Excess Lipase in Breastmilk

Every breastfeeding mom's nightmare is throwing out her breastmilk.  These past few months I've received several emails and texts from moms complaining about how their babies don't like to drink their expressed milk.  The culprit? Excess Lipase.

What is lipase?  Kellymom has a comprehensive explanation on what it is:

A few mothers find that their refrigerated or frozen milk begins to smell or taste soapy, sour, or even rancid soon after it's stored, even though all storage guidelines have been followed closely. Per Lawrence & Lawrence (p. 781), the speculation is that these mothers have an excess of the enzyme lipase in their milk, which begins to break down the milk fat soon after the milk is expressed. Most babies do not mind a mild change in taste, and the milk is not harmful, but the stronger the taste the more likely that baby will reject it.

Lipase is an enzyme that is normally present in human milk and has several known beneficial functions:

• Lipases help keep milk fat well-mixed (emulsified) with the "whey" portion of the milk, and also keep the fat globules small so that they are easily digestible (Lawrence & Lawrence, p. 156).

• Lipases also help to break down fats in the milk, so that fat soluble nutrients (vitamins A & D, for example) and free fatty acids (which help to protect baby from illness) are easily available to baby (Lawrence & Lawrence, p. 156).

• The primary lipase in human milk, bile salt-stimulated lipase (BSSL), "has been found to be the major factor inactivating protozoans" (Lawrence & Lawrence, p. 203).

Per Lawrence & Lawrence (p. 158), the amount of BSSL in a particular mother's milk does not vary during a feed, and is not different at different times of day or different stages of lactation. There is evidence that there may be a decrease in lipase activity over time in mothers who are malnourished.

My own breastmilk was also high in the lipase enzyme.  We noticed that when stored in the refrigerator, N didn't have any problems taking it.  But when the milk was frozen then thawed, the milk smelled soapy.  Luckily, I had enough refrigerated milk to last N the week and all of my frozen milk got donated and pasteurized.

Ideal Workplace Lactation Room

My office already has 2 lactation rooms. Although they are not our ideal rooms, we're happy that management took time and resources to outfit our office with 2 rooms. We are working towards the

establishment of a third room in another building. Sometime in June, a reader, Bing emailed me and shared that her office will be moving to a new location with a lactation room and she was being given to opportunity to "outfit" the room on behalf of nursing moms! Lucky her!

In one of my email groups, the moms came up with a wish list of items they want in their lactation rooms. I chose my own wish list and split it into needs and wants

Thawing Tips from a Pumping Mama

This is Part II of Benz Rana's tips. Read Part I - Freezing Milk HERE.

Run a frozen pack over tap water. Notice milk goes down in seconds.

Place pack in hot cup of water

Pull out pack once desired milk temperature is reached. Others want it warm, some just wants it thawed and a bit cold. (what do you prefer?)

Cut pack using scissors. During the early days we just make a small cut to avoid spillage.

Pour and serve. Bon Apetit, baby!

Part I - Freezing Tips

Freezing Tips from a Pumping Mama

For August, our guest post was written by Benz Rana, owner of Weddings@Work. Early in her nursing career, Benz had doubts about being able to provide enough milk for her newborn Laya. But with perseverance and determination, she consistently nursed and expressed milk, allowing her to store more than 300oz. of milk in her freezer. Due to the numerous emails she received asking her how she organizes her frozen milk, she came up with a step-by-step guide on freezing and thawing milk.

August Guest Post by Benz Rana - Part I covers Freezing Tips. Part II covers Thawing Tips

What you need:

Sealer – P690 (I got mine from Office Warehouse, saw the same model at National Bookstore for P1190)

Playtex Pre Sterilized Disposable Liners – P449/box of 125 pcs (available at all leading department stores)

Glad Freezer Ziplock Bags – 26.8cm x 27.3 cm 15pcs per box (I assume they are

available at all leading supermarket I got mine at SM Hypermart)

Expressed Milk

When using the sealer there are heat settings ranging from1to 8, 1 being the least hot to 8 being the hottest. I tinkered with it and found my setting to be 2.5 where I press it at roughly 2 seconds, with my daughter (Benz has an 11 year-old daughter, Kite) she presses longer so I put the setting at 1.

