Breastfeeding Mums Australia by Read Publishing

Breastfeeding Mums Australia Magazine

Contents

Pinky McKay: Busting Out With Breast Engorgement.................................................. 4 MASTITIS: Causes, Symptoms And Management........................................................ 8 Dr Robyn Thompson: Three Golden Hours....................................................11

5 Ways To Have A Positive Breastfeeding Experience......................................16 Protecting Your Mental Health Whilst Breastfeeding.................................19 Kristy Manners: Give Your Baby The Best Start In Life................................................. 22 7 Common Breastfeeding Concerns........................................................................ 25

Breastfeeding More Than One: Tips And Tricks For Feeding Twins And Triplets.....................................................29 Successful Breastfeeding After A Caesarean...................................................... 32

BMumsreastfeeding Australia Magazine Advertising Enquiries: READ PUBLISHING Published By: READ PUBLISHING Distributed By: READ PUBLISHING

ALL RIGHTS RESERVED Reference to any specific commercial product, process, or services by trade name, trademark, manufacturer, or otherwise, does not constitute or imply its endorsement or recommendation by READ PUBLISHING. Links outside of this publication are provided for user convenience and do not constitute or imply endorsement, recommendation, or favouring by READ PUBLISHING. The publisher or any of the editors, writers or contributors will not accept responsibility or liability for the correctness of information or opinions expressed in the publication. All material submitted is at the owners risk and while every care will be taken the publisher does not accept liability for loss or damage. No person, organization or party can copy or re-produce the content on this site and or magazine or any part of this publication without a written consent from the editorsâ&#x20AC;&#x2122; panel and the author if the content, as applicable. The publisher, authors and contributors reserve their rights with regards to copyright of their work.

Editor In Chief Hollie Faye Welcome to Breastfeeding Mums Australia Magazine! We are so excited to share our next issue with you. Our magazine was created to educate and inspire you on your parenting journey. This can be an exciting, but overwhelming time with challenges thrown in around every corner, so we have included plenty of articles to help support you throughout your breastfeeding experience. We are very excited to have a midwife and Breastfeeding Consultant with a 55-year history working in the Australian Health Services, Dr Robyn Thompson, sharing her unparalleled expertise with us. Dr Robyn’s philosophy is doing away with the forceful way many babies (and mothers) are introduced to breastfeeding in those first moments and hours after birth, and providing them three precious hours to connect and initiate feeding naturally and gently. Turn to page 14 for this must-read article. Lactation Consultant and best-selling author, Pinky McKay, shares all the in’s and out’s, do’s and don’t for new mums dealing with breast engorgement on page 8 - it’s well worth your time and will be invaluable through those early breastfeeding weeks. Also, in this issue, we have included plenty more articles to support your journey: MASTITIS: Causes, Symptoms And Management 5 Ways To Have A Positive Breastfeeding Experience Protecting Your Mental Health Whilst Breastfeeding 7 Common Breastfeeding Concerns So, remember to always be kind and smile to another mum… you might just give her that boost she needs to get through the day! Thank you for taking the time to check out our magazine.

Hollie

Busting Out With

Breast Engorgement Expert advice from Australiaâ&#x20AC;&#x2122;s leading breastfeeding expert

Pinky McKay

reast engorgement is common when breastfeeding your baby, causing pain and discomfort. We chat with Australia’s most recognised and respected breastfeeding expert, Pinky McKay, about all the in’s and out’s, do’s and don’t for new mums dealing with breast engorgement.

In a nutshell what is breast engorgement? Pinky McKay: Sometime between

the second and sixth day after your baby’s birth, your milk will ‘come in’. For some women, this is a gradual process with relatively little discomfort, but for many, it can feel very sudden and surprisingly painful – you can feel as though your breasts are literally bursting! Your breasts may feel hot and hard and you may feel throbbing, with swelling and hardness even extending up to your armpits.

What are the most common causes of breast engorgement? PM: This ‘fullness’ is not all ‘milk’ but

is due to additional blood flow to your breasts and accompanying swelling of the tissues as your body prepares to nourish your baby. Fluid retention due to IV fluids during labour can also contribute to engorgement.

How can we prevent breast engorgement? PM: Although engorgement isn’t

always entirely preventablea, it can be minimised by feeding your baby

frequently from birth so that your milk comes in more gradually: although your baby’s first sleep after birth may be a long one, after this sleep, gently wake him to feed at least 10 times in 24 hours – this could mean every 2 to 3 hours with perhaps one stretch of up to 5 hours at night. If your baby is sleepy and not feeding well, express milk to maintain your milk supply and minimise engorgement. Feeding frequently from birth will bring your milk in more quickly with less likelihood of engorgement and will also ensure that you baby gets more of the powerful immune boosting colostrum.

If engorgement does occur what can be done to relieve it? PM: If your breasts do become

engorged (hard and painful), it is important to continue to breastfeed frequently – every two hours is ideal. Applying cool compresses between feeds (20 minutes on and 20 minutes off) will help relieve the swelling. You can wrap a pack of frozen peas (don’t put ice directly against your skin) or even more effectively, pour water on a disposable nappy, freeze this then wrap it around your breasts – instant relief! If you have had IV fluids during labour and some of your engorgement could be due to this, apply cool compresses and lie on your back to encourage lymphatic drainage. If your breasts are hard or lumpy after feeds, it is important to gently massage the lumps. If your breasts still feel uncomfortably full, express a little milk until they feel soft, as overfull breasts can predispose you to blocked ducts and mastitis. Hand express or use a 5

quality breast pump on a low volume to avoid overstimulation or damage to swollen tissues. Some women worry that expressing even a small amount of milk will stimulate their breasts to overproduce. However, although your milk supply depends on a balance of supply and demand, removing a little milk for comfort when you are engorged will help relieve congestion and discomfort.

