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Pioneer Living: Medical - Pregnancy and Birth


michelle

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Here is a list of links on various topics to do with pregnancy, childbirth, and breastfeeding.

 

This book is the best resource for pregnancy and childbirth information I've found.

"A Book for Midwives"

http://www.hesperian.org/publications_download_midwives.php

 

Pregnancy Signs and Symptoms:

http://www.americanpregnancy.org/gettingpr...cysymptoms.html

 

Signs of Labor:

http://transitiontoparenthood.com/ttp/pare...birth/onset.htm

http://www.justmommies.com/articles/signs-of-labor.shtml

 

Childbirth:

http://www.thefarm.org/charities/i4at/surv/ebirth.htm

 

Homebirth Supplies:

http://www.birthingnaturally.net/homebirth/need.html

http://www.gentlebirth.org/archives/hmbrthsp.html

 

Breastfeeding:

http://www.breastfeeding.com/

http://www.llli.org/

Basic Breastfeeding the first few weeks

http://www.kellymom.com/bf/start/basics/index.html

Common Concerns of the Early Weeks

http://www.kellymom.com/bf/start/concerns/index.html

Nursing a Preemie

http://www.kellymom.com/bf/preemie/index.html

Nursing the older baby

http://www.kellymom.com/bf/older-baby/index.html

Nursing after the 1st year

http://www.kellymom.com/bf/bfextended/index.html

Tandem Nursing

http://www.kellymom.com/bf/tandem/index.html

Weaning

http://www.kellymom.com/bf/weaning/index.html

Common Concerns and issues

http://www.kellymom.com/bf/concerns/index.html

Herbs and Breastfeeding

http://www.kellymom.com/herbal/index.html

Milk Supply Issues

http://www.kellymom.com/bf/supply/index.html

Is this safe while breastfeeding?

http://www.kellymom.com/health/index.html

Relactation/Foster or Adoptive Breastfeeding

http://www.kellymom.com/bf/adopt/index.html

Pumping and Bottlefeeding

http://www.kellymom.com/bf/pumping/index.html

 

 

 

If you have something to add please do. Most of the links for breastfeeding all come from www.kellymom.com . This is a very good breastfeeding site. One of the best I've ever used. If there's something here someone needs elaborated or more information on let me know and I'll go back through my info for something else for you.

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Early Signs of Pregnancy

 

Implantation Bleeding

Implantation bleeding can be one of the earliest pregnancy symptoms. About 6-12 days after conception, the embryo implants itself into the uterine wall. Some women will experience spotting as well as some cramping.

 

Other Explanations: Actual menstruation, altered menstruation, changes in birth control pill, infection, or abrasion from intercourse.

 

Delay/Difference in Menstruation

A delayed or missed menstruation is the most common pregnancy symptom leading a woman to test for pregnancy. When you become pregnant, your next period should be missed. Many women can bleed while they are pregnant, but typically the bleeding will be shorter or lighter than a normal period.

 

Other Explanations: Excessive weight gain/loss, fatigue, hormonal problems, tension, stress, ceasing to take the birth control pill, or breast-feeding.

 

Swollen/Tender Breasts

Swollen or tender breasts is a pregnancy symptom which may begin as early as 1-2 weeks after conception. Women may notice changes in their breasts; they may be tender to the touch, sore, or swollen.

 

Other Explanations: Hormonal imbalance, birth control pills, impending menstruation (PMS) can also cause your breasts to be swollen or tender.

 

Fatigue/Tiredness

Feeling fatigued or more tired is a pregnancy symptom which can also start as early as the first week after conception.

 

Other Explanations: Stress, exhaustion, depression, common cold or flu, or other illnesses can also leave you feeling tired or fatigued.

Nausea/Morning Sickness

This well-known pregnancy symptom will often show up between 2-8 weeks after conception. Some women are fortunate to not deal with morning sickness at all, while others will feel nauseous throughout most of their pregnancy.

 

Other Explanations: Food poisoning, stress, or other stomach disorders can also cause you to feel queasy.

 

Backaches

Lower backaches may be a symptom that occurs early in pregnancy; however, it is common to experience a dull backache throughout an entire pregnancy.

 

Other Explanations: Impending menstruation, stress, other back problems, and physical or mental strains.

 

Headaches

The sudden rise of hormones in your body can cause you to have headaches early in pregnancy.

 

Other Explanations: Dehydration, caffeine withdrawal, impending menstruation, eye strain, or other ailments can be the source of frequent or chronic headaches.

Frequent Urination

Around 6-8 weeks after conception, you may find yourself making a few extra trips to the bathroom.

 

Other Explanations: Urinary tract infection, diabetes, increasing liquid intake, or taking excessive diuretics.

Darkening of Areolas

If you are pregnant, the skin around your nipples may get darker.

 

Other Explanations: Hormonal imbalance unrelated to pregnancy or may be a leftover effect from a previous pregnancy.

Food Cravings

While you may not have a strong desire to eat pickles and ice cream, many women will feel cravings for certain foods when they are pregnant. This can last throughout your entire pregnancy.

 

Other Explanations: Poor diet, lack of a certain nutrient, stress, depression, or impending menstruation.

 

Source: http://www.americanpregnancy.org/gettingpr...cysymptoms.html

 

 

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Signs of Labor

 

Possible Signs Labor May Begin Soon

· Backache: Not the type of backache you have in late pregnancy that changes when you shift position, but a persistent dull ache that makes you restless and irritable.

· Cramps. Abdominal cramping that is mild to moderate in discomfort.

· PMS symptoms: crabby, irritable.

· Nesting Urge.

· Frequent, soft bowel movements. Flu-like symptoms.

 

If you experience these symptoms, it is important to remember that they are not necessarily signs that labor is imminent. They may persist for days or weeks before labor begins. The presence of these symptoms is a good reminder to make sure you have everything prepared for labor and birth, and to make sure you are aware of what other signs to be watching for.

 

However, try not to get too excited about things, or start making too many plans assuming the baby is on its way. Continue your normal routines, get lots of rest, eat and drink well, nurture yourself in these precious days before the baby arrives.

 

Preliminary Signs

· Bloody show. During pregnancy, cervix contains mucus, which may be released in late pregnancy. May be a thick ‘plug’ of pinkish mucus, which might come out when you use the toilet. May be thin, mucousy discharge on toilet paper. If there is more blood than mucus, call caregiver. (Note, it’s common to have a brownish, bloody discharge within 24 hours of a vaginal exam, or intercourse. Don’t mistake this for bloody show.)

· Water breaks:

o Trickle or a gush. If it’s just a little mucousy fluid, it may be mucous plug.

o Pay attention to what time it breaks, note down its color, odor, etc.

o Call your caregiver. Usually (80% of the time), you will go into labor on your own in the next 24 hours. Ask your caregiver what will happen if you are not in labor after 24 hours.

· Contractions. What’s the difference between non-progressing Braxton-Hicks contractions (“false labor” / pre-labor) and the progressive contractions of active labor?

o Pre-labor contractions generally don’t progress: they may be irregular, or may stay same length, strength, and frequency. May last for a short time, or for several hours. Discomfort is felt in the front of the abdomen, as muscles tighten up. Contractions may stop if you walk, change position or change activity, eat, drink, or empty bladder.

o Some women never have Braxton-Hicks, some may have for weeks before the labor. Some may even have several episodes where contractions seem to be developing a pattern: with contractions every 6-7 minutes for 2-3 hours, which then stop again.

o ‘False Labor’ doesn’t mean they don’t hurt, and it also doesn’t mean that they’re not doing anything. Although the contractions might not be dilating your cervix yet, they are helping you to progress in other ways: moving the cervix to an anterior position, ripening and effacing the cervix.

