WINE AND BREASTFEEDING

Guest Post: Breastfeeding and Alcohol Consumption By Jennifer Heisleman Ingalls Breastfeeding and alcohol…it’s the season for a holiday beverage or two. What’s a nursing mama to do? Many breastfeeding moms wonder if it is safe for them to have an occasional alcoholic beverage. Controversy and misinformation surrounds this topic. The conventional wisdom is to pump and dump. Or buy the alcohol “test strips.” Or even, “If you are safe enough to drive, you are safe enough to nurse.” But what happens if mama has a few drinks and feels tipsy, maybe not safe to drive…then baby wakes up to nurse? Is that safe? Is it worth the “risk?” The breastfeeding and alcohol question is just another way that the mother-baby dyad is consistently and insidiously undermined, or “booby-trapped.” It is so hard to know where to look for information, especially for evidence-based advice. Part of the blame lies with our consumer based economy, which needs to have a product for every situation. Our consumer based economy is constantly frustrated by breastfeeding mamas. Oh dear, they make their own perfect baby food, quick, how can we get them to buy something they don’t need?!? Whether the advice is to pump and dump (which doesn’t work and what a waste of precious milk!) or to buy the test strips (someone needs to make money off breastfeeding mamas some way) the end result is that women who consider having an alcoholic beverage while nursing are faced with guilt or shame. Each breastfeeding mother who is considering having a glass of wine is just like every other mother; she simply wants what is best for her baby! So, with all of the misinformation floating around many mothers either abstain altogether out of fear, or gently imbibe with great foreboding. But neither guilt nor abstinence is necessary if you examine the physiology and pharmacology of breastmilk and alcohol metabolism. When we look at the way alcohol is processed by the body, it helps to first look at how it is transferred into the breastmilk. Some drugs and medications stay in the breastmilk until the milk that contains them is expressed or consumed. These substances are where the “pump and dump” advice comes into play. Alcohol doesn’t work like this. Alcohol in the blood maintains approximately a 1:1 ratio with the alcohol contained in the breastmilk. This means that if your blood alcohol content (BAC) is 0.08 (over the legal limit in California) then your breastmilk alcohol content is approximately 0.08%. Only eight one-hundredths of a percent of the breastmilk would contain alcohol. This 1:1 ratio also means that as you get more sober, your milk gets more “sober.” The liver is continuously processing the alcohol as it filters your blood, and the consistently dropping blood-alcohol level is mirrored by a consistently dropping breastmilk alcohol level. Many mothers will have a glass of wine or two with dinner, and then be so concerned about the alcohol content of her milk that she will pump and dump with the mistaken belief that it is necessary to rid the breastmilk of the alcohol content. But the liver is already metabolizing the ethanol and reducing the ethanol content of the breastmilk in a 1:1 fashion. So there is absolutely no need to pump and dump your milk after drinking, or the next morning. Not even if mama were to go out and get trashed. (Which I am not recommending). More confusion comes into play when people confuse the all the numbers involved. The proof of the alcoholic beverage involved does not directly equal the blood alcohol content of the mama drinking it. There are more complicated things to consider including weight, number of drinks consumed, and rate of consumption. Compare the alcohol content of the breastmilk of a legally intoxicated mama (0.08 BAC) to the alcohol content of orange juice is approximately 0.09% ethanol-by-volume (aka ABV). The legally intoxicated mama will have breastmilk which has an ABV concentration that closely mirrors her BAC, approximately 0.08. That means that mama’s breastmilk when legally intoxicated is less alcoholic than orange juice! And for mamas who only consume one alcohol beverage, their BAC (and thus the ABV of their breastmilk) is considerably lower than that found in even the most innocuous of fresh juices. I can’t tell you how many times I have heard mamas say “Well, I will just pump and dump to be sure…” And the abundance of caution is certainly understandable. But really, if the mother would feel comfortable with a child imbibing the alcohol concentration found in fresh juice, why even blink at the alcohol concentration in milk after a glass of wine. It’s not logical. So what’s the bottom line here? It is safe to have a drink and breastfeed. Moderation in everything is key, and this should in no way be construed as encouraging mothers to become intoxicated. But the reality of the science is that even when legally intoxicated, the mother would only pose a threat to the infant through loss of motor function (dropping baby, rolling over on it, etc) and not through the alcohol content of her breastmilk. Indeed, the motor impairment of an intoxicated mother is my major concern when mothers choose to drink, rather than the risk of exposing the child to miniscule, infinitesimal concentrations of alcohol. If you would like to see what your BAC would be after that one glass of wine, for example, please check out this link. I plugged a few of my personal numbers into the handy-dandy calculator for a real-life example (like the one right here: http://oade.nd.edu/educate-yourself-alcohol/blood-alcohol-concentration/bac-calculator/). Personal Case Study: I am a 123# woman who loves to have a Guinness every now and then. After baby goes to sleep I have a 12 oz. bottle of Guinness and watch a movie with DH. She wakes up fussing two hours later. Am I safe to nurse? Yes! My blood alcohol content is only 0.004948576955424729%… which is less than five-one-thousandths of a percent alcoholic. Infinitesimal. No pumping and dumping (which doesn’t work anyway as the alcohol has to be metabolized out). No spending money on test strips. No fear-mongering. About the Author: In real life, Crunchy Mama Jenn is Jennifer Heisleman Ingalls. A Registered Nurse, Jennifer obtained her M.S.N from the University of San Francisco, with a specialization in Clinical Nurse Leadership and also has a post-licensure certification in Oncology. Jennifer has worked in pediatrics, oncology, stem-cell transplant, infusion therapy, vascular access, and most recently as an Assistant Professor of Registered Nursing. But her favorite “job” and truest calling is as