Do play with it before you actually use it for your milk. I suggest putting water in the disposable liner so you get an actual feel of sealing it. I tried filling the liner up till 7 oz and I cant do it, it fills since it seals horizontal.

I prefer Playtex Liner over the sealable bags as this is way cheaper also trying to achive a flat frozen bag is not possible with the sealable bags.

To start storing I pull the number of bags I need depending on how many oz. of milk I am going to pack and seal for that batch.I also tried the 4oz bag but they come out bulky thus it wastes freezer space so I use the 8oz bag even when I just fill it up to 2 oz. I know I am wasting the bags by not filling it to the maximum and thus leaving more carbon footprint but I figured my milk is more precious.

I usually store freshly expressed milk in feeding bottles and let them stay in the ref until I have time to pack and freeze or until I gather enough for a batch. A batch for me is between 6-14 oz. or 3 to 7bags.

The reason I do not pack and seal them immediately is because I want expressed milk to be available in our ref for darling daughter anytime. (I read that milk hierarchy is breast, room temperature, ref milk then last is frozen milk – meaning breastmilk has most nutrients and antibodies and it depletes as you go next level, but frozen milk is still better than any other formula milk)

Tip: do not allow having too much milk in a batch as it is quite difficult to freeze several bags at the same time unless you have spacious/strong freezer.

I write down the date on the bag before pouring the milk. It is very hard to write on it once the milk is in. If a batch were expressed on different days (say, 4 oz was expressed today and the other 4 oz were expressed yesterday), I indicate the date yesterday.

I decided on a 2oz milk partition as 2oz thaws faster, besides I am usually out for a short period of time only. Although packing them in 4-6oz may be wiser for a mom who’s regularly out a long period of time. Adjust milk partition to suit your lifestyle and/or your baby’s drinking pattern.

Then I seal it.

I let it rest on something after sealing as the top part is quite hot, though it cools very quickly.

This is the sealed pack.

If I wasn’t able to take of all the air then there will be bubbles in the pack. Those bubbles are not harming they just eats space so no problem about that.

After sealing, I place the new batch in the freezer. I just place them on top of our ice trays.

There’s also another tray that I use, if I have several packs to freeze.

Once frozen,

I place the batch in a small plastic bags first, then move them in 1 Ziplock bag when I reach 25 packs, for easier

inventory.

25 packs of 2oz milk bags fits perfectly in this Ziplock bags if flat. Do not forget to mark and date the

Ziplock bags so you know which

pack to use first. FIFO (first in/first out) rules apply.

Part II - Thawing Tips

Tips on Expressing Milk While Traveling Without Baby

One of the challenges that breastfeeding moms worry about is traveling. I've gotten inquiries about how to travel without baby and still maintain supply. I can't really answer that question since I've been lucky enough to always travel with Naima. However, I usually refer people to the site of Stephanie, who sells Fridge to Go. She has this wonderful comprehensive post about expressing breastmilk while traveling. This post was written in 2009 but I find that the tips she shared are still quite relevant.
She has agreed to be a guest poster and I am sharing her post with photos below. Do visit her site too. I have her Mini Fridge Sling which I used to transport Naima's milk from my office. I used it for more than 2 years and now it has a new home with my sister.

Guest Post by Stephanie Co:
Expressing breastmilk while traveling is not easy; but neither is it impossible! With a little chutzpah and a whole lot of planning and logistics, you can keep pumping even while you travel!

During my baby's first year, I had to travel thrice without my baby. By coming up with a game plan and a system, I was able to bring home all of my pumped milk each time I traveled.

