Episode 365

As an IBCLC, I hear all kinds of crazy stuff, all the time about things related to breastfeeding. So, one would think that I would be use to it!  For the most part I am, but every once in a while I hear just one too many cockamamie things in a row and I practically lose it.

It just drives me insane that there are still so much awful information being passed down from one breastfeeding generation to the next.  Makes me even crazier when we have such good, solid, evidence based research to prove that some of these things are not true, but they just keep being perpetuated from one generation to the next.

Sooo, I find myself chomping at the bit and just needing to address them once in a while.  I think it has been over a year since I have recorded a show on BF myths, so it seems it is only right that the time is ripe for another Bustin the Breastfeeding Myths Show.  The 2 I am going to address today have to do with weaning.

First up on the list of crazy things you hear is on the subject of – Abrupt Weaning  from breastfeeding. I will also include this to cover abrupt weaning from breastpumping

I recently interviewed Winema Wilson Lanoue who is the author of a wonderful book on Weaning called:  A Loving Weaning, How to Move Forward Together. She describes weaning as – the unique experience you and your child have as he or she moves beyond the need to nurse for food, health, and comfort.  Weaning begins when your child takes the first taste of solid food, and ends when your child no longer nurses.

It would be great if the weaning process for you was able to happen gradually.  Unfortunately, circumstances beyond your control can create a situation where you need to go from regular daily breastfeeding to needing to stop, like yesterday.  Because this is such a precarious health issue – physical and emotional, it would be great if the opportunity was available to quickly wean over a few days period vs. today your are breastfeeding and tomorrow you are not.

I will be doing a show on how to go about weaning and it will be in greater detail.  For now, I would just like to say that abrupt weaning is never recommended, particularly if you have been removing the milk on a regular 6-8 times or more daily basis. To stop so quickly puts you at great risk for causing clogged ducts, getting a breast infection,  or getting a breast abscess because the milk volume just does not stop as quickly as you would like or need for it to. To stop so quickly may cause great emotional upheaval as your hormones shift is hard and fast without allowing time for your hormones to gradually shift.

So my issue with abrupt weaning?   Well, let’s talk about 2 of my biggest pet peeves – ill informed

The first one is:

When mothers are told they need to abruptly wean for a health issue and I find out that for their situation, this simply is not true.  Not true at all.

I am going to share with you some examples of reasons moms are given to wean –

You have  been diagnosed with a breast infection and are told you need to wean.  I am telling you, It is rare that you need to wean.

You have had a breast abscess that needs to be treated and you are told that you need to wean.  I am telling you, it is rare that you need to wean.

I encourage you to seek the assistance of an IBCLC in this case because not every abscess needs to treated the same way.  Often there are less invasive ways of treating then what I am about to describe. However, since this continues to be a common way to treat, I wanted to highlight your options in this case.

Typically,  The incision site needs to be aspirated or lanced and drained with a needle by your physician so they can collect and culture the fluid and prescribe the appropriate medication. Sometimes the abscess needs to be surgically drained. And by the way, if this ever happens to you, don’t let anyone tell you that it is minor and it will just be a little uncomfortable and therefore, do not give you any local anesthetics.  It can be very painful as first of all your breast is hard and heavy and already in pain. Now you have someone surgically drain the fluid and they want to tell you to not worry – it will just be a little uncomfortable. You only need to listen to one mom, just one mom, tell you her experience of having this procedure performed without a local – hear her voice shaking, see her lips quivering and her body responding to reliving the experience.  You only need to listen to this once and you will realize that for a practitioner to not explain the procedure and offer pain relief borders on malpractice.

Now that the procedure is done, the incision is left open and the wound is packed with a dressing so that it can continue to drain and heal from the outside in. Experienced practitioners are usually able to make an incision away from the areola, rather than around the areola/nipple juncture.   This is least likely to interfere with your baby breastfeeding or your pumping needs. Here again, it is very important that you are working with a team that understands lactating mothers.

Why oh why are mothers told they need to wean – no longer breastfeed their baby?

Well, this is where things get really insane -Mothers are told, by ill-informed providers that they need to wean.  Sometimes it is because the medication that you are prescribed is not safe for your baby. However, this is usually easily resolved as there are several medications to treat this infection that are safe for your baby.   There is another reason you are told to wean your baby. This advice comes from the concern that milk which will leak from the ducts that were cut into will leak from the incision. Okay,,, you ask,, and what does this mean? Your baby will become infected?

