What is Your Menstrual Cycle Telling You?

By: Kerry Lett, MPH, RDN, LDN, CLC

Disclaimer: This post may contain affiliate links in which we may earn a compensation. However, this does not influence our opinions or recommendations.

When it comes to fertility, tracking and understanding your menstrual cycle offers valuable insight into your chances of conceiving and overall health & well-being. However, it is something that many women never learned about in school. Instead, we were taught that our period comes every 28 days and that any other time of our cycle we are fertile, but we know that in reality our menstrual cycle is so much more complex that that. Plus, for many of us with irregular periods or having trouble conceiving, those two pieces of information that we learned in school seem wildly inaccurate.

Why You Should Track Your Menstrual Cycle

There are so many benefits to tracking your menstrual cycle whether your goal is to conceive, to minimize symptoms that you are experiencing, or to understand your body better.

1. Determining Your Fertile Window: One of the primary reasons to track your menstrual cycle is to identify your fertile window accurately. This window when you are most fertile typically starts 5 days before ovulation to the day after ovulation when conception is most likely to occur. Understanding this time frame empowers those who are trying to conceive to optimize their chances of success by timing intercourse appropriately.

2. Monitoring Hormonal Health: Your menstrual cycle is intricately regulated by hormones like estrogen, progesterone, FSH, and LH. Irregularities in the length of your cycle, the duration of menstruation, or the presence of symptoms, like heavy bleeding or severe pain, can be indicative of underlying hormonal imbalances. Tracking these patterns over time can provide valuable information to healthcare providers - like myself -, aiding in the diagnosis and management of conditions, such as polycystic ovary syndrome (PCOS) or thyroid disorders, which can affect fertility.

3. Identifying Ovulation: Ovulation, the release of an egg from the ovary, is a star event in the menstrual cycle. Tracking changes in basal body temperature, cervical mucus consistency, or using ovulation predictor kits can help pinpoint the timing of ovulation with greater accuracy. Knowing when you are ovulating no only enhances the chances of conception, but also serves as a vital indicator of reproductive health.

4. Assessing Menstrual Health: A regular menstrual cycle with consistent cycle length and moderate bleeding is often indicative of good reproductive health. Conversely, irregularities, such as excessively long or short cycles, erratic bleeding patterns, or absent menstruation (amenorrhea), may signal underlying issues that warrant investigation. Tracking these abnormalities can facilitate early intervention and prevent potential complications down the line.

What to Track During Your Menstrual Cycle

There are so many different ways to track your menstrual cycle from the new electronic trackers, such as the Oura ring, Inito fertility monitor, Mira fertility monitor, and Kegg fertility tracker, to old school methods using ovulation test strips, a thermometer, and an app or a paper calendar. Regardless of how you are tracking your cycle below are some of things that you want to track in an app or on a calendar:

• Write down when you are bleeding, the severity of bleeding (e.g., spotting vs heavy flow), and describe the color

• Describe any symptoms, such as cramping, menstrual fluid odor, bloating, headaches, tender breasts, & mood swings, and their severity

• Note when you ovulate based on a positive urine ovulation test strip, rise in basal body temperature, or spike in LH shown on your electronic trackers

• Describe your vaginal discharge/cervical mucus (e.g., dry, sticky, creamy, egg white consistency)

Knowing this information should allow your to complete a comprehensive picture of your menstrual cycle starting with day 1 (first day of regular bleeding - not spotting), length of follicular phase (day 1 of cycle to day of ovulation), and length of luteal phase (day after ovulation until next bleeding) along with any symptoms and abnormalities along the way.

What is Your Menstrual Cycle Telling You

Once your menstrual cycle is tracked and you know all of the information listed above then you can use this information to better understand your hormonal and menstrual health, improve your chance of fertility, and reduce your symptoms.

• No menstrual bleeding or skipped cycles: If you are not having any menstrual bleeding then it is best to work with your provider to figure out why. This can be due to many different causes, such as lack of ovulation, excessive exercise, extreme weight loss, stress, trauma, PCOS, thyroid disorders, and more. It is important to note that it is common to skip a cycle occasionally or have a bleeding show up a little late especially during times of stress. However, if you are regularly missing a period, then it is important to talk to your provider to figure out why.

• Cycles lasting longer than 35 days: If you are having menstrual cycles lasting longer than 35 days, then it could be due to lack of ovulation or PCOS.

• Luteal phase shorter than 10 days: As a reminder, your luteal phase is the time right after ovulation continue your next period starts. Typically, the luteal phase is 10-16 days. However, if your luteal phase is shorter, it may be due to low progesterone related to inadequate follicle or corpus luteum development. It is important to work with your provider to look into things, such as egg quality, inflammation, thyroid disease, insulin metabolism, and nutrient deficiencies.

• Heavy flow & painful cramps: This could be due to an abundant amount of estrogen. Luckily, there are changes that can be done to help reduce your estrogen naturally, such as eating more fiber and reducing saturated fat consumption. However, if you are experiencing other symptoms, such as severe pelvic pain, painful intercourse, or GI issues alongside your menstrual irregularities, it is important to reach out to your provider for support as this could indicate something more severe, such as endometriosis.

• Menstrual fluid odor: This could be possible due to an infection or dysbiosis. It is important to reach out to your provider for additional testing.

• Light flow and/or dark/brown menstrual color: This could be due to inadequate corpus luteum development. It is important to work with your provider to look into things, such as egg quality, inflammation, thyroid disease, insulin metabolism, and nutrient deficiencies.

Tracking your menstrual cycle offers valuable insights into your fertility and reproductive health. By understanding the significance of various menstrual irregularities, you can proactively address underlying issues and optimize your chances of conceiving naturally. It is important to remember that the recommendations above are general and there are so many factors that influence your menstrual cycle. If you are looking for support to balance your hormones and increase your chance of fertility, schedule a discovery call today.

Disclaimer: This information contained in this blog is based on the experience of the author and science-based research. It is not intended to replace medical advice or diagnosis from a physician or other medical provider. This blog is not intended as a substitute for a consultation with a physician or other healthcare provider. The author is not responsible for any adverse effects or consequences resulting from the use of any suggestions discussed in this blog.

Last medically reviewed on March 26, 2024

Kerry Lett, MPH, RDN, LDN,CLC is the pediatric & maternal registered dietitian and owner of Milestones Pediatric & Maternal Nutrition in Cary, NC. Kerry is passionate about helping growing families navigate life and achieve all of their milestones along the way. Schedule an appointment today.

How to Improve Your Child's Constipation

By: Brook Orvis, PT, DPT, WCS, PRPC, CLT

Disclaimer: This post may contain affiliate links in which we may earn a compensation. However, this does not influence our opinions or recommendations.

Do you have a kiddo struggling with poo or pee problems? There’s pelvic floor physical therapy for that!

Similar to how adults may have difficulty with constipation, leaking of poop, or leaking of urine children can encounter similar issues. These symptoms are frequently (but not always!) linked to dysfunction of the pelvic floor muscles, which are muscles at the base of the pelvis that wrap around the anal, urethral, and vaginal openings of the pelvis and help with functioning of pooping, peeing, and sexual activity or intimacy.

As a Board-Certified Pelvic Floor Physical Therapist, there are SO many things that I’m taking into consideration when working with children with bladder and bowel issues. Here are a few tips and tricks to help your kiddo that may be struggling with poop or pee dysfunction:

1. Water Intake

Plain water helps to keep poop consistently soft and easy to pass to help prevent constipation and also helps to prevent irritation to the inner lining of the bladder to prevent issues with leaking of urine and urinary urgency and frequency. Typically kiddos under the age of 8 years old should be drinking their age in 8 oz cups of water per day (so if your child is 2 years old they should be drinking two 8 oz cups of water a day). Children that are 8 years old and older should be drinking eight 8 oz cups of water per day.

2. Fiber Intake

Fiber does a few different things in terms of poop consistency. For children that are struggling with constipation and hard to pass poop, it will help to soften the poop and make it easier to pass. For kiddos struggling with loose poop or leaking of stool, it helps to bulk the poop consistency and makes it easier to hold on to which helps to prevent leaking of poop.

Typically you want to add 5-10 on to the age of your child in years old to give you the recommended amount of grams of fiber that they should be eating a day. For example, if your child is 2 years old they should be eating 7-12 grams of fiber per day (2+5 to 2+10).

Make sure that you gradually increase your child’s fiber intake as it can cause abdominal bloating and discomfort when added rapidly or in large quantities. Also, make sure that your child is staying consistent with their daily water intake as an increase in fiber without sufficient water intake can actually worsen or cause constipation.

3. Poop Positioning

If your kiddo is using a toilet you want to make sure that their feet are able to touch the ground and that their knees are above the level of the hips when positioned on the toilet. This allows the pelvic floor muscles wrapping around the anal opening and the rectum to lengthen and release allowing poop to exit the body more easily and without straining. A good way to ensure this position is by placing a step stool (such as the kids Squatty Potty) under their feet.

4. Breathing Mechanics While Pooping

You want to make sure that your kiddo isn’t straining while pooping as this can cause the pelvic floor muscles to contract making it more challenging to empty when going to the bathroom. A good way to do this is by having your kiddo blow bubbles (yes, bubbles), blow a pinwheel, or “moo” like a cow while sitting on the toilet or during their toileting routine when pooping. This will help the anal opening to lengthen and release while exerting a small amount of pressure to allow the poop to come out of the body.

And it makes pooping more fun which is important when creating a positive environment surrounding going to the bathroom which will help long-term with toileting.

Last medically reviewed on March 12, 2024

Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy based in Durham, NC. As a momma to a spirited toddler and someone that is passionate that everyone with a pelvis has a pelvic floor, she believes that pelvic floor therapy is for everyone and provides accessible treatment options for men, women, kids, and the LGBTQIA+ community. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine or poop, prolapse, pelvic pain, constipation, pain during sex, and other pelvic floor issues as something that is normal.

Want to chat more to see if working with Brook is a good fit for you? Schedule your free phone consultation today!

What are the Benefits of Breastfeeding Support Groups?

By: Natalie Jarrett, MSN, IBCLC

Life can feel so overwhelming and it’s easy to want to stay home when you have a new baby. But getting out of the house can really boost your spirit in the early days, especially if you aren’t having many visitors into your home. There are many reasons why a breastfeeding support group is worth your time - read on to find out more!

1.You can get breastfeeding advice

One of the best parts of a breastfeeding support group is the ability to get your breastfeeding questions answered. You can come with all sorts of questions and the leader of the group will likely be able to answer a lot of them while you’re there. Some things may warrant a one-on-one appointment, but many things are questions that other moms may have too and can be part of the discussion at the breastfeeding support group. You’ll also benefit from hearing the answers to other moms' questions that you may not have thought of yourself.

2. You can make new friends

Another great perk of a breastfeeding support group is that you can make new friends that have babies the same age as yours. A breastfeeding support group is a nice informal way to meet new people who are in the same stage of life as you. Breastfeeding is a bond that can unite moms regardless of what stage their baby is in, so it's an instant point of connection with other moms. If you make connections with other moms, you can swap phone numbers and get together outside of the support group, or you can plan to come back to another breastfeeding support group another time together. 

3. You can learn from other moms with more experience

While the other moms may not always have babies the same age as yours, often they will be close enough to be in similar stages. However, if they are farther apart in age, the other moms can provide guidance on what to expect and can reminisce on the early days with their little one. This is fun for other moms with older babies to get a chance to look back and see how far they have come and is encouraging for moms with younger babies to be able to see what their journey may look like in a few months to a year.

4. You can hear experts talk on different topics

Another great perk of a breastfeeding support group is that occasionally there are other experts who come to offer their services to the group. Our breastfeeding support group has featured guest talks from a mental health therapist, a pelvic floor physical therapist, a sleep coach, a dietitian, and a babywearing expert. This is a great way to meet another expert in a field you may not be familiar with or just have a few questions for without having a full appointment with them. Once again, other people’s questions can benefit you so that you hear answers to questions you may not have thought of yourself.

