- Cleft Lip/Cleft Palate
- Down Syndrome
- Phenylketonuria in Infants (PKU)
- Premature Babies
- Tongue/Lip Tie (ankyloglossia)
- Breast Reduction Surgery
- Chronic Diseases
- Eating Disorders
- Maternal Depression Upon Let-Down (D-MER)
- Maternal Illness
- Postpartum Mood Disorders
- Sexual Abuse (Maternal)
- Teenagers Breastfeeding
- Breastfeeding in the Military
- Breastfeeding Multiples
- Breastfeeding During Pregnancy
- Cesarean Section Birth
- Same-Sex Parents
- Tandem Nursing
Good news: you can breastfeed your adopted baby even if you aren’t currently lactating or haven’t recently given birth. In fact, you can breastfeed with induced lactation even if you’ve never given birth or if you’ve already hit menopause.
How late is “too late” for a child to learn to breastfeed?
A baby’s instinct to breastfeed can remain intact even after being given an exclusive diet of formula: read this story about a woman who ended up exclusively breastfeeding her adopted premature NICU baby, “I Always Knew I Wanted to Breastfeed: My Adoptive Breastfeeding Journey.” You can nurse a child who’s out of the newborn stage (4+ months)! Read La Leche League’s “Adoptive Breastfeeding Beyond Infancy.” Here is a story of a mother whose adopted baby learned to breastfeed at a year old even after health setbacks: “Nursing Julia: My Supreme Challenge.” Also see this Karleen D Gribble, PhD, interview with LetsTalkAdoption.com about adoptive breastfeeding/breastfeeding older adopted babies.
Planning to use a surrogate or gestational carrier?
Find out how breastfeeding would work in this situation.
What is relactation?
Read my section on Relactation.
- “Breastfeeding an Adopted Older Child” – Jenny’s story
- “The Breastfeeding Chronicles: Nursing My Adopted Child” – Christina Pearson
- “The Protocols for Induced Lactation: A Guide for Maximizing Breastmilk Production” – Lenore Goldfarb and Jack Newman, MD
Alternative Feeding Methods
Can you skip the bottle and cup-feed your newborn? What about alternative feeding methods like a Supplemental Nursing System, syringe dropper, finger feeding, and others? Find out more in this post.
Breastfeeding in the Military
Many women actively work to defend more than just their own babies–they protect and serve for all the babies and families of our nation. As “Service Before Self” is a core value of the Armed Forces, women should be encouraged and applauded for their service to their family–for giving the best protection they can for their children on all fronts. You can’t get more “Made in the USA” than an American citizen’s breast milk!
Nursing mothers in active duty can turn to the Army breastfeeding support group Mom2Mom. Breastfeeding in Combat Boots: A Survival Guide to Successful Breastfeeding While Serving in the Military by Robyn Roche-Paull is another excellent resource for information and support for milkin’ military mamas. The book / The web site / The Facebook page
Be proud — breastfeed in uniform! One nation of babies, under mom, with love-by-teat and pumped milk for all (that’s how it goes, right?). Also, despite recent occasions of harassment against nursing mothers on base, nothing has changed about the policy: rest assured that you can breastfeed covered or uncovered on base, as with any other place you’re legally allowed to be.
- “Active Support for Active Duty Babes” – Robyn Roche-Paull, IBCLC, for Best for Babes Foundatio
- Bras ‘n Boots – non-profit organization dedicated to delivering care packages to female service members around the world (join the Facebook group here, or click the first link to read the blog).
- Breastfeeding Resources – U.S. Army Public Health Command
- “Mother of All Wars: The Battle to Breastfeed in Uniform” – Adam Weinstein
- Mothers at War – project includes stories, articles and blog
- “The ‘Breastfeeding-in-Uniform’ Booby Trap for Military Moms” – Robyn Roche-Paull, IBCLC, for Best for Babes Foundation
You’ve got two breasts, two nipples, and–what, you say?–two babies?? Thank god for symmetry, huh? Oh, did you say THREE (or more) mouths lusting for latch? I can almost see the wheel of hormone-induced crazy ideas spinning feverish as a hot-flash as you steal desperate glances at the baby’s father’s own set of nipples and wonder, okay when is it his turn? He’s got a pair… it could work, right?! Don’t risk your babies getting tangled in that hairy-mess chest for no reason! Trust that mama’s own two milk-makers will be just fine. Consider this your children’s very first lesson in “sharing is caring.”