What happens if engorgement makes feeding difficult? Any tips and tricks to help feeding mums with engorged breasts?

When should you see a health care provider? PM: Seek advice from your lactation

consultant, midwife or doctor if your baby is not latching and/or is not having enough wet and dirty nappies and, if you have an elevated temperature, feel hot, shivery, have flu-like symptoms, or a red hot patch on your breast, check with your doctor quickly as you may be developing mastitis.

PM: Engorged breasts can make it

difficult for your baby to latch on and feed if your nipples become flat as your breasts stretch (like a fully blown up balloon loses its ‘pointy’ bit). The key is to make the areola soft so that your baby can latch and his tongue can remove milk more easily. You can try hand expressing a little milk until the nipple and areola soften or, if your areola is very firm (like the tip of your nose, rather than soft like your earlobe), try reverse pressure softening: Curve your fingers on one hand with your thumb and fingers opposing, place your fingers around your nipple, pressing on your areola. With your finger and thumb tips, gently press your fingers in towards your chest wall. Using steady and firm pressure, count slowly to 50 (this shouldn’t hurt). This will press the fluid back and soften your areola, making it easier for your baby to feed.

Pinky McKay is Australia’s most recognised and respected breastfeeding expert. She’s an IBCLC Lactation Consultant, best-selling author of Sleeping Like a Baby, Parenting by Heart, 100 Ways to Calm the Crying and Toddler Tactics (Penguin Random House) and mum of five. For more insight and expert advice on all things breastfeeding, make sure you visit pinkymckay.com

MASTITIS:

Causes, Symptoms And Management

round one in five Australian mothers will develop mastitis, an inflammation of the breast tissue that, most commonly occur in the first four to six weeks after birth, but can occur at any point on your breastfeeding journey.

How do you know if you have mastitis? In most cases mothers with mastitis experience abnormally sore, red, swollen breasts that are tender to touch. Some mothers also experience flu like symptoms including chills, fevers and fatigue. Mastitis usually affects one breast at a time. Symptoms of mastitis most commonly include:

• Breast pain • A red and swollen area on the breast • Flu like symptoms • A tender, red lump in the breast caused by a blocked milk duct.

What causes mastitis? About 60 percent of mothers who have mastitis have an infection caused by bacteria that commonly live on the skin or the breast. Although infection is the cause of the majority of cases of mastitis it is not the only cause. Others include:

• • • • •

Poor attachment to the breast Damaged or cracked nipple An oversupply of breast milk A blocked breast duct Long breaks between breastfeeding • Stopping breastfeeding abruptly or too quickly • A tight bra • A baby with tongue tie who finds it difficult to attach to the breast

Treatment The best thing that you can do in the treatment of mastitis is early intervention. The quicker you start treating it, the faster your breast will heal, the better you will feel and the least chance you will have of developing a breast abscess. Here are some things that you can do to help relieve mastitis:

• Rest as much as possible. Ask your partner and family for extra help and support and don’t be afraid to put your feet up. • Drain the breast often. Keep the sore breast as empty as possible by breastfeeding on demand. Breastfeeding helps to drain the breast and relieve the symptoms. If necessary, express a small amount between feeds until your breasts are comfortable. • Gently massage your breast whilst feeding. This will help to drain any blocked ducts. • Apply a warm cloth to the sore breast for a few minutes before you begin a feed. • Use a cold pack on the breast after feeding. This can help to relieve breast discomfort and pain.

• Keep comfortable. Make sure that your bra is not too tight and avoid any unnecessary pressure on your bust area. • Feed from the sore breast first, when your baby’s sucking is at its strongest.

Prevention Like most things, the ideal scenario is the prevention of mastitis from occurring in the first place. In many cases mastitis may occur no matter how vigilant you are and how many preventative measures you take but there are certainly many things that you can do to prevent getting mastitis. Here are some things that you can do to decrease your risk of developing mastitis: • Breastfeed your baby as much as they want to feed. • Do not miss or delay breastfeeds. • If your breasts are full do not be afraid to wake your baby for a feed. If your baby doesn’t want to feed, express a small amount of milk to make your breasts more comfortable.

• Make sure that your baby is attaching correctly and feeding properly. Many babies have difficulty attaching so you may need to seek advice from a lactation specialist or your health care nurse. • Rest as much as you can. Your health is important. • Offer both breasts at each feed and if your baby only feeds off one breast, make sure that you offer the other breasts at the next feed. • Avoid wearing tight or restrictive clothing that puts pressure on your breasts. • Avoid giving your baby fluids other than breast milk, unless you are advised by a healthcare professional.

When should you seek help? If you suspect that you have mastitis, it is always advisable to see a healthcare professional as soon as possible as early intervention is key to a quick recovery. If your doctor prescribes you antibiotics, it is essential that you finish the course.

Dr Robyn Thompson:

Three Golden Hours

r Robyn Thompsonâ&#x20AC;&#x2122;s career as a well-respected and highly sought-after breastfeeding expert began by chance.

Robyn worked as a nurse for 15 years, then a midwife for 45 years, including home birthing for 25 of those years, but it was breastfeeding education that she became passionate about. She began collecting detailed data on breastfeeding complications and the struggles her clients were facing in an effort to better understand how she may be able to help.

