all posts, eczema, parentings/things about baby and kids, women's health

on breastfeeding, breastmilk, and NPR

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

A while back I took a class on breastfeeding at the hospital where I planned to deliver (North Shore Medical Center Salem Hospital). Below I’ve outlined some of the notes I took as they pertain to women’s health, as well as my own thoughts.

As many people are saying, “breast is best”, it’s interesting to look into why. Studies have shown breast feeding can help women lose some of the pregnancy weight faster as you are expelling energy to produce milk. It can also help reduce your risks of ovarian cancer, breast cancer, heart disease, and type 2 diabetes, as well as it releases hormones to calm you down.

But what’s actually going on in the body when it produces milk? The glands that produce milk (alveoli) send the milk to ducts which lead to the nipple opening. The baby draws the milk out when sucking, and the more the baby drinks, the more our breasts produce. At first we only produce colostrum, which is this fatty liquid that has all kinds of goodies like antibodies and beta carotene for our babies newly-developing immune system and gut. Then the real milk comes in after about 3-5 days. When a baby started nursing each time, first (s)he will get the foremilk which is mostly composed of water, and after feeding for a few minutes (up to 10 minutes) the hindmilk (which is a lot fattier) follows. The Letdown Reflex happens each time the baby feeds and it is when the baby has latched and the breasts transition from letting out foremilk to hindmilk. Some women can feel the letdown reflex happening (described as pins and needles or some localized tightness) but many women feel nothing.

But how does breastfeeding feel? Well, apparently it is a very novel sensation to most when the baby first latches (it definitely was in my experience) and for many it is difficult to get a good latch and takes some practice! The biggest worry is that a baby who has latched poorly and is just hooked onto your nipple and so (s)he will cause the mom pain. The way to avoid this is to make sure the baby gets more of the areola in its mouth rather than just the nipple. To detach a baby from your nipple if they are incorrectly latched, you definitely don’t want to just pull them off (ouch), but instead you should insert a clean finger into their mouth to break the suction, by running your finger along their gum line.

Also leaking is normal, especially at the beginning of breastfeeding, but it usually does slow down and stop as you continue breastfeeding and your baby gets used to it. You can use nursing pads and also press your nipple/cross your arms when you feel like you are leaking to help to try and stop it.

What about your diet; how does it affect the breastmilk? What can you eat? From this class I was told you can eat and drink anything, it’s just a matter of seeing what your baby’s reaction is (if they get gassy, fussy, hiccup-y, etc after a meal, check back to see what you last eat). Obviously some things to consider are making sure things like alcohol and caffeine are out of your system before you breastfeed (I think the advice was if you have an alcoholic drink, you don’t want to feel tipsy, and you want to wait about 2 hours before you breastfeed… but don’t quote me on those hours). Also for babies that have occult blood (invisible blood in the baby’s stool), the first things a doctor may advise you to avoid are probably dairy and soy, because they are the most common culprits that irritate the babies developing gastro-intestinal system (this is what occurred in my experience). The Kelly Mom blog has a post that goes into food sensitivities in more detail.

For pumping, the advice was not to start until 3-4 weeks unless needed and to make sure you get a pump with a suction cup that is sized correctly to your breast; you don’t want your nipple squished on the sides. The other advice was to pump in the morning, or after a baby’s feeding (I believe about 30 minutes after is the recommendation).

For general nipple care, the advice was to try using your own breast milk around the inflamed area first. Then you can try lansinoh or coconut oil on tender area, and then if it’s really bad, use manuka honey (here’s a cream made with it), but wash it off before feeding the baby.

Other painful aspects about breastfeeding include:

  • Engorgement: this occurs when you don’t breastfeed enough so your breasts become swollen and hard. Regularly nursing helps prevent this, but if you need to you can also remove milk by hand (or what’s called expressing milk) you can use a pump. Just express until your breasts are no longer hard. Cold compresses can also be used after feeding to help bring down the swelling. To express, massage the breast tissue and then grab above and below the breast with your thumb and forefinger and press back towards your chest wall, then gently squeeze, moving your hand all around to help drain multiple areas.
  • Mastitis: this is the most common problem, and it is when your breast gets infected with bacteria, causing pain. You will probably have a fever or other flu-like symptoms as well. This can occur from blocked ducts, nipple injuries, or problems with breastfeeding. You want to call the doctor if you feel this has occurred. Also also make sure to wash your hands frequently to reduce infection risk.
  • Blocked ducts: this is caused by not relieving the breasts. A blocked duct will feel sore and tender. Try taking a warm shower and apply moist heat, and/or gently massage before breast feeding. Also try expressing after feedings if you still feel engorged.
  • Yeast infection: this will cause your nipples to be shiny, red, and painful. Yeast (also called thrush) can also grow in your baby’s mouth so look for cottage cheese looking stuff in their cheeks.