- “Breastfeeding Octuplets: One Mother to Nurse 8 Babies!” – Michelle Brown
- Breastfeeding triplets around the world (Youtube video)
- Mothering Multiples (Karen Kerkhoff Gromada)
Blindness/Visual Impairment or Deafness
Are you breastfeeding in the blind? Though it probably won’t be easier than nursing as a sighted person, it certainly can’t be much harder than trying to buy, measure, mix, and feed formula without the sense of vision. One blind mother named Donna Cookson Martin who breastfed her five children is unswayed in her belief that breast is still best even when blind. Read her experience here. Also read “A Breastfeeding Story: Breastfeeding as a Blind Mother” at IANTB.
This article by Cynthia Good Mojab for LLL is aimed at those who want to help a visually impaired woman breastfeed. The bottom of the page includes direct contacts for LLL leaders who specialize in this area. For those with auditory challenges, LLL has an article aimed at Leaders: “Helping Mothers Who Are Deaf or Hard of Hearing.”
Breast Reduction Surgery
Breastfeeding success after any breast surgery of course depends on whether the ducts and nipples were traumatized and to what degree. You’ll need to talk to your surgeon about what methods were used in your operation to prepare for any future milk-making obstacles. Links:
- BFAR (Breastfeeding after Breast and Nipple Surgeries)
- “Guidelines for Breastfeeding After Breast Reduction” – Wendy Nicholson, OAM, RN, RM, LC
Breastfeeding During Pregnancy
Be sure to also read my section on “Tandem Nursing” below. Back to Top
Cesarean Section Birth
See “Returning to Work.”
Cleft Lip/Cleft Palate
A baby with cleft lip or cleft palate can breastfeed successfully, and it’s worth a motivated attempt at the very least (I will continue to repeat this for virtually every baby with almost any condition, you’ll soon notice). I emphasize this because of the miraculous situations I’ve seen with a few cleft-affected babies, and I’m a believer in the power of breastfeeding for all babies–whether medically sound, struggling to impress, or struggling to survive. Here are a few special benefits of breastfeeding a cleft-affected baby as listed by Children’s Hospitals and Clinics of Minnesota:
- “Babies with cleft lip or cleft palate tend to have more ear infections—and breast milk helps protect against these infections. The mother’s antibodies are passed on to the baby in the breast milk. For an infant facing surgery, this is a real benefit.
- “Choking and milk leaking from the nose may occur [with cleft babies]. Breast milk is less irritating to the mucous membranes than formula,because it is a natural body fluid.
- “For babies with cleft lip, breastfeeding helps strengthen the face and mouth muscles, leading to more normal facial formation. This promotes better speech skills as the baby grows.
- “The breast is more flexible than a bottle nipple, and molds itself to the shape of the lip and mouth. A breast offers a baby more control over positioning and milk flow.
- “Many infants need the extra closeness and interaction of breastfeeding. Infants suck for comfort as well as for food, and these babies may not be able to use a pacifier very well.”
- Cleft Lip and Palate Breastfeeding – resources for mothers who want to breastfeed their cleft-affected babies.
- Guidelines for Breastfeeding Infants with Cleft Lip, Cleft Palate, or Cleft Lip and Palate – Clinical protocol by the Academy of Breastfeeding Medicine, revised 2013
Read my post here.
Why do women donate their surplus milk? Many women get more milk from a pump than their child could ever need (find out who holds the Guinness World Record for “Most Donated Breast Milk”), and donations are in constant demand for premature babies and those with mothers in medically precarious positions. It’s a wonderful gift for an older baby who might otherwise be forced to have formula supplements that she cannot tolerate, for adoptive parents like same-sex couples who cannot produce their own breast milk, for single fathers, or as I’ve seen several times, bestowed by a mother as a way to grieve the tragedy of infant loss. Milk donations can also hold a gold mine of clues in breast cancer research.
Breast milk donations help babies like Charlotte, Levi John, the ones in these success stories, preemies with the highly morbid condition called nectrotizing enterocolitis (see the “Premature Babies” section) and this meth-addicted baby. Breast milk donation helped breast cancer victim Jamie Thomas and THESE TWO MAMAS who received some of my own surplus milk. Breast milk very likely would have saved Micah.
You can make a one-time donation, several donations, or become a long-term donor. If you’re interested in donating your milk surplus, you have several options. You might consider HMBANA milk banks, which provide milk to NICUs. There is also informal mother-to-mother milk donation, as linked below:
- Frequently Asked Questions here from HMBANA.
For an investigative look into milk donation, watch the 2012 documentary “Donor Milk” (purchase the DVD here) .
