Posts in Breastfeeding
Answers to Your Questions About Postpartum
Woman holding baby in carrier in forest

Most questions we received this week were related to Postpartum OCD (ppOCD), so our brilliant and kind Dr. Michelle expounds on the topic here.  

Postpartum OCD (ppOCD) is an anxiety disorder characterized by intrusive, unwanted, and repetitive thoughts, images, or urges (obsessions), which may or may not be accompanied by compulsive behaviors. While the exact cause of ppOCD is unknown, experts believe that it results from a combination of hormonal, psychological, genetic, biological, psychosocial, and environmental factors. Obsessions and compulsions can take many forms for different people and usually focus on the baby.

Obsessional thoughts might include:

  • I’m terrified my baby will get sick and die.

  • What if my baby stops breathing in the middle of the night?

  • I’m scared someone will steal my baby if we go out in public.

  • What if I accidentally or intentionally act on an urge to stab my baby?

  • Why do I keep having an image of my baby falling off the changing table?

Compulsions can include:

  • Repeatedly checking on the baby’s breathing in the middle of the night

  • Excessive bathing and washing rituals

  • Repeatedly asking others for reassurance that baby is okay

  • Taking great measures to avoid the baby

Obsessions are unwanted, difficult to control, and increase anxiety. In order to neutralize the anxiety associated with these obsessions, one might then engage in overt or mental compulsions or avoidance. For example, a mother might have repetitive images of something terrible happening to her baby while driving in the car. As a means to decrease the anxiety associated with this thought, she may avoid driving anywhere with her baby. Another mother might have unwanted thoughts that she will act on an urge to intentionally harm her own baby.  This mother might then begin to avoid her baby altogether. It is important to understand that in the latter example, this mother does not have these thoughts because she actually wants to hurt her child, but rather she is terrified that she might act on these thoughts. The obsessions are unwanted and conflict with a person's self-image and character.

According to the International OCD Foundation, up to 80% of new mothers report having strange, unwanted thoughts. This means that most new parents have similar experiences with anxiety and intrusive thoughts, but would not be diagnosed with Postpartum OCD. A diagnosis of OCD might be made when preoccupation with the intrusive thoughts is clearly disruptive to a mother’s normal functioning and greatly interferes with her ability to care for herself and her baby. It is no surprise that this can have devastating effects on the parent-child relationship and highlights the immense need for treatment. Due to the fear of stigma and feelings of intense shame, however many women are resistant to seeking help. If you or anyone you know is experiencing these symptoms please know that you are not alone and it is okay (and important) to reach out for help from a qualified and licensed mental health professional.

Others of you wanted to learn a little more about psychological and emotional responses to weaning. Dr. Michelle responds here: 

It is not uncommon for women to feel tearful, depressed, irritable, or anxious when weaning. Not much research exists on this topic, but some hypothesize that a shift in hormones when weaning may be a major cause for these feelings. Other factors might involve feelings of sadness around the loss of this special time with your infant. These mood changes usually go away on their own, but some weaning mothers may experience more severe symptoms that require treatment.

A Laywoman’s Guide to Breastfeeding Pro Tips
Woman breastfeeding

By Ellie Bergmann

Mom of 2 boys, social worker & addiction therapist, and wife to a cyclist & ski enthusiast (aka: nut)

What I’ve learned from opening up and chatting with other moms has been the gold of motherhood. Professionals like lactation consultants and postpartum doulas are angels. But I’ve gotta say: I’d be lost without the street smarts of other moms. So here’s a stream of consciousness account of some of my favorite pro tips learned in the (mother) hood.

With my first babe, breastfeeding and subsequent breast pumping went smoothly. I had enough milk, I didn’t experience pain, I had a few clogged ducts along the way, but all in all, it was manageable and enjoyable. I reached the one year goal I set and had to wean my supply. My son was over it within a day. My milk wasn’t. I talked to a few people and they suggested to take Sudafed for a few days, and it dried my milk right up. It was astonishing. This was after weeks of engorged pain and attempting to slowly pump less and less, all the while sporting a sexy cabbage leaf bra, even at work. None of this worked for me. But pop a few Sudafed? BAM, milk was gone.  That was my first pro tip.

What I’ve learned from opening up and chatting with other moms has been the gold of motherhood.