While working in Darwin, she presented her initial findings to an industry conference, which led to an invitation to undertake a Masters degree at Charles Darwin University. Her approach was unlike any others in the field beforehand and she was already seeing incredible results from the women she worked with, so her professors asked her to take her work further by converting her Masters to a full PhD study. The Thompson Method was born, named by her professors in recognition of the dedication, passion and willingness to challenge time-honoured practices for the better. 11

Central to Robyn’s philosophy is doing away with the forceful way many babies (and mothers) are introduced to breastfeeding in those first moments and hours after birth, and providing them three precious hours to connect and initiate feeding naturally and gently. “For over 40 years we, as midwives and consultants, were being taught to (and, in turn teach the mothers) to hold the baby by the head, neck and shoulders, reshape the breast to tip the nipple to the nose, try to get the mouth as wide open as you can then thrust the baby on,” Robyn explained. “However, imagine if someone held you by the base of the head, neck and shoulders, asked you to open your mouth wide and then shoved you onto a lump of meat on your plate. You would pull back, and that was the exact behaviour the babies were displaying. They were pulling back, arching their backs and setting off the Moro reflex.” This resistance was key to much of the nipple trauma Robyn was seeing in her breastfeeding consultancy clients and study participants. 78 per cent of the 653 women in her study had suffered painful nipple damage due to forceful breastfeeding, with engorgement and mastitis the next most common complications. In addition, some women experienced breast pump damage from trying to extract the milk from engorged breasts, damaging the delicate breast tissue in the process. Robyn believes that, just like every other milk fed mammals on the planet, we are born with the instinct to survive. The mother has all the skills she needs to effectively feed, and the baby has a strong instinctual drive that will guide 12

success. A healthy mother and baby do not need unnecessary force and rush to begin the delicate and beautiful breastfeeding journey, but instead need time and space to allow it to happen naturally. Of key importance to Robyn’s method is allowing (where medically possible) the mother and baby to enjoy the first three hours after birth together, uninterrupted by unnecessary procedures and protocols that delay the first feed and create undue stress. Unfortunately, this opportunity is rarely respected, therefore new mothers due to the numerous policies and procedures hospital staff, feel bound to conform. What is important to remember, is that while policies and procedures may be enforced for the sake of efficiency, they are not legislated. Robyn urges all mothers-to-be to know their rights regarding the Law Of Consent before going to hospital. A mother has the right to refuse something she does not feel is in her (or her baby’s) best interest – which includes the precious time immediately after those first newborn cries. “What happens is that they have to be rushed in, through and out of the labour ward and the hospital system. The policies only allow an hour or two postbirth, but that’s not how a mother and a newborn protect each other and work together. The mother is just so in love with the baby, and we interrupt all of that,” Robyn said. “The first hour is when everybody’s busy doing everything and there’s no quietness, there’s no calmness…and then the mother is expected to get the baby fed within that time, as well as

shower, to have something to eat, then be ready to transfer to the postnatal ward. Sometimes, they are only in the postnatal ward for a couple of hours and are sent home.” Robyn’s ‘three golden hours’ means changing these practices to allow the mother and baby uninterrupted time together, before any routine weighing, measuring and vaccinations, which are not urgent. The healthy baby can find her way to the breast in her own time, with only the mother to help, and begin their feeding journey calmly and naturally. She can draw down the colostrum from both breasts at her leisure and feeds to capacity, before drifting off to sleep. “This intimidation and rushing has to stop, so that we can respect a new mother and her baby. We must have time for them to adapt, to feel and sense, and know by just smell, taste and touch.” The added (and vitally important) benefit by starting breastfeeding in this way, is that the baby learns very quickly and will feed frequently to boost the necessary hormones over the coming

days to reach peak milk volume. Engorgement is reduced, as the milk is flowing freely through the ducts, which also reduces the risk of painful mastitis. Gentle, leisurely feeds assist the mother and baby to naturally find the best oral positioning, which greatly reduces nipple damage as well. As part of her breastfeeding course, Robyn offers her Gentle Birth and Breastfeeding Plan to new mothers so they can be better equipped to know their Rights and communicate their wishes to caregivers. It also covers what to do when things go wrong, and what your rights and responsibilities are in the case of an emergency or unexpected complication. In the case of a planned caesarean, for example, Robyn suggests women go to hospital prepared with expressed colostrum. Following the birth, she recommends the mother (with or without assistance from a trusted midwife) simulate what happens under normal circumstances by frequently and leisurely expressing the colostrum within those three golden hours if her baby is unable to breastfeed. It is then

“

This intimidation and rushing has to stop, so that we can respect a new mother and her baby. We must have time for them to adapt, to feel and sense, and know by just smell, taste and touch.

“

up to the people feeding the baby the expressed colostrum to simulate how the baby would stimulate hormone production. Rather than offering a measured volume of milk in one quick feed, when feeding with the teat simulate breastfeeding with intermittent milk flows to reduce the risk of overfilling the stomach resulting in reflux and colic. When the baby returns to the mother they can begin breastfeeding with less confusion and complication. “This method sets the mother off on a journey that’s much, much easier if they are in a surgical situation or in a difficult medical situation. If we help them to simulate what happens normally, feeding then travels in a very smooth direction most of the time,” Robyn said. To date, Robyn has received wonderful support from practicing midwives and child and family health nurses around

the country. Additional research on her method is underway at the Mater Mothers Hospital in Brisbane. With education and a new, gentler way of thinking about how the system treats the women who bring new life to our world, there is great hope for increased breastfeeding rates and, in turn, greater child and maternal health benefits as a result. “What’s most amazing is that women are really interested, given the opportunity to have the information. They are so interested, which spurs me on even more,” Robyn said. At age 75, Robyn is not ready to hang up her consulting hat. She continues to share her knowledge with clients and with professional colleagues via her online programs, Masterclasses and Conference presentations.

www.thethompsonmethod.com

Ways To Have A Positive

Breastfeeding Experience

here is a lot of pressure on new mums to breastfeed their newborns for as long as possible. Research suggests itâ&#x20AC;&#x2122;s best for mum and baby, and thereâ&#x20AC;&#x2122;s outside pressure from family and friends as well as from social media, hospitals, billboards, and magazine articles. Some of the benefits known to come from breastfeeding include: strengthened immune systems, a decreased rate of SIDS, decreased postpartum bleeding for mum, and an earlier return to pre-pregnancy weight. And while science does show a multitude of benefits, itâ&#x20AC;&#x2122;s not as easy as simply deciding to breastfeed your newborn.

