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Description: Pumping and Returning to Work: Tips for an Easier Transition

ISSUE 2013 3 Focus on Fathers My Husband s Constant Support Mothers Stories Proud to Be a Breastfeeding Mother Pumping and Returning to Work Tips for an Easier Transition United States Breastfeeding Committee Report Breastfeeding and the Affordable Care Act pdf version e Click her e Click her e Click her text only pdf e Click her rinted our p to order y now copy past issues follow us on facebook visit lllusa.org to access breastfeeding resources and information get the newest issue right into your inbox Click here to sign up for the New Beginnings e-blast Have you considered a tribute gift to La Leche League USA (LLL USA) You can make a donation to LLL USA in the name of a family member or friend to honor or remember them. Your tax-deductible donation will show that you care about them while also helping LLL USA further its mission to help mothers breastfeed. Donations of any amount will be gratefully accepted for a minimum gift of 25 New Beginnings will publish your special message of congratulations encouragement appreciation or condolences.To submit a tribute gift please send a check and the tribute wording to LLL USA 4475 N. Jefferson Avenue Miami Beach FL 33140 or click on the donate tab at the top of the page at www.LLLUSA.org to submit your tribute and make a donation to LLL USA via credit card e-check or PayPal. Anonymous gifts are also appreciated. Pumping and Returning to Work Tips for an Easier Transition [07] Mothers Stories Chemotherapy and Breastfeeding Proud to Be a Breastfeeding Mother My Relactation Story [04] [22] Eating Wisely Busy Summer Healthy Eating [12] United States Breastfeeding Committee Report Breastfeeding and the Affordable Care Act [24] New Beginnings Bookshelf Mothering Multiples by Karen Kerkhoff Gromada [14] Staying Home Responding to Negative Comments [16] Making it Work Accept a Busy Promotion [18] Toddler Tips Successful Shopping Trips [19] Focus on Fathers [20] Giving Birth Emilio s Birth My Husband s Constant Support Inspiration There is a garden in every childhood an enchanted place where colors are brighter the air softer and the morning more fragrant than ever again. ELIZABETH LAWRENCE 2 New Beginnings Issue 3 2013 Editor s Note Issue 3 2013 Volume 38 2013 La Leche League United States of America T he start of motherhood is a series of new beginnings. For those mothers who work outside of the home and plan to incorporate pumping into their daily routine learning how to successfully pump can be a stressful and frustrating time. Jennifer Lincoln provides a variety of helpful and informative tips to assist new mothers with a smooth transition back to work and make pumping a less stressful part of the day. Tandem nursing relactation and how cancer and chemotherapy interrupted one mother s breastfeeding relationship are included in Mothers Stories. Brenda Bandy shares more information about the coverage of breastfeeding services and supplies under the Affordable Care Act and insurance compensation guidelines. Balancing the care of your children with the care of your home isn t an easy task and can be made more difficult with a critical relative offering biting words and little else. Read Staying Home for ideas about how to react and respond to such a relative. When you go to the grocery store is your biggest challenge keeping your toddler occupied and content If so Toddler Tips is a must read. The mother of a five-month-old is offered a promotion that means more money but longer hours and more travel. Is this best for her family Readers offer suggestions in Making It Work. Focus on Fathers Contributing Editor Jodie Kilpatrick shares the story of her daughter Rachel s recent birth and the supportive role her husband has played now and in the past with the arrival of their three older children. In Giving Birth one mother shares the story of her son Emilio s difficult delivery and how this experience is helping her prepare for future labors and births. The increased availability of fresh fruits and vegetables during the summer months is great news for mothers in search of ways to provide healthy snacks and meals for their families. Eating Wisely Contributing Editor Amanda Jo Greep shares a couple of her favorite recipes that are perfect for these active warmer days. In New Beginnings Bookshelf Karin Ali reviews Karen Kerkhoff Gromada s Mothering Multiples a resource that countless mothers of twins triplets and more have turned to over the years as they make their way through the intense early days weeks months and years of breastfeeding and raising their families. I hope you enjoy this issue of New Beginnings. Let me know your thoughts or share your story at nbeditor lllusa.org Managing Editor Amy Nelson Contributing Editors Cathy DeRaleau Amanda Jo Greep Jodie Kilpatrick Winema Lanoue Jean Merrill Susan Pfaltzgraff Micki Sellers Review Board Fran Dereszynski Judith Gibel Diane Jeffer Carol Kolar CarolAnn Napoleon Art Director Yael Breimer Cover Photo Shutterstock.com Photo Credits Unless otherwise credited all photos are from LLLI or Shutterstock.com. Pg 8 9 Paala Secor Pg 10 Elisabeth Epperson by Earthside Birth Photography Pg 19 Jodie Kilpatrick Pg 21 Hanny Ghazi Acceptance of paid advertisements does not constitute an LLL USA endorsement of the product advertised. Please write to advertise lllusa.org if you are interested in advertising in New Beginnings. La Leche League International and its subsidiary La Leche League USA fully support the WHO (World Health Organization) International Code of Marketing of Breastmilk Substitutes. LLLI Board of Directors (2006) Amy Nelson New Beginnings is published by La Leche League United States of America 15 Two Penny Run West Pilesgrove NJ 08098 Visit our website at www.lllusa.org If you wish to receive a link to each new issue as it is published visit http www.lllusa.org lllusanewbeginnings.php to add yourself to the list directly or send your name and email address to nbsubscribe lllusa.org and ask to be added to the distribution list for New Beginnings. Amy Nelson is a La Leche League Leader in the small Missouri River town of Yankton South Dakota where she lives with her husband Cory and their four children Accalia (14) Cole (10) Ella (7) and Tylan (4). Amy can be reached at nbeditor lllusa.org The mission of La Leche League USA is to help mothers to breastfeed through mother-to-mother support encouragement information and education and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother. 2013 Issue 3 New Beginnings 3 Pumping and Returning to Work Pumping and Returning to Work Tips for an Easier Transition By Jennifer Lincoln F or many mothers returning to work after giving birth is a financial necessity. Others may choose to continue to work outside the home as they find it a fulfilling part of their lives and an important part of their identity. No matter what the reason breastfeeding can certainly continue for these mothers and babies. It does take some planning and foresight to make breastfeeding and pumping easier but be confident that it can be done. Following is a checklist of issues to address prior to your return to work that will help the transition go more smoothly. potential obstacles improve by then. However if an extended leave is not an option ask if your employer will allow you to return to work on a gradual basis such as with shortened hours or fewer days at the outset. Some mothers return on a Thursday or a Friday so that they will only have a day or two before the weekend so they can reassess and make any needed adjustments before taking on a full week of work outside the home. Meeting with a lactation consultant can often be helpful in figuring out which pump is right for you. She can help you determine that the flanges are the right sizes to avoid trauma to the nipples and to ensure adequate breast emptying. Before purchasing a pump however ask if your employer has any available. If so they may provide them free of charge for employees to use. If you do purchase a pump consider buying one or two extra sets of flanges and bottles. This can make the cleaning and storing of pump parts every night a bit easier and less stressful. Practice pumping and build a supply When do I start pumping is a question asked by many mothers who anticipate returning to work. The short answer is that there is no perfect time varying studies have suggested starting seven to ten days before returning to work versus two weeks versus the more vague a few weeks. Ideally pumping should begin after your milk supply Find the right pump and accessories There is a pump for every working mother from the mother who works full-time and needs to pump multiple times a day to the mother who is only separated from her baby once a week. For the breastfeeding mother who needs to pump frequently a double electric pump is often best. This allows her to pump both sides simultaneously and if used with a hands-free set-up (such as a bra made for this purpose) can allow her to do other things while pumping such as eating lunch or returning phone calls. Plan your maternity leave The longer your maternity leave the longer you have to focus on your postpartum recovery and establishing the breastfeeding relationship. If you can delay returning to work until your baby is older than four months you are more likely to avoid issues such as engorgement leaking and concerns regarding fluctuating supply as many of these 4 New Beginnings Issue 3 2013 Pumping and Returning to Work is well established usually around four weeks postpartum. Many mothers will start pumping once a day or every other day at a time when they feel their supply is highest which is often after their baby s first morning feed. This allows mothers to become proficient using their pump and also helps establish their milk supply and provide some milk to be stored for future use should issues arise with pumping at work. Time introduction of bottle cup It is ideal to delay introducing a bottle until your baby is consistently nursing well which is often after three to four weeks. There is no need to introduce a bottle immediately to get the baby used to it. In fact doing so may promote poor latching habits or breast refusal at such an early stage. Rather enjoy these first few weeks and learn your baby s rhythm. Oftentimes babies will reject a bottle from their mother since they know the good stuff is right there Many mothers will have their partner or childcare provider practice with the bottle instead to avoid this confusion. If it is possible see if you can have your baby brought to you for feedings or on your lunch break (or plan on visiting your baby). Any feeding times that you can skip pumping and nurse your baby would always be a welcome change Editor s note The Tear-sheet Toolkit found in Chapter 20 of The Womanly Art of Breastfeeding (8th edition) is an excellent resource with portions you may wish to share with your childcare provider including handouts on Storing milk for your healthy full-term infant Bottle-feeding a breastfed baby ideas for day care and others and Safe handling and storage of your milk. a supportive workplace breastfeeding policy. However you can only expect your employer to be aware of your needs after returning to work if you discuss them ahead of time. It is important to let your employer know how