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Low Milk Supply

Low Milk Supply

In the United States, concern about low milk supply is the most common reason given by women for supplementation and early weaning. Why do so many women in our culture lack confidence in their ability to adequately nourish their babies? Sociologists believe, that during the last century, the decline in breastfeeding contributed to the loss of knowledge about how breastfeeding really works, and how breastfed babies behave.

What Mothers Need to Know:
  • It is normal for women to feel that they don't have milk in their breasts the first days after birth. Frequent breastfeeding during this time will meet the new baby's need and cause the milk supply to increase rapidly.
  • A good milk supply is encouraged by frequent sucking and effective removal of milk. If milk is not being removed from the breast, the supply will not increase, but instead drop. If a baby needs more milk he will usually nurse more frequently which causes the hormone Prolactin to rise and the milk supply to increase.
  • New research shows that although almost all women can produce plenty of milk, some women need to nurse more often than others in order to meet their baby's caloric need.
  • A baby needs to be latched deeply onto the areola, not just the nipple, to effectively remove milk.
  • Human milk passes through the baby's stomach in 48-90 minutes. The breastfed newborn needs to nurse 8-12 times/24 hours, while the formula fed baby feeds only 6-8 times/24 hours. If a breastfeeding mother tries to feed her baby on a bottle schedule, her baby may not get enough food.
  • A baby will often need to be held, rocked, jiggled and bounced (just as in the womb) even after a good feed. Babies cry for reasons other than hunger. Don't worry about "spoiling" a newborn by holding him too much. If a baby's needs are met, trust is built and good self-esteem and independence will follow.
  • Young babies have a 3-hour wakeful stretch every day, during which they want to be at their mothers' breast the majority of the time (the marathon feed). This usually occurs in late afternoon/evening and is normal.
Possible Causes of Low Milk Supply:
  • Difficult or poor latch-on that leads to poor milk removal. If a baby cannot sustain attachment to the breast for more than a few sucks or if he is only on the nipple, he cannot remove milk and is not nursing well.
  • Early introduction of a bottle. If given formula, the baby won't need to breastfeed often and decreased breast stimulation will generally result in a decreased milk supply. If your doctor advises supplementing your baby, check with a lactation consultant for extra guidance in protecting and maximizing your milk supply.
  • Babies set their own schedule and some need to eat more often than others. Research indicates that a mother needs to be responsive to her particular baby's lead and not adhere to a rigid plan.
  • A sleepy, non-demanding baby. Make sure the baby is coming to the breast 8-12 times in 24 hours. Once weight gain is established, relax and follow the baby's lead.
  • Anything that keeps a baby from nursing vigorously (jaundice, prematurity, illness).
  • Augmentation and reduction breast surgery are both possible risks for a low milk supply. A lactation consultant can help devise a plan to maximize milk supply.
  • A woman who has absolutely no breast changes during pregnancy or during the first week after birth may be at risk for a low supply. Seek extra advice from a consultant.
  • Reduced breast stimulation as a result of: (next li Long Sleep... should be nested)
    • Long sleep stretches by the baby
    • A mother's busy lifestyle
    • Insufficient rest due to a mother's return to the workplace
    • Introduction of alternate baby foods
  • Hormonal contraception. Even the "mini" pill causes some women's milk supply to drop dramatically.
  • Pregnancy
  • Excessive exercise and/or dieting
Ways to Increase Milk Supply:
  • Improve the baby's latch.
  • Increase breast stimulation:
    • Add more feedings and/or nurse longer. Wake the baby for feeds if necessary. Unwrap and undress to help waken.
    • Use a good quality breast pump (hospital grade) and follow most breastfeeds with a 15-minute pumping session. Be patient, it may take a few days or longer to see results.
    • While nursing on the second side, pump the breast the baby just finished (third breast pumping). This effective technique saves a lot of time.
    • Switch sides. When the baby gets sleepy, remove from the breast, burp and switch to the other side. Repeat until the baby won't nurse anymore.
  • Try herbal supplements: Mothers Milk tea, Fenugreek capsules (3 capsules 3 times daily), and Fennel seeds (crushed and made into tea, or just chewed). The effectiveness of these remedies is anecdotal, not research-based, but many mothers find it very helpful.
  • Eat a well balanced diet with lots of whole grains and increase your fluid intake.
  • Ask your OB/GYN to help you choose a non-hormonal contraceptive method.
  • See a lactation consultant for an in-depth evaluation and strategies for improving your milk supply.
  • Ask your doctor to prescribe Reglan or Domperidone (Motillium). These medications are usually used for gastric problems but have a side effect of raising the level of the hormone that increases milk supply. Domperidone must be made by a compounding pharmacy.
Essential Breastfeeding Support and Baby Care Items
The Pump Station & Nurtury® has decades of experience providing new families with outstanding educational, breastfeeding and baby care support, including products and classes which can make all the difference to you and your baby. To see a list of some of the essential products that our Lactation Professionals have recommended, click Essential Breastfeeding and Baby Care Products