This time around with baby boy #2, I had a surplus of milk the first few months. Like, had-to-buy-a-deep-freezer-for-the-garage-in-order-to-store-all-the-milk, kind of surplus. Great right? Sure. Until baby started to sleep mostly thru the night (you hate me now and are about to stop reading, but hear me out) and my milk supply dipped. Suddenly at work I was pumping HALF of what he was consuming. I was NOT ready to stop or reduce breastfeeding. Baby was 7 months old. So again, I reached out to people. I talked to lactation consultants, I emailed lactation supplement people, I talked to moms, I talked to a dude at work who remembered his wife’s tips! I was desperate; I wouldn’t shut up. And again, I learned some tools that were revolutionary! And seemed so basic! How could I not have known these little tricks? Where is the universal manual that provided these gold nugget tips?  Am I the only one who doesn’t know how to pump?

One sneaky little tip was to hand express some milk upon finishing pumping. I was skeptical at this one. I just finished pumping? Why would I hand express an empty boob? Time waste…until I tried it and got probably 2 additional oz out. AFTER PUMPING. That was mind blowing. So not only getting more milk (BONUS) but also sending the message to your body to MAKE MORE MILK. So I’ve been doing that regularly and my milk supply is on the up!

Another tip related to that is to hand express about 10 mins AFTER pumping to mimic cluster feeding. I haven’t tried that but man, I now don’t doubt it.

Also, change out the little membranes on the valves of your pump. I hadn’t been doing that. Didn’t realize I needed to. They are the piece that help suction out milk.  Did that and noticed a difference. AMAZING.

Here are some other tips: make an appointment with your baby (AKA your pump) and put it on your calendar. If you have a shared calendar at work, first, my condolences. Second, call it a “hold” and keep the appointment like it’s with Michelle Obama. Space your sessions out about 2.5-3 hours apart, maybe even timing them to your baby’s feeds. As hard as it is to do, really try and shift out of your working day mentality by taking a few deep breaths with your eyes closed, thinking of or looking at photos of your baby, and/or facing away from your computer -- at least until letdown.

Make an appointment with your baby (AKA your pump) and put it on your calendar. Call it a “hold” and keep the appointment like it’s with Michelle Obama.

Speaking of letdown, the stimulation mode can be your best friend. It’s so tempting to skip ahead to the main event, but your baby always stimulates first. And they are the real experts.    

Don’t forget to eat, and drink, drink, drink. Bring a container you love to work, and try to drink 32 ounces or more of straight water. And eat healthy fats (avocados, walnuts, nut butters, Totum Treats [editor’s note, oopsie!] etc.). If you’ve found a lactation tea you like, put it in your insulated thermos with some almond milk and honey.  It’s your little secret stash.  

And then of course, the power pump. I hadn’t even heard that phrase with my first son. Probably because I was smooth sailin’ with a strong milk supply and a good eater. But with babe #2, I was told a few times by the pros to power pump. Here’s the deal with a power pump.  So after you pump a regular session, however long that is, you then take a 10 min break (those nipps need a rest, sis), then return and pump for 10 mins. Then stop for 10 mins. Then pump for 10 mins. And repeat. So you are pumping for 30 mins total over an hour. I initially did that for 3 days but was informed, again when I wouldn’t stop yapping about my reduction in milk supply, that to see a difference, do it for one week. 7 days. It’s brutal, but it’s WORKING .

Shift out of your working day mentality by taking a few deep breaths with your eyes closed, thinking of or looking at photos of your baby, and/or facing away from your computer — at least until letdown.

I’m mid-way thru this power pump jam. Wish me luck. Wish my milk supply luck. Here’s hoping I return to Dairy Queen status.  I am not ready to stop, and judging from baby boy reaching for my shirt, he’s not ready to stop either. And lest we forget how this baby refuses new things and takes MONTHS to come around; See: taking a bottle (went on hunger strike for 1.5 months when I returned to work) and baby food: gross. No way. Pass. The thought of an attempt to introduce formula to this baby seems impossible. Another reason to be diligent in increasing my milk supply. Hopefully some of these suggestions contain some helpful new info for the moms out there.  If so, pass it on. Get it Bosses.

