We’ve been hearing hype about H1N1 for months now, and it seems to be just this past week that it has hit in force in Indianapolis.  I know two families who have been quarantined with H1N1, and my friend who works at Riley Hospital says it’s just full of kids with H1N1 right now. Also last week, the classrooms at both of my children’s schools just emptied out.  My kids and I have also all been sick with symptoms matching the H1N1 symptoms list.  Of course, we don’t know how much of this sickness going around H1N1 or another virus, and we’re not going to know, because most people are not going to be tested:  Many never visit a doctor, and many who do seek medical care receive treatment for flu symptoms without ever  being tested for H1N1. But regardless, there’s enough H1N1 around that if you get sick right now, you’ll probably at least wonder if what you have is H1N1.

So what happens if you get sick while you are breastfeeding? Here are the current guidelines from the American Academy of Pediatrics for breastfeeding with H1N1:

17. Can mothers who have swine flu continue to breastfeed?

• The influenza virus is not transmitted by breastmilk.
• Mothers who believe they may be infected should be sure to wash their hands before breastfeeding.
• Be sure to use clean burp cloths, and consider wearing a face mask.
• Parents and caregivers of infants under 6 months of age should receive the flu shot to prevent illness.

Full Article [General info about H1N1 flu prevention, symptoms, vaccine, etc.]

Taking care of a baby while you are sick

Trying to take care of a baby when you are weak and feverish makes it starkly clear just how hard you have been working to take care of your baby.  Don’t be afraid to ask for help in those moments!  When you are ill,  it is reasonable to ask your spouse or another loved one to take a day off work and take care of you and your baby.   You may not be able to do it on your own! Let your loved one do the heavy lifting of diaper changing, cooking, and cleaning, while you rest in bed and nurse your baby when your baby whenever your babies needs it.   Assuming your baby is old enough to have gotten the hang of nursing, nursing is a relaxing and enjoyable way that you can still care for your baby even while you are sick.

I am wishing for a mild flu season for all of us!

I was sad to duck out of LLL today just as so many of you were arriving and the conversation was just getting going — darn preschool!

In light of our conversation about breastfeeding in public, I pulled together some great images and videos of breastfeeding in public that I thought you all might enjoy.

A postcard from Lesotho. The caption on this postcard reads "Mosotho woman weaving a basket". The breastfeeding part is seen as so normal, it's not even mentioned.

I just love this postcard from Lesotho on the right! It depicts a mother nursing an older child as she weaves a basket in a marketplace.  The caption on this postcard reads “Mosotho woman weaving a basket”. The breastfeeding part is seen as so normal, it’s not even mentioned — it just fades into the background.  How fabulous would it be if nursing just faded into the background here!

Here are some other depictions of breastfeeding in different cultures, a nursing in public comic, and a blog about why nursing in public matters.

• Nursing in public in the USA, 1943 Entire Article
• Hathor the Cow Goddess [Too funny!]
• The nerve of some monkeys
• La Teta – To give the breast is to give life [A public service announcement from Puerto Rico - not likely to be shown on US TV!]
• Nurse Here Now [a blog dedicated to the whys and how of nursing in public]

And something super important for all of you breastfeeding Hoosiers to know about. Indiana’s Breastfeeding in public law:

Not withstanding any other law, a woman may breastfeed her child anywhere the woman has a right to be.  Source: Indiana Code 16-35-6-1 Chapter 6, Sec. 7

Good luck to our nursing/pumping mothers!  Below are some of the resources about working and pumping that we discussed at our  meeting today.  I hope some of them are helpful!