Products to help increase milk


See Other Breastfeeding and Baby Care Help Topics

Copyright©2017 by The Pump Station & Nurtury®. All rights reserved. No part of this handout may be reproduced in any form without permission from The Pump Station. This article has not been prepared by a physician, is not intended as medical advice, and is not a substitute for regular medical care. Consult with a physician if medical symptoms or problems occur. Revised 01/06

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Biting and Teething

Biting and Teething

Most breastfeeding babies will at some point attempt biting. Usually, but not always, biting happens during teething. This can be painful for the mother, but it is a behavior that can be stopped if the mother is persistent.

Why do babies bite?
  • Colds or ear infections can lead babies to bite because it is difficult for them to suck when their noses are congested or their ears hurt. If your baby has difficulty nursing because of nasal congestion, you can try suctioning the nose with a bulb aspirator (or a Nosefrida). Soften the secretions before suctioning by putting a drop or two of breast milk or saline in the baby's nose. Try nursing with your baby's head higher than his or her chest. Walking while nursing is one effective way of doing this with a sick baby. Upright nursing can also help with ear pain. Using a humidifier while your baby is sleeping can also help clear congestion. If your infant is still having difficulty, check with your pediatrician about other treatment options.

     

  • Distraction during nursing. Often an older baby, or one who isn't hungry, can get distracted while nursing. A wriggling, pushing, or rolling baby is difficult to nurse and may clamp down on a mother's nipple in order to look at something across the room or to interact with the mother. To prevent a distracted baby from biting, look for signs of distraction or boredom. Try to end the nursing session before your baby gets bored, or at the first signs of boredom. If your baby is wriggling in your lap and pushing away from your breast, this is the time to end the nursing session. Other tactics are to nurse your baby in a dimly-lit, quiet room, or trying to nurse while lying down in bed, rocking, bouncing, or walking.

     

  • Attention. Some older babies will bite to get their mother's attention if she is not focusing on them during a nursing session. Paying closer attention might help to prevent the biting and will make you aware of when your baby is about to bite.

     

  • Teething is the most common cause of biting. As babies experience discomfort in their gums, they may find sucking uncomfortable. Additionally, they may find it difficult to latch correctly as new teeth cut through the gums. If your baby is biting while nursing, the first thing to do is to make sure that your infant is latched-on correctly. You can also offer a cold washcloth or teether when biting starts. This helps the baby with pain and also sends the message that the nipple is not for biting. Another effective method for dealing with biting is simply to stop the nursing session. Take the baby off of the breast; calmly say "No biting. That hurts mama," and stop the feeding. If the baby is still hungry, you may restart the session after a few minutes. Offering the baby a teether during this break can be helpful. Finally, if baby bites down on the nipple and won't let go, you should bring the baby very close to your body. This action gently forces the baby to open his or her mouth in order to breathe.
How do I know if my baby is teething?

On average, babies will get their first tooth at around six months. Common teething signs include:

  • Fussiness
  • Night waking
  • Swollen or red gums
  • Drooling and coughing
  • Drool rash on chin, chest, or neck
  • Diarrhea/diaper rash
  • Low-grade fever (under 101°)
  • Biting
Teething remedies
  • Frozen or refrigerated wet washcloth
  • Teether toys (cold or room temperature)
  • Homeopathic teething tablets or gels
  • Ice, frozen breast milk or chamomile tea cubes inside a mesh feeder
  • Acetaminophen or ibuprofen (check with your pediatrician before administering these)
  • Over-the-counter numbing gels (not recommended for use prior to breastfeeding as they numb a baby's gums and tongue; this can make latching and sucking difficult)
Does teething mean I have to wean?