The International Breast Milk Project / The National Milk Bank / The University of Minnesota Medical Center / Milkbanking.net / The Family Birth Center / The Mother’s Touch / The Birth Connection Milk Bank / The Whole Woman, Inc. / South Coast Milk Bank / Milkin’ Mamas / Miami Maternity Center
- “Biomedical Ethics and Peer-to-Peer Milk Sharing” – Karleen D. Gribble, BRurSc, Ph.D.
- “FAST FACTS: Miracle Milk” – Best for Babes Foundation
- “Peer-to-Peer Milk Donors’ and Recipients’ Experiences and Perceptions of Donor Milk Banks” – Karleen D. Gribble
- “Milk sharing and formula feeding: Infant feeding risks in comparative perspective” – Karleen D. Gribble and Bernice L. Hausman
- “Milk sharing: from private practice to public pursuit” – James E Akre, Karleen D Gribble and Maureen Minchin
- “Think donor milk is expensive? Wait ’til you see the alternative” – Tanya Lieberman, IBCLC
International Milk Bank Links:
- Adresse des lactariums et banques de lait en France – contact info for French milk banks, or “lactariums”
- BC Women’s Milk Bank – Canada
- “Información sobre el banco de leche materna en España” – Spain’s milk bank
- “iThemba Lethu breast milk bank” – UNICEF South Africa
- Sperrin Lakeland Milk Bank – Ireland’s only human milk bank
Babies with congenital disease such as Down’s Syndrome reap irreplaceable benefits from breastfeeding. Regular physical contact, opportunities for IQ-building nutrition (even an extra IQ point or two makes a drastic difference to a child with Down Syndrome), and reinforced, affectionate human socialization is offered simultaneously and constantly with breastfeeding.
Parents of babies with this condition can also enjoy great rewards (read about what that’s like here). Breastfeeding and peaceful parenting advocate Dr. William Sears has a child with Down’s. He touches upon his experience at this location on his web site. Other advocacy figures who have Down’s affected, breastfed children include Katherine Dettwyler (“The Issue of Informed Consent“) and Becky Saenz (“Primary Care of Infants and Young Children with Down Syndrome“).
- “Breastfeeding Babies with Special Needs” – La Leche League International
- “Nobody Smiles Like I Do” – Dee Cole
- “Special Advantages of Nursing Your Baby with Down Syndrome” – Becky Flora, BSed, IBCLC
- “Welcoming Babies with Down Syndrome” – Pam Wilson
- The Baby Book: Everything You Need to Know About Your Baby – From Birth to Age Two – William and Martha Sears (pp. 181-182 and pp. 395-400)
- The Breastfeeding Answer Book (revised ed.) – Mohrbacker and Stock. (pp. 304-08)
- The Breastfeeding Book – William and Martha Sears. (pp. 213-214)
- Nursing Your Baby with Down Syndrome – Sarah Coulter Danner, CPNP, CNM, and the late Edward R. Cerutti, MD
- The Womanly Art of Breastfeeding (sixth ed.) – La Leche League International. (pp. 290-291)
Visit “Pumping & Working Buzz.”
Babies with galactosemia cannot entirely break down the simple sugar galactose in dairy including all milks (human, other mammal, or formula), therefore they require a specific lactose-free type of nutrition. There are three types of galactosemia that range in level of severity.
This is an extremely rare inherited disorder. About 1 in 60,000 caucasian newborns are affected (rate differs among races). Prenatal genetic testing can screen for the autosomal recessive gene that would indicate increased risk factor for galactosemia. It’s typically detected by the newborn screening test given in the first few days after birth.
- “Galactosemia” – Genetics Home Reference
Maternal Depression Upon Let-Down (D-MER)
D-MER is a physiological response to nursing caused by shifts in hormone levels, specifically dopamine at the beginning of a feeding. It’s not the nausea some get with strong let-downs, or the pain that many experience with postpartum uterine involution. It’s not a psychological response, which would actually be postpartum depression.
So, what is it? It’s a feeling of dysphoria (the opposite of euphoria), a “yucky” feeling of hopelessly needing to get away that accompanies let-down and often disappears once the milk is flowing, but can recur with subsequent let-downs. Sometimes, it can even feel strangely similar to the feeling of homesickness. Women can get relief by keeping distracted while nursing, trying nutritional supplements or herbs as suggested in the links below, placenta encapsulation, acupuncture, exercise, consuming small amounts of caffeine, and getting more sleep (I know, good luck with that, right?).
