Welcome to the Fall/Winter 2016-17 issue of the Expressions newsletter!

Issue 3/16-17

Expressions

Fall/Winter 2016-2017

In This Issue: Message from NMC's Executive Board Chair, Annual Report: Services, Advocacy, and Accomplishments Oct. 1, 2015 through Sept. 30, 2016, Member Recognition, HOLLY EDSON: Craniosacral Therapy and Breastfeeding, NMC Luncheon and Social, SF Bay Area Chapter Open Positions, SF Bay Area Chapter Class of 2016, Breastfeeding Resources, Articles, Breastfeeding and Bodywork

“Breastfeeding’s worst enemy is separation.”

Dr. Nils Bergman

Message from NMC's Executive Board Chair

By Lori McBride, Executive Board Chair

Does it seem like we were just together one year ago celebrating NMC’s 60th Anniversary? Time goes by way too fast!

Twenty-five NMC members came together for our Annual Meeting on Sept. 26, including three of our new trainees! We had an organizational update, member recognition, continuing education, and a delicious luncheon with time for socializing.

Executive Board

NMC Executive Board: Audrey Kalman, Lori McBride, Peggy Ripley, Lisa Piediscalzi

The Executive Board oversees the functioning of NMC and meets quarterly at Good Samaritan Hospital in San Jose or has conference calls. Executive Board members are:

Lori McBride: Executive Board Chair & S.F. Bay Area Chapter Liaison

Audrey Kalman: Secretary, Membership Chair

Peggy Ripley: Treasurer

Lisa Piediscalzi: Outgoing Santa Cruz Chapter Coordinator & Executive Board Liaison

Nora Yerena: Santa Cruz Chapter Liaison

Chapter Coordinators

Becca Scheiblauer: Santa Cruz Chapter Co-Coordinator

Katie Williams: Santa Cruz Chapter Co-Coordinator

NURSING MOTHERS COUNSEL EXECUTIVE BOARD AND BOARD SERVICES

EXECUTIVE BOARD CHAIR/S.F. Bay Area Chapter Liaison Lori McBride, CLE, IBCLC bawsum@aol.com; 650 365-2713

EXECUTIVE BOARD SECRETARY, MEMBERSHIP CHAIR. Audrey Kalman ackalman@gmail.com; 650-303-2405

EXECUTIVE BOARD TREASURER. Peggy Ripley peggy@burgi.org; 707-396-9573

SANTA CRUZ CHAPTER LIAISON. Nora Yerena yerena.nora@gmail.com; 559-287-8934

WEBMASTER. Gretchen McDougall gretchen.mcdougall@gmail.com 650-728-1021

SF BAY AREA CHAPTER COORDINATOR, ASSIGNMENTS CHAIR. Gretchen Kindberg gretchen.kindberg@gmail.com 650-689-5302

SANTA CRUZ CHAPTER CO-COORDINATOR. Becca Sheiblauer borkles@gmail.com; 734-846-9016

SANTA CRUZ CHAPTER CO-COORDINATOR. Katie Williams ktwills79@gmail.com; 916-868-4268

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Gretchen Kindberg: S.F. Bay Area Chapter Coordinator

Not official Executive Board members, but Board members who do serve all of NMC are:

Gretchen McDougall: Webmaster

D. Armand: Newsletter Editor, Contributing Editor

Lori expressed her appreciation for all these Board members.

Strategic Plan

In 2006 NMC the Executive Board began working on NMC’s Strategic Plan. One goal was building an organization with stronger relationships, which we do through our Annual Meeting, member recognition, and continuing education events.

Liz Simons, Heising-Simons Foundation

NMC is so appreciative of the continued financial support provided by Liz Simons of Heising-Simons Foundation. Liz was a counselor and Board member in the Santa Clara Chapter of NMC for several years. We recently received a generous donation of $5,000. Since 2001, Liz has donated $42,000 to NMC!

Outreach/Publicity

We need our communities to be aware of our free breastfeeding classes and support.

Attendance at our breastfeeding classes has been quite low and we are getting less calls on our Referral Lines.

Do we have breastfeeding champions in our community who we can approach to publicize NMC’s services? Do any of you have recommendations? Please share with your Chapter Coordinators.

We appreciate the efforts of our members who personally deliver the brochures and class schedules to their medical practitioners or others who work with pregnant and new moms.

Thank you to every one of our NMC members!

Annual Report

Services, Advocacy, and Accomplishments Oct. 1, 2015 through Sept. 30, 2016

By Lori McBride, Executive Board Chair

We are in our 61st year of educating and supporting moms in our communities. That’s due to the efforts and passion of all you wonderful NMC members!

NMC's 46 Volunteer Counselors (32 S.F. Bay Area; 14 Santa Cruz):

helped 316 moms

provided 20 free breastfeeding classes

made 26 free home visits participated in the San Mateo Co. Breastfeeding Task Force and Santa Cruz Breastfeeding Coalition

exhibited/taught workshops at 5 conferences, baby fairs, and community events.

Counselors answered phone calls (local as well as across the U.S. and even internationally) 9 a.m. to 9 p.m. 7 days a week; 28% of calls were received on weekends,

holidays, and after 5 p.m. (when lactation centers are closed)

Santa Cruz Chapter provided lactation support on weekends at Dominican Hospital

S.F. Bay Area Chapter offered pump rentals at reduced rates or free to low-income families.

Member Recognition

By Lori McBride, Executive Board Chair

(left to right) Audrey Kalman, Carol Gillman (25 yrs.), Jennifer Hyrkin (5 yrs.), Sherrie Friedman (25 yrs.), Cassie McGraw (35 yrs.), Lori McBride, Raina Snyder (15 yrs.), Peggy Ripley, Lisa Piediscalzi (10 yrs.), Allyson Fisch (10 yrs.), Gretchen Kindberg

We recognize all members reaching milestones for every five years of service. We had many to honor this year, which was very exciting! We are so grateful for their dedication to NMC and passion they bring in providing support to new moms. We are especially appreciative of the time and energy given by those who hold Board and Committee positions!

5-Year Counseling Milestones

Tarra Knotts has 3 children: Maryann, 9; Remington 6; and Theodore almost 4

Jennifer Hyrkin is a post-partum doula. She has 2 sons: Sam, 17, and Andre, 12

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Shoshanna Kirk just moved to farmhouse on 8 acres on Bainbridge Island, WA. She has 2 children and may continue to be counselor.

Vanessa LeJeune has a son, Remi, 8. She has served on the Santa Cruz referral line, taught classes, volunteered at Dominica Hospital, and co-hosted the new mom’s support group at Luma Yoga with Virginia Kauffman.

Julie Wooten has served on the Santa Cruz referral line.

10-Year Counseling Milestones

Tine Heilig

Tine Heilig has a daughter, Franziska, 16, and a son, Finn, 15. She has served been a referral line counselor for many years, helping hundreds of moms. She has also been an advisor for trainees. Tine is one of the NMC facilitators for the Blossom Birth Breastfeeding Support Group. Tine was a pediatric nurse in Germany and now is an IBCLC. Tine also is an active volunteer in her children’s school.