5. Your baby can interact with other babies

At a breastfeeding support group, your baby can have exposure to other babies around the same age as them. They can smile at each other and play on the floor together if that is something you are comfortable with. If your baby is a little older they can see babies younger than them and enjoy interacting. No matter the age gaps, it is great for babies to get together and interact in person, especially if they don’t spend much time around other babies usually. Not only can you make some mom friends, your baby can make some baby friends! It is a win-win all around. 

If you are interested in joining our breastfeeding support group, we would love to have you! Our free groups meet regularly in Downtown Cary & Durham. See the full list of dates at: www.milestonesnutrition.com/breastfeedingsupport

Last medically reviewed on February 12, 2024

Natalie Jarrett, MSN, IBCLC is the lactation consultant Milestones Pediatric & Maternal Nutrition in Cary, NC. Natalie specializes in empowering lactating parents during their breastfeeding journey, while helping to minimize any breastfeeding difficulties. Schedule an appointment today.

Why Sleep is Important for a Baby's Development

By: Alyssa Tortorella

I know we all want a good night’s sleep and we, of course, want that for our own children. When it comes to getting our little one’s to sleep, it can be such a struggle. Starting from even before your little one is born, sleep is so unbelievably important for growth and development. While you are pregnant, your baby is growing rapidly inside your womb (obviously), but did you know that most of those 9 months, your baby is sleeping!?! Even after your baby is born, they sleep…and they sleep A LOT! A well-rested baby is a happy baby. They want to sleep, they just need to learn how to sleep!

Learning how to sleep does not just happen, we, as their parents, need to help teach them how to connect those sleep cycles. Once your baby can connect their sleep cycles, you will see longer consolidated naps and overnight sleep (and you’ll get your sleep back too!) There can be a lot of controversy over sleep training your baby because many people associate sleep training with Crying It Out, but sleep training is simply teaching your little one to sleep independently. Co-sleeping and contact naps are absolutely wonderful if they work for you, but for many moms, it just isn’t sustainable. You may have multiples at home, be a SAHM, and also work from home and just simply cannot sit on the couch while your little one naps on you for hours. Independent sleep, however you choose to do it, is highly important for your baby’s development.

First, let’s talk sleep - what happens during sleep, the benefits of sleep, and what can happen with a lack of sleep.

What happens during sleep?

Newborns, infants, and young children are rapidly growing (as we all know because it truly does go by so so fast), but did you know that most of their growth happens while they sleep? They are storing all those wonderful memories you are making with them, they are developing essential brain tissue, synapses are forming (synapses are the pathway for information to travel through the brain), connections are establishing between the left and right brain, and, the most obvious, they are recharging their bodies. So simply put, sleep allows your baby’s brain to develop.

What are the benefits of sleep?

There are SO many benefits to really good sleep and when we get a good night’s sleep, we thrive and the same goes for our little one. With consistent healthy sleep habits we improve our learning. Remember when we talked about making those memories and storing them? Well the same goes for what we learned during our day! We take all that we have learned and store that in our brains, but without healthy sleep, it is much harder to reinforce that new learning into our long term memory.

As we all know, a well-rested baby is a happy baby right?! I’m not going to lie, the same goes for me! The more well-rested our little ones are, the more pleasant it is to be around them. With healthy sleep habits, our children tend to have a more easy-going temperament, more patient, less fussy…all the things that make motherhood just a bit easier.

How do I get my baby to sleep?

If you are a mom with a newborn (0-12 weeks old), there are some great ways to help soothe your baby and help establish healthy sleep habits very early on.

1. Follow an eat, play, sleep schedule. This will help build a routine and predictability to your day and your babys!

2. Fill up your baby’s belly! Offer full feedings throughout the day and offer them every 2-3 hours or breastfeed on demand.

3. Practice laying your baby down in their bassinet or crib for one or two naps a day. Yes, you can still contact nap and snuggle up that little newborn for the other naps! Just make sure if you are contact napping with your little one that you are making sure to stay awake, since we there is an increased risk of SIDS when babies are sleeping on parents that fall asleep, which I know is easy to do when you are a tired parent.

4. Recreate their comfy cozy home they lived in for 9 months. Some ways you can do this is to swaddle them up! You may think they are resisting the swaddle or they do not like it, but they actually do! Also, when they were in your womb, it was loud, so you can use a sound machine to help them feel more comfortable.

5. Use the 5 S’s! When they are fussy or getting ready for sleep, you should always follow these 5 steps to help soothe them. First, swaddle them. Second, hold them in a side position. Then, start shushing. This sound truly starts to calm them down as that is what they heard for 9 straight months in your womb. Then, begin swinging. They love movement! Finally, add non-nutritive sucking, which can be a pacifier. Sucking on a pacifier is the icing on the cake to soothe a fussy baby. If you are breastfeeding, we recommend waiting to introduce a pacifier until after breastfeeding is established.

When you have infants 3-4 months or older, it is a great time to start sleep training.

There are so many sleep training methods to choose from and I truly believe that you must teach your child to sleep in a way that you feel most comfortable doing so. We already have enough mom guilt, teaching your child to sleep should not be one of them. Whether you choose a very gentle hands-on method or a more hands off method, as a certified pediatric sleep consultant, I cannot stress this enough…be consistent and firm with your boundaries. If you need help with sleep training your little one, reach out to a pediatric sleep consultant, like myself, for more support.

Last medically reviewed on February 12, 2024

Alyssa Tortorella is a certified pediatric sleep consultant and the owner & founder of Goodnight Sweet Baby by Alyssa Tortorella. When she had her babies, she became extremely passionate about their sleeping habits knowing that when they get the sleep they need, we all thrive. This is where Goodnight Sweet Baby was born. She wanted to be able to reach more moms and help teach their little ones to sleep in a way that matches their parenting philosophy, comfort level, and not feel that mom guilt.

Need additional support, reach out to Alyssa directly on her website www.goodnightsweetbaby.com or via instagram (@goodnightsweetbaby)

Does My Child Need a Multivitamin?

By: Kerry Lett, MPH, RDN, LDN, CLC

Disclaimer: This post may contain affiliate links in which we may earn a compensation. However, this does not influence our opinions or recommendations.

One of the top questions that I receive as a pediatric dietitian is, “does my child need a multivitamin?” The issue with this question is that it is complicated, because every child’s nutrient needs are completely different based on their age, sex, size, gut health, medications, health conditions, growth, activity level, and dietary restrictions. However, throughout this article, I am going to try my very best to help you determine if your child would benefit from a multivitamin and if so, what to look for to make sure that multivitamin is doing its job of filling in the your child’s nutrition gaps.

Nutrient Needs for Kids

Childhood is a stage of growth, development, and exploration and we know that getting the proper nutrition is crucial to every child’s well-being. Research shows that healthy eating can help children maintain a healthy body weight and even reduce their risk of developing health conditions, such as high blood pressure, short stature, type 2 diabetes, certain cancers, eating disorders, delayed puberty, nutritional deficiencies, cavities, increased injuries, and poor bone health. We have also seen that eating a healthy diet along with getting adequate hydration can help improve children’s cognitive function and memory, improve their mood, improve their school performance and attendance, and support their optimal growth and development (9, 10).

Do Kids Need a Multivitamin?

The general rule of thumb is that if children are eating a healthy, balanced diet and are not having any medical concerns, such as gut health issues or growth issues then they likely do not need a multivitamin. This follows the standpoint of the American Academy of Pediatrics (AAP) and the USDA as well that healthy children older than 1 year old who eat a balanced diet do not need supplements and instead parents should focus on feeding their children a variety of fruit, vegetables, grains, dairy products, and protein.

However, we know that there are exceptions to every rule. We also know that many children struggle to eat a balanced diet - especially vegetables and protein. Therefore, there are certain circumstances when a multivitamin or a specific vitamin/mineral supplement may be beneficial, such as:

• Children following a vegetarian or vegan diet

• Children who have a food allergy or intolerance

• Children who are picky eaters, especially those eliminating a whole food group

• Children who have a conditions or take a medication that affects the absorption of or increases the need for certain nutrients, such as celiac disease, cancer, cystic fibrous, inflammatory bowel disease (IBD), and some epilepsy, birth control, and diabetes medications

• Children who have had surgery that affects the intestines or stomach

• Children with limited sun exposure, obesity, darker skin tone, or those living above 37 degrees N latitude

Supplements for Plant-Based Diets

Children following a vegetarian or vegan diet can get most, if not all, of their nutrient needs from food along as long as there is variety, balance, and a little bit of planning. Without planning, kids may be at risk for deficiencies in calcium, iron, zinc, and vitamins B12 and D (1), which can lead to serious consequences for their health and growth, such as developmental delays, poor growth, and low appetite (3, 4). We also know that it can be hard for kids to get enough DHA, an omega-3 fatty acid that is essential for healthy functioning and development of the brain and retina (2).

Omega-3 Fatty Acids

• Vegan/Vegetarian Foods: Nuts, seeds, plant oils, DHA-fortified products

• Supplement: Garden of Life Kids Plant Omega-3 Liquid is one of my favorite omega-3 supplements for kids due to is well-accepted strawberry flavor, good distribution of omega-3 fatty acids, vegan ingredients (no fishy flavor), and third-party testing.

Vitamin B12

• Vegan/Vegetarian Foods: Nutritional yeast, dairy products (milk, yogurt, cheese)

• Supplement: Vimergy Kids Vitamin B12 is one of my favorite vitamin B12 supplements for kids who are vegan due to its low-dose, vegan ingredients, and third-party testing.

Supplements for Kids with Food Allergies & Intolerances

While science has made great strides in recent years, avoidance of all known food allergies is still the recommended treatment for those with food allergies. Due to this food restriction or minimization (in the case of intolerances), research has found that children with food allergies are at an increased risk of inadequate nutrient intake, which can lead to poor growth and vitamin & mineral deficiencies, such as calcium, vitamin D, and B vitamins (5, 6). Learn more about the nutrients that your child may be missing due to their food allergies and alternative food sources here.

Supplements for Picky Eaters

When considering if your picky eater would benefit from a supplement, there are four questions to consider:

• Does your child eat at least one food from each food group?

• Does your child eat more than 20 different foods?

• Have your child’s bloodwork & labs been normal?

• Is your child’s growth & weight gain been normal? In other words, are they following their own growth curve?

If you answer “yes” to all of these questions, then your child may not need a multivitamin or supplement. However, if you answered “no,” then your child may benefit from a supplement. If your child had abnormal bloodwork, such as low iron or vitamin D, then it is important to ask your child’s pediatrician or registered dietitian the appropriate supplement and dose to take. If your child is very restrictive and limited in the foods that they will accept, then they may benefit from a multivitamin (and additional labs tested, if they have not already been performed). If your child is falling off of their growth curve or struggling to gain weight, then they may benefit from a kids nutrition shake.

Multivitamin for Kids

• Renzo’s Picky Eater Kids Multivitamin with Iron is one of my favorite multivitamins for picky eaters, because it is complete, has adequate levels of vitamins & minerals for kids, is sugar-free, and third-party tested.

Nutrition Shake for Kids

• Orgain Kids Protein Nutrition Shake is one of my favorite nutrition shakes for kids, because it has vitamins & minerals added to it along with protein allowing it to also act like a multivitamin, it comes in a variety of flavors, and it does not contain any artificial dyes.

Vitamin D

Vitamin D deficiency and insufficiency is more common that you may think. In the US alone, 24.6% of the population has moderate or severe vitamin D deficiency and 40.9% of the population has vitamin D insufficiency (7). The problem with this is that vitamin D is important for so many things in the human body from absorption & maintenance of calcium & phosphorus, reducing cell growth & inflammation, immunity, hormonal balance, mood regulation, and insulin response. The reason that I believe vitamin D deficiency and insufficiency is so common is because adequate vitamin D is fairly hard to get, since it is only in four food groups (below) as well as sunshine. However, it takes up to 30 minutes of sun exposure daily for those with lighter skin and over 2 hours of sun exposure daily for those with darker skin to reach the same level of vitamin D production (8). For those living above 37 degrees N latitude (above North Carolina) and those with obesity, they are at an increased the risk for vitamin D deficiency.