While many babies bite at some point during the teething process, it is usually a temporary issue that soon goes away. If your baby is latching correctly, you should not be able to feel your baby's teeth (since the tongue covers the lower teeth and gums). It isn't physically possible for a baby to suck and bite at the same time. Teething is not a cue for a mother to wean her baby. In fact, it is possible to continue nursing a baby with teeth for many months.

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Thrush

Thrush

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Thrush is an irritating yeast infection caused by the fungus Candida albicans. Although this fungus occurs naturally in all human bodies, certain conditions allow it to grow unchecked, which leads to a thrush infection. These conditions include treatment of the mother and/or infant with antibiotics, cracked nipples, use of oral contraceptives and diabetes. It is most commonly seen in the mouth of newborns and babies less than six months of age; it also causes diaper rash, sore nipples and vaginal yeast infections.

Symptoms
Infants normally have a white coating on their tongue, particularly after feedings. But with thrush an infant will have creamy white dots or patches that appear inside the cheeks, on the gums, tongue and lips. These patches look like "spit-up," but it does not wipe or scrape away easily without causing bleeding. In addition, the baby may have a fiery red diaper rash that does not respond to OTC diaper rash remedies. The baby may be excessively gassy, repeatedly pulling off the breast during feedings. The baby may even refuse to nurse altogether because his mouth is sore.

The mother may experience a sudden onset of acute nipple pain during feedings, which may continue even after the feeding is finished. The pain is often described as "burning" and does not improve with better latch or positioning techniques. Shooting pain deep within the breast may also occur and sometimes radiate into the back, shoulder or armpit. Nipples may appear shiny or flaky, and may have a rash of tiny blisters extending onto the areola. There may also be apparent cracks in the nipple, particularly where the nipple and areola meet. Occasionally there are no apparent symptoms. A mother could also be experiencing a vaginal yeast infection.

Treatment
Call both your OB and your Pediatrician for assessment and treatment. If thrush is diagnosed, both mother and baby must be treated with medication prescribed by their health care providers. It is important to note that even if either mother or baby has no visible symptoms; both must be treated simultaneously to prevent reinfection. Treatment must be continued for at least 14 days even if symptoms disappear earlier.

Infant:
  • Most pediatricians treat thrush with oral Nystatin suspension which must be applied to all affected areas. Do not put the medicine dropper in the baby's mouth; instead place the dose in a small, washable dish and use a Q-tip to apply.
  • Gently wipe out the infant's mouth with a moistened gauze pad after each feeding and before applying the medication.
  • Boil all pacifiers, bottle nipples, and pump parts for 10 minutes each day, or use a Medela Quick Clean Microwave Steam Bags.
  • Wash the baby's hands often, particularly if the hands are in the mouth.
  • For a diaper rash yeast infection, wash baby's bottom with warm, mild soapy (not antibacterial) water, and then rinse with a vinegar and water solution (1 tbsp white vinegar/1 cup of water). Pat dry or use a hair dryer on a low setting to dry the area. Apply an antifungal cream such as Mycolog, Lotrimin, or Motherlove Diaper Balm before diapering. Your pediatrician can prescribe a treatment.
    • Expose baby's bottom to the air several times a day.
  • An alternative remedy to the antifungal medication is to prepare a paste of baking soda and water (1 tbsp baking soda with 3 tbsp water). Apply this solution to the affected areas in the baby's mouth with a Q-tip. This remedy may also be used on the mother's nipples or the baby's bottom.
Mother:
  • Many physicians treat nipple thrush with a prescriptive Nystatin cream. However, other OTC (over the counter) medications may be more effective. Mycolog ointment or vaginal yeast medication such as, Monistat 7, Lotrimin AF, or Micatin are all good options.
  • Another treatment choice is All Purpose Nipple Ointment (APNO). It combines an antifungal, an antibiotic, and a calming steroid. A pharmacist can compound it with a prescription from your doctor. You can provide your physician with the ingredients listed below at the bottom of this handout.*
  • You can also use OTC medication to make APNO yourself. This mixture may not be as effective as the prescriptive APNO. Mix:
    • Antibiotic: Bacitracin or Polysporin (not Neosporin)
    • Anti-fungal: Lotrimin AF (clotriamzole) or Monistat (miconazole)
    • Anti-inflammatory: Hydrocortisone 1%

