Ask Judy: How Do I Know If I Am Using The Correct Sized Breast-Flanges For My Breast Pump?

Dear Judy, I was reading your articles and wanted to ask you a question that you might know about: how do I know what size flange came with my breastpump? Also, how do I know what size I need? I’m not having discomfort and I get plenty of milk, but I noticed that some of the tissue at the very beginning of my breast, where the nipple and breast meet, gets pulled into the pump. I think I have small nipples and wasn’t sure how to figure out this stuff about the flange fit. — Amy

Hi Amy,

If you have a Medela pump, it came with 24 mm flanges. If you have an Ameda pump, it came with 25 mm flanges. Most moms need somewhere between 21 and 28 mm. If your nipple is touching the sides at all, you probably want to go up a size. Be sure it is your nipple touching and not your breast tissue. If your breast tissue is touching, then you may want to go down a size (may be too large).

Your nipples will typically swell when you have a let down, so even if they are small to start, they may get larger when expressing milk. Look at how they fit during let down. You want to make sure that your nipple is not hitting the sides of the flanges while you are expressing milk. This can cause discomfort and low milk output. You also want to make sure that your breast tissue (beyond just your nipple) is getting pulled into the flange as this might mean that your flanges are too large.

For more information on getting the correct fitting flange, please download this article.

To Wear Or Not To Wear: Are Baby Slings Safe?

Yesterday, the U.S. Consumer Product Safety Commission issued a warning on Baby Slings. This statement warns especially about “bag-style” baby slings and the potential for a baby to suffocate while in one of them. A group of sling manufacturers go together and issued a press release about the safety of baby slings following this warning. We have copied the press release in it’s entirety here:

Not All Slings Are Created Equally: Baby Sling & Carrier Manufacturers Speak Out On Baby Sling Safety Warning

Baby sling & carrier manufacturers speak out on baby sling safety warning and Associated Press article.

Dallas, TX (PRWEB) March 11, 2010 – With the publication of an Associated Press article regarding the CPSC government warning on baby slings and the Consumers Union’s concerns about “bag-style” slings, the companies co-sponsoring this release are taking a stand to help educate the public on the differences between safe vs. unsafe baby slings and carriers as detailed below.

The ancient practice of babywearing made its way into western culture in the 1960s and its popularity with American consumers has grown because of its vast benefits. Unfortunately, this has led to the creation of several potentially unsafe baby slings and carriers. Slings and carriers of concern are popularly categorized under the token term “bag-style” slings. In “bag-style” slings, the deep pouch where baby sits puts the baby in a potentially suffocating curved or “C” like position. Also, excessive fabric with an elasticized edge may cover baby’s face inhibiting breathing. Furthermore, the design may cause the baby’s face to turn in toward a caregiver’s body, potentially smothering the baby.

In contrast, shallow pouch-style slings, ring slings, mei tais and wraps hold baby in proper alignment and they fit snugly by design and instruction. They have been engineered, developed and tested by parents, often the manufacturers themselves with their own children. These carriers are often simple and without gimmicks. Dedicated and concerned manufacturers of these types of safe slings and carriers have sponsored this release.

Because of the popularity and gaining market share of small baby carrier companies, a few years ago the Juvenile Products Manufactures Association (JPMA) was approached by a handful of these companies asking for a standard to be created. These companies were initially alarmed by the creation of some carriers, mostly by home crafters, fashioned from materials unsuitable for baby products. Soon after, M’liss Stelzer, a pediatric nurse, did an oxygenation study discovering a potential link between infant deaths and “bag-style” style slings therefore creating even more need for the standard as well as further study.

Upon this need the ASTM, an internationally recognized creator of standards for consumer products and test procedures, created a subcommittee for Sling Carrier Standards. The ASTM Subcommittee is made up of manufacturers, consumer advocates and government officials from the US and Canada including members of the CPSC. The subcommittee started writing the standard two years ago. In this time more deaths have occurred, all linked to the “bag-style” sling being reported by Jennifer Kerr, a writer for the Associated Press in the article referenced in the first line of this release. This has alerted the CPSC to take necessary action and issue this warning.