 

Positive Signs of Labor

· Gush of amniotic fluid from vagina.

· Progressing contractions: Get longer, stronger, and/or closer together with time. Are usually described as ‘very strong’ or ‘painful’, felt in the abdomen, back, or both. May start in the back, and radiate around to front. Usually increase if you walk.

· Dilation of cervix seen in vaginal exam. (Self note: You may dilate up to weeks before going into labor. Some women may even dilate to up to 3 cm before labor ever begins. Ask me how I know)

 

Source: http://transitiontoparenthood.com/ttp/pare...birth/onset.htm

 

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Emergency Childbirth

 

When birth is imminent and medical help is unavailable, it is important to understand the normal course of labor and childbirth. The mother and anyone who is helping can make the birth easier and safer by knowing exactly what is happening and how best to help.

 

Labor is Divided into Three Stages

First Stage - the womb contracts by itself to open and bring the baby down to the birth canal.

 

Second Stage - the mother pushes (bears down) with the contractions of the womb to help the baby through the birth canal and out into the world.

 

Third Stage - the afterbirth is expelled.

 

First Stage

In this early part of labor it is often helpful for the mother to keep occupied as long as she does not get too tired. She should be patient and calm, relaxing as the contractions come and go and breathing slowly and deeply during the contractions as they become strong. Emptying the bowels and frequent urination will help to relieve discomfort. The mother will know she is in true labor if she has regular contractions of the womb which are prolonged and become strong and closer together. When she knows the baby is on the way, she should choose a place to have the baby that will be clean and peaceful. She should be able to lie down or sit in a leaning position (with her back well supported).

 

The following events occur as part of the first stage of labor and delivery.

1. The state of dilation: the first signs may be noticeable only to the mother, low-backache and irregular cramping pains (contractions) in the lower abdomen.

2. As labor progresses, the contractions become stronger, last longer, and become more regular. When the contractions recur at regular 3-4 minute intervals and last from 50-60 seconds, the mother is in the latter part of the first stage.

3. The contractions will get stronger and more frequent. The mother will often make an involuntary, deep grunting, moan with each contraction. The delivery of the baby is now imminent.

 

What To Do During the First Stage

Those helping the mother should know how to time the contractions. This information will give them an idea as to how far into labor the mother is and how much time remains until the baby comes.

 

Place a hand on the mother’s abdomen just above the umbilicus. As contractions begin you will feel a hardening ball. Time the interval from the moment the uterus begins to harden until it completely relaxes.

 

Time the intervals in minutes between the start of one contraction and the start of the next contraction. As labor progresses this time will decrease.

 

Walking or standing tends to shorten labor, so if that feels comfortable to the mother, let her. Also, if she becomes hungry or thirsty, let her eat or drink small amounts of food, fruit juice, or suck on ice chips.

 

Don’t Leave the Mother Alone

Make no attempt to wipe away vaginal secretions, as this may contaminate the birth canal. The bag of water may rupture during this stage of labor and blood tinged mucous may appear.

 

At the end of the first stage, the mother may feel tired, discouraged and irritable. This is often referred to as "transition" and is the most uncomfortable part of labor and such feelings are perfectly normal. The mother may have a backache, may vomit, may feel either hot or cold (or both at the same time), she may tremble, feel panicky or scared, cry or get very cross with her husband and birthing attendants. She may even announce that she has changed her mind and is not going through with it. At this time she needs plenty of encouragement and assurance that things are proceeding normally and that her feelings are normal.

 

Birth attendants, the husband, and others present at the labor and birth should have a cheerful, calm appearance. Nervousness, panic, or distressing remarks can have an inhibiting effect on a laboring woman. Comments on how long the labor is lasting, how pale or tired the woman looks can have a terrible effect on her morale. Even talking quietly can irritate a woman having an intense contraction because it is hard to concentrate on relaxing when there is noise in the room.

 

Relaxation is very important. A woman’s husband or labor coach should instruct her to go limp like a rag doll and breath deeply, making her tummy rise and fall. This is called abdominal breathing. Begin each contraction with a deep breath to keep the tissues (of both mom and baby) oxygenated. Observe the kind of breathing you do when you are nearly asleep and try to simulate it. Help her to relax her hands, face, legs etc. if you see that they are tense. Tenseness in the body fights the contractions and intensifies the sensations of "pain." Relaxation helps a woman to handle the contractions easier and have a faster labor. Sometimes a woman will breathe too fast and get tingling sensations in her hands and feet. She needs to be coached to slow down her breathing. You can have her follow your breathing until the tingling goes away.

 

Firm hand pressure on the lower back by those attending the mother may help to relieve the back ache. Alternately, the mother may prefer to lean her back against a firm surface. Deep rhythmical breathing helps to relieve annoying symptoms. The discomfort seldom lasts for more than a dozen contractions.

 

When the womb is almost fully opened the baby will soon enter the birth canal, and there will be a vocalized catch in the mother’s breathing when she has a contraction. The will signal the onset of the second stage.

 

Second Stage

The contractions of the second stage are often of a different kind. They may come further apart and the mother usually fells inclined to bear down (push) with them. When she gets this feeling she should take a deep breath as each contraction comes, hold her breath and gently push. There is no hurry here. The mother should feel no need to exert great force as she pushes. She may want to push with several breaths during each contraction. After it passes, a deep sigh will help her recover her breath. She should then rest until the next contraction. She may even sleep between contractions.

 

Some general instructions for the second stage of labor:

1. Be calm! Reassure the mother and be prepared to administer first aid to both the mother and baby. (Possible respiratory and cardiac resuscitation for the baby and hemorrhage control and prevention of shock for the mother may be needed).

2. Discourage onlookers from crowding around the mother.

3. Use sterile materials or the cleanest materials available. Clean towels or parts of the mother's clothing can be used. Place newspaper under the mother if nothing else is available. If she must lie on the ground, place a blanket or other covering under her.

4. In order to prevent infection, refrain from direct contact with the vagina.

5. Prepare for the delivery by assisting the mother to lie on her back with the knees bent and separated as far apart as possible. Remove any constricting clothing or push it above her waist.

6. When the baby's head reaches the outlet of the birth canal, the top of the head will first be seen during contractions but will then become visible all the time. The mother will now feel a stretching, burning sensation. She must now no longer push during the contractions, and to avoid this, should pant (like a dog on a hot day). This will allow the baby's head to slide gently and painlessly out of the canal. If possible allow the head to emerge between contractions. This will prevent the mother's skin from tearing and will minimize trauma to the baby's head. It is important that the mother pant instead of pushing until both of the baby's shoulders have emerged.

Delivery of the Baby

As the baby is coming down the birth canal, keep the perineum red or pink by massaging with warm olive oil (if none is available simply massage the area with your hand). Any place that gets white will tear more easily so keep massaging and keep all areas red. Use olive oil on the inside too and pay special attention to the area at the bottom, as that is the most common place to tear. Do this massage during a contraction when it will not be noticed or it may irritate some women.