Lisa Piediscalzi has 2 sons: Nathan, 19, and Elias, 16. She has been Santa Cruz Chapter Coordinator & Executive Board Liaison since 2009. Lisa has held many roles over the past 7 years: organizing trainings, serving as a Referral line counselor, conducting community outreach, teaching breastfeeding classes, and doing Dominican Hospital rounds. Lisa brought organization and leadership to the Santa Cruz Chapter at a critical time. Virginia Kauffman and Lisa were co-leaders. Lisa’s efforts in planning NMC’s 60th Anniversary were greatly appreciated by the Executive Board. Lisa also has paid jobs. Besides her private IBCLC practice, she is an IBCLC at Good Samaritan Hospital. She also is a cranio-sacral therapist and acupuncturist.

10-Year Continuing Service Milestones

Allyson, Charlotte, Kai, and Ben

Allyson Fisch has a daughter, Charlotte, 12, and a son Kai, 8. She has served as our Professional Relations Board Chair for many years, and we are very grateful for her expertise in this role. Allyson handles

questions requiring medical information, often utilizing the services of our Medical Advisory Board. Several years ago she updated our Medical Advisory Board to include more than just IBCLCs, OBs, and Peds. We even have a Sexologist! She previously held the position of Community Relations Chair,

handling brochures and materials distribution. Allyson is a Gerontological Nurse Practitioner in the Home-based Primary Care Program at Kaiser in Redwood City. She is also a Registered Dietitian. We are grateful for Allyson’s expertise in handling our medically related questions.

15-Year Counseling Milestones

Raina Snyder has two sons, Steven, 42, and Morgan, 38, and daughter, Patricia, 35. All three were born at home. Raina joined Santa Cruz Chapter first. She later joined the Santa Clara Chapter which merged into the S.F. Bay Area Chapter. She was a member of both Santa Cruz and S.F. Bay Area Chapter, but counseled only in the S.F. Bay Area Chapter until she retired last year from the Blood Centers of the Pacific and moved back to Soquel. Now the Santa Cruz Chapter has her as a counselor! Raina has held many roles over the years. She provided a pump rental station, handled brochure distribution, served as an advisor to trainees, and did many home visits throughout the peninsula, south bay, and Santa Cruz. Raina previously worked at Maternal Connections Lactation Center at

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El Camino Hospital. She volunteered at theMothers’ Milk Bank, Sutter Maternity & Surgery Lactation Center, and Dominican Hospital. Raina shared: “Successfully supporting and teaching the art of breastfeeding to new mothers and infants is an important part of my life and I hope to continue to a very old age.”

25-Year Counseling Milestones

Mel, Benji, Daniel, Sherrie, Jacob

Sherrie Friedman has 3 sons: Benji, 26, Daniel, 24, and Jacob, 22. Lori met Sherrie at Little Hands 26 years ago when Sherrie’s oldest son, Benji, and Lori’s youngest son, Casey, were in the baby class. Lori had put up a flyer about NMC’s training which led to Sherrie joining! Sherrie has held various Board and Committee roles including Orientation. She just took on the role of Journal Reader and is also our newsletter contributing editor—submitting scientific articles about breastfeeding. Her son Daniel, who is in the PhD program at Stanford, also sends us breastfeeding articles! Sherrie is a lawyer with the Juvenile Private Defender panel which is part of the San Mateo Bar Association. She is an advocate all for breastfeeding moms she encounters with her job. Sherrie just joined the CASA Board of Directors. For 12 years Sherrie

served as an educator, presenting Child Advocacy and Social & Emotional Needs of Children workshops to psychologists, administrators, and parents. She also served on the Board of California Foundation of Gifted Education. She is a very busy woman, but still makes time for NMC for which we are very grateful!

25-Year Continuing Service Milestones

Carol Gillman has two daughters: Alysha, 26, and Kelsey, 23. She has been Treasurer of S.F. Bay Area Chapter for 15 or more years. Time goes by so fast it’s hard to remember. We are so grateful for her financial expertise in addition to being our tech go-to person who always has great suggestions. Carol held other Board and Committee positions She was our Newsletter Editor and had an Assignments Box. She has done many home visits after long days at work. Carol and Sandi have tracked down breast pumps. Carol described herself as a Construction Company maven, running Kingston construction office for years. Prior to that Carol was a HR manager. She is currently looking for a new job. We are so lucky to have Carol continue to serve as Treasurer. By the way, she kept this as a secret from her husband for we’re not sure how many years. We’ve joked about it over the years!

35-Year Counseling Milestones

Cassie McGraw has two sons: Sean, almost 36, and Ryan, 32.

Cassie was Lori’s advisor when she went through the training in 1987.It is incredible that Cassie is still an active member, counseling moms and teaching breastfeeding classes. She stays up-to-date with breastfeeding information. We see her at all our continuing ed. events. Imagine the hundreds of women she’s helped over these 35 years! She held almost every Board position except Coordinator, including Treasurer, Assignments, and Orientation Chair. Cassie just retired from a 22-year career at Oracle, and her husband, Jim, also retired. They are starting a new chapter in their lives, but NMC is still part of it, for which we are very grateful. She truly is an inspiration to all of us!

Congratulations to all our milestone honorees!

HOLLY EDSON: Craniosacral Therapy and Breastfeeding

By Lori McBride, Executive Board Chair

The Executive Board was excited when we chose the topic of Craniosacral and Breastfeeding for our Annual Meeting and Luncheon. Many of us may have had moms we’ve helped or heard about whose babies would cry when put to the breast. We may not have considered it was

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due to discomfort, possibly caused during delivery. We were excited when Lisa Piediscalzi connected us with Holly Edson.

Holly is a registered nurse, craniosacral therapist, and lactation educator, with additional training in myofascial release, therapeutic touch, hospice care and Beckman Oral Motor Therapy. She is the visionary for the Bay Area Craniosacral Children's Collective, a team of professionals from various bodywork modalities who gather together once a month to provide free craniosacral therapy sessions for pre-crawling babies, which gives free craniosacral care. She’s been a nurse for 17 years and a body worker for 16 years. She is techniques certified by the Upledger Institute. With over 2000 hours of advanced practice training, she has studied with Alison Hazelbaker, Carol Gray, Deborah Beckman, and Joy Moeller.

Holly works as a nurse at St. Mary's Medical Center in San Francisco part-time while seeing 10-15 clients per week in her private practice. She lives in the Haight Ashbury with her family—Kevin Bayuk, a permaculture teacher and sustainability leader, and Sophia, 9 years old, a singer and artist attending San Francisco Public Montessori. She breastfed her daughter for nearly 3 years.

Our thanks to Lisa Piediscalzi for providing the write-up below of Holly’s presentation.

You can view Holly’s presentation here.

Presentation Summary

Holly explained that craniosacral therapy (CST)is a form of bodywork with origins in Andrew Still’s system of osteopathic medicine. CST is a hands-on method of evaluating and enhancing the function of the craniosacral system (the bones, nerves, fluids and connective tissue of the cranium and spine). Practitioners use an extremely soft touch (the amount of pressure used is about the same pressure exerted by the weight of a nickel) to release restrictions in the craniosacral system to relieve pain, increase mobility and regulate the nervous system. There are currently several different styles of CST taught at various independent schools. Not all CST programs include treatment of infants in their curriculum, so Holly strongly recommends asking a CST practitioner about their training to ensure that they are qualified to treat babies.