Here are some tips that worked for me:

A. Things to bring:

1. Your pump
a. Electric Pump
Electric pumps that enable you to pump both breasts at the same time are time-saving. When you are in a hurry during travel, the 15 minutes you save by pumping both breasts at the same time as opposed to taking 30 minutes to pump both breasts one after the other is precious! Added up, it could mean 2 hours more for sightseeing, shopping, working, or sleeping each day!
b. Manual Pump
A manual pump is very handy during travel because it is so much lighter and portable than an electric pump. It is very useful during transit -- in the plane, a train, a bus, a car, etc -- any mode of transport wherein you will have at least 35 minutes to pump. Bring your manual pump along will enable you to make better use of travel time. Instead of still having to pump once you get to your destination, you've already gotten one pumping session down and it will be in another 4 hours or so before you'll need to pump again. It's also much easier to use when there is limited space, which is the case when you are on board a plane, in a bus, etc.

2. Storage Bottle/s or Storage Bags
I bring only 1 or two storage bottles. After pumping or when I get back to the hotel, I transfer the milk into the Storage Bags. Sometimes, I also pump directly into the Storage Bags. This way, I keep the Storage Bottles clean longer and hence, will not have to wash it right away.

3. Nursing Cover
A MUST for pumping in public. If you want to continue pumping even while traveling, you must forget about being shy. It's the only way you will be able to maximize your time. Take comfort in the fact that traveling gives you a certain level of anonymity and you can get away with more things when you are abroad than if you were back home. (Then again, being in Manila never stopped me from pumping in public -- it's really a matter of finding discreet spots.)

4. Detergent
-- I normally use a dish detergent for babies when at home. However, the first time I used it abroad, I was not able to find a very secure container so it spilled. Thank goodness I kept it in a separate ziplock bag. The next time I traveled, I used those paste detergents. I chose the one with the mildest scent and I think it worked fine. I am what some people call a "quack", wanting to use all things natural, etc. but every now and then, I compromise in the name of efficiency and practicality. If you find a good container for your liquid detergents, though, which I'm sure are available, then great. If not, get a detergent in paste form. Guaranteed, no spillage, no mess.

5. Sponge for bottles and Sponge for Sink
Bring a sponge to clean the hotel sink each time you use it to clean your bottles. Use warm water to rinse the sink just to be safe. Remember, just because it is "your" hotel room doesn't mean it's actually yours. It is still, technically, a "public" toilet and you will never know how well the cleaning lady really does her job.

Do not use the same sponge you use for your bottles for the bathroom sink. Get sponges in different colors so you can distinguish them and store them separately as well when not in use.

5. Small plastic container with holes or gaps that allow water to pass thru
Even after washing the sink, do not put your pump parts directly on the sink. Bring a small tray or plastic container for this purpose. This can also serve as a drying rack. Please refer to the picture for a sample.

6. Big Freezer Bags
Put your storage bags (once filled with milk) in here. It will be a safeguard in case any of the bags bursts or leaks. You can also keep you milk in this bag when requesting the hotel to store your milk from you. These bags will keep your milk from absorbing any freezer or refrigerator smells.

7. Dish rag
Bring a dish rag that is to be used only to wipe your bottles / pump parts when you do not have time to wait for them to air-dry.

8. Container for your pump parts
Always helpful, even in Manila. You can store your pump parts in your cooler or the hotel's refrigerator for use throughout the day. It's really not necessary to sterilize after each use. I promise.

9. Your Fridge to Go!
Essential while on the plane and especially when you are bringing home your pumped milk. During travel, depending on the model you have, it may be a bit heavy to lug around all day. After all, any thing you have to carry all day while traveling becomes a hassle after a couple of hours. Some options are:
-- If convenient, bring milk that was pumped outside back to hotel before you reach the 3 hour limit. Remember, freshly-expressed milk is good for 3 hours in room temperature. If you will make it back to your hotel room in 3 hours, you do not need to bring a cooler with you.
-- Put Fridge to Go in hand-carry luggage with wheels. This way, you don't carry it -- you just pull the bag that contains it.
-- For travel, the best model to bring is the Victoria of course it always depends on the number of days you will be away. For overnight trips, the Pack N' Go and Mini-Fridge are sufficient.

You need to use the best when cooler bag when transporting, and especially when traveling with, breastmilk. Fridge to Go outperforms any other cooler bag in the market. Check out Stephanie's page for the data.