Vitamin D-Rich Foods: vitamin D-fortified foods (some dairy products & alternatives, juices, & cereals), egg yolks, fatty fish (salmon, tuna, & trout), mushrooms exposed to UV light

Vitamin D Supplement: Cymbiotika Kids Toddler Vitamin D3 + K2 is a great way to make sure that your whole family is getting enough vitamin D. This product has vitamin D in this active form, comes with vitamin K2 for better absorption, has a dose that is adequate for everyone 1-99 years old (unless there is known vitamin D deficiency or insufficiency), and is third-party tested.

Summary

In general, most kids are able to get the nutrients that they need from their diet alone. Even if they have some foods that they do not like or cannot eat, there are typically able to other foods rich in the vitamins and minerals they need to grow or thrive. However, children with extreme dietary restrictions due to picky eating, food allergies/intolerances, or cultural/religious/chosen dietary restrictions, or those who have health conditions that impact their nutrition absorption or needs, then they may benefit from a supplement.

When choosing a supplement for your child, it is always best to consult their registered dietitian or pediatrician to make sure that it is truly necessary and that the dose is appropriate for them. Supplements are not regulated and therefore the amount recommended on the product can often vary from what your child actually needs. If it is determined that a supplement is necessary, aim to choose one that is:

• Third-party tested

• Kids specific (unless otherwise indicated by your child’s healthcare provider)

• Age-appropriate

• Limited in additives and added sugar

Disclaimer: This information contained in this blog is based on the experience of the author and science-based research. It is not intended to replace medical advice or diagnosis from a physician or other medical provider. This blog is not intended as a substitute for a consultation with a physician or other healthcare provider. The author is not responsible for any adverse effects or consequences resulting from the use of any suggestions discussed in this blog.

Last medically reviewed on January 29, 2024

Kerry Lett, MPH, RDN, LDN,CLC is the pediatric & maternal registered dietitian and owner of Milestones Pediatric & Maternal Nutrition in Cary, NC. Kerry is passionate about helping growing families navigate life and achieve all of their milestones along the way. Schedule an appointment today.

How to Take Care of Your “Down There” After Having a Baby

By: Brook Orvis, PT, DPT, WCS, PRPC, CLT

Disclaimer: This post may contain affiliate links in which we may earn a compensation. However, this does not influence our opinions or recommendations.

Have you heard all of the hype recently surrounding the pelvic floor with pregnancy and delivery and wonder, “What the heck is that?”

The pelvic floor is a group of muscles at the base of your pelvis that serve the following functions:

• Sphincteric control which prevents leaking of urine, stool, and gas. On the flip side, they need to lengthen and release so you can empty your bladder and bowels completely.

• Support helping to keep your pelvic organs like your bladder, bowels, uterus, and urethra positioned where they’re supposed to be.

• Sexual function including being able to have an orgasm and pelvic penetration during sex and intimacy pain-free.

• Stabilize the body acting as a direct extension of our “core muscles” helping to give support to our low back, abdomen, pelvis, and hips.

• Circulate the blood and lymphatic fluid in the pelvis back up to the heart.

As a Duke Women’s Health Residency Trained and Board-Certified Women’s Health (WCS) and Pelvic Floor (PRPC) Physical Therapist, I work with everyone with a pelvic floor, including people that are pregnant and have had children. If my many years of experience working with this patient population, and having gone through pregnancy and delivery myself, has taught me anything, it’s that we don’t do enough to help prepare our clients for how to take care of their bodies (and specifically their pelvic floor!) once their baby arrives.

Here are five practical tips to take care of yourself after having a baby:

1. Your body mechanics while taking care of your baby are everything!

However you are feeding your baby, make sure you are bringing your baby to your chest or bottle instead of the other way around. Use a supportive pillow underneath your baby, like a Boppy or My Brest Friend, to bring them level with your chest to more easily feed without bending forward. Make sure you have good back support using a pillow behind your lower back, lean back against a supportive surface like a chair, and position your feet so they can rest completely on the floor or on a step stool. Habitually bending forward multiple times throughout the day to feed your baby could eventually lead to upper and lower back pain. And guess what back pain is linked to within research? Pelvic floor muscle dysfunction.

2. Scar tissue mobilization regardless of how you delivered your baby.

It usually takes 6 weeks for scar tissue to fully heal over, but that doesn’t mean you can’t work on the tissue surrounding your scar before the 6 week mark!

For cesarean deliveries:

Imagine your scar is broken into four sections. Working at both sides of your scar (above and below) start by gently using the pads of your fingers and gently stretch the tissue in all directions (up, down, left, right) and hold for 30-60 seconds before releasing and continuing at the next section. You can also gently do small circles working on either side of your scar and moving gently side to side and up and down for 30-60 seconds each direction. To progress further you can start to gradually sink the pads of your fingertips deeper and deeper into your tissue surrounding the scar (once working at the surface of the skin becomes more comfortable) and repeat the same types of stretches and scar mobilization techniques mentioned above. Another trick that I recommend to clients is using silicone strips (like Scar Away) over their incision once it has fully healed, typically around 2-4 weeks post-delivery. This will help to improve the appearance of your scar.

For vaginal/pelvic opening deliveries:

Similar to cesarean scar tissue, you can gently work on both sides of your scar (left and right) using the pads of your fingers and gently stretch the tissue in all directions (up, down, left, right) and hold for 30-60 seconds before releasing. You can also start to gradually sink the pads of your fingertips deeper and deeper into your tissue once working at the surface of the skin becomes more comfortable.

3. Lubricant during sexual activity is a must!

I know that sex and intimacy can be a loaded topic once baby arrives on the scene. Once you hit the six week mark and have been given the “all clear” by your OB/Gyn to return to sexual activity, it can sometimes feel scary thinking about returning to sex or solo activities post-baby. Usually estrogen levels are low in the postpartum period and if you are chestfeeding they will continue to be at a lower level until you finish up. We know that estrogen is incredibly important in our body’s ability to produce self-lubrication, and any form of dryness when paired with intimacy can cause pain, burning, and reflexive pelvic floor muscle contraction resulting in further discomfort. I always recommend to clients to use a water-based lubricant (some of my favorites are Slippery Stuff and Sliquid H2O), an oil-based lubricant (like Coconut Oil), or a lubricant that is paraben- and glycerin-free. Be generous with the amount of lubrication that you use both on yourself and your partner or whatever object you are using. There is no such thing as too much lubricant!

4. Check in with your pelvic floor and abdominal muscles. 

This is something I usually spend a lot of time going over with clients during pregnancy and postpartum because our muscles are at a mechanical disadvantage with being lengthened from pregnancy and delivery. This can cause weakness and lead to different types of symptoms like low back pain, pelvic and hip pain, leaking of urine/poop/gas, and diastasis recti (separation of the six pack muscles in the abdomen or belly).

Practice contracting your pelvic floor muscles alone. Pretend as though you have a straw inserted in the vaginal/pelvic opening and you are using the muscles at the vaginal opening to suck fluid up and in through the straw. The trick with doing a pelvic floor muscle contraction aka “Kegel” is that no one else should know you are squeezing your muscles but you! If that’s the case and you can breathe and carry on a conversation like normal, you are likely doing them correctly. As long as your contractions are pain-free, practice doing them in any and all positions and activities throughout the day (laying down, sitting, standing, exercising). You want to make sure that you incorporate longer contractions where you squeeze the pelvic floor and hold up to 10 seconds and quicker contractions where you squeeze for a few seconds at a time before releasing.

Practice activating your deeper “core” muscles alone. Pretend as though you are trying to put on a pair of pre-pregnancy pants or you are blowing out birthday candles by gently bringing your belly button to your spine. You should feel the muscles at the inside of your hip bones gently activate, which is the deepest layer of your core or abdominal muscles and works together with your pelvic floor. You can incorporate this deeper core activation throughout the day such as when bending over to lift heavy objects (like your baby!), carrying different objects, or getting in and out of bed or out of a chair.

Finally, put the two together! Using the activation of these two muscle groups together can be incredibly helpful if you’re struggling with leaking of urine, poop, or gas with activities that increase the pressure in your abdomen such as coughing or sneezing. Simply do the abdominal and pelvic floor muscle contraction before the activity where you have the leaking, maintain the contraction during the activity, and then let it go immediately following.

5. See a pelvic floor therapist if you’re struggling.

You don’t have to wait until your six week postpartum checkup to seek additional help from a pelvic floor specialist and can start addressing any symptoms you may be struggling with as soon as you feel ready. All recommendations provided above are general recommendations and not a one-size fit all solution for everyone.

Websites that I frequently recommend to help find a skilled provider near you for specialized treatment interventions tailored to you and your symptoms are pelvicguru.com and pelvicrehab.com. Checking Dr. Google for local providers always works, too.

Just know that there are treatment options available to you if you are struggling…you don’t have to “just live with things” or accept your symptoms as “a normal part of having children.”

Last medically reviewed on December 5, 2023

Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor during pregnancy and post-delivery. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people so that they can take better care of themselves. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of having a baby.

Want to chat more to see if working with Brook is a good fit for you? Schedule your free phone consultation today!

5 Steps to Correctly Latch Your Baby

By: Natalie Jarrett, MSN, IBCLC

Latching your baby deep onto your nipple is one of the best ways to ensure you have a comfortable latch, so that your baby can remove milk from the breast effectively. Read on for 5 tips to help you get your baby latched more deeply. 

1.Put Your Baby Belly to Belly

In order to get a good latch, start by putting your baby tummy to tummy with you and their head close to your breast. This will ensure your baby’s head is aligned straight with your nipple and not turned to one side or the other while they are trying to nurse. This keeps your baby more comfortable and helps them to get a deeper latch. If you notice your baby’s head is turned, try to align them so their head, hips, and shoulders are in a straight line. 

2. Align Your Baby Nose to Nipple 

The next thing you will want to do to get a good deep latch is to have your baby’s nose lined up with your nipple right before they latch on. This ensures you are bringing your baby up to your breast, rather than bending over and bringing your breast to your baby. Bringing your baby to the breast will allow them to get a deeper latch and will be more comfortable for you. 

3. Tap Your Nipple to Baby’s Lips 

You want to ensure your baby opens their mouth wide before you bring them onto your nipple. If they are not opening their mouth, try touching your nipple to their upper lip once. Try a second time if the first tap doesn’t get them to open. If they still don’t open their mouth, try gently brushing your nipple along their lips. Once their mouth is open wide, bring them deep onto your nipple. You want most of your areola to go into their mouth along with the nipple. Avoid having just your nipple in your baby’s mouth as this can cause damage and pain. 

4. Shove with Love 

Another step to getting a good deep latch is to “shove with love.” When your baby opens their mouth wide, bring them onto your nipple quickly. It should be a gentle shove to bring them in right when their mouth opens. Once your baby opens their mouth, you want to bring them deep onto your nipple. Having a deep latch will make it easier for your baby to transfer milk and should make breastfeeding more comfortable for you as well. When you are bringing them in, be sure not to press against the back of their head as this can cause them to push away. Instead, hold your baby on their shoulders at the base of their neck. 

5. Ensure Your Baby’s Chin Touches Before Nose 

When your baby has a deep latch, their chin should touch your breast before their nose does. Their nose will touch or be just above the breast. Even if their nose is squished up against your breast, they can still breathe. If your baby cannot breathe, they will pull away from the breast. Be sure not to hold the back of their head, so that they are able to pull away if they need. 

A deep latch should be comfortable and should feel like deep pulls. If you tried the above tips and you are still experiencing discomfort, be sure to reach out to a lactation consultant near you soon!

Last medically reviewed on November 28, 2023

Natalie Jarrett, MSN, IBCLC is the lactation consultant Milestones Pediatric & Maternal Nutrition in Cary, NC. Natalie specializes in empowering lactating parents during their breastfeeding journey, while helping to minimize any breastfeeding difficulties. Schedule an appointment today.

Feeding, Sleeping, and Your Baby's Development: What You Need to Know

By: Irene Gouge

Today, we're diving into a topic that's near and dear to our hearts – the connection between feeding and sleeping in children, from newborns to preschoolers. As someone who's passionate about creating flexible routines that foster both structure and freedom, I'm excited to explore this essential aspect of parenting with you.