Some mums have an easy, breezy time – their babies latch immediately and take to breastfeeding like it’s second nature. However, some mums struggle immensely – physically and emotionally – their first time around. If you’re a mum who struggled to breastfeed with your first child, but want to try again, there are a few things you can do to ensure a smoother experience the second time around.

Seek help early

Every pregnancy is different. Things you struggled with during your first pregnancy could be a nonissue during your second or third, but it never hurts to be proactive. Seek help early from a compassionate lactation specialist. Discuss every issue you had with your first breastfeeding experience and identify your goals for this child. Your specialist will gather the history and help you determine next steps. And if you struggle with low milk supply or severe pain the first time around, a healthcare provider can recommend steps to prevent this happening again.

Have a breastfeeding plan

Like a birth plan, a breastfeeding plan allows you to consider every aspect of your breastfeeding journey and plan in advance to alleviate unnecessary stress. A breastfeeding plan is a plan of action that outlines your desired hospital experience and feeding goals to your family and your healthcare providers. Often this will include things like goals to exclusively breastfeed, skin 17

to skin preferences, or whether or not you want to use breast pumps. Note that your circumstance may dictate the plan after the birth, but being proactive and prepared never hurts.

Get your emotions in check

Like getting aid to help with the physical challenges of breastfeeding, you don’t want to neglect your mental health. Hormones and emotions are all over the map during and after pregnancy, and if you struggled to breastfeed in the past, you will most likely feel anxious, nervous, or even guilty in the future. And many mums feel as though they have no one to relate or talk to. It can be a little lonely. Seek emotional support from friends, support groups, or even a counselor to work through some of the mental strains that come with a new baby.

Enlist helping hands

A lot of moms struggle when introducing a new baby into the family dynamic. You don’t want to neglect the new child from getting the attention it needs, but you also don’t want to neglect your existing children and family members. However, it’s important during the early stages to get to know your baby, to learn its likes and dislikes, positions it prefers to be held in, etc. Enlisting a few helping hands to help take care of your existing children isn’t selfish. It’ll let your mind rest easy knowing your other children are well taken care of and tended to while you bond with your new baby.

Do what your baby wants

Every pregnancy and every baby is different. Even if you exclusively want to breastfeed, you want your baby to be its healthiest and happiest. If your baby refuses to latch or feed, don’t feel guilty for pumping.

Protecting Your Mental Health Whilst

Breastfeeding

s a new mum, you are everything to your baby. This little bundle of joy relies on you for its every need and as beautiful as that baby bubble can be it can also sometimes be overwhelming, exhausting and, at times, scary. When you are breastfeeding, these demands can increase and the realisation that your baby relies on you as its sole source of nourishment can be a lot of pressure.

If breastfeeding does not go to plan or you experience hiccups along the way, it is very easy for new mothers to feel a sense of failure and despair. Looking after yourself physically, mentally and emotionally whilst you are breastfeeding is vital to having a positive experience and ensuring that both you and your baby thrive. Whilst many new mothers feel a sense of guilt if they practice self care, the truth is, taking care of yourself should be on top of your priority list. 19

Here, we examine some key things that you can do to beat the breastfeeding pressure, look after your own wellbeing and preserve your mental health. • Have a balanced diet: It is all too easy to neglect your diet when you are a busy new mother – opting for that packet of chips or quick sugar fix to get you through the day. A diet rich in Omega-3 fatty acids, fresh fruit and vegetables and protein will help regulate moods and give you the energy you need to get through the day. Try to have an array of healthy, easy to eat snacks such as crackers, avocado or nuts on hand when hunger cravings hit. • Get out and about: Put your baby in a carrier, pram or wrap and get outside. There is nothing like sunshine and exercise to dissipate the stress hormones, boost your serotonin levels and make you feel fresher, healthier and happier. • Sleep when your baby sleeps: Most new mums feel guilty about sleeping when their baby does. Well, don’t! The washing and vacuuming can wait. Your health and well-being are more important than unstacking the dishwasher, so put your feelings of guilt aside and rest when your baby rests. • See a specialist: Very few women breastfeed their babies without experiencing some form of difficulty, challenge or drama. You are not alone and nor should you try to tackle the problem solo. Breastfeeding issues such as cracked nipples, mastitis and engorged breasts can cause a 20

huge amount of stress for mothers so it is vital that these problems are addressed immediately. Get advice from a lactation consultant as to how to address your issues and with their support, you will find that you recover a lot quicker. • Stop comparing yourself to others: Stop following ‘mummy bloggers’ with washboard tummy’s on Instagram and realise that it is not normal to have a body like that after giving birth and that it is NOT normal for babies to sleep through the night. Stop comparing yourself to other mothers who ‘seem’ to have it all together and be doing a better job than you. Chances are, they have a laundry full of washing and a crying baby in the pram just like you do – they have just used a fancy filter! • Let go of the guilt: Guilt – especially in the world of parenting, is a highly overrated emotion. You are doing the best job that you can, so don’t be too hard on yourself. • Ignore the ‘helpful’ comments: The fact of the matter is people say stupid things and generally underestimate how upsetting their supposably ‘helpful’ comments can be to a new mum. Try to not let these thoughtless comments get to you. Who cares if your neighbour’s baby slept through the night since it was two days old of if your old school friend ‘had enough milk for Africa’. You and your baby are perfect just as you are and this is your journey to do your way.