Who can you call for help? Nowadays you can call your doctor, your baby’s pediatrician, and/or some hospitals also have lactation support groups (sometimes free), or lactation consultants (usually not free) that you can call to get one-on-one help.

A little more about breastmilk. In lieu of my own little own having some kind of sickness, I’ve been looking more into breastmilk’s functions. This searching led me to this internet viral photo showing how a mom’s breastmilk changed when her infant got sick. The 2013 study mentioned in that post talks about breastmilk’s immunological function and explains how when the mom or baby get sick, the number of leukocytes (aka white blood cells) in the breastmilk drastically increases to help protect them, because leukocytes help fight disease. I find that to be such a cool example of symbiosis. I personally have also noticed that breastfeeding seems to keep both me and the baby from getting some of the sicknesses that were going around (my mom, mother-in-law, and husband each got sick after the baby was born while the two moms were visiting!).

Lastly, I also read an article by NPR addressing the breastfeeding versus formula debate for poor countries.  The major points that this article made were that formula is not a godsend for impoverished countries for the following reasons:

  • formula requires water to make it, of which clean sources are not always available
  • formula causes increased risks of diarrhea and respiratory infections, and
  • formula can cost up to 30% of a families income, and subsequently families made dilute the formula to make it last longer, which reduces the amount of nutrients the baby gets per serving.

The article also talked about how it’s weird that we are constantly trying to research the benefits of breastfeeding when it’s as natural as “breathing, chewing, hearing, passing stool”. It also went on to explain that even an underfed mom can make excellent quality milk, and as for quantity, it is also enough except in the case of severe malnutrition. The latter point is interesting to me because I hear a lot of moms, including myself with babies labeled as “failure to thrive”, which essentially means our babies aren’t gaining weight at a rate that the medical professional expects. In my case, the doctor assumed I wasn’t producing enough milk and told me to supplement with formula. It turned out that my baby drank the same amount of formula as I was producing of milk, so I wasn’t the common denominator and rather my baby just drank only tiny amounts per feed. I’m curious as to why there are many medical professionals that believe many moms can’t produce enough milk when studies may be showing the contrary.

Anyway, the article ended by saying that it is up to the mom on how they want to provide for their child, however, it is important that they have accurate information to make informed decisions. This means that we would need to reform the system so doctors are never paid to handout formula samples, and on in which moms are not incentivized by free samples to use formula.

 

 

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all posts, eczema, women's health

policy and innovation around skin

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A long while back I came across this article called From IUDS to IVT – Designing for Women’s Health on medium a while back, by Emilie Lasseron. In a nutshell, she talks about the new innovations in women’s health and how it is important for creators in this realm to be mindful of their audience. Naturally I tried to pattern match this to blend into the eczema realm as well, to combine my two interests/where I’m at in life now.

Lasseron’s big 5 bullet points were to “design:

