This past week, we saw an ultrasound of our second child and found out it’s a girl! We have a son who turns two this week so I’m excited to start buying little dresses and being able to shop in the other 90 percent of children’s clothing stores (boy’s sections are always so small). Since I’m especially thinking about babies this week, I wanted to discuss the importance of promoting breastfeeding for our moms we counsel with diabetes.
As part of my role in clinic doing medical nutrition therapy visits, I see referrals for WIC (the Special Supplemental Program for Women, Infants and Children) and talk to several pregnant moms. Since having my son almost two years ago, I have learned a tremendous amount about breastfeeding - both its challenges and benefits to both the mom and baby. If you see pregnant moms in your practice, it’s important to discuss the benefits of breastfeeding and connect them with all the resources they need to be successful. Even though I’m a dietitian, know one of the top lactation consultants in our state, and have several family members who were successful with breastfeeding, I was still paranoid that I was doing something wrong. Breastfeeding for the first time is new to the mom and the baby so it takes a lot of reassurance that she is doing things right and boost her confidence. Knowing the benefits of breastfeeding kept me committed when I wanted to give up. These include:
Lowering your baby’s risk of getting diabetes
Helping you lose weight between pregnancies
Helping your body use insulin in a better way
Lowering your need for insulin
Helping prevent obesity
(Source: The International Lactation Consultant Association)
Since there are several risks for a baby from a mom with diabetes, the baby may be admitted to the neonatal intensive care unit after birth. Ideally, the mom would still try to breastfeed, if possible. If her baby needs to be tube-fed or supplemented, ideally the baby would be given human milk from a milk bank or non-cow’s milk formula until the mom can begin pumping colostrum to feed the baby. The ideal plan (as long as the baby is stable after birth) is to bring the newborn to the mom for skin-to-skin contact immediately after birth (this keeps the baby’s blood sugar levels from dropping due to separation or crying). The mother should try to initiate breastfeeding (within 1 hour after birth) and nurse frequently or at least every hour for the next 3-4 hours, then at least every 2-3 hours until 12 hours of age. This helps to get breastfeeding off to a great start and helps the mother’s milk come in. Diabetes can delay the process of a mother’s colostrum changing to milk by 1-2 days longer than it would in a mother without diabetes. Increasing feedings especially during the first few days should optimize the mother’s supply.
For the breastfeeding mom with diabetes, she needs to be aware that her insulin or medications may need to be adjusted. She is more at risk for low blood sugar within an hour after breastfeeding. It’s a good idea to make it a habit to have a snack and water ready when they sit down to nurse for at least the first 6 weeks when the baby is feeding so frequently. The mother may also need to test her blood sugar more frequently as she learns how breastfeeding affects her blood sugars. Since people with diabetes are more likely to develop an infection, they are more at risk for a yeast infection of the breast or mastitis.
Just as we specialize in the diabetes side of things, lactation consultants specialize in helping moms breastfeed. It’s important to know great lactation consultants in your area to refer your mothers so we can work as a team with their OB/GYNs and pediatricians for healthy, breastfed babies!
The International Lactation Consultant Association has a directory for lactation consultants on their web site: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432