In well-designed products, babywearing is not only safe, but is actually very beneficial when done properly. Studies have shown that quality baby slings and carriers have been shown to save lives, improve health, decrease crying, increase IQ, and facilitate breastfeeding and bonding. For examples of these cases and further reading see “Increased Carrying Reduces Infant Crying: A Randomized Controlled Trial” an article written by Urs A. Hunziker MD and Ronald G. Barr MDCM, FRCP(C), “Saving My Baby” a blog post written on Fierce Mama’s Blog by Sarah Kaganovsky and Dr. Maria Blois’s book Babywearing.

Studies have also shown that worn babies are happier and spend more time in the quiet alert phase. In this phase they benefit more than their non-worn peers in language development and knowledge acquisition. Babywearing also helps babies sleep better, and physical needs, including breastfeeding, are met more quickly by a close, responsive parent. Millions of babies over time have been worn to their benefit making baby slings and carriers more of a necessity than the often-publicized fashion accessory. (Source La Leche League International)

The vast benefits of babywearing should not be disregarded with the report of incidents from “bag-style” slings. The sponsors of this release make safer baby slings and carriers and have been active in the standard writing process and are dedicated to safety through engineering. “We see this as an opportunity to reach out and educate American consumers. We hope to provide valuable information allowing parents and caregivers to not only make informed buying decisions, but also to increase the awareness of how to properly wear children, especially babies, in baby slings and carriers,” says Kristen DeRocha, ASTM Subcommittee Chair. The Associated Press article regarding the CPSC warning gives proof to the growing popularity of baby slings and carriers and validates the need for education.

Several trusted websites exist to aid in the education of babywearing for caregivers and new parents. To name a few: TheBabywearer.com, the Facebook fan page for Babywearing Safety, Mothering.com and LaLecheLeague.org.

This press release was sponsored by:
Hotslings, Maya Wrap, Moby Wrap, Wrapsody, Gypsymama, Together Be, Kangaroo Korner, Taylormade Slings, Scootababy, Bellala Baby, Catbird Baby, SlingEZee, ZoloWear, HAVA, SlingRings and Sakura Bloom

The bottom line: The practice of babywearing and all of the known benefits have been documented and proven. Babywearing is an ancient tradition and has very valuable benefits. For maximum safety, BE SURE that you are wearing your baby properly and that you have a good fitting sling. Local groups exist all over the country which teach proper babywearing.

Spring Is In The Air

Lift And Support And Fit…Oh My!

I just received a brand-new nursing bra in my store (making it 50 different types of nursing bras that I carry – HOLY COW!). It is called the Smoothing Underwire Nursing Bra and it is made by Elomi (part of the Eveden family of bras designed specifically for women with larger busts). I ordered this bra because I am always on the look out for good nursing bras – especially ones that come in large cup sizes. And one combination that seems to be especially difficult to find is a bra that comes in large cup sizes AND has an underwire. I don’t know why – but this is almost impossible to find! Well – it’s impossible to find one that is comfortable anyway….

Well, I’ve found it! And when I tried this bra on, I found myself singing “Lift and Support and Fit … Oh MY! Lift and Support and Fit …. OH MY!” (to the tune of Lions and Tigers and Bears Oh My!) This bra is fantastic! It gives great lift (important when your breasts are the size of small or in some cases large melons!). It gives great support - again very important when you have large breasts and it fits FANTASTIC!! The underwire is comfortable, the cups are flattering to your figure and it places your girls – right where they belong – IN THE CENTER OF YOUR CHEST - not down in your belly!

This bra comes in sizes 34-48, DD-K. The sizing is a “funky” in that they use some European sizing standards which we North American’s are not accustomed to – but I have put “equivalent” sizing on my site so that you can get a better idea of which size to order.

If you have large breasts – then this is the bra for you! Try one out today! “Lift and Support and Fit … Oh MY! Lift and Support and Fit …. OH MY!”

Disclaimer: I received a free sample of this bra in order to decide if I wanted to order it for my store or not. I was not expected nor asked to write a review of it. I did that purly of my own volition because I was so super impressed with how truely wonderful this bra is!