• Brochure you can share with your employer summarizing Indiana Breastfeeding Laws what they need to do to accomodate you.  A great reference sheet to give to your employer, along with your request for when/where you plan to pump.  The Indiana Perinatal Network also has a “Lactation in the workplace” door hanger that you can order from their store to hang on your door while you’re pumping.
• But how do I know how often I need to pump/how long I’m going to pump/etc?  The website Workandpump.com has lots of helpful info about the logistics of breastfeeding. Make sure to read the part about Managing Your Freezer Stash — It is a must read for keeping up your milk supply.
• Bottle-feeding as a tool to Reinforce breastfeeding
• Our earlier post How to Pump More Milk (links to info about pumping & hand expressing)
• Emotional Issues — How will my baby feel when I leave?  Will my baby miss me?  How will I handle being away from my baby?  Nursing Mother, Working Mother and Hirakani’s Daughters are two helpful books. Nursing Mother, Working Mother is more of a how-to, and Hirakani’s Daughters is a book of inspirational stories of nursing, working mothers.   Our Group meetings are a great place to come and talk about your feelings about working and nursing.  If you can’ t make it to our meetings, you might try the Castleton LLL Group, which meets at nights, and is home to lots of working/nursing mothers.

How can you tell if your baby is getting enough milk?  Here’s what La Leche League International recommends you look for:

How can I tell if my baby is getting enough milk?

This may be the most asked question for La Leche League Leaders. It is understandable, since breasts are neither see-through nor marked off in ounces. Thank goodness there are other signs that indicate baby is getting enough milk.

Typically during the first few days, while the baby is receiving mother’s thick, immunity-boosting colostrum, he will wet only one or two diapers per day.

Once mother’s milk comes in, usually on the third or fourth day, the baby should begin to have 6-8 wet cloth diapers (5-6 wet disposable diapers) per day. (An easy way to feel the weight of a wet disposable diaper is to pour 2-4 tablespoons of water in a dry diaper.)

In addition, most young babies will have at least two to five bowel movements every 24 hours for the first several months, although some babies will switch to less frequent but large bowel movements at about 6 weeks.

A baby that is sleeping rather than feeding every 2-3 hours or is generally lethargic may need to be assessed by a health care provider to make sure that he is adequately hydrated.

These are additional important signs that indicate your baby is receiving enough milk:

• The baby nurses frequently averaging at least 8-12 feedings per 24-hour period.
• The baby is allowed to determine the length of the feeding, which may be 10 to 20 minutes per breast or longer.
• Baby’s swallowing sounds are audible as he is breastfeeding.
• The baby should gain at least 4-7 ounces per week after the fourth day of life.
• The baby will be alert and active, appear healthy, have good color, firm skin, and will be growing in length and head circumference.

The physical act of breastfeeding is more than the quantity of milk that is supplied, as you will find once you hold your baby in your arms. Breastfeeding is warmth, nutrition, and mother’s love all rolled into one. Understanding and appreciating the signs of knowing when your baby is getting enough to eat is the one of the most important things a new mother can learn. If you have any concerns regarding your baby, they should be addressed with your health care practitioner.

If you do need to increase your milk supply after keeping track of wet diapers, bowel movements and weight gain, there are several options you can try to increase your milk supply. See our FAQ on “Increasing Your Milk Supply” and refer to our Web resource page on milk supply issues or further information. Keep in touch with your health care provider if your baby is not gaining well or is losing weight. In most cases, improved breastfeeding techniques will quickly resolve the situation, but occasionally, weight gain may indicate a health problem.

From How can I tell if my baby is getting enough milk? at the La Leche League International website. If you have any worries about whether your baby is getting enough milk.  please don’t hesitate contact one of the Leaders of this Group.

For an in-depth overview of milk supply, at the La Leche League International website you can listen to a podcast with Diana West, author of The Breastfeeding Mother’s Guide to Making More Milk, and co-creator of the helpful website Low Milk Supply.

ONLINE RESOURCES FOR WEANING OFF OF A NIPPLE SHIELD

• Nipple Shields from Kellymom — an overview of what nipple shields are, and lots of ideas on weaning a baby off of a nipple shield.
• Nipple Shields … Friend or foe? by Kathy Parkes, IBCLC an overview of pros and cons of using nipples in various situations.  Written for La Leche League Leaders.
• Online resources for getting a good latch — Babies who are used to nipple shields often learn to latch on to the breast better when they take the lead.  You can find links about how to do this under the heading LET YOUR BABY GUIDE YOU TO A GOOD LATCH.  (We have an excellent video on this topic that you may borrow from our Group library.  For more info, please contact one of the Leaders.)