they will benefit because you breastfeed that it is best for your baby you are less likely to miss work days to take care of a sick baby healthcare costs for mother and baby are lower and employees supported in their efforts to breastfeed are happier more loyal and more productive. It is even more important to know your legal rights. As part of the Affordable Healthcare Act that was enacted in 2010 employers are required to provide a reasonable amount of time for mothers to express their milk--and in a room other than a bathroom. For more details see this fact sheet www.dol.gov whd regs compliance whdfs73.pdf Find the right childcare provider There are many options for childcare your partner family members a personal nanny in-home daycare and traditional daycare. Regardless of what route you choose the most important thing is that you find someone supportive of breastfeeding and make sure they are educated about how to feed a breastfed baby. Know how much expressed milk to provide for your baby Your baby will likely vary how much he or she eats at each feeding but the average breastfed baby takes between two to four ounces of milk eight to 12 times a day. Based on how long you will be separated from your baby you should provide this average amount of expressed milk daily. You should store your milk in small increments to match these amounts and avoid wasting milk. Make sure your childcare provider documents the time and amount of each feed so you can see your baby s patterns and ensure you are meeting your baby s needs. Make your pumping routine at work effective and efficient After a few practice sessions many mothers are able to express milk store the milk and clean pump parts in less than 20 minutes. Practice makes perfect Keep in mind that pump parts need not be sterilized in between each use. Often a quick wash with warm soapy water and storing the parts in a bag in the refrigerator can suffice (this is also where having an extra set of flanges and other parts can come in handy). It is helpful to do a mental dry run before returning to work Supply your childcare provider with information about how to correctly use and store human milk as well as a description of how breast milk normally looks. Literature on paced bottle-feeding can also help your baby s provider know how to give your baby a bottle in a way that more accurately mimics breastfeeding. Discuss pumping with your employer If you plan to pump at work you should discuss this with your employer before returning to work. An ideal work environment allows you the time and space to express milk and has 2013 Issue 3 New Beginnings 5 Pumping and Returning to Work References Riordan J. and K. Wombach. Breastfeeding and Human Lactation 4th Edition. Sudberry MA Jones and Bartlett Publishers 2010 551-577. Mohrbacher N. and J. Stock. The Breastfeeding Answer Book 3rd Revised Edition. Schaumburg IL La Leche League International 2003 237-256. The Business Case for Breastfeeding Employees Guide to Breastfeeding and Working. Washington DC U.S. Department of Health and Human Services Health Resource and Services Administration Maternal and Child Health Bureau 2008. U.S. Department of Labor Wage and Hour Division. Fact Sheet 73 Break Time for Nursing Mothers under the FLSA December 2010 www.dol.gov whd regs compliance whdfs73.pdf (29 January 2013). Storing Milk for Your Healthy Full-Term Infant. LLLI 2010. Bottle-Feeding a Breastfed Baby Ideas for Day Care and Others. LLLI 2010. Safe Handling and Storage of Your Milk. LLLI 2010. vv Where will I pump Where is the closest sink Is there a refrigerator I can use to store my milk or will I need to keep it in a cooler bag with icepacks Addressing this before your first day back can certainly help make the transition less stressful. The age of your baby is an important factor in deciding how often you ll need to pump. The bottom line is to pump when your baby would normally feed. Skipping feedings at work can lead to a decreased supply engorgement plugged ducts and possibly mastitis. Try to eat well stay hydrated and not ignore your body s (or the clock s) cues as to when you need to pump. Some mothers find setting an alarm helpful as they often lose track of time during a busy workday. spend those precious hours after work with your baby. Don t stress over that laundry basket. What better reason to slow down than to snuggle with your baby in a comfortable chair and tell each other about your day Build your support network No matter how you look at it working and nursing takes effort and dedication. There will be nights of little sleep and days where you can t stop wishing you had your baby in your arms. There may be missed pumping sessions or criticism from colleagues or plugged ducts that won t quit. These are the days when you need to have a network of supportive people. Whether it is your healthcare provider a lactation consultant an LLL Leader or Group or an online group of supportive women you need to be able to reach out. If you are struggling with something chances are you are not the first mother to have done so. Just ask. And never quit on your worst day With each bottle of pumped milk you are feeding your baby even when you can t physically be there. Women are amazing at multitasking and being a mother who works and pumps is yet another beautiful example of that. Jennifer Lincoln is a full-time mother to twoyear-old Henry and wife to Doug. She is also a part-time obstetrician gynecologist practicing in Pennsylvania and a member of the local county breastfeeding coalition. Reconnect with your baby Returning home after work can often be hectic but it can also be the best time of your day a reunion with your baby If your baby is in daycare you may want to feed him or her as soon as you are reunited. Take into account how soon after leaving work you ll be able to feed your baby when you schedule the final pumping session of the day. This may allow you to skip your last pumping session at work. Be sure to communicate this with your childcare provider so they don t give a bottle just before you arrive Know that you can t do it all every day. Ask for help with dinner preparation or try to make meals on the weekends so you can 6 New Beginnings Issue 3 2013 Mothers Stories Do you need help with a breastfeeding question La Leche League has many sources of breastfeeding information Answer Pages La Leche League Breastfeeding Answer Pages provide a single source for current breastfeeding information on a wide range of topics. Chemotherapy and Breastfeeding I was diagnosed with Stage 1 ovarian cancer in October 2010. I was 29 years old and had three young children one of whom was still nursing. I had surgery and began chemotherapy. Because the chemotherapy drugs are passed through breast milk and would be very dangerous for the baby I had to wean my happily nursing 16-month-old daughter. It was very sad for both of us to have this important part of our relationship taken away especially when I was still in shock about the cancer diagnosis. My oncologist told me that I might be able to try to nurse again after chemotherapy was over but that the likelihood of success was low. It would be more than three months before my daughter could nurse again and we didn t know if she would want to nurse if she would remember how to latch on and if I would have enough energy to even try nursing. Even if I did I might not be able to produce milk again. My daughter did not nurse during the chemotherapy treatments. My milk was gone. I cried about weaning. I felt that it was unfair that the cancer had not only taken away my health (at least temporarily) resulted in painful treatments and brought fear and anxiety but it also had taken away such an important part of my relationship with my baby. I felt angry and very sad about it. Most people could not understand why it hurt so much. After I got the okay from my doctor to try nursing again I was worried that I had hoped for this in vain. When I offered to nurse her that first night she refused said No and shook her head. The second night she still shook her head no but she wanted to look at my breast poke it and get reacquainted. Then as she was falling asleep she nursed timidly. Her latch felt wrong to me and nursing did not help her fall asleep. My husband put her to sleep instead. I considered giving up at that point since I did not want to force her but then on the third night she nursed as if she had never stopped. Ever since our nursing relationship has been back to the way it used to be before my cancer diagnosis. My milk supply picked back up to meet the demand without pumping. I decided to think about this experience as picking back up where we left off and not as unweaning. Neither of us had been ready to wean. My daughter still wanted to nurse but had been told she couldn t anymore. She was very happy to nurse again and did not care that I was not making much milk at first. Once I had a good supply she was able to benefit fully from nursing once again and we could wean in our own time. One and one-half years later My daughter is done nursing. It was a long and very gradual weaning process--a happy process. Johanna Mother-to-Mother Forums Connect with other parents and La Leche League Leaders to discuss breastfeeding and parenting topics. Se Habla Espa ol Press Releases Browse our media release archive for La Leche League s perspective on current issues in the news. Ask a question Find personal support in your local area or use our online help form. For fastest support contact La Leche League in your local area. Breastfeeding Answer Pages offer immediate information. Podcasts La Leche League offers a wide variety of podcasts on breastfeeding and parenting topics. You can subscribe to a feed or select individual podcasts on topics of interest to you. For more information visit www.llli.org resources.html m 0 2013 Issue 3 New Beginnings 7 Mothers Stories Proud to be a Breastfeeding Mother Paala and her children Paaloma and Amelie I However I did have a mental struggle to overcome. I was plagued with distress for the first two years of motherhood thinking that I was acting too primal--like an animal-- because I was using my breasts for their biological purpose. Somehow I felt that I had surrendered my strength as a modern woman and fallen into something undignified. I had not accepted my role as a breastfeeding mother tending to the needs of my infant. Sure I realized that breastfeeding was best for the baby but breastfeeding in public for example posed a whole new set of problems. Breastfeeding in public or around anyone other than my husband scared me. I thought my breasts would be seen as sexual or that I would be confronted. During outings I hid in bathrooms in my car or under covers to conceal something that I was trained to think society didn t want or need to see. Even though I had this fear continuing our breastfeeding relationship when my baby turned into a toddler just felt right. In the winter of 2011 I became pregnant with my second child. I knew my family was expecting me to wean my toddler. I knew she still needed to nurse for comfort and for nutritional reasons and I did not want to deprive her of months or years of her mother s milk because I had a new baby on the way. Breastfeeding during pregnancy was rough in the beginning. Looking forward to the bonding Paaloma would feel with her new baby sister kept me going. After the healing