REFLUX AND NATURAL REMEDIES

For my natural people THIS WAS A FACEBOOK THREAD I THOUGHT YOU WOULD ENJOY. slippery elm gruel has worked wonders on my reflux baby! Thought I'd share smile emoticon • Nancy Nels Hamm how do you use it and in what proportion etc. 9 mins • Like • • Lacey Jayne Welker Yeah, the extract? Or powder? 7 mins • Like • • Lindsay Gibson Cinnamon powder, fennel seed powder, marshmallow root powder and slipper elm powder. Its one tablespoon divided with those ingredients. Pour one cup water and bring to boil with the ingredients...summer 10 mins covered then cool. I give Layla 1/2 teaspoon after each feed and if she's extra upset or spitting up. Can't od on it...Its all food based (says pediatrician) 5 mins • Like • Lindsay Gibson No problem! Our pediatrician gave recipe so it's all ok to use! 3 mins • Like • • Nancy Nels Hamm How long does the concoction stay good 2 mins • Like • • Lindsay Gibson Store in fridge and can warm up each day a small amount to use! Also breastfeeding mommas can drink 3 to 4 cups daily as well 2 mins • Like • • Lindsay Gibson So one cup good for 4 to 5 days so I make just one cup a time for her and I make my own batch for me drink 1 min • Like • • Lindsay Gibson If a mom wants to try...tell her give it 24 to 48 hours to really take effect. The ingredients in it soothes esophagus and stomach so it takes a bit to work • • • • Lindsay Gibson I give her the alhoe if she's extra gassy/spitting up. But the main thing is when she does spit up, even if it's forceful she doesn't cry! Crying would cause her spit up even worse! She went from spitting up bad after every feed to only once or twice! ...See More 2 hrs • Like • • Robin Pierce Norris So are you refe

