On medication for high blood pressure - Is it OK to nurse?
	Having surgery - do I have to pump & dump?
	How should I clean a hospital-grade pump?
	Is pumping affecting my supply?
	Is it safe to have an occasional glass of wine?
	Can I re-lactate?
	How much should my son be eating?
	Daughter on a food strike - help!

On medication for high blood pressure -
Is it OK to nurse?

I'm 25 years old and have high blood pressure.  I'm taking Diltiazem and Hydrochlorothiazide to counter act it.  I have a 9 month old who loves to breastfeed - he even prefers it to solids (he's a picky eater).  I really, really don't want to give up breastfeeding.  My question is how much of these drugs are excreted into the breast milk.

 PLEASE HELP!





Usually, by 9 months, a baby is taking enough other solids that few medications pose a significant problems.  The other issue is the time of day that you are taking them.  Usually, people take their hypertensive and diuretic medication in the morning.  To minimize the amount that gets to the baby, I suggest that you feed the baby in the morning, take your medications, then encourage the baby to take solids and other things for about four hours, so you can avoid breastfeeding your baby during this time.  Then, proceed through the rest of the day as your baby prefers, but be sure to encourage solids since he is 9 months old.  These medications are not, however, a reason that you must discontinue breastfeeding.

Having surgery - do I have to pump & dump?

I am due to have day surgery at the end of July and am concerned about what to do with my daughter.  I am still nursing her on demand and she refuses to take expressed breast milk from any container.  Because my surgery will be done under a general anesthetic, I am worried that I will have to pump and dump for 24 hours post surgery.  Is there any type of anesthesia I can have that won't pass through breastmilk?  Thank you for your time.





What kind of anesthesia that is appropriate depends on the type of surgery.  A spinal or local anesthetic will pose no problem to the nursing baby. However, the surgery may not be appropriate for this.  I'll assume, for now, that you need a general anesthetic, such as sodium penthal which is given intraveneously or a inhalation anesthetic such as nitrous oxide or flurethane.  What is comforting is that when the mother is awake and alert, she is free of the anesthetic.  Once a mother is alert and awake, it means that you have cleared the drug from your body.  However, as a safety measure, you can pump and dump a small amount (about 1/2 ounce or 1 tablespoon from each breast) of the milk for an hour or so after the surgery, then it will pose no danger to your nursing baby. You don't need to pump and dump for longer than this. 

Another question is post-op pain medication.  Some, such acetaminophen and ibuprofen are perfectly safe for breastfeeding mothers to take.  If a stronger pain medication is necessary, such as codeine or demeral, you should nurse your baby and then take the medication.  As an adult, you will clear those medications within four hours. Then, you can breastfeed again after that four hours is up.

How should I clean a hospital-grade pump?

I am a Lactation consultant at a hospital in New Jersey and am getting many different answers about how to sanitize a breastpump.  My question to you is; how do you recommend someone clean a hospital grade pump before the next patient uses it?  The patients are educated on cleaning their own kit, but I was not sure of how to clean the pump itself.

Thank you for you time!





Hospital grade pumps are required to have a safety valve that does not allow milk to regurgitate (backflow) into the pump.  Each patient has their own disposable kit, so that each kit is cleaned by that woman.  These kits can be used multiple times by a woman, with cleanings after each use.  But these kits can't be used by more than one woman.  The only thing that is necessary to clean the pump is to wipe the pump off with the standard cleaning solution that the hospital provides for other multi-patient use equipment.  This is a standard procedure in hospitals; you don't need to do any more cleaning beyond this.

Is pumping affecting my supply?

I am a full-time working mom and I express breastmilk for my daughter twice each day while I am away from her.  I was told by one lactation consultant that my milk supply may decrease over time under these circumstances, and by another that it should not.

In fact, my supply does seem to have diminished to the point that I am considering giving my daughter one bottle of formula as a supplement to the approximately 22-25 ounces of breastmilk she drinks each day. Although she seems to be thriving, I don't know how much longer my supply will be able to keep up with her daily needs. Does it make sense that being away from her and pumping over the course of six months has affected my supply, and is there anything I can do to increase it? Thanks!





It is possible to maintain your milk supply over time while pumping at work.  What facilitates this is to be consistent about the time it is done and the length of time that is involved.  Be sure that when you are at home on the weekends or on your day off that you feed your baby or pump at these same times.  Using a double electric pump usually results in better milk production.  On the other hand, with the stresses of work, the fatigue involved with adding work to child care responsibilities, it is not surprising that you milk supply may diminish.

Continuing to nurse with the baby will be very important to continuing your overall milk production.  The tricks that work to improve milk production are more rest, stress reduction, and relaxation, which may not be an option to a working mother.

You have nursed your baby for 8 1/2 months - a great accomplishment for a working mother.  You should not feel bad about having to add a bottle at this time, while you continue to nurse while you are with Madeline.  It sounds like you are doing a terrific job!

Is it safe to have an occasional glass of wine?

Is it safe to have an occasional glass of wine at dinner if you are exclusively breastfeeding your baby?





Yes, it is safe. Particularly when you drink the wine with dinner, it is absorbed very slowly with food and should not pose a problem. In many countries of the world, wine is consumed regularly at both lunch and dinner as a normal course of events.  In general, small amounts of wine with a meal does not pose a risk to the baby.