home birth of had a moment of clarity last summer as I sat with my family on the rocks by the water looking across the bay to San Francisco. I realized I was experiencing something I had never expected pride. Looking down I smiled at the two sandy colored heads of the children nursing at my breasts. I was proud of myself as a woman as a stay at home parent of two daughters under the age of three and as a tandem breastfeeding mother. In my formative years I didn t dream of being a stay at home mother. Mothers in my family worked outside of the home just like their husbands. It also never occurred to me that I would be a mother who would breastfeed past infancy or nurse siblings together. I hadn t heard of such things. I don t remember ever seeing a mother breastfeeding and the topic certainly never came up with my own mother. But there I was that warm afternoon in 2012 with my supportive husband by my side. Everything felt just right. Paaloma my older child was the first to nurse. To this day she loves sitting on my lap bouncing her feet as she breastfeeds. Then her younger sister my one-year-old Amelie began to nurse. Paaloma unlatched and looked up at me cheerfully exclaiming Mama Baby sister and me are having breast milk. I love you. Amelie poked her big sister in the cheek and giggled. They held hands. I beamed. My daughters and I were completely uncovered soaking up the warm California sun. I asked my husband to take a few photos so I could remember the moment. Gone was the sense of underachievement and failure that I carried with me following the birth of my first child. Getting to that point of acceptance and thankfulness was a journey. When I became pregnant with Paaloma in 2009 I felt embarrassed that I didn t have the painting career or even the college degree that I thought I would have at this point in my life even though I decided to put those things on hold while I pursued my chance at having a healthy family. Paaloma s birth wasn t what I expected. She was born via unplanned cesarean because of a breech presentation. I was shell shocked and traumatized. Thankfully breastfeeding began smoothly and I didn t have to fight the battle of poor latch sore nipples and mastitis or thrush that can be a challenge for so many other new mothers. Paaloma was the first to nurse. Then her younger sister my one-year-old Amelie began to nurse. Paaloma unlatched and looked up at me cheerfully exclaiming Mama Baby sister and me are having breast milk. I love you. Amelie poked her big sister in the cheek and giggled. They held hands. I beamed. Amelie I found that it was more difficult than I had imagined breastfeeding two children of different ages. Adjusting to the increase in household size and learning to meet the needs of two nursing children was tough. The latch of my older child seemed unbearably strong 8 New Beginnings Issue 3 2013 Mothers Stories and I struggled to allow her to continue. The sensation of two breasts being emptied at the same time was entirely new. My toddler also wanted to nurse every single time my new baby nursed. I was beyond exhausted. Thankfully I had a supportive husband and friends and things got better as the weeks and months went by. Breastfeeding in public or around family still posed a problem. I kept my eyes low and my new baby covered with a blanket or scarf. Paaloma was given limits and I hardly ever nursed her outside of the home because I was afraid of the judgments of others. I felt terrible about putting my concerns and the opinions of others above my child. I attended my first nurse-in during December of 2011 after I heard about a mother who was harassed for nursing in a store. The mother s breasts were covered I felt that negative incident could have happened to me. There surrounded by other breastfeeding mothers I was able to nurse out in the open without a cover for the first time without shame. I realized that the community support I felt at the nurse-in was also available online. I joined breastfeeding support pages online and began writing my very own blog about my experiences as a nursing mother. Recently I had an experience nursing in public while I was at a local shopping mall. I will never forget it. I was nursing my 18-month-old who was becoming restless and upset while Paala and her children Paaloma and Amelie I tracked the whereabouts of my older child and pushed an empty stroller in a department store. When I was ready to check out the clerk commented on my younger child who was lying sideways across my chest with her feet dangling in the air. The clerk didn t realize that my daughter was nursing and asked me if she had fallen asleep. The other clerk who was a mother herself took one look at the two of us and said Nope. She s multitasking Then I chimed in with a chuckle and replied No she s not asleep. It was a nice moment. Everyone was smiling. There were no awkward rude comments glances or hesitation after the first clerk found out I was nursing. I was even given a compliment. That simple exchange proved to me that I have regained my dignity after years of doubt by just believing in myself and doing what feels right. Every single day since then I do my best to remember that what I am doing with my life-- being a mother raising nourishing and comforting my children--is the most important thing in the world that I could be doing. No matter how much I wish I was a better mother some days I will always be proud of this one thing I can do for my children. Paala Secor San Francisco Bay Area To Honor and Remember In honor of In appreciation of the awesome and loving parenting Shelley and Dennis Catanyag gave to our precious granddaughter Caitlin Hope Dunn Catanyag each day of the 12 weeks that she lived. From Bill and Misty Dunn In memory of In memory and appreciation of the love and support my father Frederick Arnold Stollery gave to me throughout his life. From Misty Dunn Paala and her children Paaloma and Amelie 2013 Issue 3 New Beginnings 9 Mothers Stories My Relactation Story I already had a plan when I found out I was pregnant. I was going to have a home birth and I was going to nurse my baby until she was at least two years old. I didn t have my head in the clouds I researched home birth and I attended every La Leche League meeting I could until the birth of my baby. My plan began to fall apart when after 22 hours of labor we were surprised with a breach presentation--the baby s bottom rather than the baby s head in the birth canal. I ended up transferring to the hospital and had a cesarean birth about four hours later. My milk came in quickly and there was plenty of it. But the next eight weeks were difficult. I had imagined that within days of giving birth I would be walking up and down the street with my new baby in my arms. I recovered well from the birth but my overall health deteriorated. I had terrible back pain and spasms. I was finally diagnosed with a herniated disc and was told time and rest would improve things. I temporarily gave up nursing when Jane was two and one-half months old because I could barely hold her. For some reason lying on my side to nurse hurt my back more than anything. I cried the first time she took a bottle even though at first it contained breast milk. The months went by and the medications were increased to keep up with the growing pain. I lost weight. The doctors didn t know why I wasn t getting better and I was given more medications for pain and to help me sleep. Eventually my husband and I had to hire someone to take care of our baby because I could barely take care of myself let alone her. Those were dark days and the doctor added two anti-depressants to the list of medications. I wasn t depressed because I just had a baby. I was depressed because I was sick and I was sure I was dying. I just had a baby whom I loved more than life itself and couldn t even take care of her. I was 15 pounds under my pre-pregnancy weight and I finally had to stop pumping milk. I lost so much weight I wouldn t let anyone take pictures of me and would only let a couple of close friends see me. I couldn t sleep because of the pain. I would cry from loneliness as my baby and my husband slept together in the next room. Eventually a new doctor identified one definite problem I was addicted to the pain medications. I experienced a month of pain and anxiety while I went through detoxification from the pain medication. It was worth every second because I knew we had a plan. When my baby was about five months old the anxiety attacks stopped and I was off every medication. I was still in pain still barely able to sleep and still dependent on Jane s nanny for her care. The pain was different though and I went to see my doctor again proudly bringing the leftover pills for disposal. It was then that she asked me about ulcers and I said that I had suffered from them a long time ago. She prescribed a medication used in the treatment of dyspepsia gastroesophageal reflux and peptic ulcer disease. I took the medication before I went to bed that night and I finally fell asleep. In the past I would sleep for a maximum of two hours before pain would wake me. But this time I woke up four hours later in no pain. I waited for the pain to start but it never did. I was so excited I couldn t sleep. Was it possible I just had ulcers I researched and discovered that peptic ulcers can cause back pain and the medications I d been on only makes them worse. I was so thrilled to be alive and well and cured that I just focused on my baby. We all started to sleep together again. Elisabeth and daughter Jane Within a couple of weeks I was crying all the time again. I was angry at what had been stolen from me months of my baby s life I would never get back and losing our nursing relationship. I discovered that relactation was an option and I knew I had to try it. I couldn t get back those months with my baby but if I could nurse again I believed I could put the pain behind me. I pumped for a couple of months while trying many suggestions from friends. I took fenugreek and ate oatmeal. I stayed well hydrated. I slept skin-to-skin with my baby not only to help her remember to nurse but also because just being close to my baby would help my body produce the hormones needed to make milk. I pumped in the middle of the night when those hormones are highest. Progress in my supply was noticeable. Jane showed some promising early signs such as relaxing against me when we were skin-to-skin and even turning her head to my chest. Yet she hardly noticed or cared about my breasts. My heart broke when she was excited to receive a bottle. 