• Ask for help: You do not need to do this alone. If you are struggling, you need to speak up and ask for help. Talk to your partner, a relative or a friend. Tell them how you are feeling and what could be done to make you feel more supported. People are not mind readers and can often miss the cues that something is wrong, so use your voice to be an advocate for yourself. If people offer you a cooked meal, to do a load of washing or to take the baby for a walk, say YES! • Give yourself a break: You are doing a fantastic job! Give yourself credit where credit is deserved. There is no such thing as a perfect parent and the sooner that you come to terms with that the more you will start to enjoy being a mum! • Join a breastfeeding support group: Everyone needs to surround themselves with likeminded people experiencing the same milestones in life so join

a group of other breastfeeding mums. You will find that you are not the only one experiencing the highs and lows, triumphs and struggles. It is great to have a sense of community and a network of people to share information, tips, tricks and stories with. The social interaction with other mums can be a tonic for the soul. • Spend one on one with your bub: There is nothing more nourishing than some relaxing skin-on-skin time with your baby. Snuggle together on the couch, watch your favourite movie and soak up the beauty of your baby. As you relax and enjoy your environment you will release endorphins (happy hormones) and oxytocin (the love hormone) and this will help to boost your milk supply and reduce your stress levels – your baby will adore the one on one too! • Don’t give up: Breastfeeding can be tough, especially in the beginning, but try to stay positive and persevere. When it works well, breastfeeding can be good for your mental health. It is important to remember that Post Natal Depression (PND) affects one in every seven mothers, so if you are experiencing any symptoms of depression or anxiety, it is absolutely vital that you seek help immediately, without delay. Talk to your doctor or health care professional and advise them about how you are feeling and that you are breastfeeding. They will be able to guide you on the right path to recovery. 21

KRISTY MANNERS:

Give Your Baby The Best Start In Life

id you realise that the first 1,000 days of a child’s growth, beginning right from conception and finishing around their second birthday, sets a benchmark for health and wellbeing for their entire life? This is according to prominent international scientific journal, The Lancet, who’s evaluation of research in this area has become pivotal to global child and maternal nutrition policies. However, while this is incredibly valuable information, from a parent’s point of view it can seem pretty overwhelming. There are so many things to think about, plan and deal with on a day-to-day basis after those two little blue lines appear, and for new mothers – food is not always high on the priority list. Accredited Practicing Dietitian, Kristy Manners, who has specialised in pre-natal and post-natal health, understands the pitfalls many mothers face in ensuring their nutrition is up to scratch. She has niched her services to help mothers maintain health and wellbeing for themselves as well as their growing child from the first trimester and beyond, offering expert advice gleaned from her extensive experience working with mothers around the globe. Kristy’s interest in health began as an 8-year-old living in Pakistan with her humanitarian-working parents. As a family, nutrition was always important, but Kristy’s interest piqued when she began competing in triathlons in her 20’s. She became intrigued about how the foods she ate transferred into sporting performance and recovery. While working as an Ambulance

Paramedic, she took her passion for nutrition to university studies and later completed a Masters in International Health. During this time, she was offered the opportunity to intern with the World Health Organisation in Albania, before moving on to a post in Somalia to assist with the devastating famine crisis happening at the time. Her work became focused on maternal and child nutrition and health programs, infant feeding and supervising malnutrition feeding centres over the next five years. Kristy met her Kenyan husband while working abroad before returning to Perth to begin a family of her own. With her extensive knowledge and fresh perspective on child and maternal health from her time overseas, Kristy noticed gaps in services for women right here at home as well. She began Growth Spectrum, a specialised consulting service helping women recover from the physical trauma of pregnancy and childbirth and give their baby the best start to life. When it comes to post-partum nutrition, Kristy’s top advice is that it is certainly not a time for dieting, particularly for breastfeeding mums! She strongly advocates for a nutrient-rich and calorie-dense meal plan and plenty of fluids, with a focus on healing and recovery. “In many cultures, after childbirth, mothers are encouraged to eat foods linked to health restoration and they are prohibited from eating foods linked to illness. The first 40 days are devoted to helping the mother to recover, rest, bond with her child and consume iron rich foods from organ meats and bone broths. Family members usually offer 23

the new mum foods high in protein, nutrients and calories to ensure she will make enough milk for the infant and for herself to heal,” she said. “In regards to recovery from pregnancy, delivery and the continuing needs of breastfeeding, mums really need to concentrate on: consuming enough calories; replenishing their iron and calcium stores; consuming more protein, collagen and antioxidants for healing; and drinking enough fluids and electrolytes for what was lost in delivery and continuing to be lost with breastfeeding,” she advises. “In addition, don’t forget the importance of fibre. As a mum recovers, she wants to limit the strain being placed on her pelvic floor and wounds. Good hydration and fibre intake will help prevent constipation and strain in the nether regions!” There are also several key nutrients that are particularly important for a new mother to ensure she consumes enough of for both herself and her baby. These include iodine, choline, selenium and fatty acids, plus Vitamins A and D as well as the water-soluble B vitamins. These nutrients pass through the breastmilk to the baby and are dependent on maternal intake. While Kristy always advocates for a wholefood diet, there are circumstances where a supplement may be needed, particularly during this period of high caloric and nutrient need. If you are unsure if a supplement is right for you, speak to an APD Dietitian specialising in women’s health for more advice. 24

For more information on postpartum recovery and nutrition for breastfeeding, head to Kristy’s website www. growthspectrum.com.au and follow her via Facebook and Instragram through @growthspectrum If you’d like to grow in confidence as a mother and get postpartum ready through the online Postnatal Roadmap community, join her waitlist here: growthspectrum.com.au/ membership Designed for 3rd trimester pregnant mothers entering postpartum, this community offers 24/7 access and guidance from accredited health professionals and a tribe of new mums navigating key milestones related to: breastfeeding, nutrition, pelvic floor, sleep challenges and weight loss. Kristy also recommends the book Real food for Pregnancy by Lily Nichols to help prepare your body and your kitchen for the months ahead.