 

You can support under the perineum with your hand on top of a sterile gauze pad or washcloth. Do not hold it together, just support it so the baby's head can ease out. The other hand can gently press with the fingers around the baby's head so it won't pop out too fast causing tearing. As the baby's head is born, support it with your hand so the face doesn't sit in a puddle of amniotic fluid. Gently wipe the face with a clean or sterile washcloth. Check quickly around the neck for the cord. If you feel it, just hook it with your finger and pull it around the baby's head. Check again. Some are wrapped more than once. If the cord is so tight it cannot be slipped over the baby's head, just wait until the baby is born to untangle it. Most cords are long enough to permit this. IF the cord is too short to permit the baby to be born, it has to be cut and clamped and the baby delivered rapidly. In this situation the baby may be in distress because the oxygen supply was cut off prematurely. With the next contraction, one of the shoulders comes and then the whole body slips quickly out. IF several contractions have passed without a shoulder coming, you may have to slip two fingers in and try to find an armpit. With one or two fingers hooked under the armpit, try to rotate the shoulder counterclockwise while pulling out. Usually this does it.

 

As the baby's head emerges, it is usually face down. It then turns, so that the nose is turned towards he mother's thigh. Support the baby's head by cradling it in your hands. Do not pull or exert any pressure. Help the shoulders out. For the lower shoulder, support the head in an upward position. As the shoulders emerge, be prepared for the rest of the body to come quickly. Use the cleanest cloth or item available to receive the baby.

 

Make a record of the time and approximate location of the birth of the baby.

 

With one hand, grasp the baby at the ankles, slipping a finger between the ankles. With the other hand, support the shoulders with the thumb and middle finger around its neck and the forefinger on the head. (Support but do not choke). Do not pull on the umbilical cord when picking the baby up. Raise the baby's body slightly higher than the head in order to allow mucous and other fluid to drain from its nose and mouth. Be Very Careful as newborn babies are very slippery.

 

The baby will probably breathe and cry almost immediately.

 

If the baby doesn't breathe spontaneously, very gently clear the mouth of mucous with your finger. Stimulate crying by gently rubbing its back. IF all this fails, give extremely gentle mouth-to-mouth resuscitation. Gently pull the lower jaw back and breathe gently with small puffs--20 puffs a minute. If there seems to be excess mucous, use your finger to gently clear the baby's mouth.

 

The mother will probably want to hold the baby. This is desirable. If the umbilical cord is long enough, let her hold the baby in her arms. If the cord is short, support the baby on the mother's abdomen and help her hold it there.

 

It is of benefit to the baby and makes the afterbirth come with less bleeding if the baby can be allowed to suckle at the breast as soon as it is born. The cord should not be cut until the afterbirth has completely emerged.

 

Third Stage

The placenta delivery or afterbirth is expelled by the womb in a period of a few minutes to several hours after the baby is born. No attempt should be made to pull it out using the cord. Immediately following the afterbirth, there may be additional bleeding and a few blood clots. The womb should feel like a firm grapefruit just below the mother's navel. If it is soft, the baby should be encouraged to nurse, and the mother may be encouraged to gently massage the womb. These actions will cause it to contract and lessen the chances of bleeding.

 

If hemorrhaging occurs, do the following:

1. The uterus should be gently massaged to keep it hard.

2. The woman should lie flat, and the bottom of the bed should be elevated.

3. Put a cold pack (such as a small towel dipped in cold water and wrung out) on the lower tummy to irritate the uterus to contract.

4. Put pressure on the perineum with several sanitary napkins and the pressure of your hand.

5. Most importantly, have the baby nurse. Sucking stimulates the uterus to contract.

 

Another problem to be alert for is shock. Symptoms of shock are vacant eyes, dilated pupils, pale and cold or clammy skin, faint and rapid pulse, shallow and irregular breathing, dizziness and vomiting. If you notice any of these symptoms, keep the woman warm, slightly elevate her feet and legs, use soft lights, and talk softly and calmly to her.

 

The baby has some danger of getting an infection through the cut cord, so it should not be cut until sterile conditions are available. If there is a possibility of getting medical help within a few hours, do not cut the cord but leave it and the afterbirth attached to the baby. If there will be no medical help, wait until the afterbirth is out, or at least until the cord is whitened and empty of blood. The cord should not be cut until it quits pulsating so the baby can have a transition time before he absolutely has to breathe on his own. As long as the cord is pulsating, the baby is still receiving oxygen from his mother.

 

If the cord is long enough, the baby can be put on his mother's tummy so she can hold him and talk to him. IF not, the father should touch him and talk to him. After the cord has stopped pulsating and has become limp it can be clamped or tied about one inch from the baby's tummy with a cord or sterile cloth and then cut.

 

As the placenta separates from the uterus, the cord will appear longer. Wait for the delivery of the placenta. It will usually be about 10 minutes or longer before the placenta is delivered.

 

Never pull on the cord. When the placenta appears, grasp gently and rotate it clockwise. Then tie the cord in two places--about six inches from the baby--using strips of material that has been boiled or held in a hot flame.

 

The placenta and attached membranes must be saved for a doctor's inspection. Leaving the cord and placenta attached to the baby is messy but safe. Save all soiled sheets, blankets, cloths, etc., for a doctor's examination. Check the amount of vaginal bleeding; a small amount (1 to 2 cups) is expected. Place sanitary pads or other sanitary material around birth areas. Then cover mother and baby but do not allow them to overheat. Continue to check the baby's color and respiration. The baby should not appear blue or yellowish. When necessary, gently flick your fingers on the soles of the baby's feet; this will encourage it to cry vigorously.

 

The mother will probably need light nourishment and will wish to rest and watch her baby. She should keep her hand away from the area surrounding the birth outlet. If uncontaminated water is available, she may wish to wash off her thighs. She may get up and go to he bathroom or seek better shelter. All care should be taken to avoid introducing infection into the birth canal. The mother can expect some vaginal discharge for several days. This is usually reddish for the first day or so but lightens and becomes less profuse within a few days.

 

Stay with the mother until relieved by competent personnel. This is a relatively dangerous period for the mother, as hemorrhage and shock may occur. Almost all emergency births are normal. The babies typically thrive and the mothers recover quickly. It is very important when assisting with an emergency delivery that you continually reassure the mother and attempt to keep her calm.

 

Source: http://www.thefarm.org/charities/i4at/surv/ebirth.htm

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Homebirth Supplies

 

Birth:

plastic mattress cover

absorbant pads such as chux or puppy training pads

4 old towels and 4 washcloths

Flashlight with new batteries

2 bowls - one for the placenta and one to vomit in

Box of white kleenex

Plastic trash bag

gloves

sharp, sterile scissors

cord clamp and iodine

Honey and a spoon (a small honey bear works well)

Unopened non-citrus juice (white grape juice is good)

 

After Birth:

Box of Kotex Overnight pads

Isopropyl Alcohol

Cotton balls and swabs

Hydrogen Peroxide (for blood clean up on carpet if necessary)

bulb syringe

Underpants for mom and a gown she can nurse in

Peri bottle or other squirt water bottle

 

Baby:

Socks

Infant hat

Diaper and pins

4 receiving blankets

Outfit for baby if desired

Wash cloth or baby wipes

 

Sources:

http://www.birthingnaturally.net/homebirth/need.html

http://www.gentlebirth.org/archives/hmbrthsp.html

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Nursing: The First Few Weeks

 

The First Week

Nurse as soon as possible after birth and continue nursing frequently. Try to nurse at least 10-12 times a day (every 24hrs). Nurse at the first signs of hungers (stirring, rooting, hands in mouth), don't wait til baby is crying.

