Folic Acid

Researchers have found that 50-70% of NTDs (neural tube defects) can be prevented when women supplement their diet with folic acid, a water-soluble B vitamin. The Centers for Disease Control (CDC) recommends all women of childbearing age eat a diet high in folic acid or take a multivitamin with 0.4mg of folic acid each day, especially one month prior to conception through the first three months of pregnancy. This dosage is the amount found in most over-the-counter multivitamins. However, women who have had a previous NTD pregnancy are recommended to take an even higher dosage of folic acid prior to planning a pregnancy. They should increase the daily dose of folic acid from 0.4mg to 4.0mg (10x the recommended amount), one month prior to conception through the first three months of pregnancy. The 4.0mg of folic acid should only be obtained through a prescription from the doctor.

But even if you are not actively trying to get pregnant one should still take folic acid if you are engaging in any acts that may result in pregnancy. This is because the early spinal cord of the embryo begins as a flat region, which rolls into a tube (the neural tube) 28 days after the baby is conceived. When the neural tube does not close completely, an NTD (Neural Tube Defect) develops. NTDs develop before most women know they are even pregnant.


Its a good idea to increase your folic acid dosage even if you have not had history of a prior NTD. I am living proof that taking the recommended dosage does not prevent all NTDs. I was on the recommended dosage 3 months before trying to conceive and all through my pregnancy with Genesis. Had I been taking more folic acid she may have not been born with anencephaly. Though know that even with an increased intake of folic acid there is still a 1% chance you may have a child with a NTD. Another thing to keep in mind is that most people who have a child with a NTD hav had no prior family history of NTDs.

How a woman can get enough folic acid?

There are two easy ways to be sure to get enough folic acid each day:

1. Take a vitamin that has folic acid in it every day. 
   
   Most multivitamins sold in the United States have the amount of folic acid women need each day. Women can also choose to take a small pill (supplement) that has only folic acid in it each day. 
   
   Multivitamins and folic acid pills can be found at most local pharmacy, grocery, or discount stores. Check the label to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 micrograms (mcg).
2. Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day. 
   
   Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

Audiocast: Folic Acid Now  
Listen to an audiocast about folic acid.

What Foods Contain Folic Acid?
Approximately half of all pregnancies are unplanned, so the U.S. Food and Drug Administration has taken steps to fortify certain foods so that all women of childbearing age get a daily dose of folic acid. The following foods can help you obtain your recommended amount of folic acid:

• Leafy green vegetables, such as large spinach salad
• Citrus fruits, such as orange juice
• Beans
• Breads
• Cereals
• Rice
• Pastas

Can You Overdose On Folic Acid?
Folic acid has no known toxic level. If you were to eat a bowl of fully fortified cereal (400 micrograms), take 400 micrograms (0.4 milligrams) folic acid supplement, and eat fortified foods and foods rich in folate, women of reproductive age would not have a problem with too much folic acid. Even in very high amounts folic acid is non-toxic. Nevertheless, it is recommended that women consume no more than 1,000 micrograms of synthetic folic acid a day. Large amounts of folic acid may hide the ability to quickly diagnose pernicious anemia, a rare vitamin B-12 deficiency. This condition primarily affects the elderly population and, in some cases, can lead to neurological damage. Today, Doctors can use a simple definitive test to check for a B-12 deficiency. Folic acid is water-soluble. Water-soluble vitamins dissolve in water. Leftover amounts of the vitamin leave the body through the urine. That means you need a continuous supply of the vitamin in your diet. Because of this, overdose is not likely. Anything your body cannot absorb gets excreted through your urine.


Findings from a survey conducted in 1998 to assess folic acid knowledge and practices among women of childbearing age in the United States indicate that of all women surveyed, only 13% knew that folic acid helps prevent birth defects, and only 7% knew that folic acid should be taken before pregnancy to prevent birth defects.

You should not take folic acid if you have any of these conditions. You may need a dose adjustment or special tests to safely use folic acid:

• Kidney disease (or if you are on dialysis)
• Hemolytic anemia
• Pernicious anemia
• Anemia that has not been diagnosed by a doctor and confirmed with laboratory testing
• An infection
• If you are an alcoholic
• If you are allergic to folic acid

Who Is At Risk:
NTD-affected pregnancy. It is not possible to predict which women will have a pregnancy affected by an NTD. 95% of NTDs occur in women with no personal or family history of NTDs. However, some risk factors are known:

• An NTD-affected pregnancy increases a woman's chance to have another NTD-affected pregnancy by approximately twenty times
• Maternal insulin-dependent diabetes
• Anti-seizure medication use
• Medically diagnosed obesity
• High temperatures in early pregnancy (prolonged fevers and hot tub use, for example)
• Race/ethnicity (NTDs are more common among white women than black women and more common among Hispanic woman than non-Hispanic women)
• Lower socio-econimic status

