Continence and Women’s Health for first time mums, Interview with Hayley Sternson

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s 1st Podcast Episode: Continence and Women’s Health for first time mums, Interview with Hayley Sternson

As a change of pace, Pharmamum is proud to present its FIRST podcast episode, which covers Continence and Women’s Health issues for first time mums through an interview with APA Physiotherapist Hayley Sternson.

 

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.

Your easy to digest guide to constipation

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Constipation

I feel I have had my fair share of constipation issues to deal with as a parent. Both of my daughters caused me a lot of stress with  their bowel habits but thanks to them and my knowledge as a pharmacist, I will be able to pass on what I have learned and provide you with good practical advice with how to treat and hopefully prevent constipation.

It’s amazing when your child is born, besides worrying about the most obvious feeding and sleeping issues, I’d say the next most common concern is about the child’s bowel habits? Is my child opening their bowels enough? Is my child constipated? Are you sure that is what a baby’s poo should look like? Is it too green? Too yellow? Too much? How much can one little baby poo? We seem to discuss our children’s poo quite often at mother’s group, as if we are discussing the weather.There is always one baby that opens their bowel at every nappy change and then one like my eldest  daughter, would open her bowels once a week.

When your baby is born, your baby’s first bowel motion (meconium) is a black, thick, tarry looking excretion.  Once the meconium is out, the bowel motions tend to become thinner, lighter and watery excretion.Your baby should have a bowel action within the first 24-48 hours after birth. If they don’t it is important that they be seen by a doctor. Depending on whether your child is breastfed or formula fed will determine the consistency, appearance and odour of the bowel motion. If breastfed, the bowel motion is more watery, light brown mustard colour, not much of a smell and easy to remove. Stools can be greenish in colour and that can be perfectly normal too. Formula fed babies have stools that can range in colour from yellow green and brown (depending on which formula they are on) , thicker, pastier, and a stronger smell. I  had a combination of both. I breastfed my children, but needed to top up with formula, so I had a combination of bowel excretions.  It does depend on your baby’s gut processing speed as to how often your baby’s bowel opens. Both of my children were very slow with their gut processing and this led to very infrequent bowel motions.  I remember with my eldest daughter, once we got home from the hospital, her bowels would open every 1 or 2 days and then it began to slow down and would open every 3 to 4 days, and then between 2 and 4 months of age her bowels  sometimes didn’t open for up to 10 days. To be honest I was freaking out by that stage, but every maternal nurse, doctor, paediatrician I asked, gave me the same answer. That answer was, ‘some’ babies poo 12 times a day and that is perfectly normal and some babies poo once every 12 days and that is perfectly normal.’ I had two babies that opened their bowels every 10-12 days and I learnt that that was perfectly normal. That put my mind at ease, but when they finally opened their bowels, they would go bright red in the face and look like they were really straining. However, the bowel motion was always soft. When babies are getting use to making a bowel motion they can often go red in the face, grunt or even cry and still produce a soft bowel motion. Long periods between stools in a baby who is generally well, putting on weight and thriving is not a cause to worry. As long as the baby’s tummy feels soft, they are not distressed or consistently crying, and the stool produced is soft. The important thing to understand is that even though a baby may only have a bowel action every 12 days, it is not considered  ‘constipation.’ A baby/child is only considered to be constipated if their bowel motions are very hard and firm and described as passing ‘pebbles’.

It is very unusual for breastfed babies to be constipated unless there is a medical problem (eg. Milk protein allergy, hypothyroidism,coeliac disease). This is because breastmilk is easy to digest and there is a hormone in breast milk that stimulates bowel contractions. Formula fed babies can become constipated on formula for a few reasons:

  • Formula preparation– each formula requires a different amount of water to make up the formula. It is important to always check, because if not enough water is  added, that can lead to constipation and dehydration.
  • Depending on the infant formula, the ingredients and the ratio of proteins ie. whey to casein, can all affect how your baby digests the formula. Most formulas are whey dominant which is easier to digest than a casein dominant formula. Casein dominant formulas are harder to digest and hence will move slower through the bowel, allowing more fluid to be reabsorbed, which can lead to constipation. As the casein is slower to digest than whey protein, it may keep baby’s tummy full for  longer. Every baby is different and sometimes it really is trial and error as to which formula is right for your baby. As a mother you can tell if your child is comfortable on the formula. However, it can be very hard in the early days as sometimes it can be a multitude of factors ie colic, reflux etc. Constipation may be caused by a milk-protein allergy or intolerance. If your pediatrician/GP diagnoses your baby with a milk-protein allergy they will switch your baby’s formula to one that isn’t milk-based. I would always recommend consulting a doctor before switching formulas.

