Hand Expression: Tips For Increasing Milk Supply

Research is showing that hand expression helps increase milk supply in mothers who are dependent on the pump to bring in their breast milk. A low milk supply is the most common reason for mothers to stop breastfeeding. We have learned that what we do (or do not do) in the first 3 days after delivery can have a major impact on future milk production potential. Research has found that milk production in pump-dependent mothers of preterm babies depended on the frequency they used hand expression in the first 3 days after delivery.

Mothers who used hand expression more than 5 times a day in the first 3 days, yet pumped with the same frequency as other study mothers, expressed an average of 955 mls, about a quart a day by 8 weeks. This is more than a term 4 month old would need. Mothers also found consistent increases in production when they did not rely solely on pump suction alone to remove milk, but used “hands-on pumping”. This technique combines breast massage, compression and hand expression with electric pumping and does not require more time than simple pumping. By the end of the study, these women were producing 45 percent more milk than women who used hand expression fewer than twice a day during the first three postpartum days.

For mothers of term and late preterm babies, there is an important role for an alternative way to remove colostrum when the infant has not yet learned to latch on and nurse effectively.  Occasionally, mothers can have difficulty getting their baby to latch in the first day. Hand expression is one way to continue to remove breastmilk and give it to baby even if mother and baby are still working on latching well.

Make sure you ask a nurse to show you how to hand express and incorporate this into your pumping routine. If you would like to watch a video of hand expression, Stanford University School of Medicine has an excellent video teaching hand expression located at this link:

http://newborns.stanford.edu/Breastfeeding/HandExpression.html

(All research study information and statistics taken from “Lactation Matters: Official Blog of the International Lactation Consultant Association”)

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Join us! March for Babies

March for Babies Walk sponsored by the March of Dimes will take place on Saturday, May 3, 2014.  The Childbirth Center has four teams: MBU, L&D, NICU and Women’s Clinic.  We would love to have staff, family, friends and former patients join us on this 3 mile walk.  This fundraiser provides money for treatment and research for the very tiniest of infants.

If you would like to join a team just go to the marchforbabies.org website and register.  Should you join a Overlake Childbirth Center team by April 4, you will receive one of our hot pink t-shirts “We walk for future generations!”  Our goal is  100 walkers between the four teams, so please consider walking with us.

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Who are all these people?

You have waited months for the birth of your new baby.  Finally, the laboring process has begun and you are being coached by your labor and delivery  team, your obstetrician or midwife.  They are all there to assist you and welcome your new baby into the world and as such you may become quite bonded with them.

As the birth nears additional team members may appear who haven’t been through the labor process with you.  You may be suddenly thinking, “Where did all these people come from?”  “Who are they?”  The labor and delivery team is continually monitoring your baby and as such may feel it necessary to have additional team members present.  These new members’ primary responsibility is for the care of for your newborn infant once he/she is born.  Depending on the circumstances one or multiple people may make up this neonatal team.

The neonatal team can consist of several members; a neonatal nurse practitioner, a registered nurse and/or a respiratory therapist.  Their sole responsibility is to support and monitor your baby in those first few minutes after birth.  As your newborn successfully transitions from birth the neonatal team will return care of your baby to you and the labor and delivery staff.

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A change in the standard fetal karyotype: News from Maternal Fetal Medicine

The most recent widespread advance in the genetic evaluation of the fetus is the introduction of micro arrays for whole genome evaluation.  Think of microarray analysis as a high definition image of the chromosome, compared to a traditional karyotype, which is more like a blurry web cam image.

Traditional prenatal diagnosis uses amniotic fluid or placental villi to grow fetal cells, then stain and count fetal chromosomes. This allows the diagnosis of numerical disparities or gross abnormalities of chromosomes, the most common of which is trisomy 21 (Down syndrome).

Microarray analysis starts the same way, with some form of fetal tissue, such as cells from an amniocentesis or CVS. Rather than just staining and counting, however, the microarray technique takes the fetal DNA and cuts it into small pieces, which are then matched to small standard sequences arranged on a microchip (the array). Pieces that don’t match are abnormal, and thus abnormal sequences or deletions and duplications of the DNA can be identified, in addition to confirming the correct number of chromosomes. These deletions and duplications would not be detected by traditional karyotyping and are not related to maternal age. In addition, because microarray analysis does not require growing and dividing cells it is more reliable than karyotype in cases of stillbirth.