10. Wet Wipes and Hand Sanitizers
Get the ones you can place in your bag for when you really do not have access to soap and water to wash your hands before pumping.

12. Tissue
Very helpful for accidental spills.

13. Bottle Brush / Tongs (Optional)
I did not bring these anymore to save space and to minimize the number of things I need to pack although if you prefer, these do come in handy when cleaning bottles.

14. Sterilizing Tablets (Optional)
You can find sterilizing tablets in the US or Singapore. I used them during my first trip but not on my succeeding trips because I figured, if the Medela manual says just wash in hot, soapy water then surely it is safe to skip sterilizing, right? Especially if it's only for a few days. What I do as an extra cleaning step is to pour freshly-boiled water on my pump parts using the electric kettle provided in most hotel rooms.

15. Medela Quick Clean Wipes (Optional)
This is handy. You can use this to clean pump parts when they're dirty and you have no way of properly washing it until you get back to the hotel. Just wipe it thoroughly with the Quick Clean Wipes after use and it's good to go the next time you pump. OR, rinse in hot water. Of course I always try to find a way to rinse it in hot water before using. Makes me uncomfortable not to rinse coz the wipes have soap. Thought of using pump cleaned with soap without rinsing first is scary. I never dared to follow Medela's instructions on this one.

B. To freeze or not to freeze your pumped milk
-- For trips below 6 days, there is no need to freeze your milk because freshly pumped milk is actually good for 7 days in the refrigerator. I say trips below 6 days just to be on the safe side. One Fridge to Go fan, however, went on a 7-day trip to Japan and brought home all her pumped milk chilled only, not frozen, without encountering any problems with her baby.
-- When you get home, that is the time you FREEZE your chilled milk.
-- For trips that go beyond 7 days, you must freeze. One Fridge to Go user was able to successfully bring home all her frozen milk by using dry ice -- just make sure to wrap the dry ice in newspaper to prevent it from "burning" your milk. She said she came home with all her milk still frozen. I have not personally tried this but have always kept it in mind should I need to bring home frozen milk in the future.

C. How to bring your pumped milk home:
1. Keep all storage bags in the Big Freezer Bag. Make sure the freezer bag is not too full so as not to cause any of your storage bags to burst.
2. Ask the concierge to freeze your Fridge to Go in the hotel freezer at least 2 nights before your departure. This is to ensure that it is frozen very, very well.
3. Packing your breastmilk into your Fridge to Go should be the LAST thing you do before you leave the hotel. This is to minimize the amount of time your milk is exposed to room temperature and to lengthen the performance of your Fridge to Go.
4. As an extra precaution, use blue ice to extend the performance of your Fridge to Go when traveling. You do not want to risk your milk getting spoiled in case of delays, traffic, or other unforseen events. In addition, the time you leave your hotel to the time your plane lands in your destination to the time you actually reach your home will take longer than 12 hours (even for short trips) and the cooling power of Fridge to Go, while already much longer than other cooler bags, is only up to 12 hours.
5. For extra long flights, some have successfully used dry ice. This has even enabled some to bring home frozen milk.
6. You may pack your Fridge to Go with breastmilk into your luggage for check in. Your Fridge to Go cooler bag will not condense and cause contents of luggage to get wet. As a precaution, you may place your Fridge to Go in the big laundry bags hotels provide.
7. If you prefer to bring your Fridge to Go and pumped milk with you on board the plane, you MUST have with you a doctor's certificate to prove that you are a breastfeeding mom. Even if you show your pump parts and even if your cup runneth over and you are obviously lactating, airport officials will, as a matter of policy, make you THROW the milk away. So, if you intend to carry any of your pumped milk on board a plane, you MUST have a doctor's certificate.
8. The rule in the HK airport is that as long as your CONTAINER is not more than 100ML, you can bring it in without a doctor's certificate. Otherwise, you need to throw out the contents.
9. The advantage of hand-carrying your pumped milk is so that you can make sure it stays cold. If, after several hours you notice that your Fridge to Go is losing its coolness, you can ask for ice from the airplane staff. Just make sure you have a ziplock bag ready for you to place the ice in. This will tide you over until you get home.