Once a baby starts solids, it can be a time where the bowel habits change dramatically. Going from a liquid diet (ie breast milk or formula) to introducing solids, your baby’s digestive system needs to ‘up its game’ by working out how to digest and breakdown food in the form of a solid.  The body needs ‘to learn’ how to digest the food that is being introduced and there may be some initial problems’ in the form of constipation. You may start to notice that you see certain foods that have been partially digested and you can recognise them in your baby’s bowel motion.  Babies can become constipated when starting solids because as the food is making its way through the intestines the body will  absorb the nutrients and the water content. The longer it takes for certain foods to make its way out of the body, the more opportunity the body has to absorb the water content for the solid. My daughters both suffered with constipation when starting solids. What I learnt from treating their constipation and trying to avoid further bouts of constipation was:

  • Keep offering water. Try and have a sippy cup always on hand offering sips of water in between normal breast/ formula feeds. I was recommended that once I made up the formula using the correct amount of water, to add an extra 10mL of water just to increase the fluid content. I would never recommend diluting formula any further as then it compromises the nutritional needs of your baby. It is preferred to offer sips of water in between feeds.
  • Certain foods are binding and can increase the risk of constipation in babies and others may promote a loose bowel action. What I found over time was depending on the consistency of  my childs bowel actions, determined what foods I would add or avoid in their diets to either try and make the stools  firmer or looser. Finding a balance is important.

Binding foods:- Rice cereal (Rice is binding and all rice cereals are  fortified with iron which can cause constipation), Bananas, the starchy vegetables (eg.potatoes and sweet potatoes), apples, white bread and rice. Too much dairy can also lead to constipation.

Foods that can speed up gut processing: stewed Prunes and apricots, Pears, Kiwi fruit, peaches, plums,  diluted prune juice (small amounts), green fibrous vegetables (eg broccoli, beans, brussel sprouts, zucchini). Fibrous foods (eg wholemeal pasta, brown rice and fruits such as blueberries, grapes, raspberries and strawberries are all high in fibre.

I was never able to give my daughters rice cereal because of its constipating effect. I needed to make my own baby cereal by blending oats and millet and then cooking it and mixing it with pureed pears and prunes etc.

  • As soon as you notice your baby is constipated, the quicker it is resolved the better. You don’t want to get to the point where the bowel motion is so hard, that an anal fissure occurs which is a little tear in the anus. Anal fissures are painful and you don’t want your baby associating a bowel action with pain as this will set up fear and anxiety when passing stools.

If your child is constipated and under the age of one, it is important to speak to your baby’s doctor immediately with any of the following symptoms:

 

  • Constipation with a hard belly and vomiting
  • Passing blood in bowel motions
  • Tear or soreness around the anus
  • Looking unwell
  • Reduced number of wet nappies in a day
  • Constipation with poor growth and development

Once you have seen the doctor and they have checked for any serious health problems, they may recommend the above remedies (eg increased water and diet) as well as some medication to soften the bowel motions or help encourage the stool to be excreted. What happens is a hard dry stool forms at the anus and once that has passed, the faecal matter that follows is loose. Hence, you may need to treat both orally and anally. The aim is to have your baby’s bowel empty and keep it empty by maintaining soft lubricated stools:

  • Infant glycerol suppositories can be used once a day. They are very small rocket shape suppositories that you can insert into the anus. A bowel action can occur within 5-30 minutes. If that initial stool is really firm,passing it may cause your baby  to be in pain. I would also recommend applying some vaseline on a clean finger around the anus to help stimulate the bowel to open.
  • Coloxyl Drops contain a stool softener called poloxamer. The drops can be used in infants and can be added to bottle feeds or diluted fruit juice.  They help soften the stools.
  • Lactulose can be given orally to infants from one month old. Lactulose works by drawing in fluid into the abdomen to soften the bowel motions. It is very sweet and can be mixed in water, milk or dilute fruit juice.

Usually constipation will settle within 2 to 3 months of starting solids.

Any medication given orally can take 1 to 3 days to work, however once the bowel motions are loose and your baby can comfortably produce a bowel motion without straining, any association of pain with excreting a stool will soon disappear.

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.