Common Breastfeeding Concerns

s a new mum, you picture yourself sitting peacefully with your baby, gazing into each other’s eyes as you provide nature’s most perfect fuel for her tiny growing body. However, after a few weeks of painful nipples, doubt, guilt and exhaustion, that idealistic image seems so far out of reach. We are here to help. Here is a selection of common breastfeeding concerns to help ease your mind and make that picture-perfect feed a reality.

How will I know if my milk supply is enough? Just like we all need a unique amount of nutrients to support our bodies, the same goes for babies. While there are guidelines around recommended feeding amounts, don’t be overly concerned if your bub falls outside ‘the norm’. As long as your cherub is producing 6-8 wet nappies each day, is providing extra messy nappies on a regular basis and gaining weight at an acceptable rate – then all is well. The amount she feeds may vary dayto-day too, so be prepared to go with the flow. At times of significantly less feeding demand, you may need to pump to keep your supply up until she regains interest. If you become concerned about your baby’s health or feel she really isn’t getting enough milk, consult your doctor, lactation consultant or child health nurse for advice. Sometimes, some additional pumping, munching on some lactation cookies, sipping a specially blended tea or taking selected

supplements such as fenugreek may give you the boost you need. For more information on building your supply, have a read of the Mumasil free e-book Low Milk Supply.

How do I know if I’m feeding my baby correctly? Once established, breastfeeding should NOT be painful. Yes, there will be those first few weeks where your toes curl on latching, but after that, you should no longer be dreading your baby’s hunger cries. If feeding is still painful after a couple of weeks, it is time to see a lactation consultant or child health nurse for some guidance. Essentially, your baby’s mouth should cover your areola with a wide mouth, lips turned outwards like a little duck at your breast. You may hear a clicking sound once she gets going, but otherwise there should be no noise from air being sucked in. She will be lying comfortably in your arms or next to you on a bed, with both of you relaxed. There are many breastfeeding positions and no absolute ‘right’ way, so don’t be afraid to experiment a little to find what works for you both.

How do I know when my baby has had enough breastmilk? The short answer is, they will let you know! Essentially, breastfeeding behaviour falls into two categories – nutritive and non-nutritive. When your little one is hungry, they engage in nutritive sucking, drawing in mouthfuls of milk, fully latched and in rhythm. Once they have had enough, they may stay at your breast, but start playing,

biting and frequently pulling away. This becomes non-nutritive sucking and indicates your bub has likely had enough.

What do I do if my baby refuses to feed? Like so many aspects of parenting a newborn, just when you think you have the routine in order, something changes! Rest assured that it is common for babies to go through stages of not wanting to feed, despite how frustrating this can be for you. Some common reasons include; • Teething pain – try offering bub a cold cloth or ice ring prior to feeding to soothe their gums. • Easily distracted – as babies become more aware of the world around them, pretty much anything can be a distraction at dinner time. Try feeding in a quiet room, away from siblings and noise such as TV or radio. • Illness – ailments such as a cold that blocks airways or an inner ear infection can make feeding uncomfortable for your baby. Listen to their breathing and check their temperature. If anything seems amiss, see a doctor. • You smell different – this sounds odd, but your baby knows your smell and when it changes, she can take some time to adapt. This might occur if you swapped deodorants, washing powder or skin lotions recently. • Feeding time has become stressful – your baby is more in tune with your emotions than you know. Try to stay calm and make feeding a relaxed bonding

experience rather than a chore. Sometimes this is easier said than done, but taking your time and having plenty of cuddles together can really help.

Are there foods I should avoid while breastfeeding? Generally, continuing the same diet you had while pregnant is a safe way to go as your baby would have had a taste for your favourite dishes through the amniotic fluid. When it comes to breastfeeding, some mothers don’t find any correlation between what they eat and their baby’s health or overall fussiness, but others aren’t so lucky. Common culprits for fussy, gassy or wakeful babies are: • Caffeine – one or two coffees in a day is fine, but keep in mind other sources of caffeine such as soft drinks, tea and chocolate. • Brassicas – gas-promoting vegetables such as broccoli, cauliflower and Brussels sprouts can cause upsets in both mum and bub, so keep this in mind. These are healthy additions to your diet though, so do not cut them out altogether if you don’t need to. • Garlic and onion • Spices such as chilli and curry powder • Chocolate • Citrus fruits, strawberries, kiwi fruit and pineapple If your baby seems unsettled and you are unsure why, try keeping a food diary and see if you can work out a pattern. It may be as simple as forgoing certain foods for the time being. 27

What if I am unwell and need to take medication?

Why does my baby spit up so much?

Most illnesses you contract are not dangerous to your baby, as your body produces antibodies to protect you, which are passed to your baby through breastmilk. That said, if you are very unwell, you may find your milk supply drops or you simply don’t have the energy to feed your baby. If this is the case, seek medical advice to safely move past the difficult time and pick up your feeding routine once you recover.

New parents quickly get used to having a towel or washcloth on hand for those sudden white patches on unsuspecting shoulders.