Newborns: The Delicate Balance

The arrival of a newborn is a moment of pure joy, endless wonder, and exhaustion. Yet, it is also a time of round-the-clock needs, particularly in the areas of feeding and sleeping, all the while recovering from the birth. In these initial months, the relationship between the two is incredibly intricate. Your baby's tummy is tiny, necessitating frequent feeds to fuel their rapid growth. However, this also means short bursts of sleep for newborns. As parents, your primary objective is to provide nourishment while gradually guiding your infant into a more structured routine. This is not a time to worry about bad sleep habits. Actually, when your baby is satiated, the better your baby will sleep.  

Understanding your child's cries is key during this stage. Is it hunger, fatigue, discomfort, or something else? Learning to distinguish these cues will help establish a sense of balance between feeding and sleep, allowing you to meet your child's needs and communicate more effectively with  your little one.

Infants: The Transition Phase

As your baby grows, so does their stomach capacity, leading to longer periods of sleep and more predictable feeding schedules. This is an opportune time to introduce a consistent wake time and bedtime. It offers a sense of structure while still being adaptable during the day to accommodate your child's unique needs.

Cue-based care continues to play a crucial role during this phase. Being attuned to your baby's cues and needs helps establish a flexible routine. The goal is to create an environment where your child can thrive and feel secure, knowing their needs will be met with care and responsiveness.

Toddlers: Exploring Independence

Toddlers are known for their newfound independence and, yes, occasional picky eating habits. This phase can present challenges with feeding, but it's essential to maintain a sense of structure. Encourage a variety of healthy foods while preparing for the opinions and emotions your child may have around what is being offered.  

Ellyn Satter says that “if a struggle emerges about eating, a toddler will get so involved in the struggle and so upset that it overwhelms her need to eat. This observation is just as true of struggles about potty training, what to wear, school work, (sleep emphasis, mine) and so on. Throughout your child’s growing up years, it is important to matter of factly set the limits and avoid the emotional fireworks and struggles. Learning to do this with feeding will help you in other areas as well.”

The feeding and play routines impact sleep and having a consistent sleep schedule is equally important. It helps reduce tantrums and meltdowns that may arise due to sleep deprivation. Feeding is a full on activity and requires your child to be well rested to eat well.  Your toddler is at an age where they need clear boundaries and a sense of security in their daily routines.

Preschoolers: Routines and Boundaries

By the time your child reaches the preschool years, they will likely have established more structured eating and sleeping schedules. They've had the opportunity to practice these routines since infancy, making this transition smoother.

However, it's not unusual for preschoolers to test boundaries and seek a sense of autonomy. Maintaining clear and kind expectations during mealtimes and bedtime is vital. An effective strategy is empowering your child to participate in routines like meal preparation, making snacks like Peanut Butter Energy Bites turning them into opportunities for learning, play, and connection. Consistency in your routines is key to raising a well-rested and well-fed preschooler.

The Feeding Factor: Establishing Healthy Feeds

A key phrase I often share with parents is "efficient feeds." This means creating a routine where your child knows what to expect, feeds well, and concludes the feeding window with predictability. This approach is based on your child's cues and natural hunger signs. As a sleep consultant, I often surprise parents by highlighting the importance of monitoring a 24-hour feeding and sleeping log. This helps identify your child's organic patterns around sleeping and feeding, a critical practice, especially during the first 18 months of life.

Feeding patterns evolve over time. For instance, newborns may require 12 to 10 feeds, gradually transitioning to 8 to 6 feeds during the first year. Eventually, they settle into a routine that includes predictable mealtimes, like breakfast, snack, lunch, snack, and dinner throughout the toddler and preschool years.

Napping Transitions Over Time

Napping patterns naturally change as your child grows. Newborns might take five short naps a day, reducing to four to three naps between 4-9 months, and then to two naps until around 15-18 months when they are ready to drop down to one nap. After 18 months, children typically continue with one nap a day or, at the very least, a rest time until they reach school age.

In our Healthy Sleep Foundations Course, we dive deep into the essentials of feeding and playing, which significantly impact your child's sleep. Creating daily rhythms and flexible routines is key to ensuring a night of sound sleep. These routines accommodate your child's biological, nutritional, developmental, and behavioral needs, recognizing that your needs matter just as much in this parent-child relationship.

The Challenge: Uncertainty of Feeding or Sleeping?

Parents often find themselves in a quandary when they're unsure whether their child's needs pertain to feeding or sleep. Seeking assistance and support can be a game-changer in these situations. I offer a FREE 15-minute consultation to connect and demonstrate how Loving Lessons can support you in becoming a calm, confident, and well-rested parent.   

The Family Unit: Working Together

Creating flexible routines is a family affair. It's not just about catering to your child's needs; it's about working together as a family unit. Engage your child in meal preparation and bedtime routines, fostering a sense of responsibility and cooperation. As a postpartum doula, one of the most rewarding aspects is witnessing parents recognize their newborn's capabilities and learning to trust and communicate effectively. When parents feel stressed, anxious, or overwhelmed, it often stems from uncertainty and fear. One of my strategies to help parents shift is my Breathe LOVE guide - a FREE resource equipped with tools for both feeding and sleep, designed to empower parents and nurture their connection with their child.

The Sleep Factor: A Parent's Lifeline

Sleep is precious for both children and parents. As a sleep consultant, my mission is to help families attain the sleep they need. The feed-sleep connection is a cornerstone of this mission. When children have clear and kind expectations concerning feeding and sleeping, parents can ultimately achieve that elusive calm, confidence, and well-deserved rest.

In an ideal world, everyone would sleep soundly, and I firmly believe it's attainable with the right guidance and strategies. Let's continue to educate parents to be well and sleep well, enabling us all to savor the joys of parenthood with peaceful nights of rest.

To all the moms and dads out there, remember, you're not alone on this journey. We're all in this together, creating flexible routines that provide structure and freedom, nurturing the growth and development of our little ones. Sweet dreams and happy parenting!

Irene Gouge, the passionate CEO of Loving Lessons Sleep Solutions since 2011, is a dedicated Gentle Sleep Coach, Postpartum Doula, and Infant Feeding Specialist. Located in Holly Springs, NC, she empowers parents both online and in person to regain their sleep and strengthen the parent-child relationship. With her gentle, loving, evidence-based, and nonjudgmental approach, Irene fosters love, trust, and secure attachments through flexible routines.

Her vision? A world where everyone sleeps! Irene's mission is to educate parents on helping their little ones sleep, equipping parents with the tools they need to lead and be calm, confident, and rested.

Irene offers comprehensive Sleep Programs, catering to newborns through school-age children, including 1-on-1 sleep consultations, postpartum doula support, and group coaching for Sleep Coaching Success. Through her guidance, she transforms sleepless nights into sweet dreams, allowing families to lead with love. 

To learn more, visit Loving Lessons Sleep Solutions.

Last medically reviewed on November 13, 2023

4 Things Every Birthing Person Should Know About Postpartum Health & Pelvic Health

By: Dana Solomon, MS, OTR/L, RYT, PCES

Did you know that most people get about 15 prenatal visits and only ONE postpartum follow-up?! There continues to be gaps in postpartum care. These gaps set us up for fear and anxiety or jumping back into things too quickly and injury because there is a lack of guidance. Here are 4 things I wish every single birthing person knew about postpartum healing and pelvic health. 

1. Nothing magical happens at 6 weeks postpartum

There’s still A LOT of healing to happen. The good news is that this means there ARE gentle exercises you can do before 6 weeks. The bad news is that your body isn’t suddenly ready for ALL the exercises after 6 weeks. If you expected to feel like your pre-pregnancy self at 6 weeks and feel disappointment that you don’t - it’s not that there’s something wrong with you, it’s that it actually takes much longer. Be patient, it will happen. 

2. There’s no “safe” exercise list

We all just want a list of what to avoid, unfortunately it’s not so simple. Movements are not inherently “safe” or “unsafe”. The better question to ask when it comes to movement is: How does this movement support my body as it is right now?

In general it is beneficial to start with postpartum movement that have a focus on:

1. Breathing

2. Reconnecting to the deep core

3. Foundational and functional movement

Signs that a movement or exercise might be currently too advanced:

1. You can’t breathe well during the movement

2. You experience leaking or increase in pelvic pressure/heaviness

3. You notice significant doming at your belly

4. You experience pain during or after the movement

Does this mean that these exercises are “bad” or “dangerous”? Probably not. But these are signs that what you’re doing is not doing your body any favors.

3. Kegels are typically not the cure-all solution

Learning to understand the ways that your pelvic floor muscles move and knowing how to coordinate them is important, but that alone is not going to fix your issue. It’s also not functional!

What IS much more likely to support your healing is:

• How your whole core system is working together

• Hip and glute strength

• Managing pressure

• How you execute functional movement

• Your nervous system

• Habits & Routines

4. Those with C-sections deserve support

A C-section is a MAJOR abdominal surgery that deserves the same (or more) follow-up care that we would give to a shoulder or knee surgery. Most who experience a c-section are sent home with a short list of instructions to not lift anything heavier than their baby and not to drive for a few weeks…and that’s it. 

Did you know that pelvic health OTs/PTs can:

• Support initial healing by teaching you strategies for positions such as getting in/out of bed

• Teach you movement to support your core healing

• Help with body mechanics for holding your body, pushing a stroller, and more

• Do hands-on work to help your scar tissue

Want guidance on what’s a good fit for you in postpartum so you can get back to the things you love? Pelvic Health therapists can help! 

Dana Solomon is a proud pelvic health occupational therapist and owner of Triangle Pelvic Health & Wellness. She is committed to educating, empowering, and advocating for birthing people to expect better - through navigating fertility, pregnancy, and postpartum. Diastasis recti and pelvic organ prolapses is not a life sentence for fearing movement. Sex should be pain-free and pleasurable. Leaking urine is not a part of motherhood. Her whole-person approach helps people build resiliency from the inside out, using intuitive bodywork, retraining movement patterns, and tuning into lifestyle habits and routines, to do the things you love without fear or doubt. Get Dana’s 20 page e-booklet, Postpartum Essentials: Guide to Healing from the Inside Out, for free here or connect directly by setting up a FREE discovery call.

Last medically reviewed on October 11, 2023

14 Ways Partners Can Help in Pregnancy, Birth, & Postpartum

By: Madelene Martin

Do you find yourself saying, “We are pregnant?” This ‘we’ mentality, especially when it extends to sharing the load, can be exceptionally beneficial during pregnancy, birth, and postpartum. Odds are that your partner is going to need lots of help during these periods. Here are some practical ways that you can be a huge help.

Pregnancy

Pregnancy puts a new kind of strain on her body. While pregnancy is a biologically normal process, she may be tired, hungry, emotional, and more. 

1. Taking care of extra chores

This looks different for every family, but taking on additional load at home can remind her that you see the work that she is doing in carrying your baby. Also, she may have trouble keeping up with her portion of the housework as she deals with nausea, tiredness, swelling, pain, and more. Ask her what chores would be the most helpful for you to take over and start there.

Depending on how you and your partner divide household labor, you may already be doing all of the cooking. If so, be sensitive to her cravings and aversions and know that these can change over the course of her pregnancy. If your partner does most of the cooking or if you share cooking, take on some more meals! Cooking can be difficult when one is nauseated, but she will still need to eat, and you can be a huge help here.

2. Go to appointments as you are able

Everyone’s work schedule is different, but if you are able, attend her prenatal visits. You will hear how she and the baby are doing, learn about pregnancy and birth, and support your partner all at the same time. If you aren’t able to make all of the appointments, the ultrasounds are typically the ones that partners will choose to attend. 

3. Letting her sleep

Her body is doing a lot of work in pregnancy! Restorative sleep is needed and often craved during this time. Encourage her to take naps, sleep when she can, and put her feet up. She may feel guilty for sleeping or may feel that she needs to be doing other things; remind her to listen to her body and that those things will still be there when she wakes.

