Postpartum Depression

So many mothers  I have met have suffered from postpartum depression after the birth of at least one of their children.  Some mothers I have met have also suffered from depression during a pregnancy, which is much less talked about than postpartum depression.  This is a huge topic, and one that a blog post really can’t even do justice to, but my goal is to provide some places on the Web and links to  groups that make the support of mothers who are battling depression their main focus.

According to “Breastfeeding Answers Made Simple:  A Guide For Helping Mothers” by Nancy Mohrbacher, “More than half of new mothers have occasional bouts of crying, irritability, and fatigue sometimes referred to as “the baby blues.”  Postpartum depression refers to more consistent and severe symptoms and is also relatively common, with some estimating the incidence within the first year of new motherhood to be 12% to 25% overall and 35% or more among high-risk mothers.”

On a purely physical level, some research states the release of proinflammatory cytokines by the immune system have been found  to be a cause for postpartum depression, but there also appear to be  risk factors that can  predispose mothers toward this inflammation.  Continue reading

“I Have Done Everything and Breastfeeding Isn’t Working Out”

My last post was about the benefits of breastfeeding (http://theparentingpassageway.com/2010/11/16/why-should-i-breastfeed-my-baby/).  In general, breastfeeding and supplying infants human milk is always something that should be considered for immune health.  However, I find that bringing up the benefits of breastfeeding often can be met with anger and guilt on the part of some mothers.  That is never my intention, to hurt and polarize.  Anyone who has read this blog for any length of time would know that about me  and this space.

Continue reading

Why Should I Breastfeed My Baby?

(This post really is geared toward pregnant mothers who are trying to decide whether or not to  “try” breastfeeding.) :)

Oddly enough, I typed this into a search engine to see what would come up, and not much did. Maybe it was the way I worded it (ie, if I put in “benefits of breastfeeding”, I wonder what would have come up?)  However, I also wondered if perhaps we are not doing a great job in the medical world and the world of lactation consultants in getting the word out to the public about the very specific benefits of breastfeeding.  Many mothers seem to “know” that breastfeeding *might* be better than not breastfeeding, but I wonder if mothers can think of very specific targeted benefits.

On that note, I thought I would write a list and have it handy on this blog.  The references for this article came from the newly revised “The Womanly Art of Breastfeeding”, from Marsha Walker’s  “Core Curriculum For Lactation Consultant Practice” and varioud PubMed studies.

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Breastfeeding and Dental Caries

These are some notes I have about this topic and thought I would share:

Early Childhood Caries (ECC)

  • -Formerly known as Baby Bottle Tooth Decay or Nursing Caries
  • -Defined as the presence of one or more cavities in the deciduous teeth in a child aged 71 months or less (LEAVEN, April/May/June 2006)
  • -Recognized as an infectious disease process caused by an overgrowth of microorganisms that are part of normal oral flora.
  • -Streptococcus mutans (S mutans) is thought to be the primary cause.

Three Factors Necessary for Dental Caries:

1. A susceptible tooth – A tooth becomes susceptible through genetics ( leading to pitting/grooving, poor tooth enamel, pH level of mouth low); pregnancy factors ( maternal fever, maternal malnutrition, iron deficiency, lead exposure, stress, antibiotic use). Other risk factors include infants born via cesarean section, prematurity, small for gestational age, infant of smokers.

2. Presence of cavity causing bacteria – Typically transmitted mother to infant or from other adult caregivers, siblings, playmates to infant.

“Reducing the level of bacteria in a mother’s mouth may reduce transmission to the baby.” (La Leche League’s LEAVEN, April/May/June 2006). Ways to do this may include xylitol ( a natural carbohydrate sugar substitute that interferes with bacteria’s ability to stick to teeth), chlorhexidine rinses (this is prescription only, may have side effects, discuss with HCP).

Be aware of the “Windows” of infectivity – 19 – 36 months (although with some children this window can start as early as six months), and 6-8 years of age.

3. Presence of Acid – Decreased saliva flow decreases the protection saliva provides of washing debris away. Children who are mouth- breathers, take antihistamines and/or asthma medications may be at higher risk for caries.

