US researchers confirm Zika causes birth defects

The mosquito-borne Zika virus causes birth defects, including a syndrome in which babies are born with unusually small heads, US health authorities attributing scientists confirmed on Wednesday after months of debate and uncertainty.


"Scientists at the Centers for Disease Control and Prevention have concluded, after careful review of existing evidence, that Zika virus is a cause of microcephaly and other severe fetal brain defects," said a statement from the federal agency.


The decision was based in part on a series of studies in Brazil, where thousands of babies were born last year with birth defects, coinciding with a spike in Zika virus infections among the general public.


"This study marks a turning point in the Zika outbreak," said CDC chief Tom Frieden.


"It is now clear that the virus causes microcephaly."


There was no "smoking gun," or single piece of evidence that offered conclusive proof, said the full report, published in New England Journal of Medicine.


Rather, the decision was made based on "increasing evidence from a number of recently published studies and a careful evaluation using established scientific criteria," said the CDC.


Further studies are being launched to "determine whether children who have microcephaly born to mothers infected by the Zika virus is the tip of the iceberg of what we could see in damaging effects on the brain and other developmental problems," Frieden added.


Zika virus was first identified in 1947 in Uganda, but the virus was poorly understood and symptoms have typically been mild, including rash, joint pain and fever. Most of those infected report no symptoms at all.

Zika was first identified in Brazil in early 2015, and a surge in infants born with microcephaly began nine months later, in September.


Brazil has confirmed 907 cases of microcephaly and 198 babies with the birth defect who have died since the Zika virus outbreak started, officials there said last month.


The Brazilian health ministry said it is still investigating 4,293 suspicious cases.


"The severe microcephaly and other brain anomalies that have been observed in many infants are consistent with an infection occurring in the first or early second trimester of pregnancy," said the report in the New England Journal of Medicine.


Until now, no mosquito-borne virus has been known to cause birth defects, and the last infectious pathogen known to cause an epidemic of birth defects was the rubella virus more than 50 years ago.


Experts reviewing the evidence of microcephaly in Brazil found a similar increase in the birth defects in French Polynesia, which was hit by an outbreak of Zika in 2013 and 2014, though the number of microcephaly cases was small, totaling just eight.


Microcephaly is a rare defect that occurs in six out of every 10,000 births in the United States.


The lack of clarity on whether or not Zika could be established firmly as a cause of birth defects may have contributed to poor public understanding of the virus and its risks, the report said.


A recent poll of Americans found that one in four were unaware of any association between Zika and birth defects, and one in five believed, wrongly, that there was a vaccine to prevent it.


Women who are pregnant or considering becoming pregnant are advised to avoid the more than 30 places in Latin America and the Caribbean where Zika is circulating, and to wear mosquito repellant if they live in those areas.


While is now known to Zika cause microcephaly and other severe fetal brain defects, the actual risk of such birth defects remains unknown.


Indeed, some women who were infected with Zika while pregnant gave birth to apparently healthy children.

The CDC said it would not change it recommendations for women who are or want to get pregnant. They should continue to avoid traveling to Zika infected areas. Their partners should either use condoms or abstain from sexual contact while the woman is pregnant.


"Establishing this causal relationship between Zika and fetal brain defects is an important step in driving additional prevention efforts, focusing research activities, and reinforcing the need for direct communication about the risks of Zika," said the CDC.


"While one important question about causality has been answered, many questions remain."

How To Avoid a Caesarian or C-Section Birth

C-Sections are epidemic in the United States. 1 out of every 3 women who is pregnant right now will have one. If you need a C-Section to save the life of your baby, it's nothing short of miraculous, and worth every bit of pain and risk.

Sometimes if your baby is breech and can't be turned, or in some cases with twins, a caesarean tremendously lowers the risk to your baby.