4. Being a listening ear and extending grace

An increase of hormones in pregnancy cause most to be moody and emotional. Have extra grace in this period. She probably did not mean (or did not mean to say) those comments that seem out of character for her. If harsh words are said, try not to retaliate and remember that it could be her pregnancy talking (but don’t say this aloud!). 

Additionally, she may want to talk more, especially about pregnancy, birth, and baby topics. Remember that she is intensely feeling pregnancy. She may not be able to go about her day without feeling nauseated, glancing at her bump in the mirror, having any number of discomforts, or feeling the baby move inside of her. So while it may be tempting to get bored of these same conversations or to disengage, provide her with your listening ear and use her excitement to boost your own.

4. Asking her what feels good

Pregnancy comes with lots of aches and pains. Some common discomforts include (but are surely not limited to) pain and itching in the skin over the bump, back pain, hip pain, headaches, digestive issues, round ligament pain (on either side of the bump near where her leg meets her abdomen), and lighting crotch (shooting pain in the vaginal area and pelvis). Note if she mentions that skin in certain locations hurts and avoid touching there. Ask if you can give her a massage, put counter pressure (sustained pressure) on a certain painful area, or if she has ideas of what may feel good. 

Birth

Maybe it is because I am a birth worker, but I would argue that there is nothing quite like birth. During the ups and downs and all the unknowns, your constant support will be invaluable.

5. Staying by her side

Birth is both highly anticipated and very scary for most women. Continuous support is the best thing that you can offer your partner. This means being by her side throughout labor, staying awake when she is awake, and remaining engaged during the process. While it might be tempting to get on your phone, watch television, or work, she may feel abandoned in that moment. So stay near her the whole time and stay physically connected when you can. Holding hands and massage can mean so much more than you may think. At the same time, you need to take care of yourself. Make sure to pack more snacks than you anticipate needing. If you need to step out to use the restroom or get some food, make sure you ask if she needs anything. Her nurse will periodically come in to check her vitals; this can be a great time to leave for a moment if you need to. You can always ask if her nurse can stay with her while you are gone. And if you have a birth doula, we offer advice for how to help during birth, someone to give you a break, and knowledge of pregnancy and birth.

6. Keeping some comments to yourself

Birth is a unique experience. There are sights, smells, sounds, and activities that are very different from anything else. So while you may be thinking all kinds of things, there are some things that you won’t want to verbalize. You won’t want to share that anything is gross, that you are tired, that your back hurts, or that you are hungry (if she is unable to eat). Remember that this is a very vulnerable time for her and that she may be very sensitive.

7. Comfort measures

One of my favorite things as a doula is getting to teach partners comfort measures and watching mothers sigh in relief at the break from pain. Don’t underestimate your value in the labor and delivery room! So whether this looks like slow dancing with your partner, giving massages, or squeezing her hips, learn some of these comfort measures and offer them to your partner in labor. The Birth Partner by Penny Simkin is a great book to learn these tools.

8. Keeping ice water fresh

Hormones may make your partner have drastic temperature swings. One moment she may be freezing and the next she may be throwing all the blankets off. Keep both her jug of ice water to drink and a basin of ice fresh and available. You can leave some washcloths in the basin of ice and add some water to it. That way, they will always be cold when she gets hot.

9. Encouraging words

While everyone else in the room may know birth really well, you are the expert on your partner. You know what will lift her up and what she may need to hear. Remind her frequently that she is doing a great job, that you love her, and that you are proud of her. You are the one that she will look to and celebrate with when your baby is in her arms. 

Postpartum

The postpartum period may look very different from what you and your partner expect; keep your mind open, your schedule free, and your support up to ease the transition to life with a newborn. 

10. Managing visitors

Sometimes, the people that want to come visit your new baby are overwhelming. Before birth, talk with your partner and come up with a plan for how you will know she is overwhelmed or tired of visiting. Some couples choose a code word, some have a look that says everything, or some have a secret hand motion. Whatever you choose, your partner will rest easier knowing that she just has to give the signal and you will remind everyone that mom and baby need their sleep. 

11. Diaper changes, burping, & holding baby upright, so that she can sleep

Regardless of how you feed your baby, many parents are surprised at the number of times that a newborn has to eat, morning and night. If your partner is breastfeeding, you may feel like you can’t be of that much help, but I assure you that you absolutely can! Most families find a rhythm that often looks like diaper change, feed, burp, and hold baby upright for a given length of time. So even if your partner is breastfeeding, the only thing that you can’t do is the feed. When your baby wakes, offer to change their diaper and hand them to your partner clean. After she breastfeeds or bottle feeds (or you bottle feed), you can burp the baby, hold them upright, and then soothe them to sleep. This will give your partner the chance to sleep a little longer. 

Additionally, you could work out a staggered sleep schedule. This is when one partner will manage baby care until a certain time during the night and then the other partner will take over baby care. With this method, one partner sleeps uninterrupted in the evening and early night and the other partner sleeps uninterrupted in the late night and morning. Find what works best for you and your partner to both get quality sleep. 

12. Preparing meals and snacks

After birth, your partner’s body will be recovering. You want to encourage her to rest frequently and feed herself well. You can prepare or organize (if family and friends are brining food) meals and snacks. If she is breastfeeding, she will need additional nutrients and may be hungry more often. Make sure that you keep the pantry and fridge stocked with food. Grocery pickup can be your best friend!

13. Watching out for warning signs

After birth, your partner’s medical provider will go over some warning signs to look for. These can include fever, excessive vomiting, and uneven swelling. If she has stitches, warning signs also include oozing or pus at the stitch site, separation of the skin, and redness, heat, or streaking in the skin surrounding the stitches. Keep an eye out for these atypical but serious signs.

Perinatal mood and anxiety disorders are the most common complication following birth. These include anxiety, depression, bipolar, psychosis, Obsessive Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). If your partner seems off, cannot sleep, cannot stop worrying, or has thoughts of hurting herself or the baby, reach out to a perinatal therapist, perinatal psychiatrist, or her medical care provider. Visit Postpartum Support International at postpartum.net to learn more about Perinatal Mood and Anxiety Disorders and find a provider near you or visit UNC’s Center for Women’s Mood Disorders (https://www.med.unc.edu/psych/wmd/) to learn about treatment in the Triangle. Additionally, 1 in 10 partners experience a PMAD. If you are experiencing any of these symptoms also reach out. There is help and healing.

14. Reminding her that she is a good mom even when feelings are up and down

Emotions fluctuate in the postpartum period, and many women feel that they are not a good mom. Be a steady reminder for her that she is in fact a good mom and point out all the ways that she is responding to your baby. Help her look at the evidence; this therapy tool of looking around you for anything to suggest that your belief is true or false can be helpful in this time. When she responds to the baby’s cries, cuddles the baby, talks and sings, and feeds the baby, these all present evidence that she is a great mom. Emphasize that you believe in her, that no one has it all together with a new baby, and that you are there throughout it all to be with her, help her, and support her. 

So while it may in fact be that your partner is pregnant, you can make a huge difference in her pregnancy and experience. Don’t underestimate your worth in both emotional and physical support. Pregnancy, birth, and postpartum can come with so many emotions and feelings; remember that you are the one your partner wants to share everything with and that you have all that you need for the journey ahead.

Madelene Martin is the doula, educator, and owner behind The Beginnings Center. She supports families through competent care, evidence based information, and non-judgmental support. To learn more about The Beginnings Center’s birth and postpartum doula services, classes, groups, and more, visit www.thebeginningscenter.com 

Last medically reviewed on July 25, 2023

Understanding and Preparing for Perinatal Mood & Anxiety Disorders (PMADs)

By: Kim Konderla, MSW, LCSW

When one is planning their family or preparing to bring home a new baby, it is not typically front of mind that they may develop a mood or anxiety disorder during pregnancy and/or the postpartum period. We are decorating nurseries, finding pediatricians, making sure we have all of the necessary supplies, packing hospital bags, purchasing shoes that we do not have to tie, taking care of toddlers and hoping they’ll adjust to the new baby okay, and attending showers with loved ones, and…you get it.

None of us is going to voluntarily imagine that our pregnancy and postpartum experience would be anything other than sleepless, maybe emotional, but blissful. It is here that I will advocate for a healthy blend of hoping for the best and being prepared for some tough stuff beyond the typical pregnancy/postpartum experience. The odds that some of us will develop a perinatal mood or anxiety disorder (PMADs) are statistically significant, but they don’t have to be significantly frightening. We can be informed, prepared, and supported well ahead of time with just a little bit of learning and preparation.

Based on the current data, 1 out of 7 new mothers will develop a PMAD (and 1 out of 10 dads). It is theorized that this statistic should be much higher as it is based on reported data, and we know many women fall through the cracks, only discovering years later that their suffering was out of the norm. I could stand on a soapbox all day about the pressures of perfectionism in motherhood, but we’ll save that for another day.

For many of us, our understanding of PMADs is limited to Postpartum Depression (PPD). Some celebrities have come out to share their experience with PPD, we’ve maybe seen some ads on TV talking about it; but even so, how many of us could identify if we or someone we know was experiencing PPD? What’s the difference between baby blues, exhaustion, and depression? How much distress is expected and how much is worth talking to a professional about?

Being professionally trained as a licensed therapist with specific training in PMADs, I am able to identify such things, but I am left wondering why the information I have about PMADs is not universally taught. I am not one to gatekeep, so let’s consider this blog post a step in making this information more widely available and accessible. This information could help you, a loved one, or a stranger on the internet to avoid unnecessary suffering and get much needed (and deserved) help as soon as possible.

Let’s jump into the nitty gritty, shall we?

Define “perinatal:”

The term “perinatal” is used to address the period of time from conception through loss or birth, and the year post loss/delivery.

What are PMADs?

Perinatal Mood and Anxiety Disorders are mood and anxiety disorders that (you guessed it!) occur during/as a result of pregnancy, loss, traumatic birth, and/or the postpartum period. PMADs are typically the result of a combination of several factors including social, psychological, and biological stressors. None of us can control whether or not we will develop a PMAD, but there are some risk factors that we can take into consideration when coming up with a postpartum care plan.

Risk Factors:

● Personal history of anxiety and/or depression

● Personal history of psychosis

● History of diabetes/thyroid issues

● Past/current abuse (physical, sexual, psychological)

● Traumatic pregnancy and/or delivery

● Previous history of pregnancy and/or infant loss

● Pregnancy/birth of multiples

● Baby in the NICU

● Relational stress and/or single parenting

● Inadequate social support

Find a more thorough checklist here.

What are the different types of PMADs?

● Postpartum Depression

● Postpartum Anxiety

● Postpartum OCD

● Postpartum Post Traumatic Stress Disorder

● Postpartum Psychosis

● Postpartum Panic Disorder

● Postpartum Bipolar Disorders

What are the signs/symptoms?

● Feeling depressed, numb, and/or hopeless

● Lack of interest in your baby

● Trouble concentrating, brain feels really foggy

● Feeling anxious or panicky

● Extreme worries/fears

● Anger and irritability that are out of the norm for you

● Dizziness, heart palpitations

● Difficulty sleeping even when baby is sleeping

● Intrusive thoughts (fancy way to say: scary and unwanted thoughts)

● Urge to repeat certain behaviors

● Seeing/hearing things that others cannot see/hear

What’s the difference between baby blues and PPD?

“Baby Blues,” experienced by approximately 80% of new mothers, is a period of mood swings and weepiness lasting 2-3 weeks after birth. This is an expected adjustment period that resolves without medical intervention. Any of the above symptoms that outlast 3 weeks after birth are worth mentioning to your doctor.

When/how should I talk to my doctor?

Anytime! I’ll say it again- ANYTIME you have a concern is a good time to talk to a professional. Especially in the midst of sleepless nights, it can be helpful to have an outside perspective. Whether it’s because you’re 3 weeks post-delivery and you’re still experiencing what you thought was baby blues, or your baby is 3 months old and you’re still having difficulty feeling connected to them, the above lists and tools can help you identify what you’re experiencing, and you can use these to start a conversation with your doctor or a therapist.

