Storing Breast Milk

Have you ever smelled your breast milk and thought “Holy cow, this smells different?” Don’t worry; the smell is not a reflection of your mood after another sleepless night tending to your baby. It could be related to either the chemical composition of the breast milk or how it is stored. Human milk that has truly soured has a very distinct sour taste and odor – much like soured cow’s milk. If your milk doesn’t smell distinctly sour or rancid, then it should be safe to feed to your baby. If you have any doubts about the safety of your milk, throw out that serving.

Here are a few tips on how to store your milk in the refrigerator/ freezer to avoid spoiling:

  • If you do not plan to use the refrigerated milk within 5-8 days of expression, then freeze it. Be sure to use the milk within 24 hours of thawing.
  • Keep the milk in the back of your freezer rather than at the door.
  • If you choose to store in bottles, try glass rather than plastic. Glass bottles need to be loose during the freezing process then tightened when fully frozen to avoid bottle breakage from the expanding contents.
  • Try using bags designed for storing human milk rather than standard plastic bottle liners.
  • Eat lots of antioxidant rich foods. As the name suggests, antioxidants help to prevent oxidation. Foods rich in antioxidants include: red kidney beans, pinto beans, blueberries, pomegranate, kale and sweet potatoes.
  • Try to avoid your usual drinking water (it might have free copper or iron ions that cause oxidation).
  • Try to stay away from fish-oil and flaxseed supplements, and foods like anchovies that are full of rancid fats.

If your milk tastes slightly soapy, it may be due to an excess of an enzyme called lipase. This enzyme is a perfectly normal enzyme found in the human body. One of its main jobs is to break down fat, so the baby can easily digest the breast milk. As a result, the milk can develop a soapy or bitter taste. Many babies don’t mind the smell or flavor and there is no need to change your freezing method. If your baby is not taking your thawed milk you can inactivate the lipase. To do this, you must scald the milk on a stove or microwave. Heat the milk to 180 F (82 C) for about 15 seconds, or until you see little bubbles around the rim of the pan. Once this is done, you should immediately cool and store the milk. Keep in mind that heating the milk does damage some of the nutritional benefits. Remember, this is only required for milk you plan to freeze and reheat. There is no need to scald milk that you plan to use before freezing and scalded milk needs to be completely cooled before feeding to prevent injury.

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Join us! Third Annual NICU Reunion

With the 3rd annual NICU Reunion happening soon at Overlake Medical Center, the NICU staff is actively preparing for this fun event!  This wonderful celebration will occur on Sunday, September 13, 2015 from 1 – 4 pm.  There will be activities for all ages including a Bouncy House and possible a visit from the Bellevue Fire Department.  Light refreshments will be served.  We all look forward to seeing our graduates and their families.  Email invitations have been sent out and we are ready to begin taking registrations.  If you haven’t received one you can call 425-688-5259 to register or go online www.overlakehospital.org/reunion.  Looking forward to seeing everyone in September.

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The Sunshine Vitamin

Breast milk is the best food for all babies. It contains all the essential nutrients and immune benefits babies need – except for Vitamin D and iron. Most full-term infants are born with enough iron stores to last until iron-rich solids are introduced at 6 months of age.

However, infants may not be born with enough Vitamin D stores. Studies have shown that giving mom extra Vitamin D does not always increase the Vitamin D content of breast milk predictably and it’s unclear if the high doses necessary to get more in mom’s milk are safe for moms long term.

Doctors have been seeing more cases of rickets among breastfed infants in the U.S. due to Vitamin D deficiency. Vitamin D is made by the body when there is enough exposure to sunlight. There are many factors that affect this process and lead to low levels of Vitamin D:

  • Living at high latitudes, particularly in winter months when Vitamin D can’t be made
  • Air quality, i.e. high levels of pollution
  • Weather conditions – dense cloud covering (Pacific Northwest!)
  • The amount of skin exposed to sun
  • Use of sunscreens- public health effort to decrease skin cancer risk by limiting sun exposure
  • Darker skin pigmentation

In 2008, the American Academy of Pediatrics issued the following recommendation:

A supplement of 400 international units (IU)/day Vitamin D is recommended for all breast-fed and formula fed infants (consuming less than I liter formula/day) beginning in the first few days of life. 

Infant liquid multi-vitamin products or vitamin D only products can provide the recommended amounts of Vitamin D. These are available without prescription. Most term infants should need Vitamin D only.