If you and your health care adviser have decided that a C-Section is warranted for safety reasons, you'll be scheduling it. Obviously, you'll want to choose a care-giver who's very experienced with C-Sections and a hospital with an excellent record.

But are you aware that C-sections:

1. Are major abdominal surgery with all the attendant pain and possible complications in the following weeks, just when you want to enjoy your new baby?
2. Increase your risk of hemorrhage and infection?
3. Result in a uterine scar and internal adhesions (scarring) that can cause pain and complications for years?
4. Increase your chances of later ectopic pregnancy and difficulty conceiving?
5. Increase your baby's chances of having asthma later in life?
6. Delay your breastmilk coming in, making it so much more difficult to breastfeed that many women give up?
7. Endanger the health of future pregnancies, increasing the chances of low birthweight, premature delivery and stillbirth?
8. Often leave women with medical complaints six months or a year later?

If you really need a C-Section, they are a miraculous life-saver. If you don't, it's best to avoid it.

Luckily, most C-Sections are not actually medically necessary. 85% of all pregnancies are normal and low-risk, and absolutely do not warrant C-Sections. In fact, there is absolutely no medical evidence that a caesarean is necessary just because you had one last time, or because you're over 40. Even with a multiple birth a C-Section is often more dangerous than a vaginal birth.

Most importantly, do you know that you can tremendously reduce your risk of C-section by picking a care-giver who uses certain kinds of birth practices?

VBAC

(Vaginal birth after caesarean) If you had a C-Section last time, you can still have a Vaginal Birth this time. Do you know the most decisive factor in whether a woman can successfully have a VBAC ? Age. But not the age of the mom, or the term of the baby. The age of the doctor!

That's because doctors used to be educated with the misinformation that uterine rupture was more likely with a VBAC. But the New England Journal of Medicine published a landmark study in 2004 showing that uterine rupture occurs in less than 1% of VBACs. In other words, a woman who had a C-Section is just as likely to be able to have a healthy vaginal birth as any other woman.

Are you over 40?

It's true that women over 40 have a 40% chance of having C-Sections, and it is exhausting and demoralizing to struggle through a prolonged labor only to end up in the operating room having a C-Section. BUT did you know that you can hugely increase your chances of being part of the 60% of over-40 year olds who have normal vaginal births? That's right. Most women over 40 do not need a caesarean, and can avoid having one.

Avoiding a C-Section: 
What every pregnant woman needs to know.

You can significantly reduce your chances of having a C-Section by informed choice of a caregiver and birth place. Here's how:

1. Exercise moderately during pregnancy.

Sedentary women are 4x as likely to deliver via caesarean section as women who did aerobics during the first or second trimester.

2. Find a caregiver who has a low C-Section rate

Find a caregiver who has a low C-Section rate and is experienced with successful VBACs. This is true even if you don't need a VBAC, because it means your caregiver doesn't default to caesareans.

3. Find a caregiver who will give you all the time you need

Find a caregiver who will give you all the time you need rather than rushing your delivery because of staffing issues.

4. Ask your caregiver what she does if your baby is in a breech position

Ask your caregiver what she does if your baby is in a breech position in late pregnancy. You want to hear that she is experienced with turning babies and always tries that before scheduling a C-Section.

5. Check Hospital policies.

If you're considering a VBAC, be sure to use a hospital that allows VBACs.

6. Arrange continuous trained labor support

Arrange continuous trained labor support which studies show keeps labor moving. If you aren't using a midwife, supplement your OB by hiring an experienced labor doula. A 2001 study in the journal of perinatal education showed a 56% reduction in the risk of caesarean in women receiving continuous one to one nursing/doula or midwifery care.

7. Be sure that your caregiver and birth venue encourage practices that support the normal process of labor and keep it moving:

• Arrange to stay upright and moving rather than lying down.
• Stay well-nourished and hydrated to give you energy
• Avoid continuous electronic fetal monitoring
• Avoid hastening labor with pitocin, which increases the severity of contractions and makes other medical interventions much more likely.