What can we do ahead of time to ensure proper mental health support for ourselves and other new moms?

My number one suggestion for moms-to-be is to go ahead and consult with a couple of therapists before delivery. Finding a therapist that is a good fit takes a bit of planning and effort, neither of which you will be able to give while caring for an infant and possibly other children. Most therapists offer a free 15-20 minute consultation, so I highly recommend jumping on Psychology Today or the directory of perinatal mental health providers hosted by Postpartum Support International and putting together a list of 2-3 therapists to consult with.

It can also be helpful to have conversations with your people (the ones that you’ll be around the most during pregnancy and postpartum) about PMADs. Talk to them about the signs and symptoms so they can help take care of you in ways that it can sometimes be hard to care for yourself.

Additional Resources:

Postpartum Support International

PSI Online Support Groups

Kim Konderla, MSW, LCSW is a licensed clinical social worker working with folks in North Carolina as they work through family planning, perinatal and postpartum mental health concerns, and grief/loss. She is here to help you take a deeper dive into your emotional experiences so that you can better understand yourself, your patterns, and your relationships. Using the therapeutic space and relationship, she aims to help you learn to feel safe with your emotions and the emotions of others. She will help you learn to offer yourself compassion instead of criticism. Learn more on her website: www.groundedlivingpllc.com

Last medically reviewed on June 5, 2023

How to Ensure Children with Food Allergies Are Getting the Nutrients They Need to Grow and Thrive

By: Kerry Lett, MPH, RDN, LDN, CLC

Food allergies in the United States are on the rise (1). As many as 32 million Americans, including 6 million children, have food allergies (2,3,4). That means that 11% of adults and 8% of children have at least one food allergy (2,3,4). However, among the children that have food allergies, 40% of them are allergic to multiple foods (4).

How Do Food Allergies Affect Growth & Development?

While science has made great strides in recent years, avoidance of all known food allergies is still the recommended treatment for those with food allergies. However, restricting intake of food, especially multiple foods and food groups for those multiple food allergies, starts to bring up concerns of whether or not that individual can get the nutrients they need. This is especially true for children, who are rapidly growing and developing and, therefore, relying even more so on their diet to give them the nutrients they need.

Research has found that children with food allergies are at an increased risk of inadequate nutrient intake, which can lead to poor growth and vitamin & mineral deficiencies (5,6,7). One study found that children with multiple food allergies were significantly shorter than children without food allergies (5). In extreme cases, research studies have also reported that allergen elimination diets have caused children to develop rickets or Kwashiorkor (a severe form of malnutrition) (5,6).

How Can I Ensure My Child Is Getting the Nutrients They Need?

Luckily, research also tells us that if children with food allergies find appropriate ways to replace the nutrients they are missing, they can still continue to grow and thrive (5,6). So how can you make sure your child is replacing the nutrients they are missing out on due to food allergies? The first step is to think about what your child may be losing by not consuming their specific food allergen(s).

Below is a list of the big 9 food allergies and the nutrients they are best sources of:

• Dairy/Cow’s Milk: protein, calcium, iodine, phosphorus, selenium, zinc, and vitamins A, B2, B5, B9, B12, D, & K

• Eggs: protein, iodine, and vitamins A, B2, B5, B7, B9, B12, D, & K

• Soy: protein, calcium, magnesium, potassium, and vitamins B1, B6, B9, & K

• Wheat: fiber, copper, magnesium, manganese, iron, selenium, zinc, and vitamins B1, B2, B5, & B9

• Peanuts & Tree Nuts (varies by nut): protein, copper, magnesium, manganese, phosphorus, selenium, zinc, and vitamins B3, B7, B9, & E

• Fish & Shellfish (varies by fish/shellfish): protein, omega-3 fatty acids, copper, iodine, and vitamins B1, B3, B5, B6, B7, B12, & D

• Sesame Seed: protein, fiber, calcium, magnesium, manganese, zinc, and vitamins B1 & B6

Once you have figured out what your child’s food allergens are good sources of, it is important to find safe alternatives to replace these nutrients. Luckily, most nutrients come from a wide variety of sources, so you can hopefully find a safe source of each nutrient to serve your child.

Below is a list of the most common nutrients present in food allergies with sources:

• Protein: beans, edamame (soy), dairy products, eggs, fish, lentils, meat, nuts, nut butters, seeds, seed butters, seitan (wheat), tempeh (soy), & tofu (soy)

• Calcium: dairy products, green leafy vegetables (other than spinach), & fish eaten with bones (such as sardines)

• Copper: dark chocolate (70% or greater cacao), seeds, shellfish, nuts, and whole grains

• Iodine: dairy products, eggs, fish, seaweed, & shellfish

• Iron: beans, fortified breakfast cereal, meat, & seafood

• Magnesium: beans, green leafy vegetables (such as spinach), nuts, seeds, and whole grains

• Manganese: leafy vegetables, legumes, nuts, rice, some seafood (such as clams, oysters, & mussels), and whole grains

• Selenium: Brazil nuts, dairy products, grains (such as pasta & rice), meat, & seafood

• Zinc: beans, dairy products, fortified breakfast cereal, meat, nuts, some seafood (such as oysters, crab, & lobster), & whole grains

• Vitamin B1: fish, meat, & whole grains

• Vitamin B2: eggs, dairy products, green vegetables (such as spinach), and meat

• Vitamin B5: avocado, dairy products, eggs, fish, meat, seeds, some vegetables (such as broccoli, mushrooms, & potatoes), and whole grains

• Vitamin B6: fish, fortified breakfast cereal, meat, non-citrus fruit, and starchy vegetables (such as potatoes)

• Vitamin B7: eggs, fish, meats, nuts, seeds, & sweet potatoes

• Vitamin B9: beans, dairy products, eggs, fruit, grains (such as rice & bread), green leafy vegetables (such as asparagus & spinach), meat, & seafood

• Vitamin B12: dairy products, eggs, fish, fortified breakfast cereal, meat, and nutritional yeast

Should My Child Take a Multivitamin?

I believe that most children do not need a multivitamin. This is because most children are able to get the nutrients they need from food alone, even children with food allergies. However, if your child has multiple food allergies or is experiencing other factors that are impacting their food intake, such as picky eating or other diseases, and you are not able to find suitable replacements for the nutrients they are missing out on, then talk to your child’s pediatrician or registered dietitian about whether or not they would benefit from a multivitamin.

When Should I Seek Professional Help?

Since childhood is a time of rapid growth and development, it is important that your child is getting all of the nutrients they need. However, this can be hard! This is especially true if your child has multiple food allergies or is experiencing other factors that are impacting their food intake, such as picky eating. If you are struggling to figure out how make sure your child is getting the nutrients they need to grow or if you child is having issues with growth or weight, then it is important to seek professional help from your pediatrician and a registered dietitian with training in food allergies. It is also perfectly okay to seek professional help even if you just have questions about how to manage your children food allergies or want to triple check your child is getting everything they need to thrive. Healthcare professionals, such as myself, are always here to support you and your family!

Kerry Lett, MPH, RDN, LDN,CLC is the pediatric & maternal registered dietitian and owner of Milestones Pediatric & Maternal Nutrition in Cary, NC. Kerry is passionate about helping growing families navigate life and achieve all of their milestones along the way. Schedule an appointment today.

Last medically reviewed on May 17, 2023

5 Ways to Connect with Your Partner After Kids

By: Natalie Jarrett, MSN, IBCLC

Although we don’t always talk about it, for almost everyone, having kids changes your relationship with your partner. Maybe you are not connecting anymore, maybe all your time together focuses only on the kids, maybe you are snappier at each other, or maybe you can’t stop calling each other ‘mom’ and ‘dad’ even when the kids aren’t around. Whatever your situation may be, it's often different than it used to be. So if you’re hoping to channel the way things used to be and spend a little time connecting, just the two of you, I hope this article will help. 

So how can you connect? Here are 5 simple ideas that may help you. These may not all fit you and your partner’s personalities, but hopefully one or two will help you feel more connected to each other. 

Hold Hands 

One simple thing you can do to try to reignite that spark of connection is to hold hands for a little bit. So after the kids go to bed, turn on your favorite show or cue up a movie and spend some time together with a little bit of physical touch. Hold hands or snuggle up together on the couch and just enjoy each other’s company. 

Trade Massages 

Another way you can deepen your connection this Valentine’s Day is by giving each other back or foot massages. This is an additional way you can add some physical touch back to your relationship as well as release some built up tension to help you both relax and hopefully connect a little bit more. 

Play a Game 

Playing a board game or card game together after the kids go to sleep is another great way to connect. Put on some of your favorite music in the background and put your phones away and fully focus on some dedicated time together without the kids. You can play a simple, short game a few times or play a longer, more complicated game if you’re up for it. Relish the adult time together doing an adult activity that you may not get to do that often anymore. 

Talk about something other than your kids

This one can be hard, but try to keep the kids out of your conversation. Spend time talking about other interests you have or try a conversation starter such as “What is the most interesting thing you’ve read lately?”, “Where do you want to travel to next and why?” or “If you could only eat one thing for the rest of your life, what would it be?”

Order in Food 

It can be hard to go out to eat with kids, so this Valentine’s Day try ordering in from your favorite restaurant or cooking something in advance at home so there’s less work on the day of and fewer dishes to clean up too. This also gives the cook of the house a little break so that they can enjoy the special day too. 

Remember, you don’t have to do these things on Valentine’s Day itself to get the relational benefit. Any time you can set aside to do one or two of these ideas can help boost your connection. If some of these things help, try to build them into your monthly routine so that you and your partner can benefit from some much needed connection time.

Natalie Jarrett, MSN, IBCLC is the lactation consultant Milestones Pediatric & Maternal Nutrition in Cary, NC. Natalie specializes in empowering lactating parents during their breastfeeding journey, while helping to minimize any breastfeeding difficulties. Schedule an appointment today.

Last medically reviewed on February 7, 2023

Returning to Work while Breastfeeding

By: Natalie Jarrett, MSN, IBCLC

Disclaimer: This post may contain affiliate links in which we may earn a compensation. However, this does not influence our opinions or recommendations.

Your maternity leave is coming to an end and you are uncertain what going back to work and breastfeeding will look like. Know you most likely have the right to pump at work! Read on for more details and tips on maintaining a pumping schedule and how to care for your pump and expressed milk at and after work. 

Your Rights

Most hourly employees and some salaried employees are guaranteed by law to have a break for pumping. This break should be a “reasonable amount of time” and is allowed to happen as often as you need until your child is one year old. You should also be given access to a private place that is not a bathroom where you can pump. In order to maintain your breast milk supply while you are away from your baby, you should pump as often as your baby eats. This frequency will vary depending on your baby’s age and will likely fluctuate over time.

You should discuss your need to pump with your employer as early as possible. Discuss where you will pump, how pumping can fit into your schedule, where you will store your milk, and where you can clean your pump parts. Make sure your employer is aware it may take up to 30 minutes for you to pump, clean up, store your milk, and return to your workspace.

How to Pump

Once you have developed a pumping schedule that is similar to your baby’s eating schedule, you should try to stick to it as closely as possible. You should pump each breast for 15-20 minutes. Using a double electric pump can make this process go quicker. If you are producing much more than you need when pumping this long, try decreasing your pumping sessions to 10-12 minutes. While you pump it can be beneficial to watch videos or look at pictures of your baby to stimulate your milk-making hormones and get your breastmilk flowing. Even though it can be difficult to do, try not to focus on how much milk you are getting. This is why it can be helpful to cover up the bottles while you are pumping, so you are not watching the output. 

After Pumping

You should wash your pump parts in a clean basin and with a dedicated bottle brush and leave them to air dry after each use. Do not wash pump parts or bottles directly in the sink. If you do not have enough time or a space to clean your pump parts after each use, you could purchase enough sets of parts for the number of times you pump at work and then take them all home and wash them at the end of the day. You could also rinse your pump parts in water and sterilize them in a microwave steam bag, if you have access to a microwave. The CDC does not recommend storing pump parts in the fridge between uses. 