Is breastfeeding a skill we’re born with? or is it something we need to learn?

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Breastfeeding

When I think back to when I first breastfed my eldest daughter, the first thought that comes to mind was, ‘I really had no idea what I was doing’.  I remember when my beautiful baby girl was placed on my chest and then moments later, the midwife said, ‘Ok let’s give her a feed’. At that point, I  thought, ‘I’ve been pregnant for 9 months and I didn’t even think once, to do any research on breastfeeding’. My plan was to get through the birth and then worry about breast feeding. And that’s exactly what I did, I worried a lot about breastfeeding for at least the first 6 weeks, because for me, it didn’t come naturally. I needed a lot of education.

I think it took approximately 5 to 6 weeks to feel comfortable breastfeeding. From dealing with attachment issues, bleeding and cracked nipples to mastitis, nipple thrush and vasospasm, looking back I think I had it all. The following post will deal with many breast feeding challenges, how I dealt with these issues personally and as a pharmacist, I want to share with you, the products that can help with treating these common problems.

Attachment issues

From the minute I started breastfeeding, I struggled with attachment. For the first couple of weeks,  I constantly had to place my daughter Sophie on the breast, and then take her off, as she often, would not have enough of the nipple in her mouth and nor was she getting enough breast milk whilst attaching poorly. Whenever Sophie would start suckling, I was in pain, it felt like she was just clamping down on the nipple, so I had to gently break the seal with my pinky finger and take her off the breast and try again. I would often see the tip of my nipple with a red line down it, illustrating that she was not positioned correctly. On the positive, I was in hospital and had the constant support of the midwives  watching over and helping me to become confident with attaching Sophie correctly to the breast. Every midwife that observed, had an extra tip and this really helped. However, by the third day, my nipples were starting to bleed and I was in so much pain I was advised just to give the nipples a break and express for a day, to allow them to heal.

What I learnt:

  • The baby’s mouth needs to cover as much of the areola as possible ( more so on the baby’s lower jaw side) to drain the breast well.
  • The chin should be pressed into the breast and ensure the nose is clear to breathe freely.
  • The babies head should be tilted slightly back, at the same level as your breast.
  • Their  nose should be level with your nipple.
  • The babies lips should be flanged out.
  • The baby’s upper lip should be touched by your nipple as you begin to breastfeed. When baby opens the mouth wide, place on the breast, and aim the nipple towards the roof of their mouth.
  • Keep your breast compressed in your hand until the baby is actively suckling.

By ensuring all of the above is performed whilst breastfeeding, there should be no pain.

Treating sore, cracked and bleeding nipples:

Once you address the problem of attachment and correct positioning with the help of a lactation consultant or midwife, the nipples will begin to heal. There are products that can be used in the meantime to soothe and speed up the healing:

  • I found the best treatment for my sore nipples was hand expressing a few drops  of breast milk and spreading it over the sore nipples. Breast milk has wonderful healing properties as well as anti-bacterial properties and works really well to soothe sore cracked nipples. Just allow them to air dry before putting the bra back on.
  • Lanolin eg Lansinoh is a an ultra purified grade of Lanolin. It soothes and protects sore cracked nipples and provides a moist wound healing environment. Applying Lansinoh on the nipples when they are cracked and sore can be difficult as the Lansinoh is a thick waxy substance and at room temperature can be difficult to spread. With clean hands, warm a pea size amount by moving it around between your fingers, this will make it easier to apply. Lansinoh does not have a smell or taste to it and can be applied after a breastfeed. It is not necessary to wipe it away before a breastfeed. A small percentage of people using lanolin may have a reaction. It will occur if you are sensitive or allergic to wool. I always recommend doing a skin test and  applying a small amount to the skin, even if it is on your hand just to test that you are not sensitive to it. However Lansinoh’s lanolin formulation  have removed the part of lanolin that most people are sensitive to.
  • Hydrogel soothing pads provide cool soothing relief to sore nipples. They help heal damaged nipples and are placed directly on the nipples in between feeds. You can place them in the fridge before applying them to the nipple and that will provide cooling comfort and reduce inflammation. They also provide a barrier to the nipple, so that the nipple is cushioned and not rubbing against the bra when sore and irritated. The pads can be reused and  rinsed with warm water in between use. There are a few different brands available eg Mother’s mates, Dr Brown’s hydrogel soothing pads and Rite Aid. I found them to be really soothing in between feeds.