PLEASE NOTE:  Nipple shields have been shown to decrease the milk supply of women with  inverted or flat nipples. The nipple shields may keep the baby’s tongue from compressing the breast enough to get the milk flowing.   If you have inverted  or flat nipples, it is recommended that you only use a nipple shield under the supervision of a lactation professional.

Do you really need a breast pump? Many mothers (even working mothers) manage just fine without one.  Some links:

• Do all breastfeeding mothers need a pump? by Kellymom
• Hand-expressing breastmilk (video) from the Stanford School of Medicine.

Some useful links on pumping more milk:

• I’m not pumping enough milk — what can I do? from Kellymom
• Maximizing milk production with hands-on pumping (Video) from the Stanford School of Medicine
• Milk supply pages at Work and Pump

Two very interesting articles have been published recently that delve into the history and culture of breastfeeding.

• Baby Food:  If Breast is Best, Why are Women Botting their Milk? by Jill Lenore for the New Yorker.  There’s a neat ad for a very vintage breast pump.
• Nursing Times by Paul Doolan in History Today.

Enjoy!

Here are some of the links on a variety of topics that we talked about at our meeting today.

VITAMIN D

• La Leche League’s Oct. 08 Press Release on Vitamin D

WHO GROWTH CHARTS FOR BREASTFED BABIES

• Growth Charts for Breastfed Babies (Make sure your baby’s pediatrician is using these)

MILK STORAGE/BOTTLE FEEDING

• LLLI Milk Storage Guidelines
• How much expressed milk will my baby need? (Kellymom)
• Discuss Milk Storage with other mothers at the LLLI Forums
• Discuss Pumping with other mothers at the LLLI forums
• Discuss Working and Breastfeeding at the LLLI forums

TEETH/BITING

• LLLI FAQ on teeth

• LLLI FAQ on biting

A brand-new Harvard/BYU study uncovers information about how  breastfeeding protects a baby’s immune system.  Read about it here.

Getting a good latch and position is essential for comfortable, effective breastfeeding. For most mother-baby pairs, pain and discomfort melt within hours or days of finding a good position and latch.

But how to find that great latch? Your local La Leche League Leader is someone who will help you find the position and latch that work for you and your baby. Also, here are some great online resources for finding a good latch. Thank you to LLL Leaders Norma, Joni, and Joy for contributing these links.

POSITION AND LATCH BASICS

• How do I position my baby to breastfeed?
  
• When Latching by Jack Newman
• The Mother-Baby Dance

ANIMATED LATCH

• Animated Latch 1
• Animated Latch 2
• Animated Latch 3 (with article)

VIDEOS

• Dr. Jack Newman’s videos of nursing babies
• Latch on (article + video)
  By Nancy Mohrbacher, IBCLC, Ameda Products
  

LET YOUR BABY GUIDE YOU TO A GOOD LATCH

• Infant Self-Attachment Teresa Pitman LEAVEN, Vol. 38 No. 6, December 2002 – January 2003, pp. 123-125.
• Baby-led Latching: An “Intuitive” Approach to Learning how to Breastfeed [PDF]
  By Mari Douma, DO
  Assistant Professor of Pediatrics, College of Osteopathic Medicine,
  Michigan State University
  
• Baby-led Attachment
  
• Breast Crawl Video
• Suzanne Colson’s web site at: http://www.biologicalnurturing.com/ (You can email her and ask her for a copy of her article Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding)
  

SPECIAL SITUATIONS:

• When the baby refuses to latch on
  Handout #26. When the baby refuses to latch on. January 2005
  Written by Jack Newman, MD, FRCPC. (c) 2005
• Nursing Lying Down (with pictures)
• Too swollen to latch on?
  Reverse pressure softening