Before you store your breastmilk, make sure to clearly label containers with your name and the date the milk was pumped. You can store your milk in a refrigerator in any fridge that is safe for food or an insulated cooler once you are done pumping. Your expressed breastmilk is good for up to four days in the fridge and for up to 24 hours in an insulated cooler bag with frozen ice packs. Upon returning home, make sure to instantly use the expressed milk, refrigerate it, or freeze it, so it does not go to waste.

Traveling with Breast Milk

If you need to travel for work, you are allowed to fly with fresh or frozen breast milk, since it is considered a medically necessary liquid. Even though you are limited to the amount of liquids you can bring in your carry-on luggage, any amount of milk is allowed. You are also allowed to take ice packs or frozen gel packs, regardless of the presence of milk. Be sure to inform the TSA officer at the beginning of the screening process that you are carrying greater than 3.4 ounces of breast milk. You will need to remove the milk from your bag to be screened separately. TSA officers may need to test the milk for explosives or other banned items. Even if milk is tested separately, nothing will be inserted into the milk. Remember that milk is good for 24 hours in an insulated cooler bag with frozen ice packs, but the sooner you can use, refrigerate, or freeze it the better. 

If you need help creating a pumping schedule that works for you or need help boosting your milk supply, schedule an appointment today! 

References

1. Workplace support in federal law. U.S. Breastfeeding Committee. https://www.usbreastfeeding.org/workplace-law-guide.html. Accessed October 21, 2022.

2. Breastfeeding and returning to your workplace. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/workplace-breastfeeding.html#:~:text=The%20federal%20Break%20Time%20for,space%20to%20express%20breast%20milk. Published May 18, 2022. Accessed October 21, 2022.

3. Traveling with children. Traveling with Children | Transportation Security Administration. https://www.tsa.gov/travel/special-procedures/traveling-children#quickset-traveling_with_children_1. Accessed October 21, 2022.

Natalie Jarrett, MSN, IBCLC is the lactation consultant Milestones Pediatric & Maternal Nutrition in Cary, NC. Natalie specializes in empowering lactating parents during their breastfeeding journey, while helping to minimize any breastfeeding difficulties. Schedule an appointment today.

Last medically reviewed on August 30, 2022

How to Prepare for Breastfeeding

By: Natalie Jarrett, MSN, IBCLC

Disclaimer: This post may contain affiliate links in which we may earn a compensation. However, this does not influence our opinions or recommendations.

So you’ve heard about breastfeeding and you think you want to try it. What now? Throughout this blog, we are going to review some tips and tricks that will help you prepare for breastfeeding in your last couple months of pregnancy.

Get your pump and other essentials 

Even if you are planning on exclusively breastfeeding, go ahead and get your breast pump before your due date. Most insurance companies will cover part, if not all, of the cost of your pump. You can check what pumps are covered directly with your insurance company or online at The Lactation Network. You may end up needing your pump sooner than you expect, so having it cleaned, sanitized, and ready-to-go can make the first use a smoother experience. Read through the instruction manual to get a general idea of how to use it, so you will be prepared before you need it. Buy a few nursing bras and one pumping bra. A nursing bra has a flap on front which opens up, so that you do not have to remove your whole bra to breastfeed. A pumping bra has slots in the front for your pump flanges to fit into to make pumping hands-free. A pumping bra is essential to be able to hands-on pump or multi-task. Some moms find wearing a robe with a nursing bra around the house in the early days is the best way to have quick, hassle free access to breastfeed. 

Plan Ahead 

Make freezer meals or have a friend set up a meal train. Put together a nursing cart where you can keep supplies like your pump, Haakaa, snacks, water, burp cloths, nipple cream, such as Lanolin, and even a few special toys you might set aside for an older child to play with while you nurse your new baby. Consider which family members and friends might come over to help with housework or cooking after the baby is born. If you do not have people close by who can support you, consider using a postpartum doula, if this is a financial option for you. Put together a hospital bag with any necessary breastfeeding supplies, such as Lanolin and nursing bras. The hospital should be able to provide you a pump, if this is needed, so you can leave yours at home.

Do Skin-to-Skin Right After Birth 

See if you can find out your delivery hospital’s policy on skin-to-skin. If possible, try to do skin-to-skin immediately following your baby’s birth. There are many benefits of skin-to-skin for both mother and baby. For the mother, benefits include less bleeding, lower stress, and an increase in breastfeeding confidence (1). For the baby, immediate skin-to-skin helps calm, regulate temperature, and reduce crying (1). Skin-to-skin also stimulates the hormones needed for breastfeeding and can encourage the baby to feed. 

Make a Birth Plan

Having a plan written up that you can give to your providers at the hospital can help get breastfeeding off to a good start. Try to breastfeed your baby for the first time within an hour after birth. Let the staff know you want to do skin-to-skin immediately and ask the staff not to give your baby a pacifier, formula, or sugar water, unless it is medically necessary. If your baby does need supplementation, consider using an alternative feeding method to a bottle, such as a syringe or spoon in order to limit the use of artificial nipples. Have your baby stay in your room around-the-clock, so that you are available to breastfeed on-demand.

Learn How to Hand Express 

According to Le Leche League, in order to hand express, you need to “press, compress, release” (2). Start by holding your breast in a C-shape, slightly away from your areola. Then press straight back toward your chest. Next, compress your breast between your thumb and fingers, moving them slightly forward. Release the compression without removing your hand from your breast. Repeat and occasionally move your hand to another spot on your breast. Think about moving around your breast like a clock to ensure you remove milk from all of the milk ducts. You can practice this at home before you have your baby, but be sure to wait until later in your pregnancy, around 37 weeks. If you want more support on this, take our Breastfeeding Basics course or schedule a prenatal lactation appointment.

Talk to Your OB-GYN

Tell your OB-GYN you plan to breastfeed and discuss your health history to see if there are any underlying issues in your history that might make breastfeeding difficult. PCOS, thyroid problems, diabetes, and obesity can all play a role in breastfeeding. You can also discuss all your current medications with your OB-GYN and be sure they are all safe in breastfeeding. 

Choose a Lactation Consultant 

Some pediatrician offices have a lactation consultant or you can find someone in private practice. Knowing in advance who you plan to work with if you have any problems can relieve some stress when issues do arise. Many lactation consultants - including us - offer prenatal consults to discuss your health history and give general breastfeeding advice. If your OB-GYN identifies any issues in your health history, a lactation consultant can help you make a plan for how to best feed your baby. If you would like to speak to someone today, you can make an appointment at www.milestonesnutrition.com/lactation.

Natalie Jarrett, MSN, IBCLC is the lactation consultant Milestones Pediatric & Maternal Nutrition in Cary, NC. Natalie specializes in empowering lactating parents during their breastfeeding journey, while helping to minimize any breastfeeding difficulties. Schedule an appointment today.

Last medically reviewed on August 30, 2022

Sleep Regressions: When & Why They Happen & How to Survive

By: Liz Harden, MPH

What are Sleep Regressions? 

Sleep “regressions” occur when a baby or child who was sleeping well (or at least okay), suddenly, seemingly inexplicably, starts sleeping poorly. The child may skip naps, fight sleep, resist bedtime, wake up a lot in the night and want to start the day before dawn. Needless to say, sleep regressions are exhausting for parents and caregivers and parents reach out all the time for help navigating these dicey periods in sleep. In this blog, I’m going to give you the down low on sleep regressions that commonly happen in the first few years, and how to survive them with relative ease.

Keep in mind that sleep regressions can happen due to teething, illness, travel, or changes to the routine or due to big leaps in cognition or physical abilities. When sleep patterns change due to brain development or working on new skills, this isn’t really a regression at all. They are progressing as little humans, learning and growing and becoming more capable, so the worsened sleep is actually due to a progression, not a regression. 

Whether you’re dealing with the 4 month sleep progression, the 8-9-10 month, the 12 month, 18 month, or 2 year “regression,” they can be disruptive for sure. And since your child isn’t sleeping well, they may also be a hot mess during the day. They become overtired, which pumps cortisol through the system, makes their limited executive functioning more limited, and often leads to increased crying and crankiness day and night. Yikes! 

When Do Sleep Regressions Typically Occur? 

The 4 Month Sleep Regression

The first and most notorious sleep regression typically happens around 3 to 4 months–the infamous 4 Month Sleep Regression. This is when your baby’s sleep patterns change permanently, from newborn sleep to a more mature progression between sleep stages and cycles throughout the night, like older babies, children, and adults. There’s now a brief waking at the end of each sleep cycle, which happens every hour or so, all night long. During these brief arousals from sleep, we check to make sure that everything is “ok.” By “ok,” we mean: the same as when we fell asleep. If all’s well, we go right back to sleep and we typically don’t even remember waking in the morning. 

If a baby falls asleep in your arms while rocking, nursing, or drinking a bottle, for example, and wakes up at the end of a sleep cycle in their own crib, they may not feel “ok.” Where are those snuggly arms that were holding them? This brief wake up and innate checking behavior is the cause of most “sleep problems” that babies experience once they’re out of the newborn stage. And it often comes to a head around 3 to 4 months of age when this big change in sleep patterns most typically happens. But again: this isn’t a regression at all! It’s a maturation in sleep architecture and progression in brain development that will last a lifetime. 

The 8 (or 9 or 10) Month Sleep Regression

You can expect another rocky road in sleep at some point between 7-10 months, when your baby becomes more mobile, goes through a couple of huge cognitive leaps, and starts experiencing separation anxiety. This is often called the 8, 9, or 10-month sleep progression and it often coincides with learning to crawl and/or pull up. 

The 12 Month Sleep Regression

Over the years, I’ve also found that another sleep regression tends to happen around the first birthday, and often plays out as nap resistance. This is the 12-month sleep regression (progression!). My hunch is that it happens when a kiddo is learning to walk and perhaps their nap needs are beginning to shift. But please don’t interpret this as your baby needing to drop a nap! Most babies need to hang on to two naps (but perhaps with longer wake windows) until at least 14 months or so. 

The 18 Month Sleep Regression

Around 15-18 months, most babies make a leap toward toddlerhood. There’s newfound independence and excitement about being an actor in the big wide world, but this also comes with sizable separation anxiety. They also learn that they actually can assert their opinion and say “no” to something. The 18-month sleep regression often takes parents by surprise, because their baby has suddenly become a loud, persistent, and opinionated little being. For the first time, there’s an element of discipline that may be necessary around bedtime. This is a big shift! 

The 2 Year Sleep Regression

Finally, the 2 year old sleep regression (which can happen at any point in toddlerhood or early preschool, but often around the second birthday or 2.5 years) can drop out of the clear blue sky and really throw parents into a tailspin. Suddenly, your kiddo who may have been sleeping really well, for as long as you can remember, starts screaming their head off at bedtime, and often in the middle of the night as well. Sometimes it also shows up as flat-out nap resistance (and they may or may not need the nap, but chances are they do if they’re younger than 3 years old). This particular regression is often due to big transitions (e.g., potty training, new schools or classrooms, new siblings, switching to a toddler bed) and shifting sleep needs. Fears may also emerge, and another wave of separation anxiety is common during this timeframe. 

But honestly, these bouts of crummy sleep (aka sleep regressions due to progressions!) can happen any time your baby or child is mastering a new skill or experiencing a big cognitive boom. It’s also important to note that not all children experience sleep disturbances when they are going through these progressions. Every healthy baby will reach these various developmental and cognitive milestones, but the degree to which the progression impacts sleep will vary from one child to the next. 

How Long Do Sleep Regressions Last? 

Now we have a general understanding of when and why these sleep regressions last, but I bet you’re wondering how long? When sleep regressions are due to things like teething or illness, you can expect the regression to only last as long as the discomfort, so long as you go back to the old way of doing things quickly (e.g., maybe you rocked your baby to sleep when they were sick, but they usually fall asleep on their own). 

When sleep regressions are due to cognitive or physical progressions, you can expect the period of disrupted sleep to last anywhere from about two to six weeks. You may be thinking: “YIKES! Six weeks? But that’s an eternity!” Fortunately, there are things you can do to speed up the process and ensure you’re supporting yourself and your child during this time of major growth! 