    Apply an equal amount of each ingredient to the tip of a clean finger. Mix together and apply to nipple and areola four times a day after the feeding. The correct amount of cream will make the nipple and areola appear glossy or shiny. Gently wipe nipple area with a cotton ball dipped in olive oil to remove any remaining cream before nursing.
  • Whichever medication you use, apply medication after each feeding and remove before feeding again. Use a cotton ball soaked in olive oil to remove the medication.
  • After nursing, rinse your nipples in a solution of 1 cup water mixed with 1 tbsp of white vinegar or baking soda. Pat dry and apply antifungal cream.
  • Instead of a topical cream your doctor may prescribe an oral antifungal medication such as Diflucan (Fluconazole) to be taken daily for 14 days.
  • To help relieve nipple pain mix an equal amount of 1% hydrocortisone cream (OTC) with the topical antifungal cream and apply to your nipples and areola.
  • Wear wide-based, hard, Medela nipple shells to prevent your bra from sticking to your sore nipples; or use soft, disposable nursing pads changed at every feeding.
  • Wash your hands frequently. Use paper towels for drying
  • Change bra daily.
  • Reducing consumption of dairy products, heavily sweetened foods and processed carbohydrate foods can be helpful.
  • Probiotics can build good bacteria in the digestive track and help clear the body of the overgrowth of yeast. A reliable brand is Healthy Trinity by Natren; take as directed or follow the directions on the bottle.
    • There are safe probiotics available for babies too.
    • Another immune system booster is Echinacea. Buy a quality brand such as Nature's Way and take 3 to 4 capsules a day.
  • Because freezing does not kill yeast, any milk frozen during the infection will need to be boiled before being given to the baby. It could also be used later when the baby's immune system is stronger. Milk pumped during the infection, but not frozen, can be fed to the baby within 24 hours of pumping.

Alternative Treatment/Gentian Violet
Gentian Violet is an antifungal that is a very old treatment for thrush. Dr. Jack Newman, a Canadian Pediatrician and breastfeeding expert, states it can be very effective when used in conjunction with All Purpose Nipple Cream.
Please be aware: In the US the solution sold is often a 2% solution which is too strong, and probably accounts for the mouth ulcers that some babies get after being treated with it. The pharmacist should dilute it for you.

To learn how to use Gentian Violet go to: https://www.breastfeedinginc.ca/informations/using-gentian-violet/
Revised by Edith Kernerman, IBCLC, and Jack Newman, MD, FRCPC© 2009

*Prescriptive All Purpose Nipple Cream
The ingredients are as follows:

  • 100,000 units/ml Nystatin (15 grams)
  • 0.1% Betamethasone (15 grams)
  • 2% Mupirocin ointment (15 grams)
  • 10% Clotrimazole (vaginal ointment) (15 grams)
See Other Breastfeeding and Baby Care Help Topics

Copyright© 2013 The Pump Station & Nurtury®. All rights reserved. No part of this handout may be reproduced in any form without permission from The Pump Station & Nurtury®. This article has not been prepared by a physician, is not intended as medical advice, and is not a substitute for regular medical care.
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Raynaud's Phenomenon (Vasospasm of the Nipple)

Raynaud's Phenomenon (Vasospasm of the Nipple)

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Raynaud's phenomenon is a term used to describe intermittent loss of blood flow to some extremities due to a spasm in the blood vessels (vasospasm). The most commonly affected areas are the fingers and toes, but it can affect the nipples as well. The constriction of blood flow causes a loss of color and severe pain. Raynaud's phenomenon is known to occur in up to 22% of otherwise healthy women of childbearing age, and is now recognized by many lactation experts as a treatable cause of painful breastfeeding.