Types Of Neural Tube Defects (NTDs)
There are two types of NTDs. The most common type are called the open NTDs. Open NTDs occur when the brain and/or spinal cord are exposed at birth through a defect in the skull or vertebrae (back bones). Examples of open NTDs are spina bifida (myelomeningocele), anencephaly, and encephalocele. Rarer types of NTDs are called closed NTDs. Closed NTDs occur when the spinal defect is covered by skin. Common examples of closed NTDs are lipomyelomeningocele, lipomeningocele, and tethered cord.

Lastly, spina bifida occulta (SBO) is potentially another form of an NTD in which there is a typically benign (or non-symptom-causing) bony change in one or more vertebrae, but not involving the nerves within the spinal column. The incidence of SBO is not well defined; however, it is more common than the NTDs described above. The cause and potential similarities, or, link to NTDs, has not been established.


Even More Folic Acid Resources:

• March Of Dimes
• National Council On Folic Acid
• National Council On Folic Acid (second page)
• Folic Acid Awareness Campaign 
• Folic Acid Partnership

Milk Supply Boosters

I had previously written a post with a few recipes for foods that may help you increase your supply. But I thought I would go more in depth with what steps you can take to actively increase your milk supply.

First and foremost I recommend seeing your local lactation consultant or La Leche League Leader.

1. Nurse, Nurse Nurse
It's the basic principle that you will hear me and other birth professionals repeat like a broken record: Supply and Demand. The more your baby nurses the more milk your body produces. Simple as that. If you are not nursing then pump, pump, pump. The first few weeks are the most demanding but DON'T give up! All the frustrations and sleepless nights and hours at the pump will pay off. Try pumping between nursings as well to signal your body to produce more milk. Don't get discouraged if you don't actually pump a whole lot. Keep pumping for at least 15 minutes on each breast. Another bit of advice along the lines of pumping: the amount you pump is not the amount you produce. Having your baby nurse is the most efficient way to empty your breasts. Pumps do not remove anything near what your baby does. So please don't measure your success on what your pump removes.

2. Avoid artificial nipples and formula
As mentioned earlier, the first few weeks are the hardest and most crucial weeks to establish a good milk supply. A key to success is to remove anything that may stumble your efforts in trying to provide milk for your baby. A baby has a strong need to suck even when they are not nursing. Allow baby to suck on the breast even when they are not nursing. That sends messages to produce milk as well. Consider avoiding using artificial nipples to satisfy that need at least for the first month or so. Also consider removing formula from your home. I personally know how tempting it is to just mix a bottle of formula that is sitting on the counter while you have been struggling to feed the baby for hours, frustrated to no end and has left both you and the baby crying. My biggest word of advice: DON'T GIVE IN TO THE TEMPTATION! Sadly most mothers that go on to "just supplement with formula for a couple feedings" are never really able to establish a good milk supply and eventually give in to formula feeding full time. {please not that there are exceptions and that some are able to get back to breast feeding. However of the women I have encountered 9 out of 10 women will not be able to nurse exclusively or at the level they were hoping to have nursed} If you must supplement then do so with very small amounts, 2-3 oz at a time and consider feeding your baby by not using artificial nipples (example: needle less syringe or SNS).

3. Don't wait for your breasts to "fill up" to determine when it's time for another feeding. There is always milk in your breasts for your baby, and more milk is made while you feed. Studies have shown that fat levels in milk are higher when the time between feedings is shorter. This means when you offer the breast again minutes after the last feeding (when your breasts may still feel "empty"), your baby is getting high-fat milk that will help him gain weight. Letting your breast fill up or get engorged actually signal you body to produce less milk, so the trick is to keep your breasts drained by having your baby nurse or by pumping frequently.

4. Consider a galactagogue
A galactagouge is a substance that increases milk supply. Here is a list of some of the most commonly used herbal galactagogues:
Fenugreek
Blessed thistle
Alfalfa
Brewer’s Yeast

I personally had a great experience increasing my supply with the products from MotherLove. I have to tell you, the drops taste terrible. And they make baby's gas smell wretched. BUT it totally works and increased my milk a ton. So for me personally it was well worth it. If you are not sure if its for you, my suggestion is to buy a small bottle and go from there.

I also found much success in drinking Mothers Milk Tea. Clicking on the link to the right will take you to their site to print out a coupon. You can buy this tea at various places including ebay and amazon.com.