 

Is baby getting enough milk?

Newborns may lose up to 7% of birth weight the first few days. After your milk comes in the average breastfed baby will gain about 6oz/wk. The first couple days of life baby should have one dirty diaper for each day of life (1 on day 1, 2 on day 2) and this will be a dark sticky stool. After day 4, stools should be yellow and baby should have at least 3-4 daily. This will usually be about the size of a quarter and loose or may be seedy or curdy. At first baby will have one wet diaper per day of life and after mom's milk comes in should have at least 5-6 every 24 hrs. To feel what is sufficiently wet, put 3 tablespoons of liquid on a diaper.

 

Your milk should come in from day 2-5. Nurse often to minimize engorgement, make sure baby is latched properly, and let baby finish the first breast before changing to the second. If needed express a little milk before nursing so the nipple is soft for baby to latch.

 

Call your doctor if:

- baby is have no wet or dirty diapers

- baby has dark colored urine after day 3 (should be pale yellow to clear)

- baby has dark colored stools after day 4 (should be mustard yellow, with no meconium)

- baby has fewer wet/soiled diapers or nurses less frequently than the goals listed here

- mom has symptoms of mastitis (sore breast with fever, chills, flu like aching)

 

Weeks Two to Six

Frequent nursing in the early weeks is important for establishing a good milk supply. Most newborns nurse 8-12 times per day. Allow baby unlimited time at the first breast when sucking actively, then offer the second breast.

 

The following things are normal:

- frequent and/or long feedings.

- varying nursing pattern from day to day

- cluster nursing (very frequent to constant nursing) for several hours - usually evenings - each day.

- growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurts are the first few days at home, 7-10 days, 2-3 weeks, and 4-6 weeks.

 

Is baby getting enough milk?

The average breastfed newborn gains 6 oz/wk. Expect at least 3-4 stools daily the size of a quarter. Some babies may have stools every time they nurse. This is usually yellow and loose, seedy or curdy. After 4-6 wks the stools are less frequent maybe be even one every 7-10 days. If baby is gaining well, this is normal. Expect at least 5-6 wet diapers a day and should be about 3 tablespoons of liquid. After 6 wks, the number of wet diapers a day may drop to 4-5 but the amount of urine will increase to 4-6 tablespoons.

 

Hunger Cues

Early

* Smacking or licking lips

* Opening and closing mouth

* Sucking on lips, tongue, hands, fingers, toes, toys, or clothing

Active

* Rooting around on the chest of whoever is carrying him

* Trying to position for nursing, either by lying back or pulling on your clothes

* Fidgeting or squirming around a lot

* Hitting you on the arm or chest repeatedly

* Fussing or breathing fast

Late

* Moving head frantically from side to side

* Crying

 

Source: http://www.kellymom.com/bf/start/basics/index.html

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Common Breastfeeding Concerns

 

Treatment of Sore, Cracked or Bleeding Nipples

Poor positioning and latch-on is the most common cause of nipple soreness in the early weeks of nursing. Sometimes attention to positioning and babys' latch will correct this problem, if not try to see a lactation consultant for help.

 

In the meantime certain measures will make nursing more comfortable for you as your nipples heal:

* Nurse frequently - at least every 2 hours. This will ensure that your baby does not become too hungry between feedings causing him to nurse ravenously and aggressively at your breast.

* Hand express or pump a few minutes before the feeding. This will elicit letdown and elongate the nipple for the baby so that he does not nurse so aggressively.

* Nurse on the least sore side first as this is the side that your baby will nurse more aggressively on.

* You may want to take a mild pain reliever such as Tylenol or Advil about 30 minutes prior to nursing or around the clock until your discomfort lessens or disappears. Both of these drugs are compatible with breastfeeding.

* Open both sides of your bra during the feeding.

* Consider applying warm, wet tea bags to your nipples for a short time after nursing. Many moms report that this can be very soothing.

* Warm, moist compresses (wet washcloth works well) often bring relief to nipples both before and after nursing.

* After feeding, pat dry your nipples and express some breastmilk to rub into them (this should be avoided if you have thrush as it thrives in milk). Breastmilk has Vitamin E in it which is very healing to the skin. Note: Avoid applying Vitamin E oil from a capsule to your nipples as this can be toxic to your baby!

* Try appling a 100% USP modified lanolin preparation to your nipples after nursing. Apply enough to thoroughly coat the entire nipple/areola area. This does not need to be washed off prior to nursing as it is safe for baby to ingest.

* Some moms find a hydrogel pad soothing and healing to nipple trauma.

* Change your nursing pads immediately after they become damp. Moisture against your nipples can prolong healing. If your pad sticks to your nipple moisten it with water before attempting to remove it. Also avoid nursing pads with plastic linings.

* If your nipples become so sore that you cannot tolerate the pressure of your bra or clothing on them and it is painful for you to hold your baby, try wearing breast shells inside your bra to protect your nipples as they heal.

* If its impossible to nurse your baby due to nipple soreness, you may opt to feed him with an alternative feeding device such as an eye dropper, medicine dropper, feeding syringe, soft, flexible medicine cup, or spoon while your nipples heal. Avoid bottles to prevent nipple confusion, especially if your baby is less than 4 weeks old. If only one nipple is very sore, you may decide to feed your baby from the well side only while pumping the other side. You will want to pump the other side as often as your baby nurses for 10-15 minutes each time.

 

Plugged Duct or Mastitis

Plugged Duct

A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked or the obstruction may be further back in the ductal system. A plugged duct usually comes on gradually and affects only one breast.

 

Symptoms:

Mom will usually notice a hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened. Occasionally mom will only notice localized tenderness or pain, without an obvious lump or area of engorgement. The location of the plug may shift. A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected side may be painful, particularly at letdown. There are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3°F / 38.5°C) may be present.

 

Side Effects:

* Milk supply and pumping output from the affected breast may decrease temporarily. This is normal and extra nursing/pumping generally get things back to normal within a short time.

* Occasionally a mom may express "strings" or grains of thickened milk or fatty-looking milk.

* After a plugged duct or mastitis has resolved, it is common for the area to remain reddened or have a bruised feeling for a week or so afterwards.

 

Usual Causes:

Milk Stasis/restricted milk flow may be due to:

* engorgement or inadequate milk removal (due to latch, oversupply, limited/hurried feedings, etc)

* infrequent/skipped feedings (due pacifier use, baby sleeping longer, supplementing, etc)

* pressure on the duct (from tight bra or clothing, etc.)

* inflammation (from injury, bacterial/yeast infection, or allergy)

Stress, fatigue, anemia, weakened immunity

 

General Supportive Measures:

* rest

* adquate fluids

* nutritious foods will help to strengthen mom's immune system

 

Medication:

Analgesia

* pain reliever/anti-inflammatory

* second choice - pain reliever alone

Antibiotic

* No

 

Mastitis

Mastitis is an inflammation of the breast that can be caused by obstruction, infection and/or allergy. Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation. Mastitis may come on abruptly, and usually affects only one breast.

 

Symptoms:

Local symptoms are the same as for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area. Typical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu-like aching, malaise and systemic illness.