Breastfeeding women with Raynaud’s phenomenon experience debilitating nipple pain that usually follows the feeding (although it can occur during the feeding) and may last for hours. When the warm mouth of the baby comes off the breast, the face of the nipple, or part of the nipple, will blanch white and burning pain begins. The nipple can go through several color changes (white, blue, red) and the entire breast may throb. Poor positioning and poor latch may cause nipple damage, nipple blanching and pain, and are thought by some to trigger the problem. However, the symptoms of Raynaud’s phenomenon can occur even without improper breastfeeding techniques and nipple damage. Not all nipple vasospasm is Raynaud's Phenomenon and may fully resolve if the latch can be improved and the damage healed. Exposure to cold is also a known trigger in Raynaud’s phenomenon.

Treatment Options include the following:
  • If your nipples are sore and damaged, make an appointment to see a lactation professional who can evaluate your latch technique and help you to improve it.
    Lactation Consultations are offered at The Pump Station & Nurtury®
  • Prevent or decrease any cold exposure to your breasts. Heat will usually stop the vasospasm, which will increase blood flow to the nipples and help alleviate the pain.
    • Cover breasts and keep them warm. Even your warm hands can help.
    • While nursing, keep the opposite breast covered and warm.
    • Wear hand warmers inside your bra when going out into cold air.
    • Use dry heat when experiencing pain. Try a hair dryer or heating pad to warm breasts. Wet, warm compresses will help during use, but when removed, evaporation will occur causing cooling, and the pain can start again.
    • Massage olive oil, warmed between your fingers, into the nipple when it is burning. Press forward from the base of the nipple which helps blood flow forward into the nipple.
  • Don't smoke. Nicotine is a vasoconstrictor and can increase episodes.
  • Avoid caffeine and other stimulants. Check labels to make sure soft drinks don't contain caffeine.
  • Avoid vibration. Use a good quality breast pump that has a smooth, comfortable action.
  • Reduce stess. Try a post partum yoga class, a few minutes of meditation or a little nap when the baby is sleeping. Let others help with cooking and chores if at all possible.
Medication:
  • Nifedipine. (one 30 mg., long-acting tablet/daily). This prescriptive medication is a calcium channel blocker and vasodilator used in the treatment of high blood pressure. It has been shown to be very effective in quickly relieving the pain of Raynaud's phenomenon and might be the best course of treatment. Very little of this medication enters the milk so it is considered by the American Academy of Pediatrics to be a safe option for breastfeeding women. Call your primary care physician or your obstetrician to discuss. Try Nifedipine for two weeks; if the pain returns you can go back on the medication.
  • Vitamin B6. Take 100-200 mg daily for 4 days, then 25 mg/day from then on. If pain free for 2 weeks, try weaning off altogether.
  • Fish Oil has been helpful to some women. A recent study suggests that a higher than usual dose (perhaps 12 g daily) is required to get results. Check with your physician.

Essential Breastfeeding Support and Baby Care Items
The Pump Station & Nurtury® has decades of experience providing new families with outstanding educational, breastfeeding and baby care support, including products and classes which can make all the difference to you and your baby. To see a list of some of the essential products that our Lactation Professionals have recommended, click Essential Breastfeeding and Baby Care Products
Items Our Team Recommends
breast pain relief cold compress Lansinoh Breast Therapy
Lansinoh 3-1 Breast Therapy
soothe sore breasts with warm booby tubes
Earth Mama Booby Tubes
Easier pumping with Medela Breast Pump
Medela Breast Pumps
deep latch help with nursing pillow
Luna Lullaby Nursing Pillow
better deep-latch with back pillow
The Pump Station Back Pillow
get deep latch using adjustable stool
My Brest Friend Adjustable Stool

Copyright© 2014 by The Pump Station & Nurtury®. All rights reserved. No part of this handout may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, without permission in writing from The Pump Station & Nurtury®. This article has not been prepared by a physician, is not intended as medical advice, and is not a substitute for regular medical care. Consult with a physician if medical symptoms or problems occur. Revised 01/06
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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

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by Diana Cheng Scheible, MA, OTR/L, CLE, IBCLC

Carpal tunnel syndrome (CTS) is a condition brought on by increased pressure on the median nerve at the wrist. In effect, it is a pinched nerve at the wrist. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hand and fingers.