5. Your diet
You must make sure that you are well hydrated. Drink to thirst. Drowning yourself in water isn't going to make you produce more milk. Try to avoid caffeine and alcohol as those things can actually lower your milk production. You may also want to consider eating these types of foods that have been said to increase milk supply for many women:
Black Beans
Papaya
Oatmeal

6. Talk to your doctor about domperidone
Domperidone is a medication used for stomach problems that has a side effect of increased milk supply. To read more about it click here. I personally took this after the birth of my second child to help with milk production. I did notice a difference but my OB refused to refill the prescription more than once and I found that after the medication wore off my supply would drop and I was back at square one.

7. Nurse longer. Don't limit the length of your baby's feedings to a predetermined number of minutes on each side. Allow your baby to finish the first breast before switching to the other side. This gives baby an opportunity to fill up on the high-fat hindmilk brought down by the milk-ejection reflex. If you switch your baby to the second side too soon, he'll fill up on the watery foremilk, which will make his tummy feel full but may not give him enough calories to grow.

8. Trust that nature's system works. If you're nursing often enough, and baby is sucking effectively, you will make enough milk. It's rare that a mother is unable to produce enough milk for her baby. And while it may seem that your life is stressful, mothers throughout history have breastfed their babies through war, famine, and personal tragedies. Your body nourished this baby through pregnancy. There's no reason to think that you won't succeed at breastfeeding.

9. Relaxation & Sleep
You will be shocked that once you begin to relax while breastfeeding or your pumping sessions, just how much more milk you will begin to have. If pumping, one of the most important thing – do not look at the breast milk while you are pumping. Everyone says to get enough sleep, but what new mother gets enough sleep during those first weeks after the baby is born. The good thing about breast pumping is that dad can feed the baby while you get a few extra hours of sleep.
 
{please note that this post is for informational purposes only. I am not a medical professional and each person should first consult with their doctor before trying any herbal or medical options. Please do your research on possible side effects}

Breastfeeding is a piece of cake

The title of this post is not necessarily true for most people. Someone once told me, "How hard can breastfeeding be? you just put the baby on your boob and poof....you're breastfeeding." There are a few, and I do mean few, who have experienced such easy nursing. And to you all I say that I am jealous and that I'm happy it worked out so easily for you. Please do not take that for granted. But for the majority of nursing mothers, it takes some work. It truly is a learned art. No two nursing pairs are alike and each pair must learn on their own.

This post is not to discourage any from breastfeeding. On the contrary, I encourage you to not only do it, but to not give up when its most difficult (in the first few weeks). It is most definitely the best thing you can do for your baby and for yourself as it lessens the chance of you getting certain types of cancers among countless other benefits. And I promise you, the pay off is huge when you succeed. But this post is to tell you the truth about breastfeeding and the obstacles you may encounter. Id rather you to be prepared for anything and succeed than for you to be caught off guard with a complication you have never heard of, feel confused, disappointed, frustrated and then quit.

So here are a few complications that you may or may not encounter:

• bad latch
• nipple pain
• cracked/chapped/bleeding nipples
• engorgement
• plugged duct
• nipple confusion
• candidiasis
• mastitis
• overactive letdown
• lip/tongue tie

These are just a few of the most common complications. Don't let this list or any other complications intimidate you. You can and will overcome these should you encounter any. First off, I highly recommend doing three things if you are expecting and planning to breastfeed (no matter how long). First, contact your local La Leche League office and start attending meetings during your pregnancy. I know we all lead very busy lives but these meetings will be for the greater good. If your schedule doesn't allow for it, then at least have their information such as phone number and address and LLL Leader info readily available for any breastfeeding questions and concerns. Second, I highly recommend choosing a location to birth you baby at that has a lactation consultant on hand. Now just because they have one on hand doesn't mean your are going to have everything work out. I personally have experienced horrible treatment from the lactation consultant where my children were born and I think it may have lead to me not being able to breastfeed all my kids. So I encourage you to meet the lactation consultants before hand. Get a feel for the type of support they offer. They should have a personal interest in you and want to see you succeed. If you don't get a good vibe from them or would like additional support for when you are discharged, I encourage you to find a local lactation consultant and at least have a consultation with them (either over the phone or in person) and have them ready to go on speed dial should you need their help once baby is here. These steps might just save your breastfeeding relationship with your baby. And last but not least, I encourage you to find a comfortable and easy to use nursing bra. I highly recommend looking at La Leche League nursing bras and Medela nursing bras. I personally have had great experiences with both those brands. I have also tried your generic nursing bras from Walmart, Target, Motherhood Maternity and the such... and have found that you get what you pay for. You buy cheap you get cheap. So investing in a good great bra will pay off in the long run and is totally worth the investment. I promise you.