Like I said, pumping while traveling is not impossible. The rewards, on the other hand, are that you do not lose your milk supply and your baby will have so much nourishing milk once you return. That, my friends, is the best pasalubong you can ever bring home for your baby. Pumping while traveling, as is practically everything a mother does for her child, is truly a labor of LOVE.

=================
I can't add anything more. This is an excellent, comprehensive step by step post by Stephanie Co. If you want to contact her to purchase her Fridge to Go products, you can email her here. She's expecting her 2nd baby anytime soon.

Breastfeeding Mechanics

Check out this video from Bumpology showing how a baby takes out milk from the breast as revealed through an ultrasound.

The video was prepared by Donna Geddes of Western Australia who was also a speaker during the 5th International Breastfeeding and Lactation Symposium organized by Medela.  Dr. Geddes states that what happens during sucking is not a milking action but rather, "what we see is that when the tongue is lowered and the vacuum applied, that's when the milk is coming out of the breast, and that doesn't involve any compression of the nipple."  She goes on to explain that "infants who struggled to breastfeed generated much weaker vacuums" and for women with these babies, "keeping the milk flowing using a breast pump and using this to top up breastfeeding until the baby is strong enough to suck effectively may be a better option than giving up on breastfeeding altogether."  For women who find breastfeeding painful, Dr. Geddes' team explained that they found that the infants involved had "a particularly vigorous action" and as strong suckers, some were distorting or crushing the nipple.  
Some lactivists and breastfeeding purists may react and say that putting baby to the breast is still the best pump and is the best way to encourage baby to strengthen their weak suck.  However, for exclusive pumpers and even for working, pumping moms like me, understanding how babies really get out milk and knowing how a pump company is taking time, effort and funds to do this type of research is exciting.  Yes, babies are the best pump but for every pumping mom, being able to express as much milk within a shorter time is a goal to be achieved - especially since you are often pressed for time (at work!) and certainly don't enjoy the company of a cold machine (as opposed to your baby's warm body).  
As a pumping mom, I welcome this research and hope that this will pave the way for Medela (or some other pump company) to develop an effective pump with the goal of MORE MILK @ LESS TIME for moms.

Preventing Freezer Burn on Breastmilk

With the frequent rotating brownouts all over the country, one of the concerns of pumping moms is freezer burn on their frozen breastmilk. I found this informative video on how to prevent freezer burn:

Meanwhile, if your frozen milk already shows signs of freezer burn, should it already be discarded? According to Britannica Online, freezer burn occurs when "improperly package frozen foods lose small amounts of moisture during storage, resulting in surface dehydration. If you have lots of extra stored milk, I would suggest that you throw out the frozen milk bags exhibiting freezer burn. However, considering that freezer burn is really just loss of moisture and doesn't mean that the milk is spoiled, my opinion is that you can also do the taste and smell test. Thaw out your milk in the refrigerator, then smell and taste if it is sour and spoiled. If you're lucky to have a baby who is not picky (like Naima), then you wouldn't have problems giving it. But if your baby refuses it, you can either throw it out or donate it to a milk bank with a pasteurizer. Don't forget to inform the nurse that it has already been thawed out and should be pasteurized immediately!

Pumping Moms! - Giveaway Week 1

I’m a working, pumping mom who never got the hang of hand-expressing milk.  So the pump was definitely a very good friend for 2 years.  When I first went back to work, I pumped 4x a day at the office, 1x when I woke up and one more time before I sleep (if Naima drank a lot that day).  That's about 2 hours of pumping per day or 60 hours per month for the first 6 months.  Pumping sessions slowly waned and now I am just at one pump a day - storing milk for my preemie niece.  

My most recent post on pumping was about the Time Magazine article on exclusive pumpers.  I also previously wrote about how pumping moms can increase and maintain their milk supply to ensure a long-term nursing career.   I compiled tips on proper milk storage and even wrote about how we set up a lactation program at my workplace.