Well, your baby has already been getting the milk from your infected breast.  The same as they do when you have the cold or the flu or mastitis or in this case, a breast abscess.  You are now going to be taking antibiotics AND the human milk that might leak, well this is totally fine because, guess what?  Your milk is power packed with antibiodies, which is exactly what your baby needs after having been exposed to an infection. It is like medicine for your baby.  You do not want to take away their medicine and replace it with formula. – which lacks the very ingredients and antibodies your baby needs right now.

If it is too painful for you to breastfeed, you can always hand express or pump until you feel that you have healed sufficiently enough.  You cannot just leave that side alone and let that side “dry up.”

You might also be asking – If a mom has an abscess in one breast, why does she have to wean from breastfeeding altogether?  There is rarely a reason for her to do so.

However, some moms are told by their physicians that they need to.  Seeds are planted – and they take hold in moms thoughts, those scary ones that we sit with night and day when we have a problem.  Moms are often told – well if it happened once, it is likely to happen again. Or if it happened on one side, it can happen on the other side.  Sometimes moms are told to wean from one side and with them thinking – well one side is going to be big and full all the time and the other side is not – I don’t want to walk around like that.  With no guidance on how to proceed with continuing to breastfeed from both sides or assistance with weaning from one side and support to continue on the other side, some moms are not told to, but make the decision to wean altogether.  The other very common reason I see for this happening is that they have already been having great difficulties with breastfeeding and they are just so sick and tired of being sick and tired and in pain. Perhaps they have already begun to give their baby bottles and they just figure that weaning is for the best.

I acknowledge that you might have a unique situation that does call for you to wean. This is why I recommend that anyone who needs to abruptly wean to seek the help and guidance of an IBCLC who, along with your physician,  can assist you with making the right decisions that is in your best interest.

My first pet peeve is moms being told they need to wean, when there is a very good chance that she does not need to wean.

The second pet peeve is HOW moms are told to wean.  

To add insult to injury and yes, this pun is intended, because abrupt weaning the wrong way can cause major injury,  so to add insult to injury, they are given the worst advice possible as to how to go about weaning. Often moms are given little to no information or downright poor and dangerous information.

Some people who do not fully understand the way our breasts make milk may tell you to do some crazy things.  For many years it was very popular to advise moms to take ace bandages and to bind their breasts. Thank goodness I rarely hear this anymore, however, some other poor advise seems to have replaced this.

Rather than bind their breasts with ace bandages,  moms are told to wear a tight fitting sports bra and then to put another bra over that.  The thinking is that if the milk does not come out, the breasts will quickly dry up. While this will eventually happen, this method will likely cause some of the same problems you are now dealing with – clogged duct and abscess.  You have a beautiful and wonderful and amazing lymphatic system that cannot keep the milk moving if the whole ductal system in your breast tissue is being compressed by several tight fitting bras. Backed up milk that cannot move through the breast tissue, causes clogged ducts, which if left untreated, can cause a breast infection.  Which is the exact reason I say that this is adding insult to injury. The last thing we want to do is put you in a position where you are at risk of getting another breast infection.

Removing the milk can be a bit tricky, but it is important to keep the milk moving.  A lot of things you read and hear will say – empty the breast. But this is also being said by people who don’t understand the lactating mother.  Your breast is never fully empty. You cannot fully drain your breast. If their is too much pain or if the cut and dressing over the affected area is getting in the way of you breastfeeding, you can remove the milk by hand expression or pumping.

Here we go with Bustin another myth that drives me insane –  It is always so interesting because I can go a few months sometimes in not hearing a mom tell me about some poor advice that she was given.  I am feeling better now and thinking, thank goodness I am not hearing this silly advice anymore. And then I hear some cockamamie advise and realize – oooops   never let your guard down Lori.

I have a FB group, which you are welcome to join by going to AABC.  This is a fabulous group of breastfeeding moms who enjoy the friendship and support of other breastfeeding moms.  I posted in the group that I would be interviewing an expert on weaning and asked if they had any questions to post them.  Jessica posted this question:

My obgyn told me to stop nursing my toddler by the time I am 20 weeks pregnant with my second to give my body time to prepare for the next baby. Is that true?? Thanks!!

I had two immediate responses to this question –  The first one was – Unbelievable! Are the physicians still giving this crappy advice?  And my next response was – Well, thank goodness she asked this question because if this information is still being given out, I welcome the opportunity to set the record straight.

I want to first state that it is the answer that gets me upset, not the question.  It would be quite normal for a newly pregnant mother to have questions about breastfeeding while pregnant.