 

Side Effects:

Side effects may be the same as for a plugged duct, plus:

* Expressed milk may look lumpy, clumpy, "gelatin-like" or stringy. This milk is fine for baby, but some moms prefer to strain the "lumps" out.

* Milk may take on a saltier taste due to increased sodium and chloride content - some babies may resist/refuse the breast due to this temporary change.

* Milk may occasionally contain mucus, pus or blood.

 

Usual Causes:

Milk statis (usually primary cause)

* same as for plugged duct

* plugged duct is also a risk factor

Infection

* sore, cracked, or bleeding nipples may be entry for infection

* hospital stay increases mom's exposure to infectious organisms

* obvious infection on the nipple (crack/fissure with pus, pain)

* past history of mastitis is a risk factor

Stress, fatigue, anemia, weakened immunity

 

General Supportive Measures:

* bed rest (preferably with baby)

* increase fluid, adequate nutrition

* get help around the house

 

Medication:

Analgesia:

* Same as for plugged duct

Antibiotic:

* No if symptoms are mild and have been present for less than 24 hrs. Yes if symptoms are not improving in 12-24 hrs or if mom is acutely ill.

* Most common pathogen is penicillin resistant Staphylococcus aureus.

* Typical antibiotics used for mastitis: dicloxacillin, flucloxacillin, cloxacillin, amoxycillin-clavulinic acid; cephalexin, erythromycin, clinadmycin, ciprofloxacin, nafcillin

* Most recommended 10-14 day treatment to prevent relapse.

* Consider probiotics to reduce thrush risk.

 

Talk to doctor about antibiotics immediately if:

* mastitis is in both breasts

* baby is less than 2 weeks old or you have recently been in the hospital.

* you have broken skin on the nipple with obvious signs of infection.

* blood/pus is present in milk

* red streaking is present

* your temperature increases suddenly

* symptoms are sudden and severe

Follow up:

* Re-evaluate treatment plan if symptoms do not begin to resolve in 2-3 days.

* Investigate further if mom has more than 2-3 recurrences in the same location.

* Consider the possibility of thrush if sore nipples begin after antibiotic treatment.

 

Engorgement

It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (“comes in”) 2-6 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

 

How to prevent or minimize engorgement

* Nurse early and often - at least 10 times per 24 hours. Don’t skip feedings (even at night).

* Nurse on demand. Wake baby to nurse every 2-3 hrs, allowing one stretch of 4-5 hrs at night.

* Allow baby to finish the first breast before offering the other side. Switch sides when baby pulls off or falls asleep. Don't limit baby's time at the breast.

* Ensure correct latch and positioning for baby to nurse well and sufficiently soften the breasts.

* If baby is not nursing well, express milk regularly to maintain milk supply and minimize engorgement.

 

 

Signs & Symptoms of Engorgement

When? Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment).

How does the breast feel? The breast will typically feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth, tenderness, and/or throbbing. Engorgement may extend up into the armpit.

How does the areola feel? The areola will typically feel hard (like the tip of your nose or your forehead) rather than soft (like your earlobe), with tight skin that may appear shiny. The nipple may increase in diameter and become flat and taut, making latch-on challenging.

You may also have a low-grade fever.

 

Moms’ experiences of engorgement differ. Engorgement:

* May occur in the areola and/or body of the breast;

* May occur in one or both breasts;

* May build to peak then decrease, stay the same level for a period of time, or peak several times.

 

 

Tips for treating engorgement

Before nursing

* Gentle breast massage from the chest wall toward the nipple area before nursing.

* Cool compresses for up to 20 minutes before nursing.

* Moist warmth for a few minutes before nursing may help the milk begin to flow (but will not help with the edema/swelling of engorgement). Some suggest standing in a warm shower right before nursing (with shower hitting back rather than breasts) and hand expressing some milk, or immersing the breasts in a bowl or sink filled with warm water. Avoid using warmth for more than a few minutes as the warmth can increase swelling and inflammation.

* If baby is having difficulty latching due to engorgement, the following things can soften the areola to aid latching:

o Hand expression

o If the above two things don't work, try pumping for a few minutes with a hand, electric (low setting) breast pump.

 

While nursing

* Gentle breast compressions and massage during the nursing session can reduce engorgement.

* After nursing for a few minutes to soften the breast, it may be possible to obtain a better latch by removing baby from the breast and re-latching.

 

Between feedings

* If your breast is uncomfortably full at the end of a feeding or between feedings, then express milk to comfort so that the breasts do not become overfull.

o Hand expression may be most helpful (though obviously second to breastfeeding) as this drains the milk ducts better.

o Mom might also use a hand pump or a quality electric pump on a low setting for no more than 10 minutes (engorged breast tissue is more susceptible to damage).

o Massaging the breast (from the chest wall toward the nipple area) is helpful prior to and during milk expression.

o It's not good to overdo the pumping, as too much pumping will encourage overproduction.

* Use cold compresses (ice packs over a layer of cloth) between feedings; 20 minutes on, 20 minutes off; repeat as needed.

* Cabbage leaf compresses can also be helpful.

* Many moms are most comfortable wearing a well fitting, supportive bra. Avoid tight/ill-fitting bras, as they can lead to plugged ducts and mastitis.

* Use a non-steroidal anti-inflammatory such as ibuprofen to relieve pain and inflammation.

 

Avoid:

* Excess stimulation (for example, don’t direct a shower spray directly on the breasts).

* Application of heat to the breasts between feedings. This can increase swelling and inflammation. If you must use heat to help with milk flow, limit to a few minutes only.

* Restricting fluids. This does not reduce engorgement. Drink to thirst.

 

Contact your lactation consultant or health care provider if:

* Engorgement is not relieved by these measures.

* Baby is unable to latch or is not having enough wet/dirty diapers.

* You have mastitis symptoms: red/painful breast, temperature greater than 100.6 degrees F, chills, body aches, flu-like symptoms.

 

Other treatments for engorgement

Cabbage

Applying cabbage leaf compresses to the breast can be helpful for moderate to severe engorgement. There is little research on this treatment thus far, but there is some evidence that cabbage may work more quickly than ice packs or other treatments, and moms tend to prefer cabbage to ice packs.

 

What are cabbage compresses used for?

* Engorgement.

* Extreme cases of oversupply, when the usual measures for decreasing supply (adjusting nursing pattern, nursing "uphill," etc.) are not working

* During weaning, to reduce mom's discomfort and decrease milk supply.

* Sprains or broken bones, to reduce swelling.

 

To use cabbage leaves:

* Green cabbage leaves may be used chilled or at room temperature.

* Wash cabbage leaves and apply to breasts between feedings.

* For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for 20 minutes, no more than 3 times per day; discontinue use after engorgement/oversupply subsides.

* During the weaning process: Leave the leaves on the breast until they wilt, then apply new leaves as often as needed for comfort.

 

"Juice Jar" breast pump

 

This simple pump can be useful to help with engorgement, and to draw the nipple out when baby is having a difficult time latching on.

 

* Find an empty glass jar or bottle at least 1 liter in size with a 5 cm or larger opening. The type of bottle that cranberry juice comes in is often a good size.

* Fill the jar nearly full with very hot water. The glass will get very hot and you will need to hold it with a towel.

* Pour all the water out of the jar.

* Use a cool washcloth to cool down the rim and upper part of the jar so you can touch it without burning yourself (test it with your inner arm).