The AAP and FDA recommend choosing products that deliver 400 IU in a 1 ml dose.

NOTE: Avoid products for infants that deliver very high concentrations of Vitamin D in 1 or 2 drops. There is a high risk of overdose and this may lead to serious health problems.

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The Childbirth Center at Overlake recognized in a national publication for focus in perinatal patient safety

Overlake received an “A” score from The Leapfrog Group and excellence awards from various other regional and national public reporting parties due to our success and commitment safety of moms and babies (Healthcare Business Insights, 2015).  We have used safe practices for many years, including eliminating early deliveries.  An early elective delivery means choosing to have a baby born before 39 weeks of pregnancy without a medical reason.  Research has told us that babies that are born between 37-39 weeks do not do as well as babies born between 39-41 weeks unless there is a medical reason.  Therefore we remain committed to not taking the risk of delivering babies early unless there is approved reason to.

Healthcare Business Insights Cost & Quality Academy. (2015). Improving Patient Safety Measures by Reducing Risk and Focusing on Quality Initiatives. Efficiency & Effectiveness, (May), 1-4.

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Postpartum Support

Having a baby is an exciting event, involving tremendous changes for the parents (as well as the baby).  In the midst of welcoming a new family member, however, about 10-20% of women (and approximately 10 % of men) will experience postpartum depression, now more commonly called post-partum mood disorder (PPMD).

Years ago, this was not a recognized condition, and people struggled through it in silence and guilt. It is now recognized that many of us are prone to develop this condition, particularly if there is a past history of anxiety or depression, a birth that didn’t go the way we planned, and lack of at least two or three solid hours of sleep at a time  during the post-partum period. There are also other contributing factors.  Symptoms of PPMD (among many) can include physical symptoms, such as muscle tension, irritability or anger, restlessness or shortness of breath.

Information and assistance is available at no charge through the “Postpartum Support International of Washington.” They have a helpful, comprehensive web site at www.ppmdsupport.com. There is also a toll-free support line a 1-888-404-7763.  The web site included risk factors, signs and symptoms, free support groups and the  toll free “warm line.”

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Nighttime can be the best time to feed your baby

One of the most surprising elements of taking a new baby home is how much they love to sleep all day and party all night. This can be extremely challenging especially after an all-night labor that capped off weeks of poor sleep associated with common discomforts of late pregnancy. Sometimes it helps to understand why babies are awake at night and how their night schedule is actually helpful.

While you were pregnant, you rocked your baby to sleep all day because you were moving. You were probably so happy to feel him/her start kicking around when you finally got off your feet in the evening. Unfortunately, this wake-up time is often when your baby starts to wants to feed frequently in the evening because that is what he/she is used to. There is good news though; if you are breastfeeding, your body is programmed to respond to feedings easier than during the day. This helps you to build up the hormones required for a full milk supply. Your baby is actually partnering with you so that there is enough milk for feedings to space out a bit. You are a great team!

Add a portion of patience to your understanding and soon your schedules will be more in synch. In the meantime here are a few tips that may help:

  • Wake your baby for daytime feedings. “Never wake a sleeping baby” is not a good rule to follow if he/she is sleeping all day and feeding all night. He/she will still need night feeds but the more you feed during the day the sooner nighttime feedings will space out.
  • Establish a nighttime routine. This keeps bedtime and naptime different. This routine needs to be portable-you do not want to be spending the night at grandma’s house and realize you forgot to bring the glow light lullaby toy you use along with you.
  • During naptime and nighttime keep the room dark and quiet and allow light and noise to penetrate only when you want them to be awake – 2am is not time to start playing peek-a-boo!
  • Be prepared for change. Many babies will take a stretch of sleep one night and then not again for a few nights. Remember, he/she is immature in every way and as his central nervous system matures, he/she will sleep more at night.

Sleep is a common topic at our After Baby Comes Groups. If you are a new parent and want to interact with other new parents register today at http://www.overlakehospital.org/classes/

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Overlake Medical Center is Bananas for Babies

The “Overlake Medical Center is Bananas for Babies” banner was personified on May 2 when more than 100 Neonatal Intensive Care Unit (NICU) graduates, Childbirth Center staff, physicians, families, friends and dogs took to the streets of Seattle to march in the annual March of Dimes March for Babies. The 3.1 mile walk celebrated a two month effort to raise funds to support the March of Dimes Mission to improve the health of babies by preventing birth defects, premature birth and infant mortality.

