Selecting a Bra for Breastfeeding

When I took my breastfeeding class as mentioned earlier in the blog, the teacher advised us not to buy bras for breastfeeding until after your milk comes in. 

So you might ask, “what can I wear when I leave the hospital?”  The best option is to buy a nighttime sleeping bra or a flexible cloth bra.  It is recommended to buy only one because your breast size is likely to increase.  In my case I changed sizes by one cup. I didn’t think that was possible but milk let down will do that! 

It is important to remember that a bra that is too tight or has an underwire can cause mastitis or plugged ducts.  

Some of the brands that I like are:

·      Bravado

·      Bella Materna

·      Majamas

I bought Basics by Bravado which is a nylon spandex blend in nude and white and it keeps the girls comfortable and prevents pressure that could cause a plugged duct or mastitis.

Tearing down there!

When giving birth a large percentage of women will have tearing in the perianal area (the area between the vagina and anus).  Episiotomies were the standard procedure for many years but they are now only done when a forceps or vacuum delivery is needed and then only when necessary. 

During my labor I had a 2 degree tear which means I have a giant paper cut on my tush.  In more medical terms here is the breakdown of the degrees of tearing.

·      First degree:  Tearing of only the skin around the perineum.  This tearing usually requires stitches and heals fairly quickly.

·      Second degree:  Tearing of the skin and muscle tissue in the pelvic floor.  This will require stiches of each layer (stiches are dissolvable), will take weeks to heal and does cause more discomfort.

·      Third degree:  Tearing that involves the muscle and skin but extends to the rectum and can even include the anal sphincter.  This can be uncomfortable for months and can cause some incontinence.

·      Fourth degree: Tearing that involves the muscle and skin but extends to the rectum and can even include tearing completely through the anal sphincter to the tissue below.

Tears most often occur if:

•   This is your first vaginal delivery.

•   You've previously given birth vaginally and had a third- or fourth-degree tear.

•   You have an assisted delivery, particularly if forceps are used.

•   You have an episiotomy or you had one in a previous delivery.

•   Your baby is big.

•   Your baby is born in the posterior position (face-up).

•   You push for a long time.

·      The distance between your vaginal opening and anus is shorter than average.

Once you have tearing how do you treat it?  The most common way is to use witch hazel pads called Tucks.  The hospital will usually provide these to you.  Unfortunately I found out that not only am I allergic to witch hazel, but some of the other ingredients in Tucks.  

One technique I learned is to do sitz baths using loose leaf or bagged varieties of the sitz bath and doing a light soak.  The best technique is to do what is called a pad-sicle.   A pad-sicle is where you soak a maxi pad in water or witch hazel and place it in a bag and freeze.  It is wise to do this before baby comes so that you have several in the freezer. Then even if you have a mild tear you can ice the area and then dispose of the pad as bleeding will be present from your uterus.  I loved putting ice on this area with a gentle barrier.  It felt amazing. 

Breast Trouble

Some of the many things that can happen to a new mom when breastfeeding are mastitis, plugged ducts, yeast on the nipples and low milk production.  Combine this with fatigue and taking care of a new baby and any one of these can be enough to tempt you to give up breastfeeding. 

Unfortunately I have had to deal with mastitis as well as a plugged duct.  In fact a plugged duct often precedes mastitis since it means that a milk duct isn’t draining allowing an infection to take over in that duct.  Mom then gets a fever, fatigue, flu- like symptoms and a red streak across the breast. 

There are some natural ways to prevent and treat both if you catch them in time.  However, if you don’t catch it quickly then you may need an antibiotic.  This doesn’t mean however that you can’t get another infection or round of mastitis as I did.  So you will want to take supportive measures along with the antibiotics. 

I took Dicloxacillin for the first round.  I got a second infection while on the antibiotics meaning that the antibiotic was not effective in treating the infection. They gave me a different antibiotic (Cephalexin) my third time around.

For natural support and to prevent getting another infection I also am taking:

·      Lecithin Granules helps with milk flow from the ducts and can prevent further plugging.  Talk to your doctor about which form is best for you.

·      Grapefruit seed extract -- natural anti- yeast/bacteria.  Please check with your doctor as not all women can take this.

·      Fenugreek to boost milk production

Always remember taking care of yourself is important and absolutely necessary if you are going to breastfeed because a sick body won’t produce enough milk for baby.

Breast-feeding Pillows: Good, Bad or Gimmick.

When you talk to most lactation consultants, and I talked to several, they will urge you not to use the pre-made nursing pillows.  The position that most will recommend is a 45-degree angle in which the baby is positioned laying across mom’s body in the cradle hold position. The reason they are not huge fans of the pillow is because it puts the infant in a horizontal lying position that reduces gravity, which helps in digestion. 