* Place your breast gently into the mouth of the jar so that it makes an airtight seal. Some moms lean over a table to do this, others put the jar in their lap on a pillow and lean forward. Expect this to take a few minutes, so make yourself comfortable.

* As the air slowly cools inside the jar, it creates a vacuum inside the jar and this gentle suction expresses milk from the breast. Break the suction immediately if you feel discomfort - if the jar cools too quickly it may create excessive suction which can damage breast tissue.

* Repeat for the other breast.

* Some moms need to repeat this, others find it works sufficiently with only one try.

 

Fenugreek seed poultice

This is a traditional treatment for engorgement or mastitis. Steep several ounces of fenugreek seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots.

 

 

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Herbs and Medications During Pregnancy

 

Asthma

* Budesonide inhaled or nasal spray (Pulmicort®, Rhinocort ®)

Bladder infection (UTI)

* Nitrofurantoin (Macrobid®)

Cough

* Dextromethrophan (Robitussin DM sugar free ®)

Constipation

* Metamucil® , Citrucel®,

* Docusate (Colace®, Ducolax ®)

* Milk of magnesia.

* Polyethyelene glycol (Miralax®)

Diabetes

* Insulin

* Glyburide (Micronase®)

* Metformin (Glucophage®)

Diarrhea

* Loperamide (Imodium A-D ®)

Gas

* Simethicone (Gas-X ®, Mylicon ®, Phazyme ®)

Gastroesophageal reflux disease (GERD),

* Ranitidine (Zantac®)

* Cimetidine (Tagamet®)

Hayfever, sneezing, runny nose, itchy watery eyes

* Chlorpheniramine (Chlor-Trimeton ®,Efidac ®, Teldrin ®)

* Diphenhydramine (Benadryl ®) Clemastine (Tavist Allergy ®)

Headache or fever:

* Acetaminophen (APAP,Paracetamol,Panadol, Tylenol®)

Heartburn

* TUMs®

Hemorrhoids

* Tucks®

* Preparation H®

* Anusol®

High blood pressure

* Methyldopa (Aldomet®)

Hyperprolactinemia

* Bromocriptine (Parlodel®)

* Carbergoline (Dostinex®)

Hypothyroidism

* Thyroid hormone

* Levothyroxine (Synthroid ®, Levoxyl ®)

Infection

* Acyclovir (Zovirax ®)

* Azthitromycin (Zithromax ®)

* Cepaholosporins

examples: Cephalexin (Keflex®),

Cefazolin (Ancef ®), cefaclor (Ceclor®)

* Clindamycin (Cleocin®)

* Erythromycin

* Penicillins

example Amoxicillin (Amoxil®),

Amoxicillin Clavulanate (Augmentin®),

methicillin, carbenicillin

* Metronidazole (Flagyl®)

Insomnia

* Doxylamine (Unisom Sleep Tabs® )

Motion sickness

* Dimenhydrinate (Dramamine ®)

Nasal congestion

* Pseudoephedrine (Sudafed ®) -Avoid in first trimester.

Nasal congestion, sneezing, runny nose, itchy watery eyes

* Actifed Cold and Allergy ®

Ingredients: Triprolidine, Pseudoephedrine

-Avoid in first trimester.

Nasal congestion, sneezing, runny nose, itchy watery eyes, fever, and headache

* Actifed Cold and Sinus ®

Ingredients: Acetaminophen, Chlorpheniramine,

Pseudoephedrine- Avoid in first trimester.

Nausea

* Ginger

* Pyridoxine 25 mg PO TID WITH Unisom Sleep Tabs (Doxylamine Succinate 25 mg) 1/2 tablet TID

* Metoclopramide (Reglan ®)

Preeclampsia

* Magnesium sulfate

Vaginal yeast infection

* Clotrimazole cream (Gyne-Lotrimin®)

 

Prescription Medications During Pregnancy

Safer prescription drugs

* Antibiotics: Several major classes, including penicillin, cephalosporin, erythromycin, clindamycin

* Asthma medications: Most inhaled medications, including inhaled steroids

* Antacids: Many, including Zantac and Carafate

* Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft; and tricyclic antidepressants, such as imipramine, sold as Tofranil, and amitriptyline, sold as Elavil

* High blood pressure drugs: Several, including Aldomet, Normodyne, and Trandate

 

Less safe prescription drugs

* Antibiotics: Tetracycline and doxycycline (avoid after the first trimester), streptomycin and kanamycin

* Antiseizure drugs: Carbamazepine, sold as Tegretol or Carbatrol, and valproic acid

* Migraine medications: Ergotamine drugs such as Ergomar and Bellamine

 

Unsafe prescription drugs

* Acne medications: Accutane and other oral vitamin A compounds

* Arthritis drugs: Arthrotec

* Blood thinners: Warfarin, sold as Coumadin

* High blood pressure medications: ACE inhibitors such as Lotensin, Accupril, Monopril (Avoid after the first trimester.)

* Ulcer medications: Misoprostol, sold as Cytotec

 

Herbs Which May Be Beneficial:

Red Raspberry (antiemetic, astringent, laxative, tonic)

The leaves of red raspberry are often considered useful for making “Pregnancy Tea.” Red Raspberry used reasonably can help with pregnancy sickness, help prevent miscarriage, reduce the chances of uterine hemorrhage, reduce labor pains and aid in increasing milk. A tea may be made by simmering a handful of the dried leaves in a quart of pure water for about 20 minutes. A small amount of spearmint can be added for better flavor. The following recipe can be mixed then made one cup at a time.

 

Pregnancy Tea • 10 parts red raspberry

• 5 parts blackberry

• 1 part cinnamon

 

1 teaspoon to 1/2 cup water

 

Yellow Dock (alterative, astringent, laxative, nutritive)

Yellow Dock is high in IRON and therefore excellent for anemia. It does not constipate as most iron pills can do. It works best combined with other iron-rich herbs such as Alfalfa, Dandelion and Nettles. It is a blood purifier.

 

TEA: up to 3 cups daily

TINCTURE: 5 - 30 drops 3 times daily

POWDER: 5 - 10 #0 caps daily

 

Alfalfa (alterative, nutritive, antipyretic, diuretic, tonic)

NUTRIENT, blood purifier, fever reducer, source of calcium, magnesium, vitamins K & P, potassium, phosphorus.

 

TEA: 3 cups daily

TINCTURE; 5 - 15 drops 3 times daily

POWDER: 5 - 10 caps 3 times daily

 

Dandelion (aperient, cholagogue, diuretic, tonic, stomachic)

Good for jaundice, gallstones, fever, insomnia, and constipation. Good source of iron.

 

Nettles (astringent, diuretic, galatagogue, hemostatic, tonic)

Promotes the flow of milk. Good for urinary tract problems and calcium deficiency.

 

Which cleansing herbs are too strong or irritating?

Arnica Barberry

Bee Balm Black walnut

Blessed thistle Catnip

Chapparal Chicory

Colsfoot Comfrey

Ephedra Fenugreek

Gentian Horehound

Horsetail Ipecac

Juniper berries Lobelia

Oregon grape root Poke root

Rhubarb root Rosemary

Uva ursi Yarrow

 

Which laxative herbs are too strong to use at this time?

Aloe vera Buckthorn

Butternut Cascara sagrada

 

Which herbs that affect hormones are contraindicated during pregnancy?