10 New Beginnings Issue 3 2013 Mothers Stories The supplemental nursing system (SNS) was a disaster for us. She would play with the tubes and wouldn t even attempt to latch even with a nipple shield. I must have tried it several times before I decided that if every session would result in a sobbing baby and me throwing the SNS across the room it just wasn t going to work for us. I had to figure something else out. After reading and talking more with other mothers I found an article online that contained one of the most useful tips I came across during this journey. It was about relactation and adopted babies. As far as teaching a baby to nurse it reminded mothers that nursing is an intimate act that is part of the trusting relationship between mother and baby. It really resonated with me. I felt that after Jane abruptly weaned at a young age and then was hardly held close by her mother for two months we had to rebuild our basic relationship. I stopped worrying so much about every attempt to nurse and focused instead on bonding with her through bottlefeeding diaper changes and other everyday activities. Soon we went on a long vacation and I had to decide exactly what I could handle while we were away. I received an email from a nursing. I also packed my nipple shield--just in case--but had no intention of using it. I just knew that if an opportunity presented itself I would be sorry if I didn t have it with me. After a week or more passed Jane started to exhibit different behaviors. She began rooting everywhere my eight-year-old cousin my husband even the bed. I knew what she was looking for even if she still didn t. Suddenly I knew she would get back to breastfeeding and she would do it soon. I had a bottle of breast milk ready for her nap but when I brought her into the guest room I took out the nipple shield and closed the door. By now I had enough of a supply that I was able to hand express some milk into the shield and offered her my breast while we lay side by side on the bed. She latched on with the third try. I did not cry tears of joy. I just breathed a sigh of relief. I knew I only had about half the milk she needed for each day but I knew the hardest part was over. She began nursing again at seven and one-half months old five months after the last time she nursed and about two months after I started the process of relactation. When she fell asleep I went straight to my husband with the bottle of breast milk still full. It took him a second to figure out what it meant. Then more in awe of the sight than when she was a newborn. It was even more miraculous the second time around. I stopped pumping almost immediately because it was so tiring for me. With good breastfeeding management I was up to a full supply when she was about nine months old. It was a struggle but a worthy one. Each day I am grateful for the return of my nursing relationship. Elisabeth Epperson Salt Lake City Utah Fenugreek is an herb native to Asia and Southeast Europe and is used to increase milk production. Most mothers who take fenugreek report an increase in milk production within 24 to 72 hours after starting to take the herb. There appear to be few adverse effects although some mothers have developed diarrhea and some mothers may notice a maple-like odor to their urine and sweat. Mothers with diabetes should be aware that fenugreek has a tendency to lower blood glucose levels. There is also the possibility of increased asthma symptoms for those mothers with asthma. Information taken from Fenugreek One Remedy for Low Milk Production by Kathleen E. Huggins RN. www.breastfeedingonline. com fenuhugg.shtml sthash.KCVrnRfU.dpbs She latched on with the third try. I did not cry tears of joy. I just breathed a sigh of relief. I knew I only had about half the milk she needed for each day but I knew the hardest part was over. She began nursing again at seven and one-half months old five months after the last time she nursed and about two months after I started the process of relactation. high school friend who is an LLL Leader. She reminded me that lots of skin-to-skin was most important. So I made a decision I would do what I could on vacation--things that were working for us already--but focus on consistently continuing to a) keep my supply up by maintaining a pumping schedule b) provide as much skin-to-skin as I could considering we would be with relatives most of the time and c) nurse her during bottle feedings by putting her face against my bare skin (even if it wasn t actually my breast) and looking at her and smiling at her as if we were I sent a message to the high school friend. She was on her way to an LLL meeting where everyone cheered at the news. I felt blessed with my wonderful family and friends and their support. At first Jane would nurse at night and for naps (no more getting up to pump ). I started nursing her in the carrier too. Within a few days it was obvious she didn t need the nipple shield. As we walked around New York City she was in the baby carrier and my husband peeked in to watch her nurse. He was even Information about Relactation For more information about relactation please visit www.lalecheleague.org nb nbrelactation.html 2013 Issue 3 New Beginnings 11 United States Breastfeeding Committee Report Breastfeeding and the Affordable Care Act By Brenda Bandy LLL USA representative to USBC M any mothers have heard that breast pumps and lactation consulting services are now covered at no cost under the new women s preventative health services guidelines of the Affordable Care Act (ACA). These are covered with no cost sharing for new health plans. However plan coverage varies greatly as the law is not specific. This leaves many families confused about just who and what is covered. As with many parts of the ACA there is still a great deal to be determined. While we wait for more guidance to insurance companies from the U.S. Department of Health and Human Services let s explore what we do know. What is covered Comprehensive lactation support and counseling by a trained provider during pregnancy and or in the postpartum period and costs for renting breastfeeding equipment are all covered under the ACA. The U.S. Department of Health and Human Services (HHS) has expanded the interpretation of this to include the purchase of breastfeeding equipment as well. grandfathered and how those plans might lose this status. previously adopted essential health benefits. Until such time as insurance providers receive guidance from the HHS coverage will continue to vary greatly among plans. As a consumer your best recourse in the event of a disagreement with your insurer is to contact your state s Insurance Commission or Department. Most have consumer assistance departments that will help you sort out whether your plan is grandfathered and what the coverage is for breast pumps and lactation services. The coverage of breastfeeding assistance and equipment under the ACA is an important step to support breastfeeding in the United States. What types of pumps are covered Currently this is determined by each individual insurance plan. Some will cover only manual pumps while others require a doctor s order to prove a pump is medically necessary. Most plans require mothers to purchase covered pumps through an approved vendor thereby limiting her options. Who is covered Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market policy year) that began on or after August 1 2012. Some insurance plans are grandfathered if they were in existence prior to the ACA passage on March 23 2010. These plans are not required to adopt the new women s preventative health benefits until such time as they have made significant changes to their plan and lose their grandfathered certification. Remember that even though the plan may be new to you it could still be grandfathered. Ask your insurance company if they are certified grandfathered under the ACA. See the resources list at the end of this article for more information about how plans have been What type of credential or certification is needed for a lactation consultant to be covered by women s preventative health services Again it is up to the individual plan to determine whose services will be reimbursed under this coverage. The credentials required for a lactation support provider are also determined by the plan. Some may require that the provider be a medical doctor others a Certified Breastfeeding Education or an International Board Certified Lactation Consultant. Still other plans may offer only a specific phone line staffed by a breastfeeding counselor hired by the insurance company. Hopefully the HHS will soon issue more detailed guidance to insurers. It has taken a couple of years for this to occur with Brenda Bandy lives in Manhattan Kansas with her husband and four children. She has been an LLL Leader for over 16 years and an International Board Certified Lactation Consultant (IBCLC) since 2010. She currently serves as the La Leche League alternate representative to the United States Breastfeeding Committee and the Area Professional Liaison for LLL of Kansas and continues to serve mothers and babies as a local LLL Leader. 12 New Beginnings Issue 3 2013 Resources Women s Preventive Services Required Health Plan Coverage Guidelines www.hrsa.gov womensguidelines Affordable Care Act and Grandfathered Upcoming LLL USA Events Here are some upcoming opportunities for Leaders and families to gather and share information about breastfeeding and LLL. Health Plans www.healthcare.gov news factsheets 2010 06 keeping-the-health-planyou-have-grandfathered.html National Women s Law Center Getting the Coverage You Deserve www.nwlc.org resource getting-coverage-you-deserve-whatdo-if-you-are-charged-co-payment-deductibleor-co-insuran October 4 2013 LLL of the Sunshine State Health Care Provider Seminar. Hilton Daytona Beach Oceanfront Resort Daytona Beach Florida. Featured speaker Catherine Watson Genna BS IBCLC. www.lllsunshinestate.org hps2013.html Questions to Ask Your Insurance Company Regarding Lactation Support http www.mobreastfeeding.org wpcontent uploads 2013 08 Questions-to-AskYour-Insurance-Company-Regarding-LactationSupport.docx October 4-6 2013 LLL of Sunshine State Parenting Conference. Hilton Daytona Beach Oceanfront Resort Daytona Beach Florida. Featured speaker Laura Markham PhD. www.lllsunshinestate.org conference.html October 12-18 2013 National Breastfeeding Month Campaign On August 6 2011 the United States Breastfeeding Committee (USBC) officially declared that August is National Breastfeeding Month (NBM). The USBC is pleased to announce that this year s NBM campaign will address four different topic areas (one each week) aligned with their Strategic Advocacy Plan goals. Each topic will have action templates for individual advocates and organizations in both social media and legislative advocacy areas. Please mark your calendar with this schedule and plan to join in the action on any or all of the topics if you d like to inform your legislators about these important issues. Visit www. usbreastfeeding.org for more information. LLL of Wisconsin Continuing Education Day. Hilton Garden Inn Milwaukee Park Place Milwaukee Wisconsin. Featured speaker Dr. Nils Bergman MB ChB MPH MD. www.lllofwi.org events Connect with Other LLL Mothers Join a Local LLL Group Find a local Group at http www.llli.org webus.html Visit the La Leche League Mother-to-Mother Forums The La Leche League Mother-to-Mother Forums offer breastfeeding support 24 7. You ll find a collection of resources and threads about various breastfeeding and parenting concerns. You can join the conversation and post questions to get the breastfeeding and parenting support you need. Forums.llli.org index.php August 4-10 Peer Counseling August 11-17 Paid Family Leave August 18-24 Maternity Care Practices Join the Conversation August 25-31 Employer Support 2013 Issue 3 New Beginnings 13 Staying Home Responding to Negative Comments That s not to say she ignores household tasks but if it doesn t get done during the day then they tackle it together when he gets home from work. She points out that this is what they used to do when they both worked outside of the home before the children came along. I think that is half of this