Problems Caused By Caries-

They can be painful and cause abscesses, the ability to eat and chew is compromised, children with dental caries may show “slowed growth rates or failure to thrive”, speech may be affected, if primary molars are lost to decay malocclusion may result, caries may affect self esteem of child. Having ECC is a strong predictor of decay in permanent teeth.

Signs of Decay – White spots on the surface of the teeth, usually on the front teeth, or white lines at base of teeth. This will later turn to brown spots and decay. Dentists recommend a child first visit the dentist by 12 months of age or within first six months of teeth erupting.

PREVENTION of ECC

  • -Non-breastfeeding infants are at higher risk of decay when compared to breastfeeding infants . One recent study of Jahalin Bedouin infants in Israel found that the children drinking bottles had levels of ECC almost two times the infants that were breastfeeding. (from Early Childhood Caries among A Bedouin Community residing in the eastern outskirts of Jerusalem by Livny, Assali, Sgan-Cohen, BMC Public Health 2007).
  • -Human milk is not cariogenic unless another source of carbohydrate is introduced for bacteria to feed on.
  • -Human milk does not decrease the pH of the mouth while almost all brands of artificial milk do – S mutans thrives in low pH
  • -Most artificial milks support high level of bacterial growth, while human milk supports moderate bacterial growth
  • -Components in breast milk, including secretory IgA and IgG play a protective role and slow the growth of S mutans and lactoferrin kills bacteria. Also, the calcium and phosphorus from breast milk are deposited on the tooth enamel.
  • -However, once first teeth erupt and additional foods and fluids are added to the diet, the breastfed infant can be at risk for caries just like any other infant
  • -Also, if the infant is receiving human milk by bottle the protective mechanisms of breastfeeding are compromised.
  • - Fluoride is controversial in treating caries. Some studies suggest flouride decreases the rates of caries from 50 to 70 percent, but other experts cite fluoride as a neurotoxin and that fluoride inhibits calcium absorption. Some holistic dentists are working with Vitamin D or combinations of Vitamin D, Vitamin C and calcium to try to reverse early decay. Vitamin D can be toxic at higher levels, so please discuss this with your HCP.

SOURCES

Early childhood caries:new knowledge has implications for breastfeeding families. Altshuler, A. LEAVEN, vol 42, No 2. April/May/June 2006, 27-30.

Avoiding dental caries. Fowler J. NEW BEGINNINGS, vol 19, no 5. Sept/Oct 2002, 164-7.

Big bad cavities: breastfeeding is not the cause. Reagan L. Mothering Magazine. July/August 2002.

Breastfeeding Beyond A Year

The facts:

  • The World Health Organization recommends nursing for a minimum of two years.
  • The United Nations Children’s Fund also recommends a minimum of two years.
  • The American Academy of Pediatrics recommends nursing for at least a year and for as long after that as is “mutually desirable”.
  • The estimated median age of weaning throughout the world is between three to five YEARS.

Why Breastfeed Beyond a Year?

  • At one year of age, a baby’s immune system is functioning only at 60 percent of the adult levels. A child’s immune system is not fully functioning at adult levels until six years of age. Nursing toddlers grow better and have better resistance to infection.  Some of the antibodies in breast milk actually increase after the first year.
  • Better skin.
  • There is no easier way to comfort a sick child.
  • There is no better way to get nutrition into a picky eating or sick toddler
  • Nursing may help improve the dental arch
  • Comfort nursing can be a fundamental part and advantage of nursing a toddler;  a true temper tantrum tamer!
  • Connection and closeness with your child!

The Myths Surrounding Extended Nursing:

  • “If a child can ask to nurse, there is something wrong with doing so.”
  • “Once a child no longer needs mother’s milk solely for nutritional purposes, there is no sense in breastfeeding.” Or “Your child would eat more solid food if you would just wean him.”
  • “After a certain point, the nursing relationship is more for the mother than the child.” (This is especially said regarding 4, 5 year olds who still nurse)
  • “Extended nursing will spoil a child.”
  • “A toddler who is still nursing is too dependent on his or her mother.”
  • “If you weaned your child, your child would not be (insert behavior here)”
  • “Comfort nursing encourages the toddler to turn to food for comfort”

All myths; if you need help in refuting these myths please, please contact your local chapter of La Leche League:  http://www.llli.org/

Handling Pressure to Wean:

Weaning deserves thought and respect as an important rite of passage in a child’s life.