- “D-MER” – Nichole’s story
- D-MER.ORG – “Because breastfeeding shouldn’t make you feel this way.” The link to the organization’s blog is here.
- “D-MER (No, You Are Not Crazy)” – Mama Bice
- “Dysphoric milk ejection reflex: A case report” – Alia M. Heise and Diane Wiessinger
“Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society. And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost always: Almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping.” – “You Should Continue Breastfeeding (Illness in Mother or Baby” by Jack Newman, MD, FRCPC
Newman further explains that not only is the advice to stop breastfeeding usually wrong, it’s also “impractical” as pumping and bottle-feeding are not always easy or feasible. If the mother realizes she is sick (with viral infection, bacterial infection, even strep throat), by this time she has already exposed her child to the sickness during stage of contagion. Passing along the antibodies in her milk will protect the child or at least allow for milder symptoms should he get sick, too. The mother can in this way think of having the double role of both patient and doctor. Foodborne or waterborne illness is also not a reason for a mother to stop breastfeeding; in fact, increased nursing can protect the child, according to the CDC.
What are they?
“Controversial, hated, overused,” at least according to LLL. Now, this is not the kind of nipple shield we’re talking about:
Breastfeeding shields are silicone nipples that fit on top of a woman’s nipples. Like this:
They should be used short-term with a plan to wean and in most cases, not used during the first week after birth (though this is often recommended by ill-informed health care workers). Proper use of a nipple shield is crucial, otherwise poor milk transfer is a concern (and thus prompts a possible cycle of poor weight for baby, and mastitis or plugs for mom). A good lactation consultant is usually the best person to instruct on proper use and how to wean from the shields when it’s time. If there is no medical indication to introduce a breast shield–don’t! Why not? Per La Leche League:
“Since the infant has to rely on suction alone to transfer milk, these types of nipple shields can drastically reduce his milk intake, potentially causing slow or inadequate weight gain. There are reports that even the thin silicone nipple shields cause reduced milk intake and present a potential for reduced maternal milk supply and nipple damage with improper placement.”
I should have probably listened to LLL on this one. Read my post “My One-Nurse Stand with a Nipple Shield.”
What situations might warrant beneficial use of a nipple shield?
Physical abnormalities, physical barriers in preemies, or deformities in the baby that affect latch. Or, otherwise insurmountable latch issues due the following: flat nipples or abnormal nipple shapes, excessive and constant engorgement, inability of an infant to recognize the mother’s nipple due to bottle-nipple or pacifier confusion, and to protect nipple injuries as they heal.
- “Nipple Shield” – Diane Wiessinger, MS, IBCLC
- “Nipple Shields” – Kelly Bonyata, MS, IBCLC
- “Nipple Shields” – instructions,Barbara Wilson Clay, BSEd, IBCLC for Medela
- “Nipple Shields: Cautions & When to Use” – Ask Dr. Sears
- “Nipple Shields: life-saver, supply -wrecker or just another tool for nursing mothers?” – Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM
Phenylketonuria in Infants (PKU)
PKU is a rare, inherited amino acid metabolic disorder that’s routinely checked for as part of the newborn screening; babies with PKU cannot easily break down the amino acid phenylalanine. Milder forms of the disorder may not need special treatment, though the “classic” type requires a diet with minimal phenylalanine. As breast milk contains very little of this amino acid, it is considered both possible and safe to breastfeed, however most babies will still require a special medical formula in addition to breast milk.
Beginning treatment for PKU before three weeks of age is important as mental retardation is a symptom of untreated PKU. A study measured later IQ as significantly lower in babies who received delayed treatment compared to healthy peers, while those who were treated in the first three weeks showed no comparative difference in IQ with the same group. Detection of PKU via urinary genetic screening also offers an opportunity for developmental and functional improvement in children with autism or atypical childhood psychosis when they’re put on a low-phenylalanine diet.
- “Amino Acid Disorders” – Newborn Screening Info
- “Maternal PKU and Pregnancy” – Organization of Teratology Information Specialists
Postpartum Mood Disorders
What’s the difference between “relactation” and “induced lactation”?
If a woman stops breastfeeding a child and wishes to later produce milk for him/her, or another biological or adopted child, the process is called relactation. The possibility of exclusive breastfeeding is herein very realistic. Induced lactation is what can happen if a woman who has never been pregnant wants to produce milk. Exclusive breastfeeding is often less realistic in this case, but of course any amount of regular breastfeeding is better than none.
How does it work?