CST can be used as a “well-baby tune-up” to facilitate baby’s natural ability to self-heal and self-regulate. CST also addresses a wide variety of infants’ complaints including: breastfeeding difficulties; poor latch; pre/post care for tongue-tie revision; torticollis (favors turning head to one side); plagiocephaly (flattening of the skull); crooked nose or face; plugged tear ducts; colic; spitting up; constipation; high sensitivity; excessive crying; difficulty

relaxing. Holly explained that many of these issues have their origin in the baby’s intrauterine lie position (i.e. breech or transverse position, early engagement in the pelvis, multiples), and/or can result from circumstances occurring during vaginal birth (i.e., posterior presentation, unusually fast or slow birth, vacuum assistance, epidural) or Cesarean birth. During pregnancy, the baby’s body molds to fit within the mother’s uterus, and then molds again during birth to go through the mother’s pelvis. It is normal for the cranial bones to override each other during this period. After birth, these overrides and other accommodations in the baby’s skull and body should not persist. If they do not correct themselves, they can interfere with proper cranial nerve function and create tightness throughout the body, leading to problems with breathing, swallowing, feeding and digestion, as well as sensory-motor impairments. Cesarean birth can be hard on babies even though there may not be any visible cranial molding. The birth process is more abrupt and potentially more frightening for baby and mother than vaginal birth. Babies born by Cesarean miss out on the compressive forces that typically occur during birth, and have more respiratory distress, lower Apgar scores and more abnormal neurological exams than vaginally born babies. CST can effectively address all the above issues, any

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of which could potentially impact a baby’s ability to breastfeed.

CST is a wonderful modality for infants because it is so safe and gentle. Sessions are slow-paced and non-invasive. Babies remain fully clothed, and can be asleep, awake or feeding. Therapeutic touch consists of gentle “nudges” and light massage. Many babies babble, wiggle and stretch during treatment, while others fall quietly asleep. Occasionally a baby will release emotions or cry during a session, but the techniques themselves do not hurt or tickle. If a baby does cry, the practitioner always stops treatment and gets parental approval before proceeding. Some babies experience resolution after just one or two treatments, while others see change after a series of 4-8 sessions. CST complements, and works well in conjunction with, other modalities such as occupational therapy, physical therapy and pediatric chiropractic. Holly reinforced the importance of having realistic expectations of what CST can accomplish, and of maintaining clear communication with the practitioner regarding your questions, concerns and expectations.

For more information regarding craniosacral therapy or the Bay Area CranioSacral Therapy Children’s Collective contact Holly Edson.

NMC Luncheon and Social

with Founder Laurie Vavuris and Early Members Verne Rice and Ruth Rosenbaum on Saturday, August 27, 2016

By Lori McBride, Executive Board Chair

About 17 of us including three new members going through training had the opportunity to hear our founding member, Laurie Vavuris, and early members, Verne Rice and Ruth Rosenbaum, share some of their memories and NMC experiences when we held our luncheon and social on Sat., Aug. 27, 2016.

Laurie graciously offered to host our luncheon in her beautiful courtyard at her home in Palo Alto where she raised her nine children and had many moms come for breastfeeding assistance. Three of her daughters joined us: Katy, Margie, and Ruth.

Nonette Hanko, Founding Member, was out of town. Sadly, Lil Kavanaugh, the third Founding Member, was in hospice care after suffering a severe stroke. She passed away Sept. 9, 2016, at age 86.

This was a once-in-a-lifetime experience for those of us who attended. Laurie is 86 years young and full of stories. She has

a wonderful memory and sense of humor!

Laurie Vavuris’ Home Visit Kit

Verne and Ruth were the key members who put together NMC’s training manual, which was used to train all our members until a few years ago. Verne even brought the draft with her! They remember the endless hours put into creating the manual and the countless revisions made.

Old Manuals

We loved hearing their memories and realized that even though decades have passed, we still are doing the same things they did—providing free classes and supporting moms. Some of us do more home visits than others. Laurie might have been the queen of home visits!

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Lori McBride, Julianna Rees, Nancy Hill, Cassie McGraw, Gretchen Kindberg, Sandi Tordoff

Although we taped this event, it needs some editing and isn’t ready for viewing. I hope to provide details for viewing in the next newsletter.

You can read my interviews with these three women (along with other founders and early members) in NMC’s 50th Anniversary newsletter and also our 60th.

Ruth Rosenbaum

Verne Rice

I think all of us who attended will treasure the memory of this event.

SF Bay Area Chapter Open Positions

By Gretchen Kindberg, SF Bay Area Chapter Coordinator

We have the following opportunities. Contact me for details:

Exhibits: house exhibit materials, register for events, secure volunteers

Instructor materials: maintain inventory of instructor materials, house materials not currently out to instructors, order as needed

Library: house the 2 bins of books and materials that NMC counselors can check out, maintains inventory on google sheet, tracks books/materials checked out

Publicity!!!!!!!

SF Bay Area Chapter Class of 2016

By Audrey Kalman, Executive Board Secretary, Membership Chair

Twenty-two women finished NMC’s 8-week training on Nov. 2, 2016 (14 volunteers from the SF Bay Area Chapter, 3 from Santa Cruz, and 5 professionals). We welcome them and look forward to the volunteers finishing their requirements and beginning to counsel!

v – volunteer p – professional

Nicole Bowers (p)

My name is Nicole Bowers and I am a Birth & Postpartum Doula in the Bay Area. I am passionate about helping families through the journey of birth and parenthood. I look forward to becoming a mom one day and applying all the information I learned from NMC.

Kulia Blick (v-Santa Cruz)

Kulia Blick is the mother of three: a 6-year old boy and twin 2.5-year old girls. She is excited to be joining NMC to spread support and knowledge to new moms, especially mothers of multiples. She lives in the Santa Cruz

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mountains and continues to tandem nurse her daughters.

Nancy Cerri (v)

I am an RN, IBCLC currently working at Sequoia Hospital in Redwood City. I have two sons (40 and 36) and two grandsons.

Robin Comfort (p)

As a birth and postpartum doula, I’m passionate about supporting new and growing families. I love talking, brainstorming, and supporting families—wherever they may be in their family’s journey, and always love supporting breastfeeding relationships and lifestyles!

Emily Gourlie (p)

I am a birth and postpartum

doula as well as an infant and toddler program specialist at Stanford. I love working with new families and babies. Someday, I would like to be an IBCLC!

Amanda Peiffer (v)

Amanda is a mother and volunteer.

Jennifer Fung (v)

I’m mama to three boys and have been breastfeeding for over eight years. I’ve had numerous hurdles over the years and decided to become a counselor to help other moms through their hurdles. I love the outdoors—especially hiking, camping, backpacking, and going to the beach.

Cassandra Gentry (v)

Cassandra lives in South San Jose and has one child, a boy, who is still nursing at 16 months. She had “the usual” challenges in the

beginning, including oversupply and needing to make dietary changes until her son was 7 months old. She works part time as a bartender.

Beth Lilienthal (v, Santa Cruz)

Beth Lilienthal is a postpartum doula, DONA living in the Santa Cruz Mountains. She has been working with families for the last 3 years in Santa Cruz County most days, after she drops off her 11 and 13 year old at school. Beth is also the Volunteer Coordinator of the Siena House Doula Program.

Verity Hermawan (v)

I was born in England and raised in Southern California. I have a 2-year-old son, Andrew. I am currently in nursing school to become an RN.

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Yin Yin Lin (v)

Yin Yin Lin is a new NMC trainee in 2016. She has two girls (one is four and one is coming in January 2017). She has an RN background and is a full-time mom for now. She wants to become an IBCLC and promote breastfeeding to her community because she found out that there is not much in the way of resources and support for her culture/community (Chinese) about breastfeeding.

