CDC-Recommended Non-Profit Launches “MotherToBaby CA” In Time for Mother’s Day
Experts Provide Free Answers about Medications and More during Pregnancy and Breastfeeding
As Mother’s Day approaches, the University of California, San Diego School of Medicine announces MotherToBaby CA, the new name of its free, statewide counseling service that connects experts in the field of birth defects research with moms-to-be and the general public. MotherToBaby CA was formerly known as the California Teratogen Information Service (CTIS) Pregnancy Health Information Line and is housed at the Center for the Promotion of Maternal Health and Infant Development, a division of UC San Diego and Rady Children’s Hospital.
MotherToBaby CA is an affiliate of the international non-profit Organization of Teratology Information Specialists (OTIS), a prestigious professional society that supports and contributes to worldwide initiatives for teratology education and research. MotherToBaby affiliates and OTIS, which are suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC), are dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding.
“In addition to my primary health care provider, MotherToBaby experts offered me an added layer of support by giving me an individualized risk assessment,” said Pamela Salgado, a San Diego resident who called the service when she was thinking about getting pregnant. She had questions about the safety of a long-term medication she was taking and its potential risks during pregnancy. “Afterwards, I felt informed and empowered to make smart decisions about my health. Today, I have a healthy three-year-old boy.”
All North Americans can be connected with MotherToBaby experts toll free through its phone counseling service 866-626-6847 or online at MotherToBabyCA.org, where a private, online chat counseling service is also offered.
Compound in human milk associated with reduced transmission from HIV-infected mother to breastfed infant
An international team of researchers has found that certain bioactive components found in human milk are associated with a reduced risk of HIV transmission from an HIV infected mother to her breast-fed infant. Their study will be published in the August 15 online edition of American Journal of Clinical Nutrition.
“In developing countries, HIV-infected mothers are faced with the decision of whether or not to breastfeed their babies,” said Lars Bode, PhD, assistant professor in the Department of Pediatrics at the University of California, San Diego School of Medicine. “Breastfeeding exposes the baby to the virus and increases the risk of the baby dying from HIV infection; but not breastfeeding increases the risk for the baby to die from other intestinal or respiratory infections.”
Bode and colleagues set out to find why the vast majority of breast-fed infants do not acquire HIV-1, despite continuous exposure to the virus in their mother’s milk over many months. Even in the absences of antiretroviral drugs, only 10 to15 percent of infants will acquire HIV infection from their HIV-infected mothers.
They discovered that immunologically active components called human milk oligosaccharides (HMO) – a type of carbohydrate made up of several simple sugars linked together – may protect from HIV transmission. These complex oligosaccharides are the third-most abundant component of breast milk, yet are not digestible and therefore become highly concentrated in the mucosal surfaces of the infant’s gastrointestinal tract.
“HMO act as prebiotics that promote the growth of desirable bacterial communities in the infant’s intestine,” said Bode. Additionally, HMO structurally resembles sugar chains called glycans that are normally found on epithelial cell surfaces, and can serve as “decoy” receptors to inhibit pathogens from binding. Last, HMO exhibit anti-inflammatory activity and have been shown to modulate immune cell responses in cell and animal models.
The researchers analyzed HMO amount and composition in breast milk samples collected from more than 200 women as part of a larger study of HIV-infected women and their infants in Lusaka, Zambia, following them from birth to 24 months. (Most were recruited to the study and followed before antiretroviral therapy became available to them, thus offering a unique look at associations between HMO and HIV transmission.)
Higher concentrations of HMO in milk were associated with protection against postnatal HIV transmission, independent of other known risk factors. In the future, a better understanding of how individual HMO facilitate or obstruct HIV transmission may guide the development of interventions to complement antiretroviral strategies and more effectively prevent transmission, according to the researchers.
Breastfeeding: A Users Guide, Part II
Finalizing our series on breastfeeding tips, Lisa Stellwagen, MD, director of Newborn Services and the Supporting Premature Infant Nutrition program (SPIN) answers questions about what to expect once mother and baby leave the hospital and danger signs to be aware of.