Borage Damiana

Dong quai Licorice

Sarsparilla Siberian ginseng

Vitex (can be used the first trimester)

 

Which herbs bring on contractions or bleeding?

Angelica Birthwort (bethwort)

Black cohosh (may be used in the last 2 weeks of pregnancy)

Blue cohosh (may be used in the last 2 weeks of pregnancy)

Cotton root Elecampane

Fenugreek Feverfew

Goldenseal Horehound

Lovage Mistletoe

Motherwort Mugworts

Myrrh Osha

Parsley Pennyroyal

Rue Sage

Tansy Thuja

Thyme Turmeric

Wormwood

 

Herbs for Birth and Labor

* Blue cohosh and black cohosh are two herbs that work synergistically to bring on labor (but do not use them before the last two weeks of pregnancy). During labor they can make contractions more efficient in a long, stalled labor, and help the uterus clamp down after birth.

* Raspberry leaf (tea or tincture) is one of the best uterine tonic herbs to prepare uterine muscles for an efficient labor. Its astringent action slows bleeding and helps to expel the placenta. Have the tea on hand or make raspberry tea ice cubes to suck on during labor.

 

Many herbs can help ease the pain of contractions:

* Crampbark can be used for uterine cramping during labor, and after birth to eliminate after birth cramping pains.

* Scullcap and catnip relieve pain, as well as calm and relax the body.

* Chamomile helps control pain during labor by relieving tension.

 

Other herbs help with emotional balance during labor:

* Motherwort is one of the best herbs to give immediate emotional balance during the ups and downs of labor, but it may increase uterine bleeding.

* Rescue Remedy, a Bach flower remedy, is excellent for bringing one quickly into focus when under stress or shock during a difficult labor. It can also be put on the baby's forehead or wrist after a stressful birth.

* A massage oil, enhanced with herbs, will relax the muscles and ease back labor pain. Use relaxing, aromatic herbs such as chamomile, rose, and lavender. Rubbed on the perineum, it helps prevent tearing as the baby crowns and ease swelling and burning.

* Essential oils in a mister can give clarity and focus. Clary Sage gives a sense of well being and combats mental fatigue. During birth it helps focus breathing and calm anxiety. Geranium essential oil balances emotions and works well for perineal massage, as it stimulates circulation. Lavender is calming and strengthening, relieving depression and irritability. Citrus essential oils are clean, refreshing and uplifting. Be sure that essential oils are used in a carrier oil or mister and not applied directly to or on the skin.

* Shepherd's Purse tincture is the best herb to quickly stop postpartum hemorrhaging. Every midwife should have it with her in case an emergency situation arises.

* After the birth, use a sitz bath to soak the perineum, heal any tears, shrink swelling, and slow bleeding. It helps the perineum to heal quickly, and makes walking more comfortable. Herbs to use include yarrow, uva ursi, witch hazel, Shepherd's purse, and garlic.

* Fill a plastic squirt bottle with a strong herbal tea of these herbs to squirt on your perineum as you urinate to lessen any burning and heal tears.

* Homeopathic arnica pills, taken every few hours for several days after the birth, help reduce bruising and swelling of the perineal tissue. Be sure you are taking arnica internally only in homeopathic form, as arnica tincture prevents clotting and should not be taken internally.

 

- For sources or additional information see the first post of this thread.

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Herbs while Nursing

 

 

Herbs that may decrease milk supply:

* black walnut * periwinkle herb (vinca minor)

* chickweed * sage

* herb robert (geranium robertianum) * sorrel

* lemon balm * spearmint

* oregano * thyme

* parsley * yarrow

* peppermint

Herbs to avoid while nursing:

* bladderwrack * indian snakeroot

* buckthorn * kava kava

* chaparral * petasites root

* coltsfoot * phen-fen, herbal

* dong quai * rhubarb

* elecampane * star anise

* ephdra/ma huang * tiratricol

* ginseng * uva ursi

* wormwood

 

Herbs for increasing milk supply:

Alfalfa

Dosage: up to 4 capsules, 3 times a day; homeopathic 6 tablets a day. Note: Not recommended for people taking blood thinning agents. Can be taken in combination with blessed thistle, marshmallow, and fenugreek.

Anise/Aniseed

Dosage: crush seeds just before use. Pour 1 cup of boiling water over 1-2 tsp of seeds. Let stand covered for 5-10 minutes. Drink 1 cup 2-3 times a day. Note: Not recommended during pregnancy. Do not take when using birth control pills containing estrogen. Also reported to be helpful for baby colic.

Blessed Thistle

Dosage: Capsules: up to 4 capsules, 3 times a day. Tincture: up to 20 drops, 2-4 times a day; tea: pour one cup of boiling water over 1.5 to 2 grams of crushed Blessed Thistle and steep for 10-15 minutes. Drink 1 cup 2-3 times per day. Note: Use with caution if you are allergic to plants in the daisy family. Can be taken in combination with red raspberry, alfalfa, marshmallow and fenugreek.

 

Fenugreek for Increasing Milk Supply

Effect on milk production

Fenugreek (Trigonella foenum-graecum L.) appears to be the herb that is most often used to increase milk supply. It is an excellent galactagogue, and has been used as such for centuries. In one study of ten women, "the use of fenugreek significantly increased volume of breastmilk" [swafford 2000].

 

Mothers generally notice an increase in production 24-72 hours after starting the herb, but it can take two weeks for others to see a change.

 

Dosages of less than 6 capsules/day (approx 3500 mg/day) produce no effect in many women. One way to determine if you're taking the correct dosage is to slowly increase the amount of fenugreek until your sweat and urine begin to smell like maple syrup. If you're having problems with any side effects, discontinue use and consider alternative methods of increasing milk supply.

 

Fenugreek can be used either short-term to boost milk supply or long-term to augment supply and/or pumping yields. There are no studies indicating problems with long-term usage. Per Kathleen Huggins "Most mothers have found that the herb can be discontinued once milk production is stimulated to an appropriate level. Adequate production is usually maintained as long as sufficient breast stimulation and emptying continues" [Huggins].

 

Suggested dosage

capsules (580-610 mg)

* 2-4 capsules, 3 times per day

* 6-12 capsules (total) per day

* ~1200-2400 mg, 3 times per day (3.5-7.3 grams/day)

* German Commission E recommends a daily intake of 6 grams

capsules (500 mg)

* 7-14 capsules (total) per day

powder or seeds

* 1/2 - 1 teaspoon, 3 times per day

* 1 capsule = 1/4 teaspoon

* can be mixed with a little water or juice

tincture

* 1-2 mL, 3 times per day (or see package directions)

tea

* one cup of tea, 2-3 times per day

 

Possible side effects and cautions

* Sweat and urine smells like maple syrup; milk and/or breastfed baby may smell like maple syrup.

* Occasionally causes loose stools, which go away when fenugreek is discontinued.

* Use of more than 100 grams of fenugreek seeds daily can cause intestinal distress and nausea (recommended dose is less than 8 grams per day).

* Repeated external applications can result in undesirable skin reactions [Wichtl 1994].

* Ingestion of fenugreek seeds or tea in infants or late-term pregnant women can lead to false diagnosis of maple syrup urine disease in the infant due to presence of sotolone in the urine. See [Korman 2001] and other studies on fenugreek and maple syrup urine smell.