Ask Judy: When Will My Baby Sleep Through The Night?

Dear Judy: Well, I know that every baby is different and all will finally sleep through the night whenever they’re ready, but at 6 months, my daughter is still not sleeping through the night (she did it 3 times over the course of last month, then it stopped). Various people have told me that this is because she’s not learning how to put herself back to sleep because I breastfeed her everytime she wakes up. They’ve told me that she’s conditioning herself to need the breast to get to sleep. She’s always been a big comfort nurser, it’s how I get her to bed every night, and honestly, it seems like they’re right — she won’t go back to sleep unless she breastfeeds (pacifiers, bottles of breastmilk, rocking, etc. don’t really work). She doesn’t eat much at these feedings, and they’re occurring every 3-4 hours, so I don’t think it’s a hunger issue.
I don’t want to give up opportunities to breastfeed her because I work full time and one lunch feeding plus evening/night feedings are what I have left, but if I’m creating a child that won’t sleep, that’s not good either.
It’s a big worry because she doesn’t sleep much at all during the day (seriously, this child will NOT nap), so I want to maximize the sleep she’s getting at night. Thanks, Krista

Hi Krista, Sleep is probably the “issue” with the most divergent opinions when it comes to babies. The truth is – every baby is different and every baby has different needs. Many breastfed babies wake frequently at night. You have to remember that your baby’s belly is only as large as her little fist - so even though she is six months old, she may need to eat during the night to help her get back to sleep. You might want to try waking her up a bit when she wakes up so that she gets a bigger feed and then put her back down. If she gets more in, she may stay asleep longer than if she just takes a nibble and falls back to sleep. There is a great article on babies and sleeping which you can read here.

Also, keep in mind that when doctors talk about “sleeping through the night” they mean that your baby goes for 5 hours without waking. Sleeping through the night does not mean sleeping all night long! Your baby may be “sleeping through the night” more often than you realize.

Have you considered co-sleeping? My son started sleeping through the night at age 4 weeks (yes I was VERY lucky!). When he was 4 months old, I went back to work and within 2 days of returning to work, my son started waking during the night to feed. You mentioned that you also work – so your daughter may be waking up to spend time with you. Once I started working again, my son was up all night nursing. He didn’t eat very much during the day with his caregiver and did the majority of his nursing at night. To get some sleep myself, I started co-sleeping with my son. He would go down in his own bed at 8 PM and then when he woke up at 1 AM or so, I would bring him into my bed. He would then nurse whenever he wanted and we would both get much more sleep! My husband used to tell me that he would wake up during the night – my son would be nursing away and I would be sound asleep. This worked until he was about 11 or 12 months old and he got too squirmy to sleep with – then I transitioned him back to his own bed.

You may want to try co-sleeping. You can read a great article about it here.

I’m sorry that I don’t have anything “concrete” to help you – but all I can say is YOU KNOW YOUR BABY better than anyone else – if you think this is what she needs, then it probably is. Don’t worry what others are telling you – do what is right for you and your baby.

Did you have sleep issues with your baby? How did you overcome them? Please leave a comment with any tips or tricks that worked for you!

Comfy Cozy And Just In Time For Spring!

Breastfeeding And The Medical Profession, Part Two

By Tiffany Holley

Let me start by briefly reiterating what I explained in my previous post of medical escapades:

I appreciate my doctors. I appreciate the medical system that got me through a variety of health issues. They know a lot about what they were trained in…

…But they do not necessarily know anything about breastfeeding.

It makes me so sad to think of all the babies that lose out on this amazing food (and relationship!) because their mother took the inappropriate advice of an ignorant (on this subject) medical practitioner.

Let me tell you some more of what I went through to learn this lesson…

Sadly, the Emergency Room visit and hospital stay I talked about last time was not the end of my troubles.

Over the next few months I underwent two outpatient procedures to treat my (newly discovered) kidney stones. The machine uses sonic waves to break up the stones from outside the body, so there is no “surgery” involved.