Jodi Lindenstruth (v)

Joni Lindenstruth is a former marketing professional turned stay-at-home mom, considering a future career path in childbirth

education/lactation counseling. She has two December babies: Miles, born in 2009 at UCSF, and Nora, born at home in 2013. She enjoys cooking, reading, and being crafty in her spare time, which is basically non-existent.

Nicole Reginelli (p)

Nicole is mom to a 6-year old she nursed to 19 months, and an 18-month-old who is still nursing. She works as a birth doula and childbirth educator and describes herself as a “perpetual student.” She does a lot of pro bono work but has decided to take NMC’s training in a professional capacity for now since she is quite busy. Previously, she worked for a presentation company and uses her skills in this area teaching a presentation.

Anya Matkowski (p)

I’ve nursed two children and am still nursing my second who is 3-1/2 and does not want to stop. I’m now a birth doula and find it hard helping clients through breastfeeding challenges, even though I was able to work through mine with relative ease. With the new information I learned in the class I hope to be a better support for my clients.

Talia Perlman (v)

Talia Perlman lives in Redwood City with her husband, Seth, and two young kids, Hannah and Isaac. She has really enjoyed breastfeeding her kids and continued to do so while working full time.

Dusanka Rosenbaum (v)

Dusanka is a mom to three—a college graduate and a college freshman and senior. Now that she has more time, she is inter-ested in helping support moms because she understands how critical it is to have support in the early days. She’s very interested in doing home visits and in possibly working with teens.

Marta Rachetti (v)

Since an early age I have been

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enjoying taking care of both babies and children. My family is relatively big, so I have had the opportunity to care for their babies as well as young children. Later on, having three children of my own, I experienced how help and emotional support from my immediate family made the challenging postpartum experience easier with the arrival of each baby. After being a stay-home-mom and a volunteer at LASD for many years, l decided to become a volunteer at the Nursing Mothers Counsel in order to guide, help and support breastfeeding mothers.

Kathy Townsend (v)

Kathy has two boys who are three and five years old. She breastfed both of them and her youngest is still nursing several times a week. Kathy is an RN and works as a med-surg nurse at Regional Medical Center of San Jose. Kathy hopes to eventually become an IBCLC.

Vanessa Wennstrom (v, Santa Cruz)

Vanessa Wennstrom is a Doula (B & PP), Retailer & Lactation Counselor, CLC, who specializes in fitting moms of elegant, yet practical, nursing bras in the comfort of their homes. She has 3 children and lives in Santa Cruz County. She nursed her first two exclusively for over a year, and after latching issues and graphic injury-type scenario with her third, pumped milk exclusively full time until she turned 1 year old (with a Pump in Style).

Heidi Wiltsee (v)

Heidi Wiltsee is a new NMC trainee, lives by the bay in Marin County and is raising two awesome boys who have helped her to be a semi-expert in the SF Giants, Star Wars, card games, and bad joke-telling. Heidi holds a masters in Social Work with experience in community organizing and is currently doing

administrative support for the wonderfully vibrant local school where her kids attend. She is very curious and excited to explore a new professional chapter in the field of lactation support.

Crystal Young (v)

Crystal Young is a Registered Dietitian Nutritionist living in San Mateo. She greatly benefited from lactation support with her first child and would like to pay it forward as an NMC counselor. Personal interest areas include postpartum depression/anxiety and hyperlactation/overactive letdown.

Shirlin Yiu (v)

Shirlin was born and raised in Hong Kong where breastfeeding is definitely not a norm. Similar to all new mommies, she has faced quite a few challenges during her breastfeeding journey, and she wants to share her experience to help other mommies. Shirlin hopes her multi-language skills can help extend the work of NMC in various cultural communities. Shirlin holds a BA in Psychology from Northwestern University and an MBA from USC Marshall School of Business. She works at a technology start up and currently lives in San Mateo with her husband and her energetic 2 year old boy who is still a big fan of nursing.

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Breastfeeding Resources

Just a reminder that support groups are also listed on the S.M. Co. Breastfeeding Task Force Comprehensive Resource Guide on NMC's website.

For a while NMC maintained this guide, but it was passed on to the Co.Task Force. Ana Klanjac, S.M. Co. Breastfeeding Services Coordinator and Chair of the Task Force, will maintain this document. Information changes frequently, and we need to make some updates. If you have any additions or changes, please let us know.

Articles

Body Work

IBCLCs and Craniosacral Therapists, Strange Bedfellows or a perfect match

New AAP Sleep Recommendations

American Academy of Pediatrics Announces New Safe Sleep Recommendations to Protect Against SIDS, Sleep-Related Infant Deaths

American Academy of Pediatrics Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment

Breastfeeding Report Card

2016 Breastfeeding Report Card

Brain Development

Breast milk for preemies tied to better brain development

Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation

Breastfed babies may have longer telomeres tied to longevity

Miscellaneous

Study says moms should breast-feed their babies longer

My Brother's Pregnancy and the Making of a New American Family:

The First 1,000 Days, Nourishing America's Future

After Losing Son, Mom Makes Historic, Heroic, Breast Milk Donation

When the Captain is Mom, Accommodating New Motherhood at 30,000 feet

In a Facebook post on August 18, 2016, Congresswoman Jackie Speier said, “I applaud the pilots featured in the New York Times for taking a stand on women’s rights in the workplace and I urge their union leaders and the airlines to join the rest of us in the 21st Century and establish what should be relatively simple accommodations for nursing airline pilots. Women have made remarkable strides in the American workplace and society, and yet we still have so far to go. Women still make, on average, 79 cents to every dollar earned by their male counterparts. Those numbers are even worse for African American women and Latinas. And women continue to

have their mental and physical fitness baselessly called into question for a variety of careers and tasks. This is why I am so adamant about ending discriminatory practices, like the gender wage gap and the pink tax, as well as fighting sexual assault and harassment. The treatment of women and many other so-called minority groups in the United States is archaic and offensive. It’s time for everyone to wake up; it’s time for #EqualityForAll.”

Breast Pumps

It Sucks; Startups Look to Redesign the Breast Pump

200 Years of Breast Pumps in 18 Images

BREASTFEEDING AND BODYWORK THREE GOLD CONFERENCE WRITE-UPS

GOLD Conference Write-Up #1

By Gretchen Kindberg, SF Bay Area Chapter Coordinator

The Impact of Bodywork on Infant Breastfeeding Presented by Dr. Alison Hazelbaker, PhD, IBCLC, FILCA, RCST

This presentation was top on my list of must-listen-to videos because I think the relationship between breastfeeding and an infant’s body structure are not taken seriously amongst medical professionals. As you’re about to read, however, you’ll notice that an infant’s body structure can have a severe impact on breastfeeding. For those of you unfamiliar with bodywork,

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bodywork is defined as “any modality of treatment using hands-on techniques that makes changes to structure in order to restore optimal function.” These include, but are not limited to, chiropractic, physical therapy (in some cases), craniosacral therapy, myofacial therapy and osteopathic techniques as practiced outside the U.S.

Dr. Hazelbaker started my education by defining normal suck as a “complex combination and precise synchrony of sensory and motor function with voluntary and reflexive feeding behaviors that coordinate sucking and swallowing with breathing and enable an infant to effectively transfer milk from the breast.” Hopefully, you are already getting a sense of why an infant’s body would be a key component in effective breastfeeding.