Please see the other weaning posts on this blog:

http://theparentingpassageway.com/2009/06/25/weaning-a-child-who-is-over-the-age-of-4/

http://theparentingpassageway.com/2009/02/04/weaning-with-love/

Happy mothering,

Carrie

Breastfeeding, Fertility and Sexuality

I am always amazed that many women do not understand the impact of breastfeeding their child on their fertility and sexuality.  Here are some quick general notes I recently threw together.  Hope it is helpful!

Sexuality:

  • Some women report less sexual desire after the birth of their baby – taking care of a baby is intense work, and many women feel so much love and connection to their infant that the baby can consume much of the mother’s emotional energy. The couple may also be adjusting to being new parents and having less time alone.
  • Some women report they feel heightened sexual feelings while breastfeeding.
  • Masters and Johnson’s 1966 study pointed out that many breastfeeding mothers are more comfortable with their sexuality and are more anxious to resume sexual relations with their mate when compared to women who formula-fed their infants.
  • Low estrogen levels associated with breastfeeding can cause severe vaginal dryness and tenderness. Mothers can try water-based lubricants or also talk with their health-care professional  estrogen-based prescription creams or suppositories.
  • Lovemaking may stimulate a let-down
  • The father’s feelings are important. Unlike the mother, his hormone levels have not changed, and he may feel hurt and confused by lack of sexual interest from his partner. Mothers also may feel fatigued and “touched out’ by the end of the day. Open communication is important!
  • You do not have to “get away” from your baby in order to have a fulfilling relationship as a couple.  :)

Breastfeeding and Fertility

“If all breastfeeding were to stop, within a year there would be a 20 to 30 percent rise in the birthrate world-wide.”

The Lactational Amenorrhea Method (LAM):

A Mother has LESS than a 2 percent chance of getting pregnant if

  • A mother’s menses has not returned (no vaginal bleeding after the 56th day after birth)
  • The mother is not supplementing regularly OR going longer than four hours between feedings during the day OR longer than six hours during the night

AND

  • The baby is less than six months old.

THE KEY TO SUPPRESSION OF FERTILITY THROUGH BREASTFEEDING IS FREQUENT NURSING DAY AND NIGHT!!

Breastfeeding increases the likelihood that the mother’s first menstrual cycle will be anovulatory (Not preceded by ovulation), but the longer a mother’s menses are delayed by breastfeeding, the more likely she is to ovulate before her first menstruation. Even after menstruation returns, breastfeeding can reduce fertility. A woman’s own body chemistry also influences when menses return.

 

CONTRACEPTION Compatible with Breastfeeding:

  • LAM
  • Natural Family Planning  – classes available through Couple to Couple League
  • Barrier Methods –  do be aware spermicides can enter into a mother’s milk though no problems in babies have been documented and barrier methods with spermicides are considered compatible with breastfeeding
  • IUD (copper); for progestin IUD see below
  • Sterilization – hysterectomy does NOT affect breastfeeding
  • Progestin-Only Methods – seen as compatible with breastfeeding, although in my work over the years many mothers have reported they felt their milk supply dropped with progestin-only pills
  • Norplant maintains a lower level of hormones circulating than with the mini-pill, whereas injected contraceptives such as Depo-Provera result in higher circulating levels of progestin. Other time released progestin only methods include the vaginal ring, progestin IUDs, injected and implant. Timing of introducing these methods is still controversial – six to eight weeks is suggested by the WHO task force. No negative effects to the baby from the hormones (mainly studies have been done on the mini-pill)  have been found so far, and research has followed these children for up to 17 years.
  • Estrogen containing methods – decreases milk supply and duration of breastfeeding. It is recommended by the WHO Task Force that babies be at least six months of age before considering these methods. There are no case reports of long-term effects of estrogen on breastfed babies.