Mastitis

When I got home from hospital with my baby daughter, my milk had not come in yet. I had my daughter on a Tuesday and by Sunday my milk finally came in. My breasts that evening suddenly became engorged, they were red, felt  lumpy  and I had a fever. I rang my obstetrician and he mentioned to me that a fever can occur when the milk is coming in, but come to his rooms the next morning and he will check for mastitis. My obstetrician confirmed it was mastitis and gave me a prescription for an antibiotic. He said, it is important to start the antibiotics straight away. Mastitis often comes on quickly and it can feel like you are coming down with the flu,  feeling feverish and unwell.  It is an infection caused by a blocked duct that has not cleared properly. The milk is banking up and going in to the breast tissue causing inflammation which gives the breast a red appearance  and often the skin can appear shiny. The breast becomes hot, very sore and inflamed.

Treatment:

  • It is imperative to get treated for the infection with antibiotics as soon as possible, within 12 hours.
  • Often one’s first reaction is to want to leave the breast alone, because it is so painful, however that will only make the infection worse. The milk ducts needs to be cleared and by getting your baby to breastfeed on the infected side will help drain the breast best. It is perfectly safe for your baby to drink from the infected side. To clarify, the baby cannot catch the infection as any bacteria in the milk will get killed by the digestive juices in the babies tummy.
  • It is important to breastfeed more often (approximately every 2 hours) alternating breasts with each feed but do try and feed from the infected side first because often the babies suck will be stronger initially before the baby gets tired.
  • Your baby  may be hesitant to drink from the affected breast just because it feels different eg harder and lumpier, and may be a little more difficult to feed from, but not because the milk tastes differently.
  • The breast must be drained often and the baby is best at draining the milk from the breast, however if the breast is too painful to feed from, express with an electric pump for less pain and feed baby using a bottle until feeling better and more comfortable.
  • Keep massaging the breast in the direction of the nipple to encourage the clearing of the blockage and ensure the milk flows in the right direction. Gentle pressure behind the lumpy area may help clear the blockage too.
  • In terms of whether to use ice or heat:

Heat: Apply a heat pack about 10 minutes prior to breastfeeding to help the flow of milk. You can use a hot water bottle, a wheat pack, or even sit in a warm/hot bath.

Ice: Apply ice immediately after a feed, for pain relief. Don’t place ice directly on to breast, ensure you wrap an ice pack in a tea towel and place it on the affected area. A cabbage leaf can be placed in the bra to also give some pain relief.

  • It is worth waking your baby to feed from the breast, however if your baby is too tired or not interested, then express as often as you need, until you feel comfortable.

Drink plenty of water and rest as much as possible to recover quickly.

Paracetamol and Ibuprofen can be taken when needed for pain relief. They are both safe to use whilst breastfeeding.

Some breastfeeding mothers may not experience a fever or flu like symptoms when they notice a clogged or blocked duct in their breast. They may feel an area that is tender or a knotty hard lump in the breast where the milk duct is not draining well. It can become sore and inflamed. The blocked ducts do need to be addressed quickly to avoid developing mastitis, which is where the above symptoms are accompanied with fever, nausea, and flu like symptoms. If the milk flows freely and the bacteria is flushed out, then the bacteria doesn’t have the opportunity to multiply. However if the milk stagnates, the growth of bacteria can occur in the ducts. Hence, the above dot point treatment plan for mastitis apply here as well, feeding frequently and draining the breast completely along with massage and heat  to ensure those hard lumps/areas do not progress to mastitis. Women’s health physiotherapists also offer an effective treatment using ultrasound which can relieve the symptoms of breast engorgement, blocked ducts and mastitis.

I was recommended by a GP who was also a lactation consultant to give my new born baby probiotics after my course of antibiotics as a small amount of the antibiotics would pass through my breast milk to the baby. Occasionally, a rash and disruption of the baby’s good bacteria in their digestive tract can result in diarrhoea or thrush. Bioceuticals make a probiotic that can be given to infants including ‘premmies’ called Baby Biotics and Inner health make a probiotic powder that can be given from three months. They contain the most common bacteria present in the gastrointestinal tract of healthy breastfed newborns and infants. Both can be mixed with a small amount of breastmilk and made into a paste and tiny amounts placed in their mouths, or on the mother’s nipple for the baby to consume whilst breastfeeding. Obviously be mindful of the risk of choking and only place it in their mouths when they are awake and in an upright position.