- “From bottle to breastfeeding: a hard journey to contentment” – Sylvia Thompson
- “Relactation and Adoptive Breastfeeding: The Basics” – Kelly Bonyata, BC, IBCLC
- “Relactation Boot Camp” – Adoptive Breastfeeding Resource Website
- Relactation stories – LLL
- “The Road Back to Breastfeeding and Beyond” – blog journal by MommyHopeful3
- The Breastfeeding Mother – blog with relactation/SNS system info
Teenage mothers are less likely to breastfeed than any other population. Those who did continue to breastfeed longer than six weeks report “significant emotional, informational and instrumental support from family, friends, school, and their babies.” Teenage mothers who consider breastfeeding have special concerns such as whether nursing will “ruin” their breasts and how it will affect their bodies, their usual social activities, relationships with romantic interests, friends, and the baby’s father, attending school, potential regular habits such as exercise, smoking, and birth control pills, and fears about nursing in public.
The AAFP says that doctors are on the frontlines of support for pregnant adolescents, especially given our society’s largely shaming attitude about young motherhood.
“Pregnant and breastfeeding adolescents often have significant concerns about body image. These concerns can be addressed by providing positive images of discreet breastfeeding and educating them about changes that will occur during pregnancy and breastfeeding. Often, teenagers are disinclined to bring up such concerns, but if asked they are willing to discuss body image concerns, as well as issues such as sexuality and contraception. Because teenagers worry about their changing bodies, it is important to proactively share information about proper nutrition, diet, exercise, and weight loss with the mother and those in her support system.
Milk production in teenagers has been evaluated because of concerns about a possible decreased milk supply in adolescent mothers.They may make less milk as a result of having less breast tissue. Teenage mothers often feed their infants less frequently and supplement with solids earlier.However, most teenage mothers with proper support have ample milk supplies.”
In Amy Spangler’s book Breastfeeding: A Parent’s Guide, you’ll find a whole chapter devoted especially to teenagers who want to breastfeed (pgs. 35-43). What teens say in the book:
“I feel proud that I breastfeed. Many people said that I am too young to breastfeed. You are never too young. I mean, if you have a baby, you are not too young to breastfeed.” – Lee
“…Just try it. If you find that you have problems, do not give up real quick…Clear your mind of all the advice, and all the wrong ideas you have been given about breastfeeding. Start fresh. Know that it is best for your baby to breastfeed and that you are going to do it.” – Kayla
“There are no rules to breastfeeding. You can breastfeed wherever you feel comfortable. Don’t worry about what other people think. Your baby needs to eat like everyone else…” – Maggie
“Don’t worry about having to go to school because you can still breastfeed in between. If you’re just going to breastfeed at night, that’s better than not breastfeeding at all.” – Faith
Check out these articles by Jacqueline Levine LCCE, FACCE, CD(DONA), CLC:
- “Encouraging Teen Moms to Breastfeed” – Kelly Bonyata, BS, IBCLC
- “Helping Adolescent Mothers Breastfeed” – Bonnie Tilson
- “Promoting Breastfeeding in Teen Moms” – Lily L. Carter, RN, BSN, PHN, CLE (pg. 5)
Tongue/Lip Tie (ankyloglossia)
This condition is a midline facial defect that likes to run in families. The effects of a tongue or lip tie can severely affect breastfeeding; in fact, it’s a common cause of otherwise unexplained maternal pain and early cessation of breastfeeding, whether the mother (or a health care practitioner) knew about it or not. Read more more about the breastfeeding consequences here. The American Academy of Pediatrics has also finally recognized the reality of congenital ties in this newsletter. Per Dr. Lawrence Kotlow, DDS:
“Infants are often born with a combination of [these] conditions… A tongue tie occurs when the embryological remnant of the tissue attaching the tongue to the floor of the mouth does not disappear when an infant is born. A lip tie is when the upper lip remains attached to the upper gum.”
Class 1 – tie is at the tip of the tongue
Class 2 – tie is just behind the tip of the tongue
Class 3 – tie is near the tongue’s base
Class 4 – tie may be covered by mucosal membrane and cannot be diagnosed by sight alone (this video is helpful in determining whether posterior tie is the issue)
Class 1 – tie is minimally visible
Class 2 – tie is mainly attached to gingival tissue
Class 3 – tie attaches just before the hard palate
Class 4 – tie reaches into the hard palate
In Kotlow’s online booklet, learn about ankyloglossia myths, examination criteria, surgical release methods, post-surgery care, and see PHOTOS of tie examples. This video demonstrates how to care for a tie day-by-day after it’s been surgically released. Read about special aftercare and important stretching exercises here.
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