What to expect when you meet a Lactation Consultant

As a Melbourne-based Lactation Consultant, I offer home visits or clinic consultations for an initial 1.5 hour visit. I often think I have the world’s best job, meeting babies and their wonderful parents. It is a privilege to be involved in a new family’s most precious, earliest moments. I am a health professional (Family & Children’s Dietitian) with additional specialist training in breastfeeding management & counselling, baby sleep and settling.

I will aim to understand your specific goals and concerns, such as: damaged or sore nipples, latching problems, worries about oversupply or low supply, baby’s growth, mastitis, thrush, blocked ducts, how to mix feed & which formula to use, how to introduce solids & general questions, such as ‘how do I know when my baby is full?’ or ‘is my baby getting enough milk?’ or ‘is my baby’s poo normal?’. I will take a detailed history about your pregnancy and birth and the overall health of mum and baby. I will assess how your baby is growing, by plotting their weight, height and head circumference on growth charts and then explain the charts to you. I assess baby’s appearance, behaviour, sleep & output (number of dirty and wet nappies). I understand that newborn sleep & feeding patterns can be unpredictable and I will guide you with questions to enable an accurate assessment.

I will examine your breast and nipple health, followed by observation of a breast or bottle (or both) feed & an expressing session (if needed). I assess how the baby is positioned, feeding, breathing and swallowing at the breast or bottle and will explain to you what I see. During the feed, I will make suggestions to improve the latch for a comfortable and efficient breastfeed and have you and your baby fitting together like a gorgeous puzzle. I will also have a look inside your baby’s mouth, to check for tongue tie & assess your baby’s sucking pattern.

As a Dietitian, I might also ask about your eating habits, to make sure that you are looking after yourself, as rapid weight loss, or not eating properly can also affect supply, and impact overall energy levels and coping. In the early days of sleep deprivation with a newborn baby, a mum needs all the energy she can get. Here are some quick tips on easy meals and snacks for new families.

I will talk you through every part of the assessment and answer all your breast & bottle feeding, baby sleep and settling questions and provide you with options for management to best fit you and your family. We will make plans for follow up as needed. You will be provided with written recommendations, resources & local support information. With your consent, I will liaise with other members of your healthcare team, such as your GP or paediatrician. I phone my families within a few days of the initial lactation consultation to see how things are developing. I would love the privilege to meet you and your little one, please contact me on 8840 1652 to discuss your family’s needs.

Image courtesy of Colin Maynard on Unsplash

April 25, 2023

BREASTFEEDING

April 25, 2023

BREASTFEEDING

Breastfeeding is a normal, learnt skill that takes time and practice.
Breastmilk provides all the nutrition your baby needs for the first 6 months of their life.
From the age of 6 months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to 2 years and beyond (WHO, UNICEF)

What are the health benefits of breastfeeding for your baby?

Breastmilk is the perfect food for your baby. Breastmilk is a live, biodynamic fluid that changes in accordance to your baby’s age and needs.
Breastmilk contains all the nutrients and hydration that your baby needs in the first 6 months of their life, and includes essential factors such as antibodies, antibacterial agents, probiotics, growth factors and long-chain fatty acids to optimize the growth of your baby.
Due to these vital nutrients that help to support your baby’s health and immune system, breastfed babies are less likely to experience illness in the first 6 months of life.

What are normal feeding patterns for a newborn?

Frequent breastfeeding encourages good milk supply and growth in your baby.
Babies vary in their feeding needs. Some babies may need as much as 10-15 times a day, or as few as 6-8 times in 24 hours.
Nurse at the first signs of hunger (stirring, hand in mouth, fidgeting, squirming, fussing).
Newborn babies should be fed every 1-3 hours.
It is normal for your baby to lose a little weight (10% of their body weight) in the first week of life. After this, your baby should be steadily putting on weight and growing each week.

HOW DO YOU KNOW IF YOUR BABY IS GETTING ENOUGH MILK?

URINE OUTPUT (WEE)
Minimum of 5 heavy, wet nappies each day (24 hour period) after the age of five days.
Pale urine – if your baby’s urine is dark or smelly, it might mean your baby is not getting enough milk.

STOOL OUTPUT (POO)
Good-sized soft stools are expected.
Before 6-8 weeks of age, your baby should have three or more runny stools/poos a day.
After this age, it is quite normal for your baby to poo less often, even every 7-10 days.
When your baby poos, there should be a large amount of soft or runny poo.

GROWTH
Your baby is gaining a good amount of weight, and growing in length and head circumference. Your baby is meeting their developmental milestones.

APPEARANCE
Your baby is fitting into their skin, and has good skin colour and muscle tone.
Your baby is alert and is mostly happy after feeds.

You cannot overfeed a breastfed baby, but you can underfeed your baby.

What do you do if you think your baby isn’t getting enough milk?

The best way to increase your baby’s intake and your milk supply is to feed more often.
It is important to let your baby finish the feed on their own and come off the breast by themselves, this will mean that baby is taking the most milk out of the breast as they would like.
Have you only been offering one breast every feed? Some babies only need one breast, but other babies need both. You could try offering the second breast and see if your baby takes it.
Is your baby sleeping longer at night? Long nights sleep can mean missed feeds, which can reduce milk supply, baby’s milk intake and weight gain. You might consider waking your baby up for a feed during the night.
Is your baby attaching and sucking effectively? Babies with poor sucking action may not be capturing enough milk from the breast. An appointment with a Lactation Consultant can help you learn how to position your baby.

Breastfeeding should be an enjoyable and rewarding bonding process for both Mother and Baby.
Breastfeeding effectively does take time and practice as it is a learning process for both Mother and baby.