equation realizing that being home doesn t make the house a mother s job. And the second half is probably about stating boundaries with your mother. It is important for your young family to see their mother standing up for herself in a healthy way. Would you allow a stranger or acquaintance to speak rudely to you in your own home Probably not--and your mother shouldn t speak rudely to you either. She doesn t have to agree with the choices you are making but she needs to hear firmly that she is no longer welcome to comment on your choices in this area. Michelle Nebel via Facebook I went through this for years with my mother. Finally I looked at her one day when she was criticizing my house and said If you really can t stand it there is a bucket and mop in the corner. Help yourself. I really wanted to say that I would have preferred having time with her than a neat house growing up but that would have hurt her more. Instead I surround myself with people who parent (and keep house) like I do. It is actually a wonderful feeling to know that my best friends have a laundry mountain and dishes in the sink sometimes too Courtenay E Grabowski via Facebook I cross-stitched and hung the words people before things in my home. I am lucky that my mother felt the same way. Tell your mother that her comments are hurtful. Remind her that you are raising a family that will not always be there but that the house and mess will be. Mary Kay Turner Smith via Facebook That is your mother. Let her know how much it hurts you. If she can t stop saying hurtful things maybe she shouldn t come over or she should reduce how often she comes to your house. Let her know that you love her and respect her and appreciate everything she did accomplish. Jessica Porntono-Currin via Facebook Perhaps you can point out that our generation knows a lot more about the importance of bonding and interaction during those early years because we have more access to information. My own mother has said to me that she would have done things differently had she known. I am lucky though because she is very supportive of my choices. It might help you to be honest without criticizing the way she did things. I have two very busy boys--one and four--and it is very different from my mother s experience with her two girls who were five years apart. Candace Helm via Facebook M y mother raised two children and was an excellent housekeeper. She likes to tell me how I should do things and maintain my household. These suggestions aren t helpful to me. Her comments are hurtful especially when she refers to my house as a pigsty. I might be able to handle criticism about my housekeeping. However when she criticizes how I raise my four children and the time I spend with them I feel frustrated and resentful that I can t live up to her standards. She doesn t listen to me when I ask for help. Instead she makes me feel like I m a failure. How can I react and respond to the negative comments of someone I thought I could turn to for support New Mother s Situation How does a stay at home parent know that they are not hurting their children with their rules My son s friends are about the same age. He tells me that they are permitted to watch television shows play video games and go to activities that I find unacceptable for him. How can I help him understand that I am trying to do the very best for him to help him to grow into a responsible and kind adult and that I feel that these games and programs will not help him do that How do I help prepare him to interact with his friends if I don t allow him to do these things I feel it is best to distance people who pull you down rather than lift you up. No opinion or thought should affect your worth and it should not feel like they do. Have you told your mother how you feel It is possible she actually does have good intentions and communicates them horribly. Try asking her to say things constructively or let her know it would be nice if she could take the children for a few hours each week so you can get some focused cleaning time. If all else fails and you don t want to distance yourself try meeting at public places. You could meet at parks and other non-confrontational places that give you the freedom to leave and remove the potential for critical comments about your home. Dasha Gurov via Facebook I have a friend who is a mother of four. She inspires me when she says I m a stay at home mother not a stay at home maid. She and her husband have made it their priority for her working hours to focus on the family. Staying Home is edited by Cathy DeRaleau. An LLL Leader Cathy lives in New Castle Pennsylvania with her husband and five children. Please send responses and new situations to staying.home lllusa.org 14 New Beginnings Issue 3 2013 advertisement 2013 Issue 3 New Beginnings 15 Making It Work Accept a Busy Promotion I ve been offered a promotion that comes with a major financial boost--a boost my family could really use right now. Unfortunately it also comes with longer hours and some travel which means a lot less time with my five-month-old son. I d love to hear other mothers experiences and ideas about similar situations. is number one and even though we could use some extra money I wouldn t sacrifice my family time for that. Being present for my baby s milestones has much more value to me. Also I would consider how my significant other (if that applies of course) would support the additional tasks such as extra feedings daycare pick up drop off etc. And there are always the pumping supply and bottle issues to consider in this decision. Sometimes if a mother is too busy she may miss pumping sessions that in the end could affect the overall supply. Depending on how long you re planning to breastfeed the time away could impact the way your baby nurses. I am a working mother as well and at least for this first year I have tried to avoid traveling or spending long periods of time away from my baby. I still got a raise and a bonus But in the end it will depend on your own priorities and it will be your decision. And it will be okay leemami via LLLI Mother-to-Mother Forums It s tough to know how to help without more details about your position. Although not financially urgent I decided to go back to work full-time because it seemed like the only option for us. I also decided to continue with my overtime duties although they were scaled back as much as possible. I negotiated to work from home one day a week which helps to make up for those days. If you can manage to negotiate anything--such as working from home or having a flexible schedule--it might be easier on you if you decide to accept the promotion. It s very hard to turn such things down but it s hard to be away from your baby too and I think communicating that to your superiors might end up making the situation better for you. filmmommy via LLLI Mother-to-Mother Forums It s not worth it to me. I had that life with my two older children. I missed out on a lot. Every day I drove to work feeling guilty. The stress The business world is much more baby friendly than it was even 10 years ago. You might actually be able to travel with your baby sometimes and hire a professional nanny service for the hours you are in face-toface meetings. After taking the position you may be able to look for ways to use video conferencing more and save your company money You can ship milk on dry ice overnight via a package carrier and hotels are usually happy to store milk for you in the refrigerator or freezer. Also look for ways to negotiate. Everything is negotiable. For example if your baby starts sleeping in you might slip out of the house and work really early and get home at a better hour. If your baby wakes early to play but takes long afternoon naps you might come in a little later and keep adjusting to your family s schedule. Melinda Toumi Lawrence Kansas I have not been in a similar situation but if something like this happened to me in my current financial situation it would be really hard to say no. However the first thing I d consider is the work life balance of the new position. To me family was heavy trying to balance a professional life with having young children who needed me and not a surrogate sitter. I chose to stay home with my third child. My son doesn t care about my title money for vacations or a fancy car. He cares that it s me he wakes up to after a nap that it s me who soothes him when he hurts and that it s me who shares the glorious day with him. Bella Bates via Facebook I m a mother who not only had to work but also likes her profession. I work very hard to balance it all as best I can. I have successfully breastfed three children for a cumulative total of eight years so far (and still going). It isn t easy but being up front about my situation with my employer as well as being very diligent in my work and trusting the others around me has made all the difference. I travel to Washington D.C. a few times a year and was able to find a wonderful caregiver through a colleague. My son and I loved her instantly I will be truthful I m tired all the time and have to be on top of every moment every day to ensure that my children get what they need from me in terms of love and attention. Raising my children as gently and lovingly as possible while balancing my own needs and our family s finances has paid off. As a single parent I have supported my family comfortably while raising boys who are complemented as loving sweet smart and well adjusted. Good luck in your decision The fact that you are being so cautious in the first place tells me you are a great mother Karena Marinas via Facebook 16 New Beginnings Issue 3 2013 Making It Work Are there expenses you can cut at home Working longer hours and traveling more can come with added expenses less time to cook meals from scratch and shop for sales more eating out more wear and tear on the car more expensive wardrobe etc. I know we all need money to live but you cannot get time back that you would otherwise be spending with your child. I d really weigh wants vs. needs and make sure you re on a good budget and then weigh the pros and cons of accepting the new position. I personally find it worth it to live in an older smaller house have one used car and have time with my child while he is young. krystine via LLLI Mother-to-Mother Forums How flexible could your longer hours be Sometimes it doesn t have to be an all or nothing choice. You could ask if some of the travel is negotiable for a while (perhaps until baby is one year old). Also I have a friend whose company allows her to split trips with other coworkers so she only goes for half the week and the other worker goes the other half. And to help with the longer hours you might see if you would be able to take a longer lunch and then stay later in the evening. Maybe then you could go by your son s daycare nanny and nurse him spend some time with him at lunch. It doesn t hurt to ask and I d ask up front. Maybe make it a condition if you accept the promotion. Often people are flexible with things if we just ask. Congratulations on being offered the promotion Kate Craft LLL of Blacksburg and the New River Valley Virginia New Mother s Situation I plan to continue breastfeeding after I return to work which will happen when my daughter is three and one-half months old but I m concerned about more frequent night nursing or reverse cycling. I want to give my