Pumping is definitely not easy and I'm sure every pumping mom has a story to tell about their pumping challenges - from plugged ducts, to no let-down as well as have their own tips to share to new pumping moms.  For this week, the give-away will be 1 box of Honeysuckle Breast Milk Storage Bags which consists of 25 pieces of bags.  I will be giving away 2 boxes which means there will be 2 winners.  

From Honeysuckle Bags website:

Honeysuckle Breast Milk Storage Bags are the new solution to your milk storage needs.  A superior double zipper closure lets you know when you've sealed the bag.  Our bags have an excellent tamper evident top to insure sterility and a large writing area for you to mark the date and other information.  Wide side seals and a reinforced bottom offer leak protection not available with any other brand.  These bags are made from FDA approved, BPA free materials,  to far exceed today's demanding ecological and safety requirements.

What sets these Breast Milk Storage bags apart from others is that they are the first line available that are environmentally conscious.  With the inclusion of the Oxo-Biodegradable technology, these bags will deteriorate in the environment in approximately 18 months after they are disposed of.  This will provide a better future for you and your child.

Read a review of the Honeysuckle Milk Storage Bags here. 

How to join this contest?

Leave a comment about your biggest pumping challenge with a tip to pumping moms.  You can also get extra entries (total of 4 entries) by:

1. Becoming a fan of Mama.Baby.Love on Facebook.
2. Tweeting about this giveaway (please leave a link to your status update.  Right click in the time stamp and copy the URL).
3. Blogging about the giveaway (please leave a link to your blog entry)

Leave a separate comment for each entry so it will be counted separately.  One comment = 1 entry.  However, a pumping challenge + tip counts only as 1 entry even if you write down xxx number of challenges/tips in separate comments.

If your email address is not in your public profile, leave it with your comment in words (e.g. fabnaima[at]gmail[dot]com) so I can contact you if you win.

This contest is open to readers within the Philippines and items will be shipped to you for free using Xend.  Contest will end on May 7, Friday at 11:59PM.  Names of winners will be posted in this entry and will be contacted by email.  Please respond within 48 hours – otherwise, I will choose another winner.  Two winners will be chosen using random.org.  Winners can win once per week.

CONTEST CLOSED.    
Week 2 Giveaway already up HERE.  Winners will be announced on Tuesday.   

Congratulations to the winners!
Mavie and Nachobing.  Please check your emails.  
Deleted comments not included in count.

For Exclusive Pumpers

When I was a new breastfeeding mom with latching problems and contemplating exclusive pumping, I was told by one of the lactation consultants I met with that choosing to exclusively pump would lead to a short-lived breastfeeding career. As I grew older (in terms of breastfeeding years!) and wiser, I realized that it IS possible to exclusively pump long-term and I have developed a high regard for exclusively pumping moms.

My own sister-in-law exclusive pumped for 6 months for her son. I have known other mothers who have exclusively pumped for 1 year or more for their babies. There is even a group for exclusive pumpers (or EP-ers). When acquaintances and clients ask me if it is still possible to breastfeed exclusively even without latching, I tell them YES but it takes hard work. Exclusively pumping would mean pumping at least 8x a day, waking up at night even when your baby is asleep, purchasing and using a good quality pump and keeping to the schedule no matter what. I also advise them to read relevant websites and inspiring blogs.

Recently, an article about increasing number of exclusive pumpers came out in TIME. Tanya of the Motherwear blog pointed out some items that needed clarifying - such as same health benefits and bottle feeding issues. For moms who rarely pump and are able to be stay at home moms and directly nurse their babies, fiddling with the pump and taking time to pump and clean the paraphernalia is tedious and time-wasting. However, as a work-out-of-home mom who started with pumping 4x a day at work, I realized that once the routine is established, setting up and cleaning pump parts becomes automatic, leading to less time needed as mom becomes more practiced.

I do think agree with the article that a major reason for the surge in exclusively pumping moms would also be the wide availability of pumps and the marketing efforts by the pump manufacturers. And as emphasized by Tanya, good information and help is essential as well as support for moms who are contemplating exclusive pumping.