Live Event Transcripts

Jo-Anne Lawless, HCA, LC: Getting Started With Breastfeeding

StorkNet: Welcome to our first StorkNet interactive guest event! Our guest is Jo-Anne Lawless, lactation consultant. She has traveled from one end of the health spectrum to the other, with 12 years clinical experience, working primarily with Alzheimer's patients and in palliative care, combining that with 10 years experience as a lactation consultant. She graduated from St. Lawrence College in Kingston, Ontario, with honours, in 1980. Recently, Jo-Anne has been involved with the now-legal homebirth movement in Ontario. She has devoted the past few years to raising her four children, aged 2 to 16, and moderates our Ask A Lactation Consultant forum on StorkNet's message boards. Welcome, Jo-Anne.

Jo-Anne: Thank you, I'm so pleased to be here!

StorkNet: Let's start off with a question from Shari.

Shari: I've breastfed two babies (currently breastfeeding 8 months), and am pregnant with my third. My question is regarding the second baby wanting to start nursing again after the new baby is born. I don't think I'm comfortable with that. I plan on having her weaned before the baby comes. Any suggestions?

Jo-Anne: Hi Shari, It is very important that you be comfortable with your nursing decisions. It is perfectly possible for you to nurse two at once, and you will not be taking away from your newborn's supply by doing so, but if you feel uncomfortable, it will not work well for you. Are you beginning to wean now?

Shari: She's starting to wean herself, and I think my supply is decreasing.

Jo-Anne: That will often happen during pregnancy. This is a natural occurrence, and if it happens that she does wean, you can be proud of the fact that she has been nursed so long!

Gayesy: What in your opinion are the best things that expectant mothers can do to prepare themselves for breastfeeding?

Jo-Anne: Knowledge is the absolute primary thing to be prepared with. In our culture, women are not exposed to mothers and aunts and sisters breastfeeding, so we lose so much by not seeing this natural function firsthand. Women are forced to do it on their own. Groups such as La Leche league are invaluable for the exposure they give to new moms who are unaware of what a nursing baby, properly latched on and thriving, looks like.

Gayesy: I couldn't agree more! That's why I want to become a LLLL and LC myself!

Jo-Anne: I would strongly suggest both reading, especially Sheila Kitzinger's excellent books, and being around nursing mothers long before the birth of one's own baby.

Kel: If your baby happens to go on a "nursing strike" and refuses the breast, what is the best way to maintain a good nursing relationship? How long does the strike last on average? And how long do I let the baby go without some sort of supplement?

Jo-Anne: Nursing strikes are very difficult for both mother and baby. Many women have found that they are most successful helping the baby back on the breast by maintaining physical closeness with the child, with the use of a carrier and offering the breast at every opportunity, but especially when the baby is less "aware," perhaps in the middle of the night. The duration depends primarily on the reason for the 'strike' occuring in the first place. It is necessary to get at the source of the baby's discomfort or displeasure and deal directly with it. In extreme cases, the baby will refuse to return to the breast, and the mother finds it necessary to either supplement or wean.

Tracy: Do nursing babies born from moms with diabetes appear to gain slower after birth if that baby was above average size, like 10 -11 lbs. (For instance, baby was 10 lbs, 11oz at birth and at 3 week check up was 10 lbs 11.5 oz but grew in length 2.") This is not me by the way.

Jo-Anne: Diabetes will affect the baby's growth as a fetus, and its birth weight, but should not be a factor in weight after birth.

Tracy: But would it naturally have a new growth curve, one based on Mom's diabetes causing it to be so large in the first place?

Jo-Anne: Larger babies do have their own growth curve, (see post in Ask A Lactation Consultant re the CDC growth charts,) but they tend to level out, as do the large babies of non-diabetic moms.

StorkNet: Does this answer your question, Tracy?

Tracy: Yes, thanks.

Jo-Anne: Thanks for asking!

libramom: I noticed many of StorkNet new moms (SAHM as well as WOHM) have questions regarding milk storage - any tips for storage and/or recommendations for SAHM AND WOHM in regards to pumps best for them?

Jo-Anne: It is very important to be sure that the containers and pumps are as sterile as possible before storage. It's best to freeze 2 to 4 ounces at a time, as the baby is unlikely to use much more than that initially. Pumps are very individual. Double pumps are regarded as the most efficient, but again, this is an individual choice, based on the mother's needs at the time.

Jo-Anne: It is vital to be sure that the storage temp is adequately cold, so that spoilage doesn't occur, and also that the containers are dated to ensure that the milk is used within the correct amount of time. If you are keeping milk in the fridge, it should definitely be used within 5 to 7 days; if kept in the freezer, it will do well for up to 6 months if you have a good quality cold storage freezer.

libramom: Thanks, Jo-Anne. :)

Jo-Anne: You're welcome!

Shelby: Is it necessary to "rough up" nipples during pregnancy to prepare for breastfeeding? I've heard conflicting comments about this, especially since nipple stimulation can start labor in some women.

Jo-Anne: Well, I wouldn't "rough them up" per se, but it is a good practice to go without a bra more frequently to get them away from the protection and moisture of a bra. Sometimes it is recommended to rub them with a rough towel, but it's my belief that exposure to the air is adequate.

Shelby: When in pregnancy do you feel we should start?

Jo-Anne: I would begin at most by the middle of pregnancy to expose the breasts to air. Just wearing a cotton t-shirt without a bra will be beneficial in preparing the nipples.

Shelby: Thanks Jo-Anne.