You and your baby have left the hospital and breastfeeding seems to be going well. Your baby feeds every few hours and is having some wet and dirty diapers. You feel like you are making a good amount of milk. But how do you know that baby is getting enough? You have heard some sad stories about babies not getting enough milk and you do not want this to happen! On the other hand, everything seems fine and you don’t want to give your baby cow’s milk formula when it isn’t necessary. So how can you reassure yourself that all is well?
It is all about what goes in and what comes out of that baby.
What are the signs that baby is getting enough milk at the breast?
- Baby wakes to eat 8-12 times a day (yes, it may be 12 times a day in the beginning!).
- Baby’s suck is strong and you can hear swallowing (sounds like CUH, not GULP).
- Baby stays on the breast for a good amount of time (15-45 minutes or so).
- Your breasts may leak and drip milk, especially when baby is feeding on the other side.
- Your breasts feel full before a feeding and soft after.
- Baby is hungry before feeding and satisfied after.
- Baby has at least 6 wet diapers and several (up to 10) yellow, mustardy stools a day after the 4th day of life.
- The baby appears to be getting chubbier and newborn diapers are fitting more snugly.
- When you see the baby’s doctor, he/she tells you that your baby is gaining weight, about an ounce (30 grams) a day.
What are the signs that baby may not be getting enough milk?
- Your newborn baby is eating less than 7 times a day.
- Baby is hungry all the time, and even after feedings, seems to want more.
- Some quiet babies may not act hungry at all and will sleep for more than 3-4 hours or not wake up to feed.
- Your breasts don’t feel full, or they are full but don’t feel softer after feeding.
- Baby is not having 6 wet diapers a day and the stools stay black or dark brown after the 4th day or the baby goes all day without a bowel movement.
- Baby may start to look yellow, not just in the face, but down to the arms and legs, or the eyes may look very yellow.
- You are not sure if baby is getting chubbier, and baby may look skinny to others.
Why don’t some newborns communicate their hunger to the parents?
- Some babies are born a little early, a little small or a little undernourished. These babies may not wake to feed like a normal-sized, chubby, full-term baby.
- These babies may eat a little and fall asleep even though they haven’t taken enough milk.
- Some babies are just sleepy by nature and need encouragement to eat.
- Infants that are dehydrated may become sleepy or feed poorly due to the high sodium in their bodies.
- Jaundiced babies have a high level of bilirubin. This chemical can sometimes make them sleepy or not feed well.
- It is very hard for parents, who see their baby all the time, to notice a lack of weight gain. Even if a mother or father is an expert in infant nutrition, they may not be able to tell if baby is gaining weight by looking at him/her.
What is the danger to a baby who doesn’t get enough milk?
- Newborns do not have a lot of extra body water, and when most babies leave the hospital, they have lost already lost about 5-8 percent of their body weight. This is normal, but it could be dangerous if they lose more than 10 percent of their weight.
- Loss of body water can lead to dehydration, a build-up of bilirubin (the substance that causes jaundice) or sodium (that can be dangerous to the brain), or a drop in blood sugar (also not good for the brain).
Which mothers have a harder time producing milk and which babies are at higher risk of losing too much weight?
- Some mothers may not produce milk on the normal time table that nature intended- milk may come in slowly or not in full volume.
- Mothers who have had breast surgery, especially breast reduction, are at risk of not making enough milk.
- The rare mother with underdeveloped or tubular breasts may not make a normal milk volume or may just be a little slow to fill up with milk.
- Mothers who are older and have had complicated pregnancies, such as high blood pressure, diabetes or a Cesarean delivery, may have milk that comes in slowly. But they usually make enough milk when they have recovered from delivery.
- Babies who are born early (before 37 weeks), are small at birth (less than 6 pounds) or are born skinny (growth-restricted) may have less calories stored up, less ability to suck well and less frequent feedings due to sleepiness.
- Babies with mouth problems like tongue tie, cleft lip and/or cleft palate, can have trouble nursing properly.
- Babies with low muscle tone, like those with Down syndrome, also can have trouble sucking and feeding well.
What should you do if you are worried that your baby is showing signs of not getting enough milk?
- A baby showing signs of not getting enough milk should have his/her weight checked and an exam to be sure he/she is not dehydrated.
- Call the baby’s medical provider and ask for a weight check for the same day. Do not accept a later appointment.