daughter everything she needs and am not ready to wean at night or let her cry it out but I know I will need sleep to work effectively. How do other mothers handle it Making It Work is edited by LLL Leader Winema Wilson Lanoue. A writer and avid knitter she lives with her husband Eric two sons Ezra and Zeb and daughter Vivienne outside of Blacksburg Virginia. Please send responses and new situations to making.it.work lllusa.org Advertise In New Beginnings An e-magazine full of inspiring stories helpful information news and reviews for expectant parents breastfeeding mothers and their families and supporters at all stages of the parenting journey. Like New Beginnings k on Faceboo Each issue reaches over 12 000 families in the US and countless others around the world. to Click here view rates For more information please contact Anne Easterday at advertise lllusa.org 2013 Issue 3 New Beginnings 17 Toddler Tips I Successful Shopping Trips daughter on my back. I talk to her the whole time about the items we are getting. Sometimes she is still fussy but for the most part it works. The key is to wrap her from the very start. If I try to wrap her in the store watch out--tantrum Kara Blackford via Facebook Have a list keep it short and keep moving. If I want to study ingredients I try to do that on the weekend. Also I always go to the same store(s) if at all possible so I know exactly where everything is to avoid having to search. I avoid food stores with toys on sale. I steer the cart only through aisles with things that we need and not through the candy or sweets aisle. I kept my toddler occupied in the cart by handing him the items I picked off the shelf to stack in the cart or asking him to tell me what is on the package or to sort and stack all red things or all vegetables. He also enjoyed any games involving counting for example How many bananas are in this bunch When he wanted to get out I asked him to find items for me. Another thing that sometimes worked was telling him what we needed and having him direct me there. ( We need cheese. Can you tell me where to find cheese ) mammi via LLLI Mother-to-Mother Forums I take my toddler to play at a playground for 30-40 minutes before going to the store. Then I give him a snack and a drink while I start to shop. I bring an organized list so that I never backtrack and never stop the cart for more than a few seconds. I talk to him and let him hold items even if I know it is going to get thrown and I will have to pick it up over and over. The worst part is often waiting to check out but by then it is almost over. Good luck Heather Doepner via Facebook Keeping up a running dialogue with my toddler or singing silly songs to him helped. If fussiness threatened I would zoom him in the cart. Another thing that really helped was wearing him in a backpack. Having a list and sticking to it was vital. I prepare lists to go with the store configuration. If I was hesitant or unsure or trying to figure out ingredients for dinner that is invariably when my child would start to be restless and close to melting down. When I had my second child I wore the baby in a sling or backpack so my two-year-old could still sit in the shopping cart seat. When the baby was big enough I frequented a store that had carts with two seats with steering wheels so they could drive. lllmeg via LLLI Mother-to-Mother Forums It usually works best when my husband and I go together and include our 21-month-old in the process. We have him carry items and put them in the cart even if we are holding him. He seems to feel involved and is more of a participant as opposed to a bored spectator. Rachele Misiti Hutto Texas My daughter didn t give me much issue but my son was a little Houdini and the belt on the cart was a laughable attempt at restraining him. I would either put him on my back in a carrier try to leave him home with his father or even use a stroller that was not as easy to escape as when he was in a shopping cart. Sarah Russell via Facebook I have grocery store only or church only toys in a special tote bag that my children could play with only in those places. Lisa Beabout Kvochick via Facebook find that my toddler will happily sit in the shopping cart for about four minutes. After that I chase after him while trying to get the weekly groceries. How do other mothers with toddlers plan and execute successful shopping trips with toddlers in tow Shopping with children is a challenge. Try to make it fun Play peek-a-boo or let your toddler hold a box or a small can. I often pack a few things for the grocery store a cloth carrier a snack and a toy. If the cart gets boring the carrier is a nice alternative. We can get a few more minutes in the cart with an apple or rice cake to chew on. I do sometimes order groceries and have them delivered. On occasion I do speed shopping while my husband is with the children at home or in the car. Raising happy cooperative children is an experiment and an adventure. Try a variety of tricks and your child will let you know what works. Sarah Degner Riveros via Facebook Practice beforehand what you want your toddler to do. Then he knows what you anticipate from him. Also make sure your expectations are realistic. You cannot expect a toddler to sit still for an entire stock the pantry shopping trip. Depending on the age of your child I would also make a picture grocery list for them. Children love doing what they see us doing and having their own list may be fun for them. You can print off pictures use stickers or draw your own. I still do this with my older kids. Now they are a big help to me and the list keeps them from pestering each other. Megan Volk via Facebook I do a combination of three things include the toddler in the activity make sure he has a toy with him and feed him. I try to keep him in the cart and entertained as long as possible. Once that doesn t work anymore I try to include him by having him pick items that we need. I do as much as quickly as I can before he gets to the walking stage. 5ofus via LLLI Mother-to-Mother Forums I make a list based on where items are in the store. Then I get my woven wrap and I put my New Mother s Situation I would like to finally lose the last of the baby weight now that my son is a toddler. We don t have a lot of extra money for a gym membership. When I take my son out in the stroller for a walk or for a jog he seems very unhappy. How do other mothers fill their needs to get and stay fit Toddler Tips is edited by LLL Leader Jean Merrill. Jean enjoys being at home in Maryland with her three delightful children watching them grow and develop as she writes. Send your questions or responses to toddler.tips lllusa.org 18 New Beginnings Issue 3 2013 Focus on Fathers My Husband s Constant Support O By Jodie Kilpatrick discussing new ideas. We decided we wanted to cloth diaper and that I wanted to attempt natural childbirth and definitely breastfeed her for at least one year. Timothy was a huge source of strength and support. I gave birth to Celeste as planned and she nursed within 30 minutes of being born. She continued to nurse for 11 months. I was already pregnant with my third child by this time and I believe that made the taste of my milk change and lead to her weaning. I was disappointed but felt like I did my best. And still Timothy and I continued to grow as parents constantly learning more about breastfeeding and natural childbirth. When I was 36 weeks pregnant with Lila I found a book about natural childbirth while browsing a local bookstore and contacted a local instructor to ask about the method. Lila s birth was astoundingly quick and (it seemed) more painful but I was able to handle it much better based on what I had learned from that book and the instructor. Lila also latched on within 30 minutes. Lila was born at 3 56 a.m. I felt so great that I wanted to go home by 9 a.m. Lila wasn t fazed at all that she nursed while I was pregnant with my fourth child. She continued to nurse throughout my pregnancy and she became part of my first experience with tandem nursing. She was two years old when my second son Timothy Conlan was born and she continued to nurse for quite a few months before she stopped completely. Timothy Conlan s birth and breastfeeding journey happened a lot like Lila s. He latched on the earliest--within 15-20 minutes--and he is still nursing at 27 months. He doesn t nurse very often but when he does it is almost always tandem with baby Rachel. He is most thoroughly enjoying the abundance of milk ur third daughter and my fifth child Rachel Amleigh was born at 10 04 a.m. on March 23 2013 into her father s hands while our other children our friends Shannon and Ashley and Rachel s Grandma Sue looked on. My labor began at 9 23 p.m. the previous evening. Needless to say I was exhausted but the joy and relief that she was finally here at 41 weeks plus one day quickly made that exhaustion dissipate into a fog. She latched on for her first nursing session before we had even tied and cut the umbilical cord-- about 10 15 a.m. She nursed like a champ. Daddy was involved in that first nursing session--and the first nursing sessions with his older children--by looking on proudly and wrapping us in his arms. When I had my first son in 1999 at the age of 18 I didn t know as much as I do now about breastfeeding natural childbirth and parenting in general. I had no idea there were breastfeeding support groups such as La Leche League (LLL) and of course I had no idea that one day I would grow as a parent and as a person so much that it would be so important to me to become an LLL Leader. I nursed my firstborn Darren for about six months. I was a single mother working fulltime and I would go to my grandmother s on my lunch break to nurse him use my manual pump to express more milk for him for later and try to eat my lunch before heading back to work. Unfortunately Kilpatrick Falmily that didn t last very long and soon I gave him formula and my milk supply was gone. I married my husband Timothy in 2006. Our first daughter Celeste was born two days after our first wedding anniversary. Timothy and I had spent a lot of my pregnancy Jodie s husband Timothy My husband s support has been constant and extremely encouraging. He is supportive and helpful with cosleeping and the transition that Conlan is going through now that he is not the baby or no longer has breast milk all to himself. My husband is now Conlan s snuggle buddy when we go to sleep since most of the time it can be uncomfortable for me to be in a side-lying position to nurse both Conlan and Rachel at the same time. Along with my husband s support of breastfeeding our children he has also been instrumental in my successful and enjoyable natural childbirth experiences. Our children s births are some of the best memories of my life in part because of the intense emotional and physical connection my husband and I share during these times. The need for his support extends into my breastfeeding journeys with our children. As an LLL Leader I have listened to mothers who were disappointed hurt and discouraged when a partner or husband wasn t supportive of breastfeeding. From personal experience I know how important it is to have my significant other stand by me with breastfeeding as well as other parenting decisions. I m sure it helps that my husband grew up with a mother who was a lactation consultant and taught him about the importance of