Paige: My almost 6 month old daughter is eating no solids at all. She is still nursing every 2 to 3 hours, except at night. I am getting a lot of flack from people that I need to force her to eat. Do I really need to worry about this or is breast milk still her best source of food right now?

Jo-Anne: Hi Paige. Breastfed babies can sometimes subsist on milk alone for up to a year. There is no hurry for you to provide solid food if she is not prepared to take it. Just bring her to the table with you and let her see what mealtime is all about. When she knows she is ready, she'll let you know by asking for what you're eating. (a good reason to have a healthy diet!)

Paige: Thank You!

Tonya: I'm scared about nursing due to a bad experience with my first baby. He seemed to nurse VERY poorly and I switched him to bottle on the doctor's advice. He then passed away at 2 days old (later found to be due to Group B strep which also made him too weak to nurse). I know I will be paranoid this time. How will I know this baby is getting enough while nursing and what signs should concern me?

Tonya: Thank you :)

Jo-Anne: Tonya, I'm so sorry to hear that. It is very important for you to have a lactation consultant or La Leche League Leader there with you in the first hours and days of nursing to reassure both you and your doctor that you are producing an adequate amount of milk. Reassure yourself, as well, of your new baby's health by educating yourself about the causes of strep in a newborn. When you feel confident that your baby is fine, nursing will go smoothly for you; it truly will. Please don't feel that because of this dreadful experience, you will be unable to nurse.

Tonya: When should I start attending the LLL meetings?

Jo-Anne: Start just as soon as you can! Many women attend long before the birth of the baby, and gain valuable information. Whenever you like, go right ahead! You will find marvelous people there.

Tonya: Thanks Jo-Anne, this has made me feel more secure.

Jo-Anne: Oh, you're quite welcome. I'm sure that things will go well for you this time ~ Look into a midwife as well, Tonya; they are great to have at your birth and afterward.

Norma62: I heard that nursing bras are not always that good because baby can feel uncomfortable and even reject breastfeeding.

Jo-Anne: Hi Norma! It depends on the nursing bra, really. When you think about it, a baby is born expecting to see a naked breast, but they do adjust very quickly to whatever realities life gives them. It is much more natural for the baby if, when you nurse, you do so without a bra. However if you do wear one, it is important to make sure that it is not restricting in any way. You could cause a plugged duct to occur. Underwire bras while nursing are out, as well.

Norma62: Thanks a lot, Jo-Anne.

Skully: My child will be born with congenital heart block in approximately 13-14 weeks. I am now on 8 mgs dexamethasone and 10mg of Ritodrine daily. I am concerned about the risk of infection (to me) that may occur as a result of the meds. I would like to start breastfeeding - it is my first child - immediately if possible (I will be in a high-risk clinic), but I'd like to know what I can do in the meantime to decrease the chances of my becoming ill as a result of side effects of the meds.

Skully: I am planning to go to prenatal classes, even though I know I will deliver c-section.

Jo-Anne: This is certainly a matter to bring up with your physician. If there is a feeling that you may be at risk of infection, you may be asked to hold off on breastfeeding. This is rarely necessary, and it is important that you become as educated about these particular meds as you can in the days before the birth. Are you hospitalized at the moment?

Skully: No, I am home and not doing too bad . . . just a few shakes from the ritodrine. I am supposed to exercise. I suppose I will be admitted at some point down the line. Right now they feel I should be fine, no spotting or anything.

Jo-Anne: It is important to follow the doctor's instructions while taking meds such as these. Nearer to the birth, it might be best to avoid being out quite as much. If these meds lower your immune system, and put you at risk of infection, avoiding outside sources of infection is vital.

Skully: Thanks, I was thinking that. I guess I'll be a bit of a loner for awhile ;)

Jo-Anne: Skully, I'd love to discuss this in detail with you. If you would like to send me your email address privately, by clicking on my name at the side of the screen, I'd be happy to hear from you.

Cynthia: I really want to breastfeed my twins when they come in less than 3 weeks. I have a child with severe disabilities and I am really concerned about the time it takes to breastfeed (more often and longer than bottle) and also caring for my child with severe disabilities (she is totally dependent on me for everything and demands a lot of time). Any suggestions to help make this successful?

Jo-Anne: This will be a challenging time for you Cynthia, that's for sure.

Jo-Anne: Is it possible for you to have some help with your older child when the babies arrive? If you phone your local health unit or hospital and explain your situation to them you may find that there are organizations available to assist you while you adjust to the twins' arrival. It is often felt that bottlefeeding is less time consuming and difficult than breastfeeding, but this is actually not the case.

Jo-Anne: If you awaken in the night to feed the twins, it is an easy thing to have them in bed with you and just roll over and nurse. In the day, you will need to be holding the twins to nurse them regardless of how they are fed. It is so much simpler to just sit down and nurse than to try to make bottles for 2 babies and THEN sit down and feed them.

Jo-Anne: I would strongly suggest doing your best to get all the help you can in the first days and weeks especially, so that you can provide your new little ones with the best you can give them, while making sure that your older child also receives the care she needs.

Cynthia: Thanks, Jo-Anne.

Jo-Anne: You're welcome, I wish you the best with your new babies!

StorkNet: Thank you, Jo-Anne, for a wonderful discussion tonight. And thanks to everyone else for joining us, as well. Be sure to check for the transcript in a few days. We'll add a link to it from the front page and on the message boards.

Jo-Anne: Thank you so much for having me here, I've really enjoyed it!

StorkNet: We did too, Jo-Anne. Goodnight everyone.

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