The first time, the doctors fought me tooth and nail about my choice for anesthesia, or lack thereof. Since I am unable to pump (physiologically), their advice to pump and discard my milk for 24 hours after the procedure was simply not an option.

I talked to my La Leche League leader, and consulted my copy of Dr. Hale’s book, but all they could do was confirm that the medications in question were not recommended. Nobody was able to offer an alternative.

So I opted to have a spinal block, but no intravenous sedation.

Although I was warned that it would be painful, their primary concern seemed to be that the thumping noise of the machine was rather loud, and the experience might be traumatic. This seemed really strange, since obviously the medical personnel involved are all in the room with this noise – presumably several times a day!

Over the week between talking to the anesthesiologist and having the procedure, several people from the hospital called me, trying again to talk me into breastfeeding-incompatible sedation. It was exhausting!

In all those conversations, no alternatives were offered – and believe me, I asked everyone!

My choice was either to suffer and be traumatized, or give my baby formula for 24 hours, with the possible consequences to our nursing relationship. I would also risk engorgement and other consequences due to my inability to pump out the accumulated milk. And how would the medicine even get out in 24 hours, since I couldn’t pump enough to “flush it through”? Nobody had an answer.

As a concession to their concern about traumatic noise, I brought earplugs… And the staff in the treatment room all laughed that such a big issue had been made about it.

There were some challenges with the spinal that had me bleeding and in tears before the procedure even started, and it seemed clear would lead to a post-op “spinal headache” as well.

The noise was just annoying. I lay on the table and cried during the entire procedure, however, as the spinal immobilized my legs but “did not come up high enough” to numb the pain in my kidney area.

I managed to hold my torso still, but the doctor and technician still felt they could not work as aggressively as they would have if I was unconscious. There was already a plan for a second procedure, but this cast the unpleasant possibility of a third session being needed.

Later I learned that my husband had spent the whole time walking the halls with an inconsolable screaming baby. (The wild advice he got from passers-by, nurses and patients alike, is probably worthy of a post in itself!)

Having had only the spinal, I was able to nurse Mr. Big Baby in recovery, but it was quite a while before we were able to leave.

Needless to say, we were dreading a repeat. Medically, things made it necessary to go ahead, and we hoped that the two months in between would put the baby in a better place to cope with it.

We were much better cared for the second time, however. The anesthesiologist who happened to be there that day was actually the chief of pediatric anesthesiology for the hospital, and he was shocked when I told him what I wanted to do (and had done the previous time).

He explained that there were plenty of breastfeeding-compatible ways to sedate me! For starters, he would use the medications that they would give my child if he were the one going under anesthesia – that way if things did pass through to the milk, it would still be safe.

I was medicated, and the next thing I knew I was sitting in the recovery room with my husband and children coming around the corner.

It had gone much faster, and the baby was less upset. It had also been much more effective, as the doctor felt free to “pummel me” harder. I even got to go home sooner.

This procedure was the best of everything, for everyone. And, according to the anesthesiologist, the procedures he used were common knowledge.

So why did nobody offer those options to me the first time around? Even if they didn’t know what to do, why didn’t they ask someone when I pressed the issue?

I thought I had been diligent… I asked the doctors, nurses, and anesthesiologists for breastfeeding friendly options. I refused to take no for an answer. I stood up for my baby and our breastfeeding relationship.

But I still missed it.

I hope other moms can learn the “take away” lesson that I stumbled upon by chance. If I had it to do over again I would call an obstetric anesthesiologist and a pediatric anesthesiologist right off the bat!

If your health care provider says there is no safe option, it doesn’t mean there isn’t one – it only means they don’t know.

Have you had similar experiences with the healthcare profession not knowing about safe, breastfeeding-friendly alternatives? Please leave a comment on this post to share your experiences!

Tiffany Holley has nursed three children (currently 18 mos. – 15 years old) for a total of 8 years – and counting. She and her family live, breastfeed, urban homestead, cloth diaper, homeschool, and write in Southern Florida (but hope to remedy their location situation soon). You can read about their adventures on their blog, As For My House.

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