderson@unc.edu for an application.
Get more information at:
 https://www.facebook.com/BreastfeedingFriendlyCommunities/ – like the page to get updates on businesses that have joined

By |September 17th, 2016|Breastfeeding / MILC Moment, News|0 Comments

MILC Moment




     Two of our IBCLCs, Ellen Chetwynd and Rebecca Costello, attended the North Carolina Lactation Consultant Association summit in Wilmington June 9-10 and helped teach a hands-on preconference workshop on breast massage and drainage. These techniques can help prevent and treat engorgement, plugged ducts, and mastitis – definitely things mamas want to avoid! Getting our LCs, nurses, midwives, and nurse practitioners trained on these techniques has made a big difference for so many of our WBWC mamas – we want to spread the knowledge! 

     A number of Wilmington mamas volunteered to be teaching models for over 30 IBCLCs from around the state who wanted to learn these vital skills. We were able to do hands-on demonstration and practice how to massage and hand express to relieve painful breast congestion. We got wonderful feedback from the participants, and we are so excited for them to bring this care back to the moms and babies they work with all over North Carolina. 

     The workshop was done in collaboration with Kathy Parry (one of our partners at Carolina Global Breastfeeding Institute) and Lindsey Hurd (an IBCLC who also teaches our starting solids “Pass the Puree Please” class) – we are lucky to have such great colleagues!

     Ellen also presented at the Summit on new Medicaid regulations that will give more families access to lactation consultant care, and Rebecca presented on our partnership for the “Momma’s Village” project to increase support for breastfeeding among women of color. We are proud to represent WBWC and MILC to our IBCLC colleagues statewide!

     Looking to the future, we are hoping to plan a fun event around World Breastfeeding Week in August – stay tuned!

Your MILC IBCLCs,

Deborah AdlerNancy AlbrechtEllen ChetwyndRebecca CostelloElley Schopler


milc@ncbirthcenter.org


Follow this link for a great instructional video on breast massage and hand expression
https://vimeo.com/65196007

By |June 18th, 2016|Breastfeeding / MILC Moment|0 Comments