Fluid retention during pregnancy can cause symptoms of carpal tunnel syndrome, which often go away after delivery. However, some women report exacerbated symptoms after delivery due to continued early post partum swelling and the constant bending of the wrist in baby care. There may be a combination of causes of CTS including arthritis, fractures and irritation due to repetitive, prolonged, and/or forceful motion (for example: a roofer pounding nails, a computer user keeping wrists constantly bent).

Carpal tunnel syndrome symptoms usually include pain, numbness, tingling, or a combination of the three. The numbness or tingling most often takes place in the thumb, index, middle, and ring fingers. The symptoms usually are felt during the night but also may be noticed during daily activities such as driving or reading a newspaper. Mothers may sometimes notice a weaker grip, occasional clumsiness, and a tendency to drop things.

Treatment

The first step is to call your doctor for assessment and proper diagnosis of your symptoms. Patient education and proper body mechanics are key for minimizing carpal tunnel symptoms.

  1. Maintain the wrist in a neutral position with daily activity. After you latch your baby, avoid using your hand and wrist to support your baby's head during the feeding. Instead, use a rolled up blanket or small pillow to avoid positioning the wrist in a prolonged bent position.
  2. Since we often sleep with our wrists bent in a 90 degree angle (fetal position), wearing wrist splints at night can be very helpful to decrease pressure on the nerve and reduce swelling and symptoms.
  3. Avoid positioning the wrist in a bent position while sleeping or sleeping on your wrists, once the wrist immobilization splint is discontinued.
  4. Avoid a sustained pinch/grip and awkward motions, particularly with the wrist in a bent position.
  5. Identify and treat medical conditions such as thyroid conditions, rheumatoid arthritis, and diabetes which can be associated with carpal tunnel syndrome.
  6. Take rests and stretch breaks from activities to prevent overuse of repetitive motions.
  7. Anti-inflammatory medications, such as ibuprofen and other nonprescription pain relievers, may ease symptoms that have been present for a short time. Please consult with your physician regarding any medications especially if you are pregnant or breastfeeding.
  8. Some mothers find pain relief with the use of paraffin wax baths. Dip both hands and wrists into the paraffin wax 4-5 times and relax for 10 minutes. Home use paraffin bath units can be purchased at places like Bed Bath and Beyond.
  9. You may also feel pain relief with Contrast Baths which can be done 2-3 times per day. The purpose of contrast baths are to assist with reducing inflammation along the wrist, which may serve as the contributing factor for the carpal tunnel symptoms. In addition, the contrast baths facilitate blood flow and thus helps “pump” the swelling out of the hand and wrist.
How to set up a Contrast Bath:
  1. Prepare one basin of hot water (to your tolerance)
  2. Prepare one basin of cool water with ice
  3. Immerse your hand/wrist into the hot water for 2-3 minutes
  4. After 2-3 minutes, immerse your hand and wrist in cool water for 1 minute
  5. Repeat steps 2 & 3 two more times always ending with your hand/wrist in cool water.
  6. If pain, numbness or weakness recurs and persists, return to your physician.

Some people find that a rehabilitation program designed by Occupational Therapy Hand Specialists which include education of ergonomic principles particular to their daily activities, nerve glides, stretching, splint fabrication and treatments such as paraffin wax treatments, ultrasound, and electric stimulation can minimize carpal tunnel symptoms. Additionally, alternative therapies including acupuncture and chiropractic care have benefited many people.

The Pump Station & Nurtury® has decades of experience providing new families with outstanding educational, breastfeeding and baby care support, including products and classes which can make all the difference to you and your baby. To see a list of some of the essential products that our Lactation Professionals have recommended, click Essential Breastfeeding and Baby Care Products


See Other Breastfeeding and Baby Care Help Topics

© 2006 American Society for Surgery of the Hand. Developed by the ASSH Public Education Committee. Reprinted with permission of the author. All rights reserved. No part of this handout may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, without permission in writing from The Pump Station & Nurtury®. 11/07
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