The suck, swallow, breathe pattern is a developmental reflex scheme that is complex and vulnerable to insult. The insult, in this case, is an injury or misalignment due to several factors that can occur even before birth, including our modern lifestyle, cultural birth practices, and intrauterine lie during pregnancy. These all add insult to where nerves come through the infant’s skull and can cause cranial misalignment and excessive pressure causing the brain stem to misalign, which can severely affect nerve function.

The complex coordination required for effective suck-swallow-breathe involves many

players. There are layers of connective tissue, 60+ muscles, 22 cranial bones, 34 joints, and multiple physiologic functions involved in and who support the coordination. You may wonder why you need to know the names of the cranial nerves responsible, but they – and their functions – are:

trigeminal – primary sensory for oral function, including chewing

facial nerve – relays taste sensations

vagal nerve – autonomic control over swallowing

glossopharyngeal – mixed nerve that carries sensory and motor information

hypoglossal – motor control of the tongue

accessory nerve – controls the movement of certain neck muscles

The cranial area is supported by 8 cranial nerves, and any of these nerves can become pinched and cause a change in tongue posture! There is another sensory nerve that is responsible for pain, which can cause headaches for babies and in turn cause feeding issues.

On to the bones and cartilage that play a role.

The hyoid bone floats, and if its deviates, it can pull on the tongue, causing feeding issues.

larynx and epiglottis

Fascia – tells muscles what to do

Tip of the tongue, which is the tip of the postural line

Deviations in the bones and cartilage can cause hip problems, a knot in the cord, compression from the cord wrapping around the infant’s body, breathing and respiratory diaphragm, postural problems, and jaw issues.

Tongue posture changes affect the coordination of the suck-swallow-breathe reflex. Tilt your head back, and you can feel how your fascia retracts your tongue! Further, the tongue and lips are united, so wherever the tongue goes, the lips will follow. Issues with any piece needed for perfect harmony puts tension on the mouth floor and the lingual frenum (the band that hold the tongue to the floor of the mouth) and can actually create an appearance of tongue tie even if no tongue tie is there. While tongue tie can definitely create issues with breastfeeding, sometimes bodywork can release the tension in the fascia, showing there is no tongue tie.

So, I defined bodywork as a whole for you above, but I’d like to share more about the specific modality of craniosacral therapy. It’s defined as a “light touch form of bodywork that makes changes to structure in order to restore optimal function by working via the fascial network.” Essentially, the therapist works with your fascia to make a structural change, thereby releasing tensions and allowing muscles, bones, cartilage, and nerves to work together as they should. Facsia is an organ and makes movements happen by telling the muscles what to do. Without optimal movement, the fascia is

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unable to send accurate messages to our bodies.

Optimal movement requires:

motility – inherent movement of a tissue and organ movement

mobility – ability to achieve optimal range of motion, ease in overcoming inertia, and responsiveness

stability – strength, organization, and the ability to stay and hold

flexibility – ease, elasticity, and degree of range of motion

Fascia has special properties and is composed of irregular, interwoven, collaginous fiber bundles varying in density that are semiconducting, faster than the nervous system, move nutrients, help with immune function, provide protection through lubrication, and are highly neurosensory. In short, fascia is fascinating! (no pun intended) An energy cyst occurs when the fascia stops a force before it reaches a joint and surrounds it like an abscess, like a corral. Bodywork releases these cysts.

Dr. Hazelbaker also talked about mechanoreceptors, which you can see more about on the slide “Mechanoreceptors.”

The craniosacral concept is to restore optimal function as communicated by the fascial tissues. It restores:

optimal flow of cerebrospinal fluid

inherent motility of the brain and spinal cord because yes! they DO move!

mobility of reciprocal tension membranes, like the soft tissue connections between the cranium and sacrum

articular mobility of the cranial bones and other joints in the body

involuntary mobility of the sacrum between the iliac bones of the pelvis because if you’re stuck down there, you’re stuck above, too.

So, what affects fascial integrity?

intrauterine lie during pregnancy

intrauterine stressors, both physical and psychosocial

labor and delivery interventions, especially vacuum and forceps

operative delivery

trauma

torticollis – head turned to one side

plagiocephaly – asymmetrical distortion of one side of the skull or flat head

brachycephaly – disproportionate shortness of the skull giving it a short, broad appearance

When considering contributing factors that occur during pregnancy, we must look at the mother as a container. The baby will either grow or protect itself; it cannot do both. If mother is an optimal container, baby will have plenty of room to grow. If mother is less than optimal, then baby will have to compromise his/her own alignment and structure to compensate. For

example, twins fit the available space, mom may have an abnormally shaped uterus (bifurcated, heart-shaped, tilted, or soft tissue compromise), or there may be a transverse presentation resulting in cranial molding.

The mother’s soft tissues are a boundary against which baby practices his/her cardinal movements. If her soft tissues are compromised, baby will need to compromise as well. For example, an epidural compromises mom’s soft tissues and reduces the baby’s ability to move, which means s/he can’t do his/her cardinal movements or activate primal reflexes. An epidural also slows labor, which can introduce aggressive Pitocin-induced contractions, and artificial rupture of the membranes takes away the major protective aspect of the bag of waters.

Research shows that each uterine contraction produces roughly 87 pounds of pressure, and the intact amniotic sac provides important protection by equalizing the pressure over a larger surface area. It prevents the battering ram phenomenon and ensures proper bioflavinoids during pregnancy. In short, intact membranes equalize contraction pressures. When left alone, mom and baby work together, allowing for a slow descent and a gradual adjustment for baby. 80%+ of mom/baby pairs will have intact membranes until mom is ready to push, and cultural birth practices interfere on all levels.

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Navigating mom’s pelvis requires head flexion, head molding, body rotation through cardinal movements, and primitive reflexes. Normal molding occurs when the frontal remains aligned, the right parietal shifts over the left, and the parietals shift over the occipital. The occipital condyles move forward while the atlas, which is in three parts to accommodate normal labor pressure, compresses onto its axis. The right fit gives baby a massage.

There are several primitive reflexes activated during birth, and they all come together to get baby do the all-important breast crawl.

When the skin along the side of an infant’s back is stroked, the spinal gallant reflex swings the infant’s body towards the side of the body that is stroked. This reflex helps in the birthing process and usually disappears between 3 and 9 months. If it persists, it may affect a child’s posture, coordination attention, and ability to sit still and is associated with bedwetting.

Asymmetrical tonic neck reflex (ATNR) is initiated when you lay a baby on their back and turn their head to one side. The arm and leg of the side they’re looking to should extend while the opposite side bends. This reflex contributes to hand-eye coordination and usually stops by six months.

The spinal Perez reflex occurs when you hold baby in a prone position and run your finger down his/her spine, causing the

whole body to become extended.

The amphibian reflex is activated during birth, but doesn’t show up until four to six months old. It allows the baby to have more automatic flexion of the arm, hip, and knee and helps the infant be ready to roll over, crawl, and eventually walk.

The Bauer crawling reflex leads to balance between the right and left hemispheres of the brain and activates the neural network in the brain and affects development of the whole body movement coordination, including creative thinking.

The final reflex involved in the breast crawl is the Babinski reflex, which is the reflex action that causes the big toe to remain extended or extends itself when the sole of the foot is stimulated.