If you need to take any medications, pharmaceutical or otherwise, always do your homework. A small amount of the drug will pass through your milk to baby, so you need to make sure it won’t have any adverse effects on her. If it is a prescribed medication, check with your doctor about its safety during breastfeeding. Similarly, pharmacists will be able to advise on any over the counter medications. Generally, painkillers and common antihistamines are fine, as are cold and flu medications that do not contain pseudoephedrine and phenylephrine. Not all natural supplements are created equal either and some have been proven unsafe to take while breastfeeding. Before taking ANYTHING new, do your research and talk to a reputable practitioner for advice. It is always best practice to err on the side of caution, even if you have been advised the medication is safe, and take it at least an hour before your baby’s next feed.

If your baby has a habit of spitting up after (or even in between) meals, rest assured that this is normal. Spitting up can happen more frequently if your baby has had too much milk, such as when your supply is unusually high or our breasts have become engorged due to a delay in your usual feeding regime. Your baby may also spit up more when they burp up a lot of air, so try to break up the feed with a few short burping pauses throughout to prevent a build-up of air in their little tummy. Although it may look like your baby is expelling most of what you just gave them, chances are, it is a lot less than you think. As long as your baby is still comfortable and seems satiated, then a bit of baby spit up between feeds is fine.

Breastfeeding More Than One: Tips And Tricks For Feeding Twins And Triplets

elcoming twins or multiple babies into the world at once is an enormous joy, but it is not without its challenges – especially when it comes to breastfeeding. These days, twins and triplets are becoming increasingly more common and many people wonder how they can possibly manage breastfeeding multiple babies. The good news is, although it’s a little more challenging (and time consuming) feeding two babies, it’s absolutely

possible. With the right support, more and more mothers are happily and successfully feeding twins and triplets. Here are some great strategies to help you feed more than one baby: • Plan ahead: Learn all that you can about breastfeeding before your babies are born. Make sure that you attend classes and tap into whatever resources are available prior to the birth so that you are as well informed and as prepared as possible. 29

• Remember that each of your children are unique: Just because each of your babies were born part of a multiple does not mean that they are the same remember that each baby is their own little person. This means that they will have their own needs and challenges. What works for one may not necessarily work for others. Keeping this in mind will help to keep the pressure off both yourself and them! • Ask and accept help: Breastfeeding one baby can be difficult enough but breastfeeding multiples can be downright overwhelming, so it’s vital that you tap into whatever help and support you can. Establish who your ‘breastfeeding cheerleaders’ are and work out a routine or system that utilises their support. Plan and assign various tasks and jobs to family and friends who are offering to help – that way you will have the support available when you need it. • See a lactation specialist: It is a good idea, especially with multiple babies, to consult with a lactation specialist as soon as possible. They will help you to try out and become comfortable with different feeding positions. They can also assist in ensuring that your babies latch on properly. Early advice and support from an expert will help you to avoid unnecessary hiccups and will set you up with good habits early on.

• Work out what breastfeeding style works for you: In the first couple of weeks postpartum, feeding two babies simultaneously is ideal, as it is time efficient. However, you must be sure that at least one of the babies is latching on really well and maintaining this without much help from you, otherwise it might become a bit tricky. If you need to feed each baby one at a time until one or more of the babies is able to latch on effectively, then do so. You might need to try both techniques for a while until you work out which system works best for you and your babies. Remember that there is no right way to do it. What is comfortable for you and your babies is the right way for you. • What do you do with the other babies whilst breastfeeding? In an ideal world, another set of hands would come in handy during feeding time. If that isn’t possible, the best thing to do is ‘stay low to the ground’. Put a blanket on the floor, put the babies that you are not feeding on the blanket and sit with your back against the couch or the wall whilst you feed. This way your babies are safe, you can easily reach them if needed and you can change nappies on the floor without any drama!

• If you run into a breastfeeding hurdle don’t delay: If you experience any more than to be expected discomfort, cracked nipples, thrush or a fever, then seek medical help as soon as possible. With two or more babies constantly at your breast, any problems that you may experience can develop very quickly, so act swiftly. • Be kind to yourself: It is completely normal to feel overwhelmed when you have one newborn, so to have two or three new babies at the same time presents its own unique set of challenges (and sleep deprivation). Mothers of multiples are at higher risk of postpartum depression, so getting enough sleep and rest is especially important. Accept any offers of help and don’t be afraid to reach out and ask for help when you need it. Be patient with yourself and with your babies. Remember that there is no rulebook and that each mother and baby is

different. Give yourself time to get the hang of breastfeeding and how it works for you and your family. If you are finding it all too hard, speak to your lactation consultant about other options.

Other helpful tricks and tips • Join a support group specifically for mums of multiples. • Get yourself a breastfeeding pillow that is especially designed for multiple babies. • Create a breastfeeding ‘station’ within your home, complete with snacks, water, breast pads, wipes, nappies and a hands free phone so that you are comfortable and have everything ‘at the ready’ whilst you are feeding. • Find several different positions that are comfortable to feed your babies. Having a few different feeding options will make you feel less ‘in a rut’. • Make sure that any prenatal classes that you take are specifically geared towards multiple babies.

Successful Breastfeeding After A Caesarean

he human body is an incredible thing. Being able to grow a new life inside of you, then give birth is a miracle. Your body also provides you with the opportunity to continue nurturing that new life with purpose-made nutrition, perfectly formulated for your growing child. For women who have experienced a caesarean (nearly 1 in 3), initiating breastfeeding has a few additional complications to a textbook vaginal

delivery. The first feed can be delayed, you have medication to factor in, your mobility is restricted due to pain and you have an IV line and catheter to manage. However, breastfeeding your baby is possible (and encouraged!) after a caesarean. Here are our top 6 tips to help transition smoothly from hospital theatre to home with the confidence and skills to successfully breastfeed your baby for as long as you desire.