Ellie Bergmann
The Story Behind the First At-Home Breast Milk Test

by Dr. Stephanie Canale

When I was breastfeeding my second child, I had so much milk that my husband and I joked that we’d have to buy an extra freezer!  Supply was never my problem. But when I returned to my medical practice around 5 weeks after my second daughter’s birth, pumping in my office in between seeing patients, something changed. My daughter stopped gaining enough weight, and she even stopped pooping. I was panicked.

I had enough stress juggling my medical practice, being on call, and doing hospital work while also caring for my older child. Now this? And I was perplexed - even though my supply appeared to be sufficient, something must have been off with the quality of my milk. The scientist in me wanted to know exactly what was in my milk and what I could do to help my baby thrive.

Extensive literature searches revealed blanket statements about the overall benefits of breast milk, but no tools or tests existed to find measurable, objective data. I wanted to confirm that I was providing my child with the nutrients she needed, and more, and I wanted to be able to help my patients, too. In my medical practice, many mothers expressed the same concerns about the quality of their breast milk and frustration with the inability to uncover any information about it through lab testing. 

The scientist in me wanted to know exactly what was in my milk and what I could do to help my baby thrive.

Faced with these questions and an obvious need for answers, I decided to use the academic resources available to me, consult with my colleagues and develop a unique, comprehensive set of tests specifically for breast milk. I spent over a year working with top chemists to develop a simple, at-home breast milk test to empower moms with nutritional information such as fat and calories, vitamin and mineral content and even whether their breast milk contained potentially toxic substances such as arsenic or mercury.

I made the test available first to the patients in my practice, with astounding results. I learned that while we’re all conditioned to worry about our breast milk supply, it’s actually quality, not quantity that matters most. And many of the assumptions that we have about breast milk may be wrong - especially, that all breast milk content is the same.

One mom whose baby wasn’t gaining weight took the test and found that her breast milk was extremely low in fat and calories. A simple switch to a fuller fat diet helped her baby start gaining weight.

Another mom took our premium test and found elevated levels of arsenic in her breast milk, originating from regular consumption of rice at dinnertime, which was easily remedied by reducing her rice intake.

One mother was found to have high levels of mercury, and we discovered it was her fish oil supplements. We changed her to a plant-based supplement and the levels decreased within one week. Another mother was found to have high levels of mercury which was directly related to eating sardines and tuna. She stopped eating fish and her levels went undetectable. (For more on which fish to avoid while breastfeeding, check out these FDA guidelines.)

I learned that while we’re all conditioned to worry about our breast milk supply, it’s actually quality, not quantity that matters most.

Several moms found low levels of DHA in their milk, which has been proven to support a healthy nervous system and most important for brain development. Many moms stop taking their prenatal vitamins after their baby is born, some women simply forget, and some are not sure about what they should take. Everyone knows about prenatal vitamins but there are few “postnatal” vitamins available. I am asked almost on a daily basis “well now that I am breastfeeding what should I take”? After re-starting DHA supplements, most moms I treat see noticeable improvement in under two weeks.

Seeing the value of our tests to my patients, I made the tests available commercially earlier this year through Lactation Lab, a company founded by me and my husband Eric.

Totum Women Dr. Stephanie Canale

Back to the story of why my baby wasn’t gaining weight despite adequate supply, I started to supplement my breast milk with formula, despite knowing the benefits of breastfeeding and wanting to continue. My daughter did start to gain weight and the problem resolved best when she started on solid food. I’m happy to say she loves to eat!

That said, I do believe that the quality (and quantity) of many mothers’ milk drops when they go back to work for several reasons. In general, working moms are just plain busy. They have less time to eat well and drink enough water and have more stress overall. Many moms do witness a drop in supply, but it’s important to consider the overall quality of milk as well. It’s critical for working breastfeeding moms to remember to take care of themselves, because that will affect the health of their baby.

Each test that we complete through Lactation Labs is helping us to learn more about how moms can give their babies the best nutrition possible. Short term, it’s very gratifying to see a mother’s frustration transformed into confidence; to know that a simple and accessible test can open up new vitality for a newborn baby. Long term, I’m optimistic that patterns we see through the results of these tests will give way to new discoveries about what makes breast milk so powerful.

It is my hope that the scientific knowledge gained by this research will ensure that mothers everywhere raise the healthiest babies possible.

Moms wishing to try Lactation Lab’s breast milk testing kits can receive 20% off their order by using promo code TOTUM at checkout. (Offer valid through March 31, 2018)