Based on our current cultural birth practices, how many babies get to complete their cardinal movements? Unfortunately, not many. Even in vaginal birth, the temptation to pull on baby between contractions to avoid shoulder dystocia is very hard to resist. Pulling and tugging on joints that aren’t designed to withstand that type of pressure heavily contributes to post birth structural insults. VBAC rates are appalling, and C-section rates are climbing because of the unwillingness and lack of information that physicians have to support VBAC mothers. Nearly half of all babies being operatively delivered develop an insult post birth.

On the rise is torticollis, which literally translated is twisted neck (tortus + collus). It presents as a lateral head tilt, head rotation, and asymmetric posture of the head and neck.

Plagiocephaly affects around 45% of infants and is also climbing. Plagios, meaning slanting, and kephale, meaning head, also shows as a lateral head tilt and head rotation, but instead of asymmetrical posture, involves asymmetrical head shape.

Aside from physical symptoms, baby can exhibit more chomping, popping on and off, and not being able to maintain latch, all leading to low milk transfer. Increasing the flow may not be a good strategy because it could compromise the baby’s airway. Baby’s visual field is confined, so vision can’t form properly. The hyoid is out of alignment, which causes the tongue to be out of line, leading to problems protecting the airway.

If left untreated, baby could develop infantile scoliosis. Bodywork therapy is needed for any improvement, and with science behind the different bodywork modalities, it should be an option for all families.

A baby’s suck is negatively impacted by infant trauma, which is defined as CNS overwhelm plus powerlessness. Stress is bad both in utero and after birth. A regulated baby is a good feeder, while a stressed baby is not. When a baby is stressed, we all know that cortisol is released, but it’s not

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just infant cortisol that affects the baby. Mother cortisol levels during pregnancy can also have a severe impact on infant health.

Cortisol increases the risk of miscarriage, retards fetal growth, damages brain cells, can lead to premature birth, contributes to postnatal developmental delays, causes increased release when stressed after birth, causes disconnection, dissociation, and anxiety, and decreases maternal-infant bonding. Instead of increased cortisol levels, we want high oxytocin levels, which prepares the brain for love, altruism, and empathy. “Tend and befriend.”

According to Wikipedia, the hypothalamic-pituitary-adrenal axis – or HPA axis – is “a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland, and the adrenal gland.” The HPA axis controls our reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure.

Stress on the HPA axis up regulates, or increases, anxiety, sensitivity to stress, perception of the world as threatening, and disconnection and dissociation. On the other hand, it down regulates, or decreases, coping ease, serotonin and dopamine release, and the ability to learn, attach, and be present.

In summary:

What? Restoring optimal function via structural change.

Why? Because babies with sucking problems need to have function restored.

When? As soon as the sucking problem is diagnosed.

How much? As much as it takes to restore function.

Who? All babies with sucking problems, structural compromise, birth interventions, and trauma.

Please check out the slides for some helpful visuals to reinforce this written summary of the presentation.

GOLD Conference Write-Up #2 By Gretchen Kindberg, SF Bay Area Chapter Coordinator

WHERE SHOULD WE DIG? Not All Gold is Buried Under the Tongue, Presented by Carol Gray, CST, LMT, RYT200

Carol Gray is a retired homebirth midwife who has been a bodyworker for 26 years. Her specialty is craniosacral therapy, and she has been teaching for the past 9 years. She has seen an increase in the number of infants

with feeding issues, including an increase in the infants who attend her free clinics.

Why are bodyworkers seeing an increase in infants with feeding issues? There is a growing public and professional awareness that bodywork helps breastfeeding, and many free bodywork clinics have open their doors to families in need of assistance. The gentle effectiveness of infant CST (craniosacral therapy) makes it especially appealing to new families. Most of the “research” is anecdotal, not scientific, and it’s difficult to do randomized studies on CST due to varied treatments.

Mothers expect breastfeeding to work, and when it isn’t going well, mothers seek help (hopefully). One person mothers might turn to for help is an IBCLC (International Board Certified Lactation Consultant), and often, lactation consultants are the first to notice when a baby has a feeding issues that may relate to tongue tie. More LCs are providing more and much better support in this area.

So, what is tongue tie? The scientific definition is a failure of apoptosis (programmed cell death). When baby is in utero, apoptosis turns paddles into digits, and it’s what separates the tongue from the mandible and the floor of the mouth. There are two main causes that are being recognized as possible causes of apoptosis failure: genetics or epigenetic changes and synthetic folic acid in the food supply. Synthetic folic acid

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causes absorption issues, leading to midline defects, like tongue tie, lip tie, and cleft palate.

When tongue tie is diagnosed, some babies get a frenectomy done. This procedure separates a portion of the frenulum under the tongue to give the tongue optimal range of motion. Some babies immediately and drastically improve post frenectomy, and it’s all rainbows and angels. Some babies improve a little; there’s no blanching, but breastfeeding is still painful and/or uncomfortable. Some babies gradually improve over weeks and months. Some babies improve then regress, and mothers get discouraged. They know they need to do another release, but are questioning whether they should. The last group of babies see no improvement at all.

There are very mixed results with after care instructions, especially because parental after care varies so widely. Some parents don’t do the after care, and feeding issues completely resolve. Some parents follow the instructions exactly, and feeding doesn’t improve. Some parents do the post-op stretches fast and hard because they’re unpleasant, so they want to get them over with. Others are more tentative or gentler than they were taught. Some do them less frequently than were advised, prematurely stop, wait until the other parent gets home, do it a little bit just to say they’ve done it, or just plain don’t do it at all. All with varied success!

Despite variations in post-op care, some babies still have a restricted frenulum after healing, and some babies don’t have any restriction after healing, but still can’t breastfeed. However, one fact is that ALL babies will benefit from skilled bodywork as part of their post care!

Unfortunately, mother-blame happens when breastfeeding fails after a frenectomy and healing. The good news is that not every feeding issue is a tongue tie issue. Some tongue tied babies have other issues, and mothers should never resign themselves to painful breastfeeding or feel like they have to give up.

What could be causing the feeding issues? Cranial nerve dysfunction (CND) and body torsions are interrelated causes of breastfeeding problems.

CND is a disruption in function of one or more cranial nerves and causes:

asymmetries, especially in the shoulders and neck. “No neck” is a clear indication of nerve compression.

posture and movement problems

decreased oral function through low tone, lack of social engagement, and/or weak sucking efforts

autonomic nervous system disregulation and sensory issues

Some question if stress during pregnancy affects infant cranial nerve development. Stress changes brain structure and function, and we should take better care of moms while they’re pregnant and during postpartum healing.

Body torsion is a rotation or lateral flexion present at birth, caused by a lack of mobility in utero, and some babies may be born with both. Some of the effects of a lack of mobility in utero are breech positioning, club foot, torticollis and other body torsions, hip dysplasia, and scoliosis. These twisted babies may also have a difficult time breastfeeding on one side or in one position.

What are some causes of mobility restriction?

Our sedentary lifestyles. Mothers need to move in order for their babies to move normally, and they need to watch how they sit. If their pelvis is tilted the wrong way, babies can get stuck as they grow, which can decrease the mother’s chances of a vaginal birth.

Caregivers who rely solely on ultrasound and only assess for vertex. They use these late third trimester ultrasounds instead of palpating the mother’s uterus for baby positioning, and many moms see a bodyworker for the first time at 37 weeks when their 36-week ultrasound shows their baby to be breech. If the baby is breech, and EV isn’t successful, they automatically say a C-section is necessary. Ultrasounds also don’t show if baby is

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assynclitic, meaning their head isn’t centered.