  • for passive engagement”, which was where she explained how we have a culture where we don’t really think about fertility until we start trying. I hadn’t really contemplated this concept before, but it’s so true. I would bet not many of us know if we are fertile until the point at which we try to conceive or have gotten pregnant (or unless one has had a specific procedure or sustained an injury/trauma that makes it impossible to get pregnant). It’s interesting to think about not knowing this huge aspect of our lives, especially as many women do one day want to be able to have children. At the same time, money constraints aside, how would we be able to check fertility? It seems as though even today, many women can’t know if they are fertile or not, and we see many women who try to get pregnant or go through processes like IVF and may not have success.  Our assessment of infertility is mostly “you tried and didn’t get pregnant”. But how do we know that it wasn’t just the wrong time of their menstrual cycle, or that maybe they were too stressed or some other physiological impact wasn’t the reason it didn’t work out?
  • for myths, not just the facts”, in which she explained that we have to meet people where they are at, even if that means from a perspective that may be incorrect or grounded in myths. This too was an interesting point. It makes sense because if a woman goes to see a doctor and the doctor’s first reaction is to dismiss everything the woman says because it’s not grounded in science or whatever the reason, the woman is most likely going to feel like she’s being made to feel stupid and not want to see the doctor again, rather than be open to what the doctor is saying.
  • for the conversation women want to have with their doctor”, in which she described creating tools to help women feel comfortable getting their questions out to doctors and to help them reclaim their agency. This is so important. Doctors inheriting have such a power dynamic relationship with their patients because patients come to them asking for help, and doctors use their advanced knowledge to help solve the problem. The issue is that this often results in patients completely deferring to what a doctor says without speaking up when something doesn’t feel right, or they aren’t being heard. This can be tragic, and has been one of the issues believed to be impacting the maternal mortality rates today.
  • with as few assumptions as possible”, in which she talks about not assuming women know everything about their bodies (most of us don’t), and uses the example of a period tracker app that expected you to know your cycle length before you could sign-up. I never personally know how long my cycle is as it fluctuates a lot so I probably wouldn’t use this app.
  • with side effects in mind”, in which she talks about making products that allow women to talk about/understand other side effects, an example being an app that tells you you may be more constipated during the luteal phase of your period. This would be awesome especially if it included things like “if you have X symptoms, you may be deficient in Y nutrients/vitamins and should talk to you doctor”, or things like that.

And now, how it all relates to eczema. “Design:

  • for passive engagement“. This is similar to what we see with eczema where we don’t think much about our skin until it goes nuts. It is not until the symptoms start to take over and disrupt our way of life that we feel compelled to address it.
  • for myths, not just the facts“. This is huge for eczema. From dispelling the idea that we have contracted some contagion, to explaining that no, coconut will not cure the skin, there are so many “old wives’ tales” and other myths to slog through that when talking to someone new to having eczema, it’s important to be able to calmly and concisely explain the basics and why some of the commonly heard remedies may be wholly ineffective.
  • for the conversation women want to have with their doctor“. Fear avoidance doesn’t just extend to using topical steroids. I know many people, myself included, who have to think long and hard before we are willing to try working with a doctor again. We already feel terrible about their skin, and having a doctor that reduces all our problems to a need to use corticosteroids again, or some other quick fix response is so detrimental. It is so important that we can feel able to openly talk with our dermatologist and not feel judged or scrutinized for our choices, where we are coming from in our educational journey, etc.
  • with as few assumptions as possible“. We need to stop assuming people will know exactly what they were eating, thinking, doing, how they felt, etc when their flares get worse. Eczema spreads its influence in most sectors of life, some without us realizing it is happening, and so creating apps that want really specific times and information before we can use it, or limit us to certain responses are a problem. This is like if there was an app made for eczema and it keeps requiring the patient to know exactly when the flare started, what we ate that day, how long we slept, did we encounter any new allergens, etc. It is hard to track all of these little life factors, especially if we didn’t think we were going to flare, or we are new to having to deal with severe eczema.
  • with side effects in mind“. In thinking about making apps for people to track their eczema symptoms this would be the equivalent of an app that gets you to talk about various symptoms and co-morbidities of eczema like the oozing or the flaking or the infections, the isolation or depression, etc, so that it would be easier to identify:
    • one, what stage of a flare the person is in, and
    • two, what is most common, and therefore important to address (like increasing rates of depression).

All in all it was a fairly quick read and highlighted a lot of the innovation that is and needs to continue to happen within women’s health (and could be extrapolated to what innovation needs to happen in the eczema world too) to allow for better healthcare and treatment.

Speaking of innovation, I entirely missed hearing about this event: Make The Breast Pump Not Suck, a hackathon that happened in Boston April 27th-29th last year. It was hosted to try to address not just pump technology itself, but policies around maternity leave, breastfeeding spaces at workplaces, what barriers to breastfeeding exist, how to build community engagement, and getting stories from different women about their experiences.

There were also community innovators mentioned who are doing awesome things in the field of women’s and maternity health (see here), including one in Boston called the Neighborhood Birth Clinic! The group is trying to open a free standing birth clinic in Dorchester. The event also highlighted different independent innovators like Melissa Hanna who created Mahmee, a secure platform that lets providers coordinate healthcare of both the prenatal and postpartum stages.

My dream is that there will be hackathons and the like for innovations with eczema too, besides just the Eczema Expo. And also that more and more awesome and innovated technology examples will be created to improve the women’s health community as well (especially with care for mothers of color!).