Overlake partnered with March of Dimes because we share that vision as we care for preterm infants in our state-of-the-art level III NICU every day.

We were recognized by March of Dimes as one of the top five fundraisers for last year’s walk and set lofty goals to increase participation and dollars raised by 25% this year. Our love for babies was demonstrated by exceeding both goals; having 119 walkers sign up and raising more than $25,000. Multiple staff members, physicians, and NICU graduate families were included in the Circle of Champions having raised more than $1,000 individually.

We are enthusiastically planning for next year’s march knowing that the babies we serve are worth all that we give.

You still have an opportunity to partner with us in this very worthy cause at: https://www.marchforbabies.org/march//s_team_page.asp?seid=2178309

 

 

 

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Postpartum Hemorrhage Simulation Goes Live in Childbirth Center

Obstetrical simulator “Noelle” is administered oxygen by the anesthesia team in preparation for surgery

Overlake’s Childbirth Center had the amazing opportunity to participate in twenty-seven multidisciplinary postpartum hemorrhage (PPH) simulation training sessions during the  month of March. Using a state of the art obstetric birthing simulator, approximately 300 staff participated in the simulations, recreating a “mock” PPH. PPH is an obstetrical emergency that can be sudden and unexpected and requires prompt recognition and action. The unique opportunity with the simulations was having each team member sign up to participate in their own role – to have the added value of the entire team that works together, train together – just as in everyday clinical situations. This included anesthesiologists, obstetricians, midwives, scrub techs, postpartum and labor nurses, patient care techs, health unit coordinators, blood bank and several guest observers. The opportunity to practice how to successfully manage PPH after delivery included hands-on skills, situational awareness, identification of team roles and responsibilities, and how to communicate with the patient and other team members during such a critical and stressful situation.  Sessions were digitally recorded, viewed by the team, debriefed and then erased. This has provided us with an amazing opportunity to simulate PPH, a leading cause of maternal mortality and morbidity, and to collaborate with the entire team to discuss our current practice and process and opportunities for system improvement.

 

Obstetric hemorrhage affects 2.9% of all births in the United States and is one of the top causes of maternal death. (Callaghan et al, 2010; Berg, Callaghan, Syverson, & Henderson, 2010; Bingham & Jones, 2012)

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March for Babies 2015 – Join us!

Join us for the March for Babies on May 2, 2015! This year, it’s for Kaitlin, Makenna, Ty and Carson, this year’s Overlake’s March of Dimes Ambassadors, and all the NICU graduates.

Chilbirth Center staff, along with family and friends, will be walking. If you would like to join our team or donate, please go to www.marchforbabies/teams/overlake.  It really is a lot of fun with some good exercise!

 

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Feeding Tips for Preemies

Many people don’t realize how complex infant feeding can be, as it is often so effortless for most babies. Premature infants are often asked to be able to perfectly feed by mouth before they are biologically able. This can present some extra challenges. In the old days, we used to think that preemies had “weak sucks” and that we needed to help them with special bottle nipples that provided the milk very easily. However, we now know that preemies typically have rather strong sucks, and the main difficulty that preemies face is how to coordinate breathing with swallowing. We know that by giving premature infants a slower flow rate, preemies can feed more comfortably and are better able to progress their oral feeding.

So, the main question is- how can we reduce the flow rate? First, we can use a slow flow bottle. In the NICU, we may use a disposable slow flow nipple or a Dr. Brown bottle with a Preemie nipple. The Preemie nipple is even slower than the standard newborn level 1 that comes with most bottles. In fact, for preemies that still cannot handle that flow rate, the company has recently developed the “Ultra Preemie” nipple.  Another technique is to feed babies lying on their side, which reduces the impact of gravity on the flow rate of the feeding. Sidelying is also a very comfortable and stabilizing position for infants. If we can provide this support to their body, the infant can then focus on the feeding. Lastly, some infants benefit from “external pacing”, where the bottle is tipped down to stop the flow rate of milk, encouraging these important breathing breaks.

Breastfeeding can be a little more comfortable for many preemies because the flow rate can be more modulated by the infant. However, for those infants that are still overwhelmed by the flow rate at the breast, we can sometimes change the position of the mother/baby and/or bring the baby to the breast at a time that the breast is less full.

When premature infants are provided with oral feedings in a positive and supportive manner focused on quality of feedings and not quantity, we can help them develop the necessary skills to be successful oral feeders.

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