Persistent erroneous beliefs about engagement. There’s a myth that first babies need to be engaged in mom’s pelvis by a certain week. However, baby should be able to bob in and out of the pelvis until right before the onset of labor. If the baby has dropped, the baby is stuck.

Engagement is the fixation of the presenting party of the fetus into the maternal pelvis. Most people think it’s normal between 36 and 38 weeks with primips (first babies). Multips are less likely to have engagement due to mom’s activity, i.e. up and down playing on the floor with a toddler. The reality, according to a 1975 article in the BJ of OB Gyn, is that 80% of first babies engage more than 14 d Some women have less than ideal pelvic floor mobility.

Most moms don’t get bodywork that focuses on maximizing fetal mobility.

Some women have less than ideal bony pelvis mobility.

Some women have less than ideal uterine support ligament mobility.

Some women have less than ideal lower uterine segment mobility, which may lead to difficulties delivering.

Some women have less than ideal abdominal organ mobility.

There are uterine abnormalities, such as a heart-shaped or bifurcated uterus.

Low amniotic fluid.

Uterine fibroids. They take up space.

Uterine scars, such as C-section scars. Scar tissue is less mobile, and CST can help mobilize tissues.

Twins and higher order multiples.

Short umbilical cords. Unfortunately, CST can’t do much if baby isn’t already in an ideal position.

Not using pregnancy belly-lifting garments. These garments help support the uterus during pregnancy and discourage engagement while encouraging better posture.

Is CND or body torsion the result of birth trauma? The short answer is maybe.

What is the relationship between CND and the birth process? It may have been a rough ride out due to longstanding malposition. There are babies who are so stuck, they need to be shoved out of the pelvis to be delivered by C-section. We also can’t forget that C-section is harder on babies than we imagine. In these cases, it’s NEVER too early for CST.

What worsens the effects of body torsion and CND after birth?

Swaddling, especially for sleep. Swaddling, in reality, should only be used in the first two weeks to help baby regain their state.

Car seats. Babies should never be left to sleep in their car seats.

Supine sleeping. When babies sleep on their backs, they can

develop a flat spot (plagiocephaly) or torticollis, and it interferes with normal cervical curve development.

Supine play. Tummy time engages the core muscles and strengthens the neck.

Infant furniture, like the Bumbo.

Babies don’t sleep well on their backs unless swaddled, but this leaves them no ability to move their shoulders. This could lead to not being able to place his/her forearms in front of him/her for tummy time because of lack of shoulder mobility. This, in turn, could delay crawling.

What can bodyworks do? The #1 things that most bodyworkers can recommend is safe, effective tummy time.

What are the underlying principles of CST? With roots in osteopathy, CST uses less than 5 grams of pressure on babies.

The body seeks balance. You gain maximum mobility through balance.

Structure and function are related. If baby can’t elevate his/her tongue to rest it against the hard palate, the result will be a high palate.

All body parts should move independently of their neighbors.

All healing is self-healing.

The source of pain or loss of function is not always obvious. Feeding issues can stem from many sources.

Bodyworkers offer the smallest intervention necessary to effect

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change. It truly is the homeopathy of bodywork.

Bodyworks trust babies to have great wisdom, that they know what needs to happen and in what position.

The best approach is to assume nothing. Take a history and ignore it during treatment, and don’t follow a recipe. The history is really only used to track progress and treatment goals, and you don’t necessarily want a preconceived treatment plan based only on your history.

When looking for clues, intellect can only find what it expects to find. The anatomic locations of symptoms are great, but the actual sources may not be obvious. When bodyworks use their hands, they can find the unexpected. Restricted movement can create nerve compression, even when they don’t make sense intellectually. Use your hands, including the floor of the mouth. Palpation is everything.

Don’t forget to LOOK at the baby, as they can give clues and guide treatment.

How does the baby’s overall tone FEEL? Normal? Rigid vs floppy? Asymmetrical?

How does the baby’s whole body feel? Twists? Curves?

How does the territory under the tongue feel – on both sides? Put your finger in there and feel on both sides. How do the sides compare? The area under the tongue should be yielding and symmetrical.

How is the baby’s tongue mobility? It’s not all about being able to stick the tongue out. What about elevation?

How is the baby’s suck?

How does the baby do on BOTH breasts?

Are nipple injuries present? One or both sides?

Does the mother use different holds for each breast?

Gentle CST can relieve fascial restrictions and related body torsion that can interfere with normal mobility in a baby’s body. Lack of mobility can cause or contribute to feeding problems. Gentle CST can also relieve cranial nerve compression than can interfere with normal mobility in a baby’s body. Finally, gentle CST and structured movement for mamas before and during pregnancy can help babies assume more ideal positions for both gestation and birthing. This can prevent some infant feeding problems.

GOLD Conference Write-Up #3 By Gretchen Kindberg, SF Bay Area Chapter Coordinator

Breast Milk and Sleep: Circadian Rhythms in Human Milk, Briana Tillman, LLL Leader, IBCLC, Osteopathic Medical Student (year 1), and mom

There are many biological rhythms in the world around us. Nature (plants and animals), sleep-wake cycles, hibernation, photosynthesis, leaf positioning, migration patterns, even cyanobacteria. The cycles of plants and animals around them

were noticed by the ancient Greeks, and even now, we could test the important of sunlight on plant rhythms. Does the sun going down cause plants to droop? Let’s put a plant in a cupboard with no access to light and peek in on it during the night. Surprise! The plant still drooped during the night, showing that it’s not just the sun that’s telling the plant that it’s time to droop.

There are other rhythms in life, as well, such as ultradian rhythms. These are shorter than a day and include heart rate and appetite. Another is circadian cycles, which equate to a 24-hour period, including sleep-wake cycles and basal body temperature. Other cycles last longer than 24 hours, like the infrandian cycles like menstrual cycles, tides, and seasons.

All rhythms and cycles happen even in the absence of other stimuli, but the circadian rhythm isn’t always accurate, so we depend on the sun to help us reset each day.

Human circadian rhythms involving sleep and the brain are well documented. Melatonin levels, which are affected by jet lag and cue sleep, go everywhere in the body and are our time messengers. Our sleep-wake cycles, cognitive performance, and even our basal body temperature. Your brain take a break at night and focuses on restorative services, so we experience a rapid decline in body temperature as we fall

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asleep and again as we enter REM.

But our metabolism is also a circadian rhythm and is dependent on our hormone levels, including cortisol, epinephrine, thyroid, and insulin. These hormones determine how active our metabolism is, so our bodies won’t be surprised by a sudden need for energy during the day. Other factors affecting our metabolism are our red blood cells, glucose metabolism in the liver (we produce less glucose at night), bone resorption (important for bone growth), and lymphocyte subpopulations (key players in immunity, and there are many more present at night). Interesting for researchers is that there may be a physiological link between breastfeeding and a decreased instance of diabetes!

So, where do our rhythms come from? Some of our rhythms come from clock genes, while others come from our biological processes through the creation and degradation of proteins and enzymes. There is also the suprachiasmatic nucleus and the pineal gland. Sunlight activates the nucleus and tells the pineal gland to stop making melatonin, and the lack of sunlight tells the pineal to make melatonin. An interesting fact about the suprachiasmatic nucleus is that it isn’t impacted by red light, so there’s no disruption of circadian rhythms.