HOW TO CORRECTLY FIT BREAST SHIELDS

Choosing a Correctly-Fitted Breastshield Choosing the right size PersonalFit™ Breastshield If you are using a breastpump to remove milk for your baby, it is very important that you have correctly-fitted breastshields. The breastshield is the part of the pump kit that fits directly over your nipple and forms a seal around the areola (the darkened part of your breast). The breastpump works by creating a vacuum, which gently draws your nipple into the tunnel of the breastshield – just like your baby would draw it into the mouth with sucking. A correctly-fitted breastshield will make your pumping comfortable and allow the pump to remove as much of your milk as possible each time you pump. Medela PersonalFit™ breastshields are available in five sizes: Medium (24mm), which is the size that comes with Medela’s breastpump kits; Small (21 mm), Large (27 mm), Extra Large (30 mm), and XX Large (36mm). Medela’s breastpump kits make it easy to use a larger or smaller breastshield, because all sizes are designed to fit into the same connector on the kit. Many women appear to benefit from a size other than the standard 24 mm breastshield. It is almost impossible to tell which size breastshield is the best fit without watching the nipple movement during pumping. The following tips will help you determine whether a different size breastshield would be right for you. Remember the word ‘COMFY’ to determine whether you might need a different size breastshield. The term was designed to help you remember five specific guidelines about breastshield sizing. The following identifies these five guidelines: ‘COMFY’ C – Centered nipple which moves freely. Look at your nipple as it is drawn into the tunnel of the shield during pumping. It should move freely and easily and should not rub against the sides of the tunnel. If the breastshield fits tightly, your nipple will rub against the sides of the tunnel with each vacuum movement of the pump. O – Only a little or no areola tissue is pulled into the tunnel. When your nipple moves freely in the tunnel of the breastshield, you will also notice a gentle pulling movement in the areola each time the pump cycles. If you do not see any movement in the areola with the pump vacuum, the breastshield is probably too small. If you see a lot of movement of your breast or a large amount of areola tissue is pulled into the tunnel, the breastshield is probably too big. M – Motion of the breast is gentle and rhythmic with each cycle of the pump. Just as you should see gentle nipple movement each time the pump cycles, you should also see gentle breast movement. This breast movement suggests that the breast is getting proper stimulation while pumping. F - Feels comfortable pumping. Pumping should be comfortable for you and should not cause nipple pain or tenderness. If you feel any pain or tenderness, your breastshield is probably too small. Y – Yields a well-drained breast.Your breasts should feel soft after each pumping session. An incorrectly-fitting breastshield can affect how your breasts empty and lead to problems with milk supply. During pumping, your milk flows out of the breast due to the pump’s vacuum and your milk ejection (or “let-down”) reflex. However, an incorrectly-fitting breastshield does not allow good breast emptying-even with the best breastpump and a strong milk ejection reflex-because it squeezes the small ducts inside the nipple that carry your milk out of the breast. Ordinarily, these ducts increase in size when you feel milk ejections so that the milk can flow out of the breasts quickly and easily. However, if the ducts are squeezed by a too small breastshield or not emptied by a too large breastshield, some milk stays behind in the breast. Eventually, this incomplete milk removal can lead to plugged ducts, mastitis, and problems with low milk volume. You may note breast engorgement that seems to last a long time – or little ‘knots’ or hardened areas in the breast that do not seem to empty with milk expression. If you experience nipple tenderness around the outside surface of the nipple or problems with breast emptying-your pumping will probably be improved with a different size breastshield. You will want to correct these problems as soon as possible. Sometimes you may experience discomfort at the base of the nipple due to rubbing of your breast tissue with the breastshield tunnel. Use of a lubricant such as Tender Care™ Lanolin may be beneficial. For more information or to purchase Medela’s PersonalFit breastshields, contact your lactation professional.

Great video on breastfeeding

Are Noise Machines safe?