However, the pillow can be helpful early on when you are learning to nurse and especially helpful when learning the football hold.  Many new moms will learn this position first since it allows the most control of the newborn’s head when placing baby on the breast. 

While learning the football hold I tried two pillows, the Boppy and the Brestfriend.  Of the two the Brestfriend was by far my favorite since the strap is adjustable and clasps securely like a backpack waist strap.  The Boppy seemed to slide around and I was never able to get into an optimal position.  I only used it for about two weeks until I transitioned to the cradle hold and found it better to just use an arm chair or a small pillow under my supporting arm.

See both positions below.  You can find out more techniques for each on the La Leche League website:  http://www.llli.org.  There is a local chapter in San Jose that meets the first Thursday of every month near the Rose Garden.

Feeding the Baby, Schedule or Not?

Deciding whether to keep your baby on a schedule or feeding whenever the baby cries can be confusing for new parents.  However, your parenting style and choices depend on your lifestyle, personal philosophy and schedule.

We have chosen a parent-directed feeding schedule.  Schedule is a loosely used term meaning that you attempt to set the baby’s metabolic rhythm but you always feed a hungry baby.  This is the plan I am most comfortable with since I will need a somewhat predictable schedule with my patients, but I don’t want to starve the baby waiting for the designated feeding time.

This feeding cycle is based on the book On Becoming Baby Wise:  Giving Your Infant the Gift of Nighttime Seep by Gary Ezzo and Robert Bucknam.

We like this book because of its simple and logical philosophy that helps get our baby on a somewhat predictable cycle.  The book also describes situations when the baby will deviate from the norm as such as nap times, sleeping through the night and growth spurts as well as ages when you can expect change This gives us an idea of what to expect with the understanding that every baby sets his/her own time frame and schedule.  So far we have a somewhat scheduled day with a cycle of feed-wake-sleep and this allows us to plan our day a little to help keep us somewhat sane.

My Birth Story!

Labor began for me twice.  The first time was on the afternoon of July 9^th and lasted until the next morning when labor ended abruptly. Then I had contractions off and on until Saturday morning July 13 when I awoke with contractions that were closer together and painful enough to get me up to walk around.  So when I say I was in labor for 60 hours, this is the start time even though I had been in early labor for several days.  The contractions continued to get closer and closer together and I wanted one last nice meal so my husband and I went out for Thai food. I was able to sit through the meal but still had to breath through the pain.  My parents were in Capitola and we called them to come since my mom was going to doula the birth. 

I labored at home until midnight and then my contractions were 3 minutes apart and 1 minute long and had been that way for two hours.  The hospital recommends you come in at 5:1:1 (contractions five minutes apart, one minute in duration for one hour) but I prefer 3:1:1.  That way mothers are further along in dilation. This is also the recommendation of many doulas and midwives.

When I went to the hospital I got the news that I was only 3 cm dilated and unless I wanted an epidural I wouldn’t be admitted. They gave me a high strength Benadryl and sent me home to sleep for a few hours hoping I would be rested and more dilated when I returned.  I went home and slept, but not well, between contractions for two hours and then labored at home until 1pm. At that point contractions were one minute apart, 1:30 minutes in duration and had been for over an hour.

 

When we arrived back at the hospital I was still only 5 cm dilated and they recommended some fentanyl to relieve the stress on my body so I would relax and dilate.  Fentanyl should last for 45-60 minutes but with my heavy contractions only lasted 20 minutes.  At this point I was losing strength and my contractions were painful but starting to get more erratic. My doctor told me that I would need augmentation or possibly a C-section if my body wasn't able to continue labor.  With my knowledge of Pitocin and how painful it makes labor and how much pain I was already in, my husband and I made the decision to get an epidural so the Pitocin could work.  Once this all started to unfold I was able to take a nap, but only fitfully, and then around 11:50 pm my water broke. It was like an explosion in my pelvis and I was ready to start pushing!

 

The nurse was going to do a few pushes with me then get the doctor, however after one push the baby was progressing so rapidly that she wanted me to breath through the pushing until the doctor got there.  I pushed for about 20 minutes then Zara was born at 12:22am on July 15^th.  She weighed 8 lbs. 1.3 oz. and measured 19 inches long.  She was able to latch immediately and mom and baby are doing well.  Zara got her first adjustment about one hour after birth and some cranio-sacral the next day.

 

The birth wasn’t my plan or preference, but I got two great gifts. I didn’t push very long at all and my water broke naturally.  Sometimes the baby decides for you!

She is healthy and I am blessed.