 

Use with caution or avoid if you have a history of:

* Peanut or chickpea allergy: Fenugreek is in the same family with peanuts and chickpeas, and may cause an allergic reaction in moms who are allergic to these things. Two cases of fenugreek allergy have been reported in the literature. [Patil 1997, Ohnuma 1998, Lawrence 1999]

* Diabetes or hypoglycemia: Fenugreek reduces blood glucose levels, and in the few studies using it as a hypoglycemic, also reduces blood cholesterol. Dosages higher than the recommended one (given above) may result in hypoglycemia in some mothers [Heller]. If you're diabetic (IDDM), use fenugreek only if you have good control of your blood glucose levels. While taking this, closely monitor your fasting levels and post-prandial (after meals) levels. Mothers with hypoglycemia should also use fenugreek with caution. For more on fenugreek and glucose levels, see the references below.

* Asthma: Fenugreek is often cited as a natural remedy for asthma. However, inhalation of the powder can cause asthma and allergic symptoms. Some mothers have reported that it worsened their asthma symptoms. [Dugue 1993, Huggins, Lawrence 1999].

* Abnormal menstrual cycles: Fenugreek is considered to be an emmenagogue (promotes menstrual flow). Per [White], it may cause breakthrough menstrual bleeding; this source recommends using fenugreek with caution if you have a history of abnormal menstrual cycles.

* Migraines: Fenugreek is often cited as a natural remedy for migraines. However, [White] indicates that it may trigger a migraine and/or contribute to the duration and severity of a migraine.

* Blood pressure problems or heart disease: Fenugreek is commonly reported to lower blood pressure and LDL blood cholesterol levels. [White] indicates, however, that it may cause or contribute to hypertension (high blood pressure) - this source recommends avoiding this herb if you have a history of hypertension, or if there is a strong family history of hypertension or heart disease.

 

Drug interactions

* Oral drugs or herbs taken at the same time as fenugreek may have delayed absorption due to the mucilage content of fenugreek.

* Glipizide and other antidiabetic drugs

Fenugreek reduces blood glucose levels and may enhance the effects of these drugs.

* Insulin

Fenugreek reduces blood glucose levels, so insulin dosage may need to be adjusted.

* Heparin, Warfarin and other anticoagulants

Ticlopidine and other platelet inhibitors

The fenugreek plant contains several coumarin compounds. Although studies have not shown any problems, it potentially could cause bleeding if combined with these types of drugs.

* MAOIs

Fenugreek contains amine and has the potential to augment the effect of these drugs.

 

Possible side effects for baby

Most of the time, baby is unaffected by mom's use of fenugreek (except that more milk is usually available). Sometimes baby will smell like maple syrup, too (just like mom). However, some moms have noticed that baby is fussy and/or has green, watery stools when mom is taking fenugreek and the symptoms go away when mom discontinues the fenugreek.

 

Fenugreek can cause GI symptoms in mom (upset stomach, diarrhea), so it's possible for it to cause GI symptoms in baby too. Also anyone can have an allergic reaction to any herb, and fenugreek allergy, though rare, has been documented.

 

Another reason for these types of symptoms --and perhaps more likely than a reaction to the herb-- may be that mom's supply has increased due to the fenugreek and the symptoms are those of oversupply, where baby is getting too much foremilk. Fussiness, gas and green watery stools are classic symptoms of an overabundant milk supply.

 

Where to get fenugreek

Fenugreek seed capsules, tinctures and teas can be purchased in many health food stores and online. You can also buy empty gelatin capsules and bulk fenugreek seed powder to make your own capsules.

 

Fenugreek tea is a weak form of the herb. For the tea: use a teaspoon of whole fenugreek seeds. Steep in boiling water for 15 minutes or so and drink three or more times a day.

 

Fenugreek sprouts are another way to eat fenugreek. Fenugreek seeds can be obtained in the bulk food section of some health food stores, or you may be able to find them at a store that specializes in Indian or other eastern foods. Soak 1-2 teaspoons of the seeds in water overnight. Pour that water off the next day (or drink it - it's fenugreek tea) and rinse seeds with clear water. Place the seeds into a sprouter (this can be as simple as a small, clear plastic clamshell carry-out container), and place on a windowsill or table with the lid slightly ajar. Rinse with water daily. The seeds will sprout in around five days.

 

Fenugreek seeds for mastitis or engorgement: Steep several ounces of seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots.

 

Other uses for fenugreek

Fenugreek has been used traditionally to treat diabetes, coughs, congestion, bronchitis, fever, high blood pressure, headaches/migraines, diarrhea, flatulence, anaemia, irregular menstrual cycles and arthritis, to ease labor pains and menstruation pain, and as an appetite stimulant. Fenugreek has also been used as an external poultice to control inflammation and dandruff.

 

Oatmeal for increasing milk supply

Eating a bowl of oatmeal, if nothing else, is healthy for mom. At best, it may be a simple way to increase milk supply.

 

Eating a bowl of oatmeal for breakfast each morning is a frequently heard recommendation for increasing milk supply. Although there is no scientific evidence regarding oatmeal and milk supply, oatmeal does seem to work for some. Many working moms have noticed that on the days they eat oatmeal for breakfast, they can pump more milk than on the days they eat something else. In some countries, "traditional wisdom" recommends eating oatmeal as a way to increase milk supply. A number of lactation consultants recommend eating oatmeal as a way to increase supply.

 

Some possible explanations:

* Oatmeal is is a good source of iron. It is known that maternal anemia/low iron levels can result in a decreased milk supply, so it makes sense that eating something high in iron might increase milk supply in some women.

* Oatmeal is a comfort food for many women. Anything that increases relaxation in mom can encourage let-down, and hence also influence milk supply.

* A use that some of the milk-increasing herbs share is that of decreasing cholesterol levels. Herbs used for both increasing milk production and decreasing cholesterol levels include fenugreek and alfalfa. Oat bran, which is in oatmeal, is also known to help lower cholesterol.

 

Suggested dosage:

One bowl of hot oatmeal (any type) every day. Some moms say that they see an increase in supply when they eat anything made with oats, including instant oatmeal and oatmeal cookies.

Side effects:

* Oats are not associated with any adverse effects

* Those with gluten sensitivity (celiac disease) should eat oats with caution

 

Medications while Nursing

 

Medications considered safe while nursing:

acetaminophen acyclovir

anesthetics local antacids

antibiotics (tetracycline and sulfa) anticonvulsants

antihistamines antihypertensives

asthma medications barium

chloroquine (antimalarial) cortisone

decongestants digitalis

diuretics ibuprofen

insulin laxatives

muscle relaxants pinworm medications

propranolol propylthiouracil

quinine thyroid medications

 

Drugs that need monitoring if used during nursing:

antidepressants aspirin

codeine demerol

ergots general anesthetics

indomethacin isoniazid

lithium metoclopramide

metronidazole (flagyl) morphine

oral contraceptives paxil

phenobarbitol prozac

valium zoloft

 

Drugs that shouldn't be used while nursing:

amphetamines anti-cancer drugs

cyclosporine lindane

methotrexate mysoline

nicotine parlodel

radioactive drugs

 

- For sources or additional information see the first post of this thread.

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  • 5 months later...

Another thing to do to increase milk supply is to eat a meal consisting of a large amount of beef. Every time I ate a steak for dinner, the next morning I'd easily pump double (was milk-sharing and tandem nursing at the time). It worked every time for me, if my supply was dropping because I got busy and needed to produce extra.

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