There has recently been research done that indicates that white noise machines are not good for the baby's hearing. A new study in Pediatrics suggests that some noise machines can produce sounds so loud that they could potentially damage infants' hearing and auditory development. Here is what Dr. Karp has to say about that. Surprisingly, babies cry usually reach levels up to 100 dB (as loud as a power lawnmower...and 10 times louder than a hair drier ). Loud sounds, like vacuum cleaner and hair drier sounds, have been recommended by pediatricians and parenting books for decades to calm fussy babies. But, it is very important to remind parents to only use very loud noise during infant crying. However, the new study just released by the journal Pediatrics omitted 3 critical points: 1) In the womb, all babies are exposed to the sound of whooshing through the arteries...that is louder than a vacuum cleaner (measured at 75-92dB)...24/7. 2) Moderate sound - used all night - is perfectly safe and has been shown to be helpful in boosting sleep, which is why so many families use white noise CDs and downloads. 3) Noise injury is primarily related to the high pitch of sound. The 3 sleep sounds on The Happiest Baby white noise CD are specially engineered to reduce high pitch and amplify low pitch frequencies. That makes them safer...and makes them closer to the sounds babies actually hear in the womb than any other source of white noise. When considering recommending white noise for babies, it is extremely important to consider the potential life saving benefits of white noise. Poor infant sleep causes parent exhaustion..and that leads to many very dangerous situations...including postpartum depression, maternal obesity, child abuse and sleep deaths because the exhausted parents put the baby on the stomach or bring the baby into their bed...which causes ~1000 accidental suffocation deaths/year. By enhancing sleep (and reducing crying) low pitched, rumbly white noise may help prevent these very serious problems. So when a baby cries, increase sound level - for a few minutes - to the level of a vacuum cleaner. And, for safe naps and all night sleeping keep the sound about the level of a soft shower. (Encourage parents to place the sound within a few feet of the baby's sleep area...and to listen to the sound themselves...to judge whether it is too loud.) In the study's conclusion, the authors correctly recommend sound machine sellers to instruct parents on the dangers of loud sound played for extended periods. However they cite no evidence to support their recommendations that the sound needs to be as far as possible and as quiet as possible. If sound is played not at an adequate level, it completely fails to work. There is a "sweet spot" that is effective to promote sleep (65-70dB all night)...and a totally different "sweet spot" (~90dB) to stop crying. http://www.cnn.com/2014/03/03/health/noise-machines-study/

Scientists Discover Children’s Cells Living in Mothers’ Brains

Dec 4, 2012 |By Robert Martone The link between a mother and child is profound, and new research suggests a physical connection even deeper than anyone thought. The profound psychological and physical bonds shared by the mother and her child begin during gestation when the mother is everything for the developing fetus, supplying warmth and sustenance, while her heartbeat provides a soothing constant rhythm. The physical connection between mother and fetus is provided by the placenta, an organ, built of cells from both the mother and fetus, which serves as a conduit for the exchange of nutrients, gasses, and wastes. Cells may migrate through the placenta between the mother and the fetus, taking up residence in many organs of the body including the lung, thyroid muscle, liver, heart, kidney and skin. These may have a broad range of impacts, from tissue repair and cancer prevention to sparking immune disorders. It is remarkable that it is so common for cells from one individual to integrate into the tissues of another distinct person. We are accustomed to thinking of ourselves as singular autonomous individuals, and these foreign cells seem to belie that notion, and suggest that most people carry remnants of other individuals. As remarkable as this may be, stunning results from a new study show that cells from other individuals are also found in the brain. In this study, male cells were found in the brains of women and had been living there, in some cases, for several decades. What impact they may have had is now only a guess, but this study revealed that these cells were less common in the brains of women who had Alzheimer’s disease, suggesting they may be related to the health of the brain. We all consider our bodies to be our own unique being, so the notion that we may harbor cells from other people in our bodies seems strange. Even stranger is the thought that, although we certainly consider our actions and decisions as originating in the activity of our own individual brains, cells from other individuals are living and functioning in that complex structure. However, the mixing of cells from genetically distinct individuals is not at all uncommon. This condition is called chimerism after the fire-breathing Chimera from Greek mythology, a creature that was part serpent part lion and part goat. Naturally occurring chimeras are far less ominous though, and include such creatures as the slime mold and corals. Microchimerism is the persistent presence of a few genetically distinct cells in an organism. This was first noticed in humans many years ago when cells containing the male “Y” chromosome were found circulating in the blood of women after pregnancy. Since these cells are genetically male, they could not have been the women’s own, but most likely came from their babies during gestation. In this new study, scientists observed that microchimeric cells are not only found circulating in the blood, they are also embedded in the brain. They examined the brains of deceased women for the presence of cells containing the male “Y” chromosome. They found such cells in more than 60 percent of the brains and in multiple brain regions. Since Alzheimer’s disease is more common in women who have had multiple pregnancies, they suspected that the number of fetal cells would be greater in women with AD compared to those who had no evidence for neurological disease. The results were precisely the opposite: there were fewer fetal-derived cells in women with Alzheimer’s. The reasons are unclear. Microchimerism most commonly results from the exchange of cells across the placenta during pregnancy, however there is also evidence that cells may be transferred from mother to infant through nursing. In addition to exchange between mother and fetus, there may be exchange of cells between twins in utero, and there is also the possibility that cells from an older sibling residing in the mother may find their way back across the placenta to a younger sibling during the latter’s gestation. Women may have microchimeric cells both from their mother as well as from their own pregnancies, and there is even evidence for competition between cells from grandmother and infant within the mother. What it is that fetal microchimeric cells do in the mother’s body is unclear, although there are some intriguing possibilities. For example, fetal microchimeric cells are similar to stem cells in that they are able to become a variety of different tissues and may aid in tissue repair. One research group investigating this possibility followed the activity of fetal microchimeric cells in a mother rat after the maternal heart was injured: they discovered that the fetal cells migrated to the maternal heart and differentiated into heart cells helping to repair the damage. In animal studies, microchimeric cells were found in maternal brains where they became nerve cells, suggesting they might be functionally integrated in the brain. It is possible that the same may true of such cells in the human brain. These microchimeric cells may also influence the immune system. A fetal microchimeric cell from a pregnancy is recognized by the mother’s immune system partly as belonging to the mother, since the fetus is genetically half identical to the mother, but partly foreign, due to the father’s genetic contribution. This may “prime” the immune system to be alert for cells that are similar to the self, but with some genetic differences. Cancer cells which arise due to genetic mutations are just such cells, and there are studies which suggest that microchimeric cells may stimulate the immune system to stem the growth of tumors. Many more microchimeric cells are found in the blood of healthy women compared to those with breast cancer, for example, suggesting that microchimeric cells can somehow prevent tumor formation. In other circumstances, the immune system turns against the self, causing significant damage. Microchimerism is more common in patients suffering from Multiple Sclerosis than in their healthy siblings, suggesting chimeric cells may have a detrimental role in this disease, perhaps by setting off an autoimmune attack. ABOUT THE AUTHOR(S) Robert Martone is the Neuroscience therapeutic area lead for The Covance Biomarker Center of Excellence located in Greenfield, Indiana. He is a research scientist with extensive experience in drug discovery for neurodegenerative diseases.

