Nursing and a Nanny
I used to be one of the many breastfeeding moms in Stapleton. Although it’s been a few years, it is still just as fresh in my mind. I’ll never forget when I came home the first day after going back to work after my son Beckett was born. I rushed home in hopes to catch Beckett’s 4 pm feeding. Praying I didn’t have to set up Weegew (Weegew was the name I gave my pump since it constantly sung “wee-gew, wee-gew, wee-gew”). I walked in to see Beckett eating, very happily, from a bottle. He was beaming at my nanny and was happy as a clam. I was so grateful to see things going so well but I wished I had made it to feed him in time. I immediately blamed myself; if I would’ve sent my nanny a quick text and asked her to hold off on feeding him, it would’ve saved me the dreaded session with Weegew. As I pumped, I realized I need to be more communicative in regards to nursing and my nanny. I was very fortunate, I never had the horror stories such as ounces of liquid gold thrown away, or my baby refusing the bottle. Nonetheless, I heard these horror stories often. It wasn’t until recently I had a nanny say to me, “I’m knowledgeable with breastmilk handling and storage but to be honest I don’t know what else is needed.” Voila! The bridge between nursing mommas and caregivers needed to be addressed. Of course I called on my personal lactation consultant, Sara Dale-Bley, which I couldn’t have breastfed as long as I did if it wasn’t for her continued support, and plethora of knowledge. This led into a Q&A session with Sara.
Q: What is the most important thing a caregiver, especially a nanny, should know about a baby that is exclusively breastfed?
A: Be sure to keep an ongoing, open dialogue with the breastfeeding parent about how breastfeeding is going. Knowing if there are any issues with nursing, that are being complicated by bottle feeding, and addressing them as quickly as possible, can help nip them in the bud and keep everyone happier with all feeding scenarios.
Q: Are there any tricks you can suggest if a baby has trouble taking a bottle?
A: Keep trying, and make it fun! Many families that I see specifically because the baby won’t take a bottle are very stressed. Parents are incredibly worried that baby won’t take the bottle by the time the breastfeeding parent goes back to work, and the baby often senses that stress and will refuse the bottle even more fervently. Taking a step back, deescalating the situation, and allowing the baby to have more control over the use of the bottle can be incredibly helpful. Keep in mind that we want the baby to have positive associations with the bottle, so being silly, singing, and making funny faces can help create that atmosphere. Also, remember that rhythmic action stimulates suckling, so bouncing, dancing, patting, etc during bottle feeding attempts may be useful. Going outside for a walk can be great for distracting baby enough that they may be more receptive to the bottle. I often recommend that the caregiver sit and bounce slightly on an exercise ball, while attempting bottle feeding, as an alternative.
Additionally, I always recommend that whenever babies get a bottle that caregivers use Paced Bottle-Feeding techniques (described in detail here: http://www.bfar.org/bottlefeeding.pdf). Allowing babies to be in greater control of the flow of milk from the bottle is especially important for children who are still learning how to use a bottle. If the milk is allowed to flow quickly from the bottle into the baby’s mouth when they are not prepared for it, they may experience a choking sensation which can be quite alarming and exacerbate bottle refusal.
Q: Are there any suggestions you have for mommas who are pumping?
A: Make sure that the flanges you’re using with your pump have been fitted for you. Pump flanges are fit based on the diameter of nipples mid-pump, while milk is flowing through them and they’ve expanded to their largest size. Nipples come in an incredibly wide range of normal sizes, but are rarely ever “average.” Unfortunately, pumps generally come with one standard size flange that that specific manufacturer has deemed “average.” Many parents find that this standard flange is either so large or small that milk isn’t removed effectively from the breast and can make the experience of pumping painful. Your pump manual should come with a flange sizing guide you can use, or you can consult with an IBCLC who can help you fit your flanges. If you find that you need another flange set, be sure to submit that expense to your insurer! Breastfeeding support and supplies are covered in the current provisions of the Patient Protection & Affordable Care Act.
Once your flanges are fit correctly, it can help to make the experience of pumping as relaxing as possible. Stress can inhibit let-down, so whatever works best for you will be most helpful. I often recommend covering the bottles so parents can’t watch them fill, and listening to something relaxing on their phone or MP3 player can help distract from the noise of the pump. There are many, many other tips and tricks that families have found helpful and it would be too big of a list to include here. Keep experimenting until you find what works best for you and consult with your IBCLC for fresh ideas on how to increase your pumping efficiency.
Q: As a professional lactation consultant, what upsets or frustrates moms the most about breastfeeding?
A: Ongoing pain is definitely most frustrating for families. Usually whatever issue is causing the ongoing discomfort and nipple damage is relatively easily resolved, but it can take a bit of dialogue and analysis to figure out the root cause.
Q: Would you suggest mommas and caregivers have a lactation consultant come to the home to help with the initial transition? If so, what would that look like (IE how long are the appointments, how often, when should this happen, etc.)?
A: Having a consultation where families and their chosen caregivers are able to create a feeding plan together and discuss any particular issues they each may have in the presence of a breastfeeding expert is invaluable. I would recommend such a visit take place as soon as possible after childcare arrangements have been finalized. In-home lactation consultations tend to last about 1.5-2 hours and many IBCLCs offer less expensive, shorter, follow-up visits for tweaks to the feeding care plan as issues arise. It’s always very helpful to have as many caregivers present as possible during these visits so that everyone is on the same page with regard to the updated feeding plan.
Q: Can you give moms the words to tell her caregiver about her breastfeeding journey? Such as, breastfeeding is very important to me. I want to continue and do not want to be asked to switch to formula. Or suggest some type of breastfeeding plan, like a birth plan?
A: Here are some questions that can help jumpstart the conversation:
- • How do you support breastfeeding families?
- • How do you ensure that my baby’s milk is stored and prepared safely?
- • How often will my child be fed my milk?
- • Would you ever feed my child anything other than my milk? If so, under what circumstances?
Q: What questions should a caregiver ask mom about breastfeeding?
A: What are your feeding goals?
How can I help you reach those goals?
Q: Do you have any other helpful tips, suggestions or comments?
A: Families should take the first few weeks after birth to enjoy their new little one (or ones) and revel in their babymoon! Just as a honeymoon is the time to enjoy being with your new spouse, your babymoon is the time to enjoy being with your new baby! Take that time to get breastfeeding off to a good start. Baby should be transferring milk and gaining weight well and you should feel confident that your supply has regulated to what your baby needs.
Once you’re confident that all’s well with nursing, if you know that your family will be expecting the baby to be able to take a bottle, begin thinking about starting to introduce regular bottles at about 4 or 5 weeks of age. Keep in mind that when babies are born, they have an incredibly strong instinct to suckle on anything in their mouth. As they age, they gain far greater control over their suckling. Babies who are only ever exposed to nursing, or who only had one or two bottles very soon after birth, may not have the knowledge of what the firm plastic bottle nipple is for! Introductory, learning bottles don’t need to be full feedings. I usually recommend a small bottle, starting with just an ounce or so, every day, or every other day, to keep baby familiar with bottle mechanics.
To learn more about Sara Dale-Bley or Ancient Harmony click here.
I want to thank Sara from the bottom of my heart for all she does to help breastfeeders everywhere but for helping caregivers too!