- If you are unable to get an appointment, call another office or take your baby to the emergency room.
- If your baby is lethargic, refusing to eat, or looks ill, take the baby to the nearest emergency room.
- Some babies and mothers need a little help to get back on track if breastfeeding isn’t going well. Using formula for a few days to hydrate your baby and prevent jaundice and dehydration is fine. During this time, you can increase your milk supply and improve your breastfeeding technique.
- Finally, beware of advice that is rigid in either direction, such as: “no baby should ever have formula” or “every baby needs formula at some point.” Not all breastfed babies need formula of course, but some do. Our main goal is to feed the baby!
Breastfeeding: A User’s Guide (Part I)
Breastfeeding is one of the most natural processes in the world, but it can also be a rather complex one that changes daily, even hourly. We’re asking Lisa Stellwagen, MD, our Lactation Director for the Supporting Premature Infant Nutrition (SPIN) Program, to explain what new mothers can expect in the first few days after giving birth.
Let’s start with the basics: when a mother and baby leave the hospital after birth, how do we know they are on the right track?
Great question! The process of baby learning to breastfeed and mother making milk is a gradual one; each of the early days is different. That may come as a surprise to some new moms and dads and can be confusing in those first few, sleep-deprived days. So, as a general rule:
Day 1 - Mom may have drops of colostrum, but her breasts will be soft. She may have some nipple tenderness as she gets used to the suction of the baby breastfeeding for the first time. Baby is both recovering from the birth and learning to breastfeed. He may be sleepy at times and hungry at other times. The rule for the first day is that anything goes; just keep offering the baby the breast and don’t worry about how much milk is being produced or how much the baby has in the diaper (one urine and one stool is enough for day one).
Day 2 - Mom now is making more colostrum, about a teaspoon for each feeding. Her breasts may feel a bit fuller, but her milk is not supposed to be fully in yet. She may have a bit of nipple pain when baby latches on, but it shouldn’t last for the whole feeding. Paying attention to getting a deep and proper latch is KEY to enjoying breastfeeding and making milk. Baby is now starting to get hungry, and may want to eat every hour- Yikes- it can get tiring at night especially. But baby’s job is to drive mom’s breasts to make milk and this is how they do it! Don’t be surprised by the extreme hunger of day two, especially at night- we call it ‘feeding frenzy’ and it can be a bit shocking. On day two, baby may have only two urines and two stools (still black and tarry), as they are still waiting for the milk to come in. Baby may lose five to seven percent of their body weight on this day, and this weight loss is nothing to worry about. Keep feeding frequently and don’t watch the clock- babies know better how often they need to feed!
Day 3 - This is the day that everything should start to get a bit easier. By now mom and baby have the positioning, latching and nursing down to a bit of a routine. Mother’s breasts may become much fuller and heavier today as her milk production picks up to about one ounce for each feeding. Mom may hear baby swallowing more frequently and notice the baby doing longer, stronger, slower sucks as he drinks more milk. Mom’s breasts should get a bit softer after feeding, and her nipple tenderness may still be present but getting better as she learns how to better latch the baby. Baby is still hungry - but gets satisfied or even ‘milk drunk’ after feeding. Today baby should have at least three urines and three stools, and usually the milk will start making that stool look green-or brown-or even yellow as it works its way down the baby’s GI tract. Baby’s weight loss may be as much as eight to nine percent, but if the milk is in and baby is doing well, this is no cause for concern.
Mom and baby may leave the hospital on day one, two, three or even four, so there are no hard and fast rules for where an individual family will be on the day they go home. It really depends on how old the baby is and how feeding is progressing. There are some women who do not make milk as quickly as the baby would like. Mothers who are ill at delivery, have a Cesarean Section delivery, have diabetes, have had breast surgery or moms that are over 40-years-old are at risk of having the milk come in a bit slower than normal. A baby can wait a few days for the milk, but if they have lost more than 10 percent of their birth weight, they can become dehydrated and get into trouble.
In Part II of Breastfeeding: A User’s Guide, Dr. Stellwagen will address dehyration and other problems that can arise.