The thinking many, many years ago is that the normal contractions that you have during a healthy pregnancy may cause you to go into preterm labor.  However, it has been proven, like I said many, many years ago that these contractions are harmless to the fetus and rarely increase the chances of having a miscarriage.

Here is what Jessica should have been told:

While breastfeeding during pregnancy is generally considered safe, there are some cases where weaning MAY be advisable:

High risk pregnancy at risk for preterm labor

If you are carrying twins

If you have been advised to avoid sex while pregnant

If you are having bleeding or uterine pain

Even still, this does not mean automatic weaning.  This means a discussion with your physician to determine whether weaning would be the best option for you.

i ADDED MY TWO CENTS AND RESPONDED TO jESSICA:

Assuming that you have had no health issues to warrant this advise, this is simply not true. I am not concerned at all about being politically correct here – This is major BS! Here are my questions for your OB-GYN and I hope that you are brave enough to ask each question & if so, I very much look forward to the response. Question #1 – Do I have a pregnancy/birth related medical condition that precludes me from nursing my toddler? Question #2 – Dr. Can you please share with me the research that states I should stop nursing my toddler at 20 weeks pregnant? Question #3 – What is happening in the first 20 weeks that my body is okay to be nursing a toddler and can also prepare for the next baby? Question #4 – What changes after 20 weeks that my body that had been doing a good job of nursing a toddler and preparing for the baby, can NOW all of a sudden ( 19 weeks yes, 20 weeks no more) no longer continue nursing my toddler? Dare I say that these are my first few questions. I could add a whole bunch more to the list, but I highly doubt you will need to ask any more questions once you get the answers. BTW – In these instances A lot of moms will tell me that their Drs. say they will get them the info, but it never materializes. You need to see the research! Keep us updated Jessica as I would love to hear the answer..

Once Jessica understands that she can continue safely breastfeeding during her pregnancy, I would be sure to ask her what she wants. Perhaps she is asking because she would like to wean and has some guilt over it.  We could explore these feelings and hopefully she would reach a point in her own mind that there is absolutely nothing to feel guilty about. Perhaps she is waivering – one day, yes, the next day no. We would talk about what she is feeling and hopefully she will come to the realization that it is okay to be unsure.   I love breastfeeding mothers support groups. I think FB groups are great. Mothers need to share their experiences, support one another and share some great breastfeeding tips, that even I would not even think about. And sometimes, the wrong information can get passed from one women to the next. I can even accept this.  However, I have little patience for crappy, out-dated, information being given to moms from ill-informed health care providers.

My greatest wish for all my listeners is for you to have the most accurate, the most up-to-date and well researched information about all topics related to breastfeeding.  It has been almost 4 years since I began this podcast with the mission to normalize breastfeeding around the world. I desperately wanted to reach people who were directly and not directly involved in the world of breastfeeding.  It does little good to keep preaching to the choir only!  So, for all the breastfeeding moms out there, I would love for you to choose at least 1 other person you know- another pregnant or new mother and take a few minutes to send her a link to this show.  Heed my mantra: Don’t let all about breastfeeding be your best kept secret. Share the show to someone else who could really use this information. Let’s wrap all breastfeeding moms in our arms and do all we can to help them succeed.

For moms who are looking for a breastfeeding class, please consider joining my online breastfeeding class.  I can definitely help you in several areas that I often hear moms say: I wish this could have been different.  Their is wisdom in moms who have “been there, done that.”

They are tired near the end of pregnancy and are already involved in childbirth classes and have a hard time coordinating taking a breastfeeding class with their schedule and/or with their partner.  So, they put it off, often say ing to themselves: babies were born to breastfeed. It is this natural thing to do. It will probably all be okay. And if not, I will look for some help. The other common thing I hear moms say – after the fact – when they are home, alone, isolated and struggling with breastfeeding issues – I wish someone would have told me how much support breastfeeding mothers need. I promise you that when you take my class, you will be a well informed breastfeeding mom.  You will learn the top 5 most common challenges moms have and you will have the skills you need in order to prevent them from happening. You may have heard me talk about my class before, but have you checked out the class page to find out more details – aabreastfeeding.com/breastfeedingclass

“Although we encourage breastfeeding moms to share their experiences and support one another, some of the information is not altogether accurate. And sometimes, the wrong information can get passed from one woman to the next,” says Katy Lebbing, IBCLC, manager of the breastfeeding resource organization La Leche League International.

To help you tell fact from fiction, here are seven of the most common breastfeeding myths:

https://www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/Breast%20Masses%20English.pdf