Can I re-lactate?

Jamie Lee had lack of oxygen at birth and spent 24 days in the NICU.  At first they were worried about her sucking reflex and thought she may not be able to take a bottle at all. I am happy to say she is home and takes a bottle very well. I have been pumping since she was born and we did try breastfeeding when she came home.  I was so worried about her eating enough that I didn't push the breastfeeding. My supply has slowed down to almost nothing but partly because I have not been as good about pumping as I should be.  My question is this:  Can I start to produce milk again if I have slacked off of breastfeeding her and pumping.  My OB/GYN suggests that I breastfeed and I would like to give it another try but I don't want to upset or frustrate Jamie if it is too late.





The best way to get your milk supply back is to use a lactation supplementer.  This will help train your baby back to the breast, now that she is used to the bottle.  A lactation supplementer is a device that holds fluid and has a small capillary tube so that when the baby suckles at the breast, she receives milk from the supplementer.  This stimulates the breast and provides an immediate reward for the baby for her efforts.  The baby is the best pump that there is, so you want to encourage your baby to be at the breast as much as possible.  You should ask your doctor for a referral to a lactation consultant, who can help you get the baby latched on and suckling correctly and can help you use a lactation supplementer to get Jamie Lee to nurse again.

How much should my son be eating?

How much should my son be eating within a day?  He has at least six wet diapers and has a BM almost everyday.  I am still nursing but I work full time, pump twice at work (only about 3-4 oz each time).  He has two bottle feedings at the babysitter's about 2-3 oz each time and I nurse him at lunchtime.  He nurses at bedtime and about 2-3 times in the night (family bed). This has been his schedule and amounts since he was 8 weeks.  I have replaced the dinnertime nursing with 1 jar of veggies and 1/2 jar of fruit-(last couple of days he will only eat 1/4 jar of veggies) (he was bored with cereal).  The last couple of days I have tried giving him breakfast (cereal w/ fruit).  Does all of this sound normal?  I keep getting contradicting information.  I am a first time mom, please help!





The pattern you are describing sounds normal for a 7 month old.  Each baby is a little different, so a mother must be guided by her own infant. There are no rules about when and how much to feed.  It really depends on the family and the baby.  When a mom is working you need to adjust the eating pattern to her work schedule.  It is great that you get to feed Keston at lunch time!  It is time to introduce Keston to solids, but this will take a bit of adjustment.  Replacing the dinnertime breastfeeding with solids is an excellent approach. And then moving to adjusting the breakfast feeding to solids, too, is appropriate.  The pattern that you describe sounds very normal.  I would suggest that you just continue to listen to your baby's cues.

Also, since there is a babysitter, often times nursing mothers will have the babysitter give some of the solids.  Baby's often prefer this to a bottle, then you can focus on breastfeeding!  This is often a good way to add solids into the picture over time.  You are doing a great job!

Daughter on a food strike - help!

My daughter was started on solids at 4 1/2 months because of a reflux problem.  We started with rice and moved on down the line of first stage foods. She would eat solids two times a day and breastfeed the rest of the day.  After a few weeks, she stopped eating except for one solid feeding of about 2 tablespoons and 2-3 breastfeedings for about 5 minutes each.  Her pediatrician told me to stop the solids and at her 6 month check up I was told to start her on solids again.  I have done this, and for the first 3-4 days she was okay but now she is going back to not eating.  I have tried to give her juice and water so she won't get dehydrated, but she vomits this up every time.  (She refuses the breast during her food strike.)  I feel compelled to stop the solids again, and continue breastfeeding her exclusively and to offer food only on occasion.  But my daughter loves food and wants mine all the time!  I was wondering if my breastmilk is not appetizing to her when she has food to compare it to or what? Any input would be greatly appreciated!  Thanks!!





At this age, I wonder if your baby still has reflux or not. Often, this disappears at about 6 months or begins to improve, so how you handle the solids would really depend on what the status of the reflux is. Six months is the time that solids are recommended for all babies, so your baby has arrived at a time that it is appropriate to be introducing them.

Your comment about your daughter loving your food is an interesting one, and it may be a social issue.  There are certainly foods that adults eat that babies can try too, such as small pieces of banana or other soft fruits or cooked vegetables.  Sometimes that is a way to get babies interested in solids - to have them eat what other people are eating.

In terms of the food strike, I would continue to offer the breast and to offer solids, but not both together.  Usually, if you are trying to get a baby to eat solids, you should try to give them solids, then offer the breast shortly thereafter.  If you are concerned that your baby is not getting enough breastmilk, you would try the reverse.  Don't offer solids and breastmilk at the same time, though - make each a separate episode.

In terms of growth, we like a baby to double birth weight by about 4 months.  Your baby has gone beyond this at 6 1/2 months, so her weight seems about right.  She should approximately triple her birth weight by the time she is 1 year old.  At 6 1/2 months, skipping a few feedings isn't going to make a big difference in her hydration or growth.  However, if she stops having bowel movements for more than several days or has fewer than six wet diapers each day, you should contact your pediatrician as these are signs of dehydration.


 

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