breastfeeding. She told me he used to have a patch on his backpack in high school 2013 Issue 3 New Beginnings 19 Giving Birth vv that said The milk in your breast is not put there to stay more is not made until you give some away. I try to thank him often for his encouragement help with the children and the fact that he will talk to other mothers and fathers about breastfeeding and all of its benefits. Emilio s Birth By Hanny Ghazi How Fathers Can Support the Breastfeeding Relationship Care for the other children while mother and baby are nursing. Hold rock or take baby for walks after nursing so mother can take a bath or nap. Encourage mother often and tell her how wonderful it is that she s breastfeeding. Bring mother food or drink while she s nursing. Help with household tasks including meal preparation laundry and dishes. Deflect negative breastfeeding comments from family and friends and share information about its benefits. I became pregnant one year after my wedding. After sharing the news I received presents. One gift was Ina May s Guide to Childbirth by Ina May Gaskin. If I had not read this book I might have given my baby a pacifier and formula after he was born. I might have listened to the advice of my mother to put the baby down and not carry him so much. I might have diligently followed the instructions of a pediatrician who was not supportive of breastfeeding. However reading this book changed everything. First of all I perceived my pregnancy in a completely different way. I was very afraid of labor at the beginning of my pregnancy. I was sure that I wanted to be medicated to take away the pain because it was unnatural to suffer pain when ways to take it away had been invented by modern medicine. Ina May s Guide to Childbirth also mentioned the mother-to-mother support and information offered by La Leche League and led me to attend an LLL meeting during my pregnancy. Emilio was due on Tuesday September 11th. Labor started on Sunday September 3rd with the loss of the mucus plug. The next day contractions occurred every 10 minutes and were painful for me. At my weekly checkup the next morning I was dilated enough that I could have been admitted to the hospital. Instead I had a prenatal massage that afternoon. The masseuse massaged my lower back and my hand at a specific pressure point to help release the pain. My contractions were now closer together--every six or seven minutes. That was excellent news to me. Emilio would be coming soon Around 4 a.m. on Tuesday when contractions were three to four minutes apart I doublechecked my bags and told my husband that it was time to go to the hospital. As we walked to the hospital we watched the sun rise over nearby Paris France. I prayed on the way. I wanted everything to end soon and to have my baby in my arms. I remembered the birth stories in Ina May s book and I hoped that Emilio s birth would go as smoothly. At the hospital the midwife checked me and told me that I was four centimeters dilated my contractions were happening every two to three minutes. She then asked if I wanted an epidural or if I wanted to wait. I told her that I did not want an epidural at all instead I asked for a yoga ball. I had brought a yoga mat slippers and a bottle of water. I prepared myself and I started swinging on the ball at every contraction. The midwife left me and told me she would come later to check on me. When she returned I was dilated to five centimeters. Things were going well. I declined the fetal monitor because I didn t think I could handle the contractions if I was lying on my back. I ate some yogurt and a piece of bread--my first and last meal of the day. Then there was a shift change and another midwife took over my care. She introduced herself and asked if I was going to get an epidural. I said no. She told me that I was handling contractions very well. She checked my cervix which was six centimeters. She asked if I wanted to take a shower. I said yes. The hot water made me feel wonderful and full of energy again. The midwife offered me a hospital robe and moved me to the delivery room. She told me that when the fetal monitor was attached later on I wouldn t be able to be out of bed and walk around. That announcement changed my cheerful mood to a doubtful one. I became scared. At about 1 p.m. the midwife s exam showed I was still at six centimeters. She said that she would break my bag of waters to speed up labor. However breaking the bag of waters brought a new concern. Emilio had had a bowel movement and instead of clear fluid a greenish liquid--amniotic fluid mixed with meconium--was expelled. When I asked her why she said that something was wrong but she didn t know why. Focus on Fathers is edited by LLL Leader Jodie Kilpatrick. Jodie and her husband Timothy live in southeast Alabama with Darren (14) Celeste (6) Lila (4) Conlan (2) and newborn Rachel both happily nursing. As a family they enjoy bicycling dancing and traveling. Please send your submission to focus.on.fathers lllusa.org 20 New Beginnings Issue 3 2013 Giving Birth To watch Emilio s heartbeat more accurately the midwife attached the fetal monitor. I agreed but the moment I laid on my back I felt that I was going to break in two due to the contractions. The pain was excruciating. I screamed at each contraction. I refused when she again suggested an epidural. She said the next step was to administer oxytocin to bring on more frequent contractions. I felt that I couldn t resist any more pain at this point and if contractions became stronger with oxytocin then I really needed the epidural. I felt this would be the end of my birth plan and I started crying. The midwife asked why I was afraid of the epidural. I was in too much pain to explain my disappointment and the birth plan. I received the epidural and more oxytocin. It was 4 p.m. Thirty minutes later my baby s heartbeat was low and I was not dilating as expected. The midwife was going to call the obstetrician. I turned to my husband in disbelief and told him Now the only thing that is missing is that they will tell me I have to go through a cesarean birth. Just as I predicted the midwife came and announced that a cesarean section had to be performed and that the obstetrician would be coming soon to talk with me. I remember how ridiculous it sounded when he told me Don t worry you ll have a very small almost unnoticeable scar. Emilio was born at 5 p.m. He was beautiful and small. I saw him for a few seconds. I remember his face--he looked angry my beautiful boy. When he cries angrily today I remember that face. Completely disappointed with a failed natural delivery I experienced even more frustration when Emilio spent the first night of his life alone in the nursery. I couldn t move couldn t hold him and was exhausted after the surgery. Emilio was very sleepy for the first two days of his life and he didn t have any energy to latch on. He didn t stop crying. He was given formula without my consent. When I asked one of the nurses why he was given formula she commented that he cried because he was hungry. That seemed reasonable to me at that time. I know today that if he had stayed in my arms where he could try to nurse and receive the colostrum leaking from my breasts it would have been enough to satisfy and comfort him and that would have stimulated my milk production. My baby didn t know how to latch on and I didn t know how to help him. He was hungry and he kept crying. I agreed to give him formula every time he wouldn t calm down. For four days I waited for my milk to come in. I had a breast pump in my bag but I didn t know how to use it. I thought I needed to have milk before it could be expressed. I didn t know it could be used to stimulate milk production or that I could express colostrum. Thanks to the fact that I have breastfed Emilio from the moment my milk finally came in today he is a strong healthy and happy little boy. My husband and I have chosen attachment parenting for our family. We are very happy with our choice. I will spend the next three years of my life (the time I want to wait for our next baby) reading and learning about natural births in France for when it is time for us to welcome Emilio s little brother sister to our family. Hanny Ghazi and her family live in Saint-Cloud France. The first bowel movement typically occurs after birth. However sometimes a baby will have the first bowel movement before or during labor. Usually this doesn t cause problems for the baby. If the baby inhales some of the meconium though there is the possibility that the meconium could irritate the lungs and result in breathing problems. Hanny and son Emilio Breastfeeding after a Cesarean Birth For more information and tips about breastfeeding after a cesarean birth please see the following information on the La Leche League website http www.llli.org faq cesarean.html Susan Akers Pfaltzgraff is a La Leche League Leader and freelance writer living in Gilroy California with her two daughters Melise (4 years old) and Alina (2 years old). Submissions for Giving Birth can be sent to giving.birth lllusa.org 2013 Issue 3 New Beginnings 21 Eating Wisely By Amanda Jo Greep Busy Summer Healthy Eating I t was a long cold winter for many of us but we can rejoice now that summer is here Sunny days and family vacations are a cause for celebration but can take a toll on healthy eating when routines are turned on their heads and family activities stretch into the bedtime hours because we can t bear to tear ourselves away from the sun and fun. Our exclusively breastfed babies have it easy as long as mother stays well hydrated she should be able to nourish her little one with breast milk alone. Studies done in various climates are in agreement on this motherbaby dyads that continue to nurse on cue do not need water or any other supplementation to keep baby well on even the hottest of days. And what about the rest of us Fortunately summer is not only a busy time for many families but also the time of year when fresh food is most readily available. Farmer s markets are overflowing with berries in June rhubarb in July and tomatoes in August. Fresh green beans make great raw snacks and munching on fresh frozen grapes straight out of the freezer can be better than ice cream. We tend our own garden and one of our favorite evening pastimes is to harvest some fresh vegetables fire up the grill and throw together some quick and easy kebabs for the family. The novelty of food-on-a-stick can also be a fun way to get your littlest ones excited about eating vegetables. So whip up a fresh fruit smoothie pull up a lawn chair and try some of these dishes on for size. Not only are they healthy but also delicious and good for picnics and parties alike. Quinoa Pilaf with White Beans Feta Cheese and Summer Vegetables Source Feed Yourself Feed Your Family Directions Yield 4 servings Ingredients 3 cups low-sodium vegetable broth 2 cups quinoa rinsed and drained 3 tablespoons olive oil 1 red bell pepper stemmed seeded and diced 1 orange bell pepper stemmed seeded and diced 2 green onions finely chopped 1 zucchini trimmed and diced 1 yellow summer squash trimmed and diced teaspoon dried oregano Salt and freshly ground black pepper 2 large tomatoes cored seeded and diced 1 15-ounce can white kidney beans (cannellini) rinsed and drained cup crumbled pasteurized feta cheese 3 tablespoons fresh lemon juice 2 tablespoons red wine vinegar 1. Bring the broth to a boil in a large saucepan. Stir in the quinoa. Cover reduce the heat to low and simmer until the quinoa is tender and the broth is absorbed about 15 minutes. Remove from heat and fluff with a fork. 2. Meanwhile heat 2 tablespoons oil in a large skillet over medium-high heat. Add the peppers and half of the green onions. Cook stirring occasionally until just tender about 5 minutes. Add the zucchini yellow squash oregano and a pinch each of salt and pepper. Cook stirring occasionally until the squash is just tender about 5 minutes. 