Is a man's brain damaged in gestation?

Medical research studies have shown that in the womb, between the 18th and 26th week of gestation, something happens that forever separates the sexes. If the baby is to be a boy, a chemical bath of different sex-related hormones washes over the brain, causing several important changes that never happen to the brain of a baby girl. Quite simply, the hormones which flood a baby boy’s brain cause the right side of the brain to recede slightly and destroy some of the fibers that connect the two sides. And one result is that, in most cases, a baby boy starts life more left-brain oriented from birth. The left side of the brain houses more of the logical, analytical, factual, and aggressive centers of thought. What about little girls? From the moment of birth, because they don’t go through this chemical bath, little girls are more global or “two sided” in their thinking. Electrical impulses and messages go back and forth more quickly between both sides of a little girl’s brain. Females spend most of their time camped out on the right side of the brain. Over on that side are the centers for feelings and emotions, as well as the relational, language, and communication skills. “Now, wait a minute,” you may be saying. “Are you telling me that males are, therefore, brain damaged?” I guess that’s one way to put it. You might be interested to know about a Stanford study of children. An experimental laboratory was set up where children had opportunities to work at a number of different tasks, according to their choices. The researchers observed children for 20 minutes per child. The average time a girl worked at one task was 12.5 minutes; the average boy worked 6.5 minutes per task. Boys interrupted what they were doing almost twice as often as girls. Girls finished nearly everything they started; boys completed only half of their starts. For the boys, a new category had to be added: watching others. They spent 4.5 minutes “watching.” And the boys tackled twice as many three-dimensional tasks as girls attempted. One-third of the boys took toys apart; none of the girls did. Perhaps most interesting was that girls monitored their entire activity and time with speech, almost continuously. They offered advice and information, and asked for help. It was recorded that, “Boys used more noises, uttered commands and expletives, and used more abrupt phrases, such as, ‘Look at me.’” http://runningtheraceblog.squarespace.com/journal/2010/2/6/are-men-really-brain-damaged.html