Micro-deletions and duplications account for up to 15% of human genetic disease.  Both the American College of Obstetricians and the Society for Maternal Fetal Medicine now recommend that microarray analysis replace traditional karyotyping for cases of fetal abnormality seen on ultrasound, and suggest that it has merit even in the normal appearing baby having an amniocentesis for other reasons. Studies have shown that babies with abnormalities on ultrasound with a normal karyotype have clinically significant microarray abnormalities in about 6% of cases. In addition, about 1-2% of babies with a normal ultrasound and normal karyotype can have an abnormal microarray analysis (“The use of chromosomal microarray analysis in prenatal diagnosis”. Committee Opinion No. 581. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:1374–7).

For this reason, Eastside Maternal Fetal Medicine has now transitioned to using FISH and microarray analysis in replacement of FISH and karyotype for all fetal chromosome analysis. In most cases the patient’s insurance will cover this in the same fashion as a traditional karyotype.

Like all new technology, there are occasions when information found can be confusing or of uncertain significance. We have dedicated genetic counselors that are happy to help providers and families navigate these issues.

For patients and their families who are interested in hearing more about prenatal screening and prenatal testing options, Eastside Maternal Fetal Medicine is planning to offer monthly free classes.  Contact our genetic counselor Claire Clark at claire.clark@integratedgenetics.com for further details. Patients can call our front desk to register for these classes at 425 688 8111.

The ACOG committee opinion is available here: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Genetics/The_Use_of_Chromosomal_Microarray_Analysis_in_Prenatal_Diagnosis

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Baby Blues & Post Partum Mood Disorder

Nothing can prepare us for the initial  adjustment to being responsible (24 hours & 7 days a week), for a completely dependent (although much loved) human being.  The changes in our bodies, the lack of sleep,  and a whole host of major changes can create some serious problems for approximately  10 to 20% of new moms (and, according to the PostPartum support group, 10 % of new fathers also).  The local branch of the PostPartum  group (postpartumsupportinternational.com) is a wonderful resource for information on PPMD, (including risk factors and symptoms) and a resource for support groups in the community (free) and counselors who specialize in  PPMD. Their support line is 1-888-404-7763).  No one ever chooses this condition, and guilt & self blame should not be part of it. It is not a failure to experience PPMD.   The web site has a list of risk factors and symptoms; there is also the “warm line” to talk to someone who can offer support and resources.

Another resource is the book The Mask of Motherhood by Susan Maushart. This is good for new moms and the people who love them to read and learn.  The birth of a baby should be a wondrous event and a cause for celebration, but we also must recognize that the neonatal period is a time of upheaval, confusion, and perhaps ambivalence. This book addresses the depths of feelings many of us experienced—the joy, and the pain—of becoming a mother.

So, if any new parents are experiencing emotions such as feelings of despair, physical symptoms such as chest pain and muscle tension, feelings of guilt or inadequacy,  and excessive worrying, please don’t live with these in silence or try to “ride it out.”  There is a whole community of peers and professionals who can offer support, education, and relief.

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Low Milk Supply

In the first few weeks after delivery, moms often worry about how much milk they are producing. If you ever feel as though you are struggling with your milk supply, the best advice is to get into bed with baby for 48 hours. Undress baby down to a diaper and bring baby into your bed skin to skin with you. Do nothing but sleep and nurse for 24 hours. A partner or friend should attend to all other household duties. You can get out of bed to use the bathroom, or prepare food if necessary, but otherwise stay lying down for a full two days and nights.  Because baby is right next to you, you will be feeding more often as your body rests and gathers strength for breastmilk production. Drink lots of water during this time. You and baby take in “pheremones” from each other, these are hormones we absorb through our sense of smell. Constant exposure to baby’s pheremones will increase your milk production. This 48 hours in bed intervention  is usually enough to correct a low milk supply. It is also very helpful for moms with mastitis.

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Newest 12th Man – Congratulations, Seahawks!

These hats were donated to Overlake’s Childbirth Center for the Seahawks’ newest fans. Congratulations, Seahawks! And thank you!