How Do I Get Through Sleep Regressions As Smoothly As Possible? 

1. Be mindful of schedule shifts. Scheduling issues can wreak havoc on your kiddo’s sleep. Ensure your child is following an age-appropriate schedule with enough awake time to build the sleep pressure they need to sleep well, while also preventing overtiredness. There’s a real balance and science to sleep schedules–so check out these blogs for 0 to 24 month and 2 to 5 year old scheduling guidance. Honing in on the “right” timing will help you avoid sleep problems caused by mistimed naps and bedtime. Sometimes, you can cruise with a sleep regression just by adjusting bedtime or shifting (or dropping) a nap. 

2. Go back to the basics. Keep routines and sleep environment on point, even if they seem to be doing nothing to help your baby. Maintaining (or creating if you don’t yet have one) a consistent bedtime and naptime routine to help soothe your baby and teach them what to expect. Check out our 3 C’s of the bedtime routine to ensure your baby is getting what they need. Also, if your little one is resisting sleep, making sure that it’s extremely dark will block out distractions that may be keeping them awake. Create a “baby cave” to promote the best sleep possible during this crapola time.

3. Check your mindset. You cannot force sleep. Getting frustrated and trying to force sleep will do you no good. You’ll get more and more frustrated and your child will absorb that frantic energy. Studies show that little ones mimic their caregivers’ emotions—including stress and anxiety. Scientists call this neuroregulation. When we’re in a situation that causes stress to run high (like your baby fighting sleep or screaming at bedtime, naptime, or in the middle of the night) and we’re overwhelmed, angry, or frustrated, our kiddo can sense that and will respond similarly, making it even harder for them to settle into sleep. 

   Also, for babies who have been sleeping well and independently for a while now, and are in a regression due to a cognitive or physical leap, sometimes they just need some space to practice skills and process exciting new brain powers—yes, they may need this time awake in the middle of the night when there are no distractions. As much as is possible, leave them be! They may get a little frustrated here and there, but trying to force them to sleep, when they want to be awake, is an exercise in futility. In these scenarios, turning off the monitor and letting them practice in a safe space while you get the rest you need, is absolutely appropriate! Check out our Mindful Method for Sleep, to learn a simple, evidence-backed and mindfulness-based tool to help you through sleep regressions, and other frustrations in parenting and sleep, with less stress and more success. 

4. Allow lots of time for practicing new skills during the day. If your baby is waking up in the night, getting stuck on their tummy, trying to pull up, rocking back and forth in an effort to crawl, or some other new feat of strength, make sure they get positive playtime in the crib/bed during the day. If they get sufficient practice and playtime during the day, they may require less at night (when you’re trying to sleep!). Check out this blog on positive playtime for inspiration. Also, If your baby or toddler is experiencing separation anxiety, you can use the positive playtime in the sleep space to help build their confidence. 

5. Give extra comfort but avoid new sleep crutches. Try not to introduce new sleep crutches. For example, if your child was previously falling asleep on their own, try reassuring them with extra snuggles, but without putting them all the way to sleep. If you jump to full on rock-to-sleep or nurse-to-sleep mode, you can expect the regression to last a bit longer. 

6. Find time for rest and embrace parental power naps! If you can grab a 15 minute snooze either at home while your child is nap, in your office or cubicle at work, or even with the front seat reclined in your car, you’ll be surprised what a huge difference closing your eyes and resting for a few minutes will do for your mental and physical health. There’s strong evidence for emotional and mental benefits of napping. If you are someone who has never been able to nap, try listening to a guided relaxation, breathing exercise, or yoga nidra (sleep yoga) on a free app like Insight Timer, or Headspace, Calm, or Expectful. Relaxing your body and mind for a short period of time can do wonders for your overall well-being when you sleep is disrupted and stress is running high!

Here’s a quick recap for your (probably tired) brain: your child’s brain goes through rapid development in the early years. Unfortunately, these bursts of mental and physical development tend to disrupt sleep for a while–typically 3 to 6 weeks. The impact of cognitive leaps and other brain development will vary from one kiddo to the next, but these stages are temporary–other than the permanent change to sleep patterns that happens around 3-4 months. And things will get back to normal with a little time and patience, and will likely get back to normal sooner if you take the 6 tips above to heart! 

What If My Child’s Sleep Has NEVER Been Good? Or What If The Regression Has Continued Longer Than 6 Weeks? 

Sometimes it’s helpful to bring in some outside support in sleep. Feel free to schedule a FREE intro call to discover how Little Dipper can support you in reaching all of your sleep goals. Or can access our free, sliding scale, and fee-based services here. Stellar sleep is on the horizon.

Liz Harden, MPH believes that every human deserves stellar sleep. As a certified sleep coach for more than nine years, Liz leads Little Dipper Sleep – a sleep coaching practice based in Chapel Hill, NC, serving clients worldwide. She and her team provide flexible, inclusive, evidence-based sleep coaching packages, programs, and classes to parents of kiddos, from newborns through elementary school and beyond. Known for creating the Mindful Method for Sleep(TM), Liz’s process equips parents with what nearly all sleep programs miss: the mindset tools and scientific insight they need to thrive and confidently set the stage for peaceful naptimes and bedtimes. Learn more on her website: www.littledipperwellness.com/

Last medically reviewed on August 8, 2022

How to Increase Your Milk Supply

By: Natalie Jarrett, MSN, IBCLC & Kerry Lett, MPH, RDN, LDN, CLC

Breastfeeding was off to a good start, but now your supply has dropped. Or maybe you never got your supply where you wanted it to be in the first place. What now? There are some simple changes you can make that will hopefully help boost your supply and get you back on track. 

Consider Frequency

The first thing to consider is how frequently you are feeding your baby and/or are pumping. You should be feeding your baby on demand, as often as they want to eat, usually every 2-4 hours. However, for babies who have not regained their birth weight yet, they must be fed every 2-3 hours around the clock. Some miracle babies sleep through the night from just a few weeks of age, but unfortunately some lactating parents’ milk supply cannot tolerate this length of time. If your supply was off to a good start, but then slowly started to decline after your baby started sleeping longer stretches, this might be your problem! Adding in an overnight pump session can be helpful to mitigate this. Try starting to pump around 4 hours from the last feed and then slowly stretching it a little longer to 5-6 hours from the last feed. 

Try Power Pumping

If frequency of feeds or pump sessions does not seem to be the problem, the next thing to consider is adding in a power pump session. This is when you pump for 20 minutes, take a 10 minute break, pump for another 10 minutes, take another 10 minute break, and then finally pump for another 10 minutes. This will take an hour to do and you should do it once a day. In the morning right after you have fed your baby can be a good time to do this, since the hormone that helps make milk is at its highest levels early in the day. Power pumping helps to stimulate cluster feeding, which is the body’s natural way of boosting milk supply as your baby gets bigger and goes through growth spurts.

Consider Your Nutrition

Another option to help boost milk supply is to make a few dietary changes. While there is not extensive research demonstrating that oral galactagogues (substances that increase milk supply), such as fennel, blessed thistle, and alfalfa, are effective at increasing breastmilk production, there is some evidence that natural galactagogues may benefit infant’s weight gain and the lactating mother’s milk volume (1). While there is low evidence that galactagogues are effective in research studies, many women perceive natural galactagogues to enhance their breast milk supply (2). Fenugreek is a popular galactagogue; however, recent research has found that it can sometimes cause decreased milk supply, so we would recommend avoiding supplements that contain fenugreek (3). If you are planning on trying any galactagogue, remember that the safety of these products has not been fully determined and like all herbs and medications, galactagogues may have potential side effects and drug interactions that must be considered for each lactating parent. Therefore, it is advised that all lactating parent’s considering galactagogues talk to their health care provider before starting these herbs. Additionally, it is important to remember that any galactagogue will be the most effective at increasing your milk supply when combined with increased breastfeeding frequency and milk removal.

Practice Self-Care

Be sure to take care of yourself too. Try to sleep when your baby sleeps and have other people help you around the house and with meal prep, if possible. Try to relax as much as possible. If you are pumping, it can be helpful to cover up the pump and do something else while you are pumping, so you are not as focused on watching your milk output. Looking at photos or videos of your baby can also be helpful if you are pumping, so you can connect with baby and get the milk-making biological process flowing. 

Meet With an Expert

You may also want to meet with a lactation consultant to make sure your baby is latched on correctly, is removing milk from the breasts well, and there is not something else that could be medically affecting your supply. You must remove milk from your breasts in order for your body to make more milk, so if there is an issue with your baby’s latch or suction this could be affecting your supply. If you are not able to be seen right away, try pumping frequently to protect your milk supply until you can get help. If you feel that you would benefit from a lactation consultant, schedule your appointment today at www.milestonesnutrition.com/lactation.

Natalie Jarrett, MSN, IBCLC is the lactation consultant Milestones Pediatric & Maternal Nutrition in Cary, NC. Natalie specializes in empowering lactating parents during their breastfeeding journey, while helping to minimize any breastfeeding difficulties. Schedule an appointment today.

Kerry Lett, MPH, RDN, LDN,CLC is the pediatric & maternal registered dietitian, certified lactation consultant, and owner of Milestones Pediatric & Maternal Nutrition in Cary, NC. Kerry is passionate about helping growing families navigate life and achieve all of their milestones along the way. Schedule an appointment today.

Last medically reviewed on March 25, 2024

The Importance of Getting Messy During Meals

By: Morgan Berliner, MS, CCC-SLP

Exploring food through all our senses is a vital part of eating and trying new foods. So much occurs before food is ultimately chewed and swallowed. Babies that aren’t given the chance to explore food on their hands, fingers, and face can be less likely to try new foods. Let’s dig in why it is so important to allow babies to get messy during meals.

First off, feeding should be a reciprocal action. It should not only be mom spoon-feeding baby food or placing bites of solids on the chewing surface. It should be a two-way street where baby can practice self-feeding with a utensil or with hands, while also having help from the “feeder.” Practicing feeding with some puree in a bowl, on the tray, or a loaded spoon helps baby to feel like an active participant in this new developmental stage.

Allowing baby to feel the texture on his or her hands or face provides important input to the brain for sensory experiences. Our hands and fingers are full of nerve endings that help us understand food all before entering the mouth. Exploring with our senses allows for learning smell, texture, and temperature, which are all important pieces of information being stored with each new experience. Every positive association of feeding helps your child to be an adventurous eater.

Getting messy during meals also helps to build vocabulary at the table. Feeding should be a fun experience as meals are often a social event in our culture. When baby is exploring food through touch, smell, and sight, we can introduce new words such as “sticky,” “wet,” “smooth,” “bumpy,” and “slippery.” If we are constantly wiping hands and scraping food off the chin with the spoon, baby is missing out on a whole learning experience for sensory and language input.

Does my child need to get messy every single meal? Not necessarily. There are times when life gets in the way, and we need to eat and quickly change for daycare, or we are at a friend’s house and having dinner. Not every meal needs to be an orchestra of purees and soft solids on hands and face, but look at meals as a whole. If majority of the time you can let your child explore textures, then I would consider that a win. Also remember this is just a phase, eventually your child will be eating dinner and minimal wiping needed until then let them explore!

Wondering what exactly getting messy during meals looks like? When feeding baby put a portion or all their meal on the tray, in a bowl, or on a cleaned table. Demonstrate getting messy! Put your hands in puree or squeeze the soft solid and hand it to baby. Also talk about the texture, “this carrot is squishy, your turn!” When feeding, leave puree or food on lips and cheek throughout the meal instead of constant wiping. If your child is having a hard time getting and staying messy, it’s okay to listen to their cues. Do not force it and instead work slowly up to getting messy or do lots of sensory play outside of mealtime. When you allow your baby to get messy and have fun learning, they are more likely to try new foods - a skill they will have for a lifetime!

Morgan Berliner, MS, CCC-SLP is the speech-language pathologist and owner of Eat Talk Grow based out of Raleigh, NC. Morgan specializes in educating families on speech and feeding milestones through 1:1 consults, workshops, and PDFs. Learn more on her website: www.eattalkgrow.com.

Last medically reviewed on July 11, 2022