Nipple thrush

When you hear the word ‘thrush’ most people  think of  itching and discharge. However, those symptoms are not present in nipple thrush and the symptoms are completely different to  vaginal thrush. Nipple thrush is a fungal infection and extremely painful. Nipple thrush can occur after a course of antibiotics  or after nipple damage, ie where cracks in the nipple and/or bleeding occur. The warm, moist environment is a good breeding ground for a fungal infection. I remember personally suffering with nipple thrush, however due to the trouble I was having with attachment and pain when breastfeeding, I remember thinking, ‘what’s this stinging feeling? Is this normal?’ I thought maybe it’s my body reacting to the constant breast feeding followed by expressing to try and increase my milk supply.  That stinging sensation became worse, and I felt it more so after I finished each breastfeed. I made an appointment with a lactation consultant who happened to be a doctor as well, and she diagnosed nipple thrush but thought I  may also be suffering with nipple vasospasm.

Symptoms of nipple thrush include cracked nipples which don’t heal,  Nipples can be pink/red and shiny, with or without white areas on the folds and there can be a burning sensation as well. Thrush on the nipples can enter the milk ducts which can cause deep breast pain. Thrush pain lasts while your baby is feeding and usually gets worse after feeds. I remember in the middle of the night feeds, going back to bed and lying there in agony because the stinging sensation after feeding was unbearable, and I could feel the sting all the way to the top of the breast.

Treatment:

Nipple thrush includes treating:

1)the surface of the nipple

2)the baby’s mouth

3)Oral treatment for the  mother (if the pain is deep within the breast.)

In order to get pain relief the above three areas need to be treated at the same time, to avoid passing it back and forth, from mother to baby.

The surface of the nipple– Can be treated with an anti-fungal cream e.g. Miconazole 2% (Daktarin, Resolve). Apply a thin smear of the cream to the whole nipple after each feed. Before a feed, just wipe away any excess cream but it is not necessary to wash the nipple before breast feeding.

The baby’s mouth- There are anti-fungals that can be given to infants to treat oral thrush, eg. an oral gel (Daktarin oral gel)  or drops (Nilstat or Mycostatin oral drops). They both have to be used four times a day and after a feed. I prefer to recommend the oral gel to a baby as the gel can be applied to the affected area and stays around in the mouth for a longer period of time. The drops can miss the affected areas and just be swallowed. It is safe to swallow both products. The manufacturer of  Daktarin gel states, it can be used from 4 months up and that is because it comes with a measuring spoon and the concern is the risk of choking. It is recommended to measure the dose on the measuring spoon but not to put the spoon in the baby’s mouth, rather using a clean finger apply a small amount on the affected areas of the mouth, usually the tongue or you may see plaques along the inside of the cheeks. It is recommended to treat the baby until the symptoms are gone and for two days after.

Oral treatment for the mother- Your doctor will write a prescription for an oral anti-fungal tablet to take which is safe whilst breastfeeding. Complete the course and by the end of the course the pain should have subsided. If it has not, obviously speak to your doctor.

Thrush grows in a moist warm environment so try as much as possible to keep the nipples dry, by changing breast pads often. Wash bras and towels in hot water. Canestan also make an anti-fungal wash that you can purchase from any supermarket. You can put 1-2 capfuls in the washing machine to kill any fungal species.

Nipple Vasospasm

Vasospasm is when the blood vessels in the nipple constricts and spasms causing an intense pain in the nipple and often the tip of the nipple can turn white from pink. Nipple thrush and nipple vasospasm can often be difficult to differentiate. They both cause a burning sharp stinging pain in the nipple and often an infection or nipple damage can trigger vasospasm. Often the vasospasm is first treated as Nipple thrush to ensure there is no infection and then if the vasospasm continues to occur, it is recommended to ensure the nipples are not exposed to cold air which is the main trigger. Often after the baby finishes breastfeeding and the nipple is exposed to the cold air, vasospasm will occur so breast warmers  can help. They can sit in the bra and the heat will just relax the blood vessels and stop the pain. They can be purchased through the breastfeeding association of Australia. Rubbing olive oil directly onto the nipples has also been shown to help. It can reduce the frequency of the nipple spasms and can also settle the pain quickly. Supplements like fish oil or evening primrose oil  and magnesium (eg 300mg twice daily) are also recommended  to help relax the blood vessels. If the above methods are not helping, last resort, your doctor can prescribe medication which stop the vasospasms from occurring.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.