References:

Stuebe A. (2009) The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol.;2(4):222-231. Accessed June 7th 2021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_DiscoveryDbLinks&ordinalpos=1&tool=pubmed
Bonyata K. (2018). Is your baby getting enough milk? Kelly Mom. Accessed June 10th 2021. Available from: https://kellymom.com/bf/got-milk/supply-worries/enough-milk/
Bonyata K. (2018). Breastfeeding your newborn – what to expect in the early weeks. Kelly Mom. Accessed June 10th 2021. Available from: https://kellymom.com/hot-topics/newborn-nursing/
Australian Breastfeeding Association. General Breastfeeding Information. ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).
Raising Children (2021). Breastmilk and breastfeeding: benefits. The Australian Parenting Website. Accessed June 10th 2021. Available from: https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding/about-breastfeeding/breastmilk-breastfeeding-benefits
Eat for Health (2012). Infant feeding guidelines. NHMRC. Accessed 19th June 2021. Available from:https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56b_infant_feeding_summary_130808.pdf

April 23, 2023

MASTITIS

April 23, 2023

MASTITIS

By Emma McShane, Dietitian, August 2021

What is Mastitis?
Mastitis is inflammation of the breast tissue, affecting 10-25% of breastfeeding women. The majority of cases occur during the first 6 weeks of breastfeeding, however mastitis can occur at any time during the breastfeeding journey. Mastitis can be caused by engorgement or inadequate milk removal from the breast, resulting in a blocked duct. This causes the milk blocked behind the duct to be forced into the nearby breast tissue, causing inflammation. This inflammation is known as mastitis and can lead to infection. Fast and supportive treatment is needed, as mastitis can lead to early weaning from the breast, or complications such as a breast abscess if left untreated.

Mastitis may occur due to latching problems, sucking issues, sleepy babies, oversupply, or hurried feeds, including limiting a baby’s time at the breast. These factors can affect how much milk is drained from the breast.

How do I prevent Mastitis?

Ensure your baby is well-positioned and attached to the breast.
Make sure your bra is loose and there is no pressure on your breasts e.g. clothing or fingers while feeding.
Feed on demand, offering flexible and frequent access to the breast, as missed feeds or long intervals between breastfeeding can increase your risk of developing mastitis.
Relax whilst breastfeeding to help encourage your milk flow.
Gently massage the breast by stroking towards the nipple whilst your baby feeds.
If your breasts become uncomfortably full, wake up your baby to feed them. If they do not want to feed, express a small amount for comfort.
Hand express to empty the breast.
Practice good hygiene, and if using a breast pump, clean this often, as this will help to prevent contamination.
Check your breasts frequently for lumps, pain, or redness.
Alternate from which breast you begin each feed, as this will help to ensure one breast is drained well at every second feed.
Let your baby finish when they’re ready to ensure they have taken the most milk out of the breast. Avoid timing your baby at the breast.
If you choose to wean your baby, make sure you do this slowly as rapid weaning can cause mastitis.
Stress, fatigue, vigorous exercise, or overall poor health and nutrition can increase your risk of mastitis, so self-care and adequate nutrition is essential.

Symptoms:
Please note that some mothers do not get the early signs of a blocked duct, and feel that mastitis comes on ‘out of the blue’.

Treatment:
It is important that if you feel a blocked duct coming on, to start treatment immediately. The most important part of treatment is to allow for effective milk removal, regularly.

It is important to drain the breast often, but gently.
Feed frequently, starting on the affected breast. This is not the time to wean your baby as symptoms can worsen. Allow your baby to drain the breast and also make sure that you are offering the unaffected breast. The milk is safe for your baby to drink.
Change feeding positions as this may help to clear the blockage. You can try positioning your baby at the breast with their chin or nose pointing to the blockage, as this will help drain the affected area.
Gently massage your affected breast, as this will help to improve drainage and symptoms.
Ensure good positioning and latch. A lactation consultant can help you to achieve this.
Use cold packs on the affected breast, as this can help to reduce swelling and relieve pain.
Use warm heat packs sparingly just before bed (only for a few minutes), to help trigger your let-down to help clear the blockage.
It is very important to get as much rest as possible.
Simple analgesia can be taken as needed such as paracetamol or ibuprofen.
When treated promptly, a blocked duct should clear in 24-48 hours.
If the blockage is not clearing within 24 hours, seek advice from your doctor, as antibiotics may be needed if an infection occurs. Please note that antibiotics only treat an infection, not the cause of the blockage.
Milk supply can sometimes be affected when mastitis is occurring, so look out for signs that your baby is getting enough milk including urine and stool output, and that your baby is putting on weight. A change in supply can be addressed with frequent and effective feeding.
A Lactation Consultant can check your baby’s positioning at the breast to prevent mastitis & blocked ducts.
Breast ultrasound can be an adjunct to treatment to help clear the blocked duct.

Nutrition:
It is very important to keep up your fluids, which means consuming >2 litres per day

Breastfeeding is a demanding process on the body that requires more energy and protein than usual. Other important nutrients include iron, iodine, and calcium. A dietitian can help you to meet your requirements.
Try to eat regular meals & snacks across the day, even if feeling unwell.
Simple meal and snack ideas include: Scrambled eggs with toast and chopped vegetables, baked beans on toast, roasted chickpeas, vegetable sticks and hummus or cheese and crackers.
Below is the Australian Guide to Healthy Eating recommended serves for each food group during breastfeeding.

Are probiotics helpful?

Scientific trials have found inconclusive results on the benefits of probiotics to prevent or treat mastitis. There is an emerging field of research to suggest that probiotic use may help to prevent mastitis, however further research needs to be conducted in this area to reach a conclusion.

Email: info@nicolebando.com

Call 8840 1652

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What to expect when you meet a Lactation Consultant

BREASTFEEDING

MASTITIS

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