Exercise seems to have an impact, but no one is quite sure how. Maybe because it raises

our core body temperature? Longer periods of exercise seem to have different impacts, such as endurance vs weight lifting. Noise, social interaction, and pheromones all impact rhythms, as does breast milk. Pheromone info is passed by smell, which could explain why women living in close proximity will have similar cycles.

What actually interferes with our rhythms?

Shift work! Mothering a newborn, anyone? This is the most interrupted sleep.

Jet lag occurs when our melatonin dependent processes are confused by the clock vs sunlight.

Lithium

Alcohol. Affects largely depend on the time of day.

Anti-depressant drugs. A disruption of circadian rhythms is associated with mental illness.

Age. As soon as we hit puberty, our pineal gland starts to shrink and produce less melatonin.

Depression and other mental illnesses, even ADHD, cause serious disruptions to our circadian rhythms, and prolonged disruption can lead to long-term health issues with shift workers, cancer, hypertension, cardiovascular disease, rheumatoid arthritis, diabetes, and other metabolic syndromes. Using red light can positively affect rhythms and sleep for people suffering these conditions.

Infant circadian rhythms differ greatly from those of adults. In utero, they experience day-night periods as dictated by mom’s cortisol and melatonin levels and activity cycles. However, infants lack endogenous cycles and don’t start producing their own melatonin until around three months old. Temperature rhythms develop around 10 weeks old, circadian gene expressions around 11 weeks old, melatonin rhythms around 12 weeks old, and cortisol rhythms around 3-6 months. Melatonin and cortisol could actually impact one another.

Infant circadian rhythms may relate to infant morbidity and mortality, and cycled lighting impacts activity patterns, as well as impacting growth rates and immune function. Premature infants show ultradian rhythms in temperature, heart rate, activity patterns, and with a never changing environment of white light, their care schedule definitely has an influence.

When considering neurological development, it’s important to know that sleep cycles are vital for brain development. There are neuronal connections made during REM sleep, and myelination of the nerves occurs during sleep. After birth, ultradian rhythms need to evolve into circadian rhythms to ensure proper neuronal development.

Chronobiology is a field of biology that studies cycles in living organisms and their adaptation to solar- and lunar-related rhythms. A chronobiotic

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is a substance that adjusts the timing of internal rhythms, for example melatonin taken for jet lag. There are other substances called hypnotic substances that just induce sleep vs adjusts internal rhythms.

Chrononutrition involves eating foods at certain times to promote health, and one aspect is feeding pumping milk based on the time of day it was expressed. They’re even trying to enhance formulas to have chronobiotic properties, and there’s a new idea to give toddler and the elderly tryptophan-enhanced cereal to improve sleep. For more information, you can google “The Chrono-Nutrition diet by French Dr. Delabos.”

So, as you may have guessed, human milk has chronobiotic properties and has circadian rhythms in its biochemistry. Milk is produced from substances in the mother’s blood streams, and babies are metabolizing these substances, whose responses vary. There area also many variations affected by amino acids, melatonin, some nucleotides, magnesium, zinc, copper, fat content (which could be related to feeding frequency), sodium and potassium (which are inversely related, and sodium is not affected by mom’s diet), iron, folic acid, vitamin E, and malonic dialdehyde (MDA). Unfortunately, fat content variables can’t really be researched because you’d have to have mom breastfeed at specific intervals, which is counter to what really needs to happen during breastfeeding.

Amino acids are the building blocks of proteins, and some proteins, like acetylcholine, epinephrine, norepinephrine, and phenyalanine, are used during active times. There are other proteins used during quiet times, including serotonin and melatonin. The “wakeful” amino acids peak during the day right around noon, but the “sleepiness” amino acids peak at different times in different places. These levels lead to longer nighttime sleep periods in infants. Tryptophan (a precursor to serotonin and melatonin) is present in breast milk and peaks around 3am, while it peaks in the infant’s urine around 6am. Further, 3 hours after ingesting breast milk, amino acids show up in baby’s urine to show that babies are using melatonin. Fluctuation of amino acids in breast milk seems to be consistent with the neural demands of the newborn.

Melatonin is very important. It promotes myelination of the brain, protects against brain injury, mediates inflammation in the brain, communicates circadian rhythms, relaxes the GI tract, and generally leads to less colic and improved sleep in breastfed babies.

Babies are born with no circadian rhythms, and produce very little melatonin on their own and with no rhythm. Formulas contain no melatonin, but infant massage can increase melatonin levels after the infant begins producing it on his/her own around 12 weeks. It’s also important to note that white light equals the

premature cessation of melatonin production.

Nucleotides are also important builders, as they are the building blocks for DNA and RNA, and they cycle in breast milk, as well. There is one that has a hypnotic effect, another that helps relax blood vessel, and another that depresses the central nervous system (CNS). A couple nucleotides have shown distinct circadian rhythms, but research is ongoing as to why and what this means.

So much is still unknown, but here are some interesting things about minerals and trace elements:

Magnesium is high in the morning and plays an important role in sleep.

Unsupplemented zinc is high in the morning, drops dramatically as the baby gets older, and seems related to melatonin and longer sleep.

The copper transporter in the pineal gland is only active at night.

Iron peaks at noon, impacts liver activity, and its circadian rhythm is absent in milk of women with anemia.

Other factors involved in infant sleep include:

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infant massage, which impacts electrical activity in the brain

room sharing, which shows a strong physiological effect on the brain

SIDS shows decreased melatonin in body fluids. Could melatonin levels in breast milk help explain the decreased instance of SIDS in breastfed babies?

skin-to-skin contact

Skin to skin contact has strong physiological benefits for babies. Just resting on mother’s torso, baby will have more regular breathing, more efficient use of energy, lower blood pressure, faster growth rate, less stress, and improved sleep-wake cycles. Sensory exchanges with mom will alter and/or regulate the baby’s physiology. “Nonetheless, our newborns will still spend most of their early hours in a small box, alone.” (Tilman)

By now, we’ve all heard some of the theories surrounding the relationship between breastfeeding and SIDS. Here are some of the reasons SIDS is lower amongst breastfed babies:

Breastfed babies are more easily aroused from sleep.

Quicker digestion

Reduced reflux

Immune properties are present in breast milk.

Improved airways

Increased bed-sharing impacts physiology

Optimal CNS development and myelination of the brain, partly because of the circadian rhythms of melatonin in breast milk

Mother’s awareness is increased.

Improved breathing-swallowing coordination

There are many implications of these theories. For parents, skin-to-skin contact can improve sleep-wake cycles. For pumping moms, label your pumped milk with the time of day. For supplementing moms, talk with your pediatrician about melatonin supplements, although there isn’t enough research to definitely say yes. For traveling families, breastfeeding can help lessen jet lag. For researchers, biological rhythms in breast milk should continue to be studied. For hospitals, light

cycling may improve infant outcomes, especially premature infants. Formula companies should consider researching how melatonin and other elements closely mirror natural rhythms, and develop day/night formulas. Clinicians, IBCLCs, peer counselors should consider client education and share information about chrononutrition, infant massage, skin to skin, and the effects of ambient light on circadian rhythms. Healthy sleep-wake cycles are so important to the entire family!

In conclusion, breast milk is still the superior food for infants, and more research into circadian rhythms is necessary, as is the knowledge of chrononutrition. We need to emphasize white light at night and bright sunlight during the day to improve optimal function.