1. Have a plan, but have an open mind.

3. Ask for alternative ways to hold your baby.

Before your due date comes along, it is worth learning a little about the surgery and how it may affect you. Get up to speed on the medications used, expected recovery and possible complications. As the date draws near, let your doctor and midwife know of your wish to breastfeed and any other requests important to you, but remember that sometimes even planned caesareans do not go seamlessly. Try to keep an open mind and trust in your caregivers to do the best by you and your baby.

Holding your baby across your belly in the standard breastfeeding position may be too painful straight after surgery. Plus, you may also have IV lines and other monitoring equipment to contend with. Ask your midwife or lactation consultant to show you other ways to hold your baby, such as the ‘football hold’ where the baby lays to your side rather than in front. You can also try feeding while lying down, or use pillows to protect your incision as you hold bub. These positions may feel awkward, but you will soon get used to the different ways to feed your baby, which will be of great benefit as she grows too!

2. Start breastfeeding as soon as possible. Breast milk can come in slower after a caesarean than it would for a vaginal delivery, so it is vital to begin stimulating your milk production as soon as you can. If you have had an epidural or spinal block and are otherwise awake (and providing there are no other complications), you may be able to offer your baby her first feed while still in the operating room or as soon as you are wheeled to the recovery area. However, if you have had to have heavy sedation or needed to be separated from your baby during those first vital hours, talk to your midwife or lactation consultant about beginning with a pump to give your milk production a head start. As soon as you can safely hold your baby, place her on your chest skin-to-skin. This is a beautiful bonding experience and helps stimulate your milk.

4. Aim to take your pain medication away from feeding times. Your care staff will ensure the pain medication you are taking is safe for your baby, but some of the medication may pass to her through your breast milk and make her sleepy. While this is not dangerous to her, feeding a sleepy baby can be a challenge, especially as you are both learning. Aim to take your medication 1-2 hours before feeding, or alternatively take it while you are feeding. By the time the medicine kicks in, your baby will have finished. Don’t skip your pain management – it is vital to stay comfortable so you can heal as quickly as possible and enjoy getting to know your new addition.

5. Feed often. Although you may be exhausted, feeding and continuing skin-toskin contact as often as possible in those first few days will set you and your bub up for a more successful feeding regime once you return home. It can take up to five days for your milk to come in, so be patient. In the meantime, your baby will still be getting immune-boosting colostrum to keep her satisfied. Milk production is stimulated according to demand, so maximising suckling time is the most efficient way to boost your supply to match your baby’s fast-growing needs.

6. Don’t rush home. Learning to feed your baby is challenging and coupled with pain, restricted mobility and the emotional turmoil that often comes with a caesarean birth. If you don’t feel you are ready to leave hospital you can request more time. Once you leave, you are essentially on your own, so ensure you are equipped with all the confidence and knowledge you need before checking out of the ward.

Once you do return home, don’t be afraid to ask for help so you can focus on establishing a sound breastfeeding regime with your baby, after all – you are the only one who can do that! Others can step up to assist with any housework, cooking, looking after older children and other errands. If breastfeeding after your caesarean is still challenging when you have settled in at home, there are many fantastic support services available to offer guidance. Check with your local child health clinic for resources or phone the hospital for a lactation consultant recommendation. You can also phone the Australian Breastfeeding Association helpline and speak to a trained counsellor for free : https://www.breastfeeding.asn.au/ breastfeeding-helpline

Contributors Dr. Robyn Thompson

Robyn, an experienced Midwife and Breastfeeding Consultant has a 55-year history working in the Australian Health Services. Forty-five years a Midwife, Robyn has worked beside thousands of mothers and their babies in hospital systems, community based Maternal & Child Health and 25 years beside hundreds of women who chose to give birth at home. Awarded a PhD in Breastfeeding Research in 2014, she has completed extensive presentations of her data and experience around the country and in Prague at the Triennial ICM Conference in 2014. The Thompson Method is currently being tested by research at the Mater Mothers’ Hospital, Brisbane, with the aim of improving breastfeeding outcomes for Women and their babies. thethompsonmethod.com @DrRobynThompson @the.thompson.method

Kristy Manners

Kristy Manners, is an Accredited Practicing Dietitian and owner of Growth Spectrum. I’m passionate about teaching women how to support their body through pregnancy and the postpartum period, so that they can nourish their baby at every stage of their parenting journey. The first 1,000 days of life are a critical window of opportunity. It’s the period from preconception through to a child turning two years old that establishes the foundations for long term health, growth and neurodevelopment through diet and breastfeeding. My medical career has enriched me with many experiences globally. I’ve managed malnutrition centres for vulnerable children in Africa, run health programs in Cambodia and worked as a senior Ambulance paramedic in Western Australia. These experiences have led me to where I am today, as a consultant and mother who thrives on getting game-changing results for mothers and their children. growthspectrum.com.au @growthspectrum

Pinky McKay is Australiaâ&#x20AC;&#x2122;s most recognised and respected breastfeeding expert. Sheâ&#x20AC;&#x2122;s an IBCLC lactation consultant, a mum of five, best-selling author of Sleeping Like a Baby, Parenting by Heart and Toddler Tactics (Penguin Random House). She is also the creator of Boobie Bikkies, all natural and organic cookies to nourish breastfeeding mothers. Pinky McKay works with new mums to help build confidence, knowledge and comfort around feeding their little ones. pinkymckay.com

Pinky McKay

@pinky.mckay.fanpage @pinkymckay1