3. Transfer the quinoa and vegetables to a large bowl. Add the tomatoes beans feta lemon juice vinegar remaining green onions and remaining oil. Toss until well mixed. Season to taste with salt and pepper. The pilaf can be refrigerated in an airtight container overnight. 22 New Beginnings Issue 3 2013 Eating Wisely Crunchy Chicken Salad Source Whole Foods for the Whole Family Yield 8 servings What I do all day... I walk with baby steps big feet beside little feet long fingers in small hands providing balance for a growing learning body. I applaud new sounds new movements and new days. I laugh often with new joy. I teach Love. I teach Creativity. I teach Respect. I teach Patience. I worry... Am I an example of respect Am I showing patience Am I teaching my child to worry I try to leave chores unfinished. I try to focus on now not push my family into tomorrow. I try to do my best. I try to remind myself that I am doing my best. I learn to love the outdoors. I learn that schedules and plans are not as important as people. I learn that I can t be an expert in everything. I learn that there isn t A Right Way to raise children. I learn that I need other Mothers. I watch. I show. I play. I experience. I hear. I listen. I talk. I sing. I hold. I smile. Ingredients 2 cups cooked brown or wild rice cup chopped green onion cup oil cup wine vinegar 2 cups cooked diced chicken cup chopped celery cup mayonnaise 6 ounces unsweetened crushed pineapple drained tsp. salt Dash of pepper Optional extras Chopped pecans or walnuts Chopped apple Sliced water chestnuts Chopped green pepper Directions Combine rice green onions oil and vinegar in bowl mix well. Chill overnight. Combine with remaining ingredients mixing well. Add mayonnaise as needed. Chill for two hours or longer before serving. Eating Wisely is edited by Amanda Jo Greep. She is a writer doula and proud breastfeeding mother. She lives in Chicago with her partner and two daughters. Submissions for Eating Wisely can be sent to eating.wisely lllusa.org I grow. I live. I do. Jennifer Ferrence is a Leader with LLL of Meadville Pennsylvania. 2013 Issue 3 New Beginnings 23 New Beginnings Bookshelf Mothering Multiples By Karen Kerkhoff Gromada Reviewed by Karin Ali W ith the number of multiple births per year growing at an exponential rate many more women--both expectant and new mothers of multiples-- are seeking out books meant just for them. Mothering Multiples written by Karen Kerkhoff Gromada a La Leche League Leader and a mother of twins is such a book delivering a vast amount of information about what to expect at every stage. Gromada covers it all from the initial discovery of multiples in utero to the later stages of pregnancy how to get started breastfeeding multiple babies and even parenting toddler multiples. Mothering Multiples focuses substantially on the benefits and technique of breastfeeding as well as the emotional aspect of mothering more than one baby at a time and how family dynamics change with the addition of two or more babies. There are 30 chapters and one clearly stands out and sets this book apart from others intended for women expecting more than one baby. Titled For Mothers Only Adjusting to Multiples it begins with the definition of the word intense. or more babies may look cute at the store or at the park but the reality of caring for them is something else entirely and few women are adequately prepared for the reality of mothering multiple babies at once. In order to prepare women expecting multiples and help those who already have them Gromada delves deeply into topics that mothers of multiples face every day and leaves no stone unturned. She states there is every reason to think positive when multiples are discovered during pregnancy. Numerous women now more than ever are able to deliver full term and many twins are born weighing over six pounds each. While this is not always the case with special care given to the mother and the food she is consuming the babies have a much better chance of being born healthy and at full term. Readers may wonder How can mothers increase the chances that their babies will be born with the least complications possible First and foremost an excellent diet is very important. The author explains that adequate calorie consumption (3 500 calories a day for a twin pregnancy and 4 500 calories and up a day for higher-order multiples) is key to a weight gain that will support the growth of two or more babies. Staying hydrated is another important factor adding to the health of the mother and babies. Even with the best planning and support issues and problems can come up during a pregnancy with multiples. The next chapter discusses preterm labor fetal growth restriction (FGR) Twin-to-Twin Transfusion Syndrome (TTTS) and pregnancy-induced hypertension. Once the babies are born a mother transitions from taking care of herself to taking care of multiple babies. One of the first ways she begins this journey is by initiating breastfeeding as soon as possible after birth. Gromada believes that there is no reason for a mother to change her decision to breastfeed simply because multiples are expected. She goes on to explain some of the advantages of breastfeeding pointing out that no matter what the circumstances of your babies births it is possible to breastfeed. Setting goals and realizing the importance of intention and commitment can help new mothers be more successful than those who decide to only attempt to breastfeed. Being prepared for anything and using a birth plan to state what is important during the birth and directly afterwards is another way to increase the odds for successful breastfeeding. As the expectant mother prepares for the birth of her children focusing on how to meet the needs of the babies when they come home is very important. Unlike many mothers of singletons who don t need help for extensive periods of time after the birth mothers of multiples may find that they need help for weeks months and even years later. Even when full-time help isn t needed anymore parttime help for an extended period of time may still be extremely handy . The book then moves on to discuss birth options beginning breastfeeding and multiples in the Neonatal Intensive Care Unit (NICU). Because some multiples especially higher-order will be born before they are full term a stay in the NICU may be necessary. Very helpful tips are given for mothers with babies in the NICU such as asking the staff about co-bedding physically stable multiples which can substantially reduce their stress levels and help regulate their body systems. These ideas can help parents as they plan for the birth and also assist if the babies do need to spend some time in the NICU. Intense 1. Occurring or existing in a high degree very strong 2. Strained to the utmost earnest 3. Having or showing strong emotion great seriousness 4. Characterized by much action or emotion Mothers of multiples know this particular word well remarks the author because nurturing multiples can be extremely intense during their first years. Instead of a few weeks the last word of that sentence--years--represents the complete change of life and lifestyle that comes along with welcoming multiples. Two 24 New Beginnings Issue 3 2013 New Beginnings Bookshelf If the babies do go to the NICU Gromada reviews ways to help initiate breastfeeding and pumping lists several tips for establishing a milk supply and goes over how much a mother should be expressing day by day reasons that a mother s supply could decrease and how to increase it again. More than anything she encourages mothers to do what they can to keep breastfeeding and to take it one feeding at a time. Not only do these mothers need to learn to breastfeed multiple babies they must learn ways to comfort two or more babies at one time. The subsequent chapters move on to focus on caring for twins. Gromada remarks Any mother who has felt the helplessness and frustration of caring for one uncomfortable or high-need baby can only imagine contending with another at the same time. Mothers of multiples quickly learn how to juggle the needs of two or more babies and the survival tips at the end of this chapter such as nursing rocking in a rocking chair or wearing a baby in a baby carrier can help the mother continue to meet the needs of multiple babies. Ideas for getting more sleep while still meeting the babies nighttime needs what equipment is needed and not needed for multiples and preparing to go out with multiples are some of the topics addressed in the following chapters. As the book comes to a close chapters focus on keeping the connection with your husband or partner starting solids and weaning and ideas for older babies and toddlers including childproofing. One of the other final chapters-- helping older siblings adapt to life with multiple siblings--is indispensable for families where multiples are not the first children. A chapter on parenting toddler multiples which can vary greatly from parenting a singleton toddler reviews how many perceived discipline issues with toddler multiples have much to do with their interactions and combined energy levels when they are together. The author empathetically points out that there are no easy answers when parenting more than one same-age child especially toddlers who love to explore their world and their parents and each other s limits. Once the reader has finished the last chapter there is still more to learn. An extensive list of resources awaits including multiples-specific organizations and websites information about postpartum depression (much more common in mothers of multiples) and related parenting books. An appendix relays ideas for expressing milk and keeping track of how often the babies are breastfeeding. While expecting and caring for multiples can be daunting Mothering Multiples offers the support information and encouragement that help the ever-growing group of mothers expecting and mothering multiples to trust their instincts and find the answers they need to become the mothers they want to be. New Beginnings Bookshelf is edited by Karin Ali a La Leche League Leader who loves to read and spend time with her family. She lives with her husband daughter twin sons and mother in Patterson New York. Send your book review suggestions or questions to nbeditor lllusa.org 2013 Issue 3 New Beginnings 25 La Leche League USA has partnered with Charitable Hotels to provide an easy way for you to help strengthen LLL USA financially. Charitable Hotels is the world s first non-profit travel site. You ll get the exact same price as other travel sites and Charitable Hotels will donate its commission to La Leche League USA. Three easy steps to help support La Leche League USA 1. Go to CharitableHotels.org 2. Choose La Leche League USA from the drop down menu 3. 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