Now getting back to the complications. For those of you birthing in a hospital let me give it to you straight. They say they are pro breastfeeding, but actions speak louder than words. Approximately 75% of the hospitals that I have supported at here in the Los Angeles area that I have supported at, are hardly acting in line with what they say. Almost everyone I have known that has given birth in the hospital was forced into giving their child formula. Myself included. Milk takes a few days to come in. 3 days for some, 5 days for others and even as many as 7 days or more for others. A typical stay in the hospital is 2 days. So for the majority of mothers, your milk will not have yet come in during your stay. You will have colostrum in small amounts. This is perfect for baby, don't see the small amount and feel discouraged or like there is something wrong with you. Babies loose as much as 10% of their birth weight in the first week. Totally normal. (Let me add a disclosure that in some rare moments it may be necessary to supplement due to a condition mom or baby has, so follow the advice of your doctor) So my first suggestion is let the staff know you plan on breastfeeding. Have this in your birth plan in bold and underlined. Have multiple copies of your birth plan for not only your doctor but for all the staff taking care of you. That includes different shifts in both the maternity and postpartum ward. Print a total of at least 10 copies of your plan to give out. I strongly suggest avoiding all artificial nipples as this may lead to nipple confusion in your infant (trust me, I am speaking from experience here). Some may even tell you there is no such thing as nipple confusion. And to those I pity how ignorant they are that they are not knowledgeable in a field that has failed so many breastfeeding relationships. Print out a sign such as this one:

onesie or hat. Very cute ideas. Be prepared for the staff to tell you that you must supplement for various reasons ranging all the way to weight loss, jaundice and dehydration along with any possible medical conditions, again there are some rare conditions in which it is necessary. If you are forced to feed your baby formula fear not. There are alternatives. First off I encourage you to ask if they have an SNS (supplemental nursing system) you can use. Here are examples of some types of SNS.

This is an example of finger feeding using an SNS

If you are anything like me, I purchased an SNS for cheap on eBay to have on hand at the hospital if I needed it. Luckily I didn't need it and it is a small price to pay for breastfeeding success. If you are unable to buy one ahead of time and your hospital doesn't have any readily available for you there are still options for you. You could ask for a small cup, usually the same cup they dispense medication with, to cup feed your baby. Though this can be a bit messy. Babies will usually lap it up like a little puppy does. I highly recommend asking for a syringe to feed the baby (needle-less of course). This is a fantastic way to not letting baby get used to sucking from an artificial nipple, I know this from experience. All the while I encourage you to first put your baby to the breast and ask for a breast pump to help stimulate milk production. {A HUGE tip upon being discharged: DO NOT TAKE ANY SAMPLES OF FORMULA WITH YOU! it is way to tempting to use it if you have it. I have seen higher breastfeeding success rates among mothers who leave the free formula samples than those that take it. Fight the urge. In this case, free isn't good} I personally had to syringe feed one of my children for the first 2 weeks or so. I was adamant to breastfeed and not give my child an artificial nipple. Syringe feeding isn't the most convenient especially when you are not home or in a moving car. And it is a bit time consuming. My baby still had not really grasped how to do a deep latch yet. So I settled on Adiri bottles to maybe help making feedings easier. The Adiri bottles actually helped teach my baby how to latch on my breast and we have been nursing perfectly ever since. She just needed to be shown how to latch onto something. And using the Adiri bottle that simulates a breast was the perfect thing for us. So if you are having these same problems you may want to try this.

If you find you continue to have latch/ sucking problems with not getting a deep enough latch, I encourage you to check if your child has a lip/tongue tie.

I have heard countless stories of problems with lip and tongue ties and simple snip can fix the problem. Check with your local lactation consultant if you believe your child has a tie. You can also find great resources on this here, here, here, here and here. Also I wanted to let you know that sometimes a snip is not needed at all to fix the problem. One of my children had a lip tie (shown on the top photo) and we were able to nurse just fine without doing a snip.

If you find that nursing is very painful, causing your nipples to crack and bleed or if you hear a clicking sound coming from the baby, these are signs of a bad latch and I encourage you to seek a lactation consultant asap before you add more trauma to the breast. To ease pain on cracked/bleeding/sore nipples I recommend using Lansinoh Lanolin Cream. It really works wonders.

I recommend Kelly Mom as the #1 online reference to everything breastfeeding. Please know that no online reference, Kelly Mom included, replaces a lactation consultant. If you think you have any of the listed complications or any others, please, please, please... call your local LLL Leader and a lactation consultant. Plus if you are a WIC participant, they offer breastfeeding support as well.

If I can leave you with only one golden rule to breastfeeding, it would be to not give up. Keep going, keep trying, you will and can get it.