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Storing Milk for your NICU Baby

One of the most important jobs a mother can do is pump milk for her baby to provide essential nutrients and immune system support. This is an incredible health benefit that only you can provide for your baby. Each room in the Overlake 2nd floor NICU will have a hospital grade pump for use at the baby’s bedside. When home, use of a purchased or rental pump will be necessary.

Proper breast milk storage is important to help prevent contamination or spoiling of the milk. The following are some general guidelines to help assist in storage and transportation of your breast milk from home to hospital.

  • Wash hands well prior to pumping.
  • Pump your breasts every 2 to 3 hours (at least 8x per day) using storage containers provided by the NICU. Label each bottle with the date and time the milk was pumped using the labels provided by NICU.
  • Store breast milk in the back of the freezer (the coldest part) – do not store milk in the freezer door. If using milk in less than 48 hours, milk may be stored in refrigerator.
  • Fill container ¾ full to allow for expansion when freezing.
  • Clean pump parts after use by washing (by hand or in dishwasher) with hot soapy water, rinse well, and air-dry. Do not wash tubing.
  • Bring refrigerated or frozen pumped milk to NICU in a cooler or insulated thermos bag with blue ice pack to help keep milk chilled.
  • NICU will store milk in the NICU breast milk refrigerator and/or freezer.
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Where is our baby going to sleep?

There are many factors that contribute to the decision of where a newborn baby will sleep in the family’s home.  Some parents will consider or desire having their infant sleep in their bed with them, others will have the infant sleep in their room but on a different sleeping surface or have the infant in a separate room altogether.  While co-sleeping is a common practice in many non-Western cultures it remains controversial in the United States. The best thing to do is to educate yourself and other family members about the risks and benefits of the different sleeping arrangements.  While I cannot endorse co-sleeping I advise those who choose this method of sleeping to be informed of the potential risk involved and discuss the proper safety measures to have in place with their health care provider.

Personally, I had each of my children sleep in our room in a crib.  This allowed me to feel confident that I would hear the noises they made throughout the night, have convenient proximity for breast feeding and feel confident that they were safe from any dangers that might come from sleeping in the same bed.  Then as they got a little older, somewhere between 4-6 months, my anxiety lessened as did their need for as many night time feedings and I was able to transition them into their own room.

Additional reading:

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Human Milk is Best for Preterm Babies

Human milk is the best nutrition for all babies but particularly for babies born prematurely or with low birth weight. It contains antibodies and protective properties that help fight infection and protect against some diseases. Human milk is the “gold standard” for infant nutrition because it:

  • Is more easily digested than formula for preterm infants
  • Contains beneficial fats that help promote brain and eye development
  • Contains proteins that are anti-allergenic compared to cow’s milk proteins in formula
  • Promotes beneficial intestinal bacteria for baby
  • Lowers risk of intestinal infection some preterm babies may develop

For some mothers of premature babies, breastfeeding at birth or offering their own milk isn’t possible. When mother’s own milk is not available, the American Academy of Pediatrics (AAP), the World Health Organization (WHO) and the Center for Disease Control (CDC) recommend pasteurized donor human milk as the next best thing.

What is Donor Human Milk?

Mothers whose babies don’t need all their milk donate their extra milk to a licensed milk bank. These milk banks follow strict guidelines established by the Human Milk Banking Association of North America (www.hmbana.org).  Donors undergo screening and blood testing and must meet the same health standards as blood donors. Mothers must be currently lactating with an infant less 1 year old and have surplus milk. They are not paid for their milk donation. Once a mother is approved for donating, her milk is sent to the nearest milk bank location for pasteurization and tested again for bacteria before freezing for safe storage. Many immune benefits remain after pasteurization.

Much like donor blood products, Overlake offers donor human milk to premature infants that are at highest risk for feeding issues or intolerance when mother’s own milk is not available. Overlake provides only donor milk purchased from licensed banks through HMBANA. Recent reports regarding donor human milk obtained from informal milk sharing groups have shown that the milk is often contaminated from either improper collection or storage methods and its use is not recommended.

Feel free to contact Overlake’s Inpatient Nutrition Services- 425-688-5341 or Inpatient Lactation Services- 425-688-5320 if you have any questions.

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