The Human Element in Human Milk
We decided to talk to our own breastfeeding experts in the UC San Diego Health Sciences Marketing & Communications office about their experience with breastfeeding. What was it like to breastfeed as a working woman? Why did you decide to breastfeed? Following are conversations with an experienced mom, a new mom, and a mom to be.
Jennifer Lawrence – Online Marketing Manager and mother
Q: Was it difficult to continue nursing after you went back to work?
A: It was an adjustment, but after I got into a routine it was quite easy. I made sure my pump and accessories were packed and ready the night before so I was not scrambling in the morning. I selected a great bottle system, so I pumped right into what I was going to feed my daughter with. That way bottles for the next day were already ready to go. Scheduling the pumping sessions on my work calendar was helpful and wearing shirts that were easily removable or flexible were important. Your body produces as much milk as your baby needs so I was diligent about aligning our schedules. I pumped when my daughter ate so I maintained my supply.
Q: What is the most important tip you’d give a new breastfeeding mother?
A: Stay hydrated and eat a lot! After every time you nurse, be sure to replenish your body with the same amount of liquid. Make sure you are constantly snacking and eating enough to feed yourself and your baby.
Q: Was it always easy for you?
A: Definitely not. I had some challenges initially with my daughter latching on and then suddenly refusing to eat a few times. The free breastfeeding classes at the hospital were really helpful. Not only to speak to a professional, but being able to hear stories and talk to other moms who were going through the same thing.
Q: How did you go about weaning your baby?
A: I started by reducing feedings to two times per day – in the morning and before bed. Then I cut out the morning feeding by distracting my daughter as soon as she woke up. She loved coloring with crayons at the time so I had them ready with a coloring book. The last step was to cut out the night feedings. I kept cutting the sessions shorter and shorter until I just put her in her crib. It was a lot easier than I had anticipated.
Michelle Brubaker – Public Information Officer and Expectant Mom
Q: Why have you decided to breastfeed your baby?
A: In doing research, talking to my mommy friends and in my role as PIO at the hospital, I have learned all the health benefits of giving my baby human milk. Also, giving birth at baby friendly UC San Diego, I know that I have several resources, support groups and programs available to me during the process. I believe it will be an incredible bonding experience between me and the baby. I do plan on pumping too so my husband can take some of the overnight feedings!
Q: Are you nervous about breastfeeding?
A: I wouldn’t say I’m nervous, but I am curious about what it will feel like and if I’ll have any trouble. I’m going to be open minded about the whole thing and do what I can to successfully breastfeed my baby. I’ve heard some horror stories of sore breasts and bloody nipples, but I’m not going to compare myself to anyone else to prevent setting myself up for disappointment or scaring myself unnecessarily.
Q: How long do you plan on breastfeeding?
A: If all goes well, I plan to breastfeed and provide my baby human milk for at least six months or up to a year.
Alma Fisher, Service Line Marketing Manager and First Time Mom
Q: What did you do to relieve engorgement and clogged ducts?
A: I made sure to pump/nurse on a regular schedule and also massaged the breasts during pumping sessions to make sure all of the milk was thoroughly drained. When I nursed, I made sure to hold the baby in different positions so that he was draining all of the milk ducts.
Q: I am having a hard time getting my baby to latch, do you have any suggestions?
A: First, don’t give up! Breastfeeding may come natural to some people, but it is not easy for everyone. The thing that was most helpful to me was the nipple shield. Not only did it help the baby latch, it also minimized the pain for me and ended up being the most effective way for him to nurse.
Q: What were the best resources for you during breastfeeding?
A: The weekly lactation support group at UC San Diego was a godsend! I went there a few times just to get additional guidance and reassurance from the lactation consultant. She was warm, nurturing and made me feel comfortable asking any questions I had. They also had a baby scale available so that I could weigh my baby after his feeding to find out if he was eating enough. I also had a few “go to” Web sites that I found that provided quality information about everything from milk supply to latching and engorgement. Here are the few I recommend: La Leche League and Community Baby Center
In addition to lactation classes and Web sites, I looked to other new moms for advice, and they were a great source of encouragement, too. Despite the many challenges I faced, breastfeeding was one of the most amazing bonding experiences I could have with my baby, and I am grateful for the opportunity to have been able to experience it.