These are not the top child health problems

Childhood obesity, bullying, and drug abuse are the top child health problems, according to respondents to a national survey for Mott’s Children’s Hospital in Michigan.The survey participants got it wrong on two of those priorities.  Their responses are more a reflection of what’s been getting media attention, rather than the real problems affecting America’s youth.

I was glad to see that childhood obesity, listed by 60 percent of the participants, achieved the number one ranking.  It’s hard to overemphasize the serious medical and mental health implications of this epidemic.However, those who listed bullying (58 percent) and drug abuse (53 percent) as the most serious child health problems got it wrong.Bullying is an important issue, but the prevalence is not increasing, and may in fact be declining. Schools are taking this problem very seriously, and many states have laws that help insure that our kids can go to school in an emotionally safe environment.

While drug abuse is a serious issue, it’s more of a symptom of underlying problems.If I was completing the survey, I’d list child abuse and neglect as the second most serious health problem for our kids. The overall rates of neglect, physical abuse and sexual abuse remain alarmingly high.  This is a safety issue that demands our focused attention.

I’d rate stress as the third most significant health issue, one that is related to so many other problems identified in the survey.Childhood stress is difficult to comprehend. Most of our kids are privileged, entitled and raised in financially secure environments. They have economic advantages unknown to any other generation. With so many benefits, why is stress such a serious health issue?

I’d list stress as one of my top priorities because we are raising a generation of entitled and overprotected kids who are horrible at dealing with life’s problems. When confronted with difficulties, they respond by abusing drugs, smoking, bullying or developing mental health issues.

These problems are symptoms. We don’t need more education to teach kids that bullying, taking drugs, and smoking are bad. Instead, we need to teach our children better ways to deal with unpleasant feelings, difficult people, failure and frustration.

What kids are calling “stress” today was once viewed as just a normal part of living that kids figured out how to manage.

The solution is for parents to stop solving problems for their kids, and start teaching them how to deal with difficulties on their own. Your job is to do more coaching and less controlling, helping our kids to be strong and independent, not victims of life’s normal pressures.

Using a Mother’s Microbes to Protect Cesarean Babies

The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

Photo

The transfer of the maternal microbiome occurs naturally after (a) a vaginal birth. After a (b) C-section, researchers transferred the neonatal microbiome from the mothers with a (c) gauze treatment.CreditKim Caesar/Nature Publishing Group

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section.

The small proof-of-principle study suggests a new way to inoculate babies, said Dr. Maria Gloria Dominguez-Bello, an associate professor of medicine at New York University and lead author of the report, published on Monday in Nature Medicine.

“The study is extremely important,” said Dr. Jack Gilbert, a microbial ecologist at Argonne National Laboratory who did not take part in the work. “Just understanding that it’s possible is exciting.”

But it will take further studies following C-section babies for many years to know to what degree, if any, the method protects them from immune and metabolic problems, he said.

Some epidemiological studies have suggested that C-section babies may have an elevated risk for developing immune and metabolic disorders, including Type 1 diabetes, allergies, asthma and obesity.

Scientists have theorized that these children may be missing key bacteria known to play a large role in shaping the immune system from the moment of birth onward. To replace these microbes, some parents have turned to a novel procedure called vaginal microbial transfer.

A mother’s vaginal fluids — loaded with one such essential bacterium, lactobacillus, that helps digest human milk — are collected before surgery and swabbed all over the infant a minute or two after birth.

An infant’s first exposure to microbes may educate the early immune system to recognize friend from foe, Dr. Dominguez-Bello said.

Friendly bacteria, like lactobacilli, are tolerated as being like oneself. Those from hospital ventilation vents or the like may be perceived as enemies and be attacked.

These early microbial interactions may help set up an immune system that recognizes “self” from “non-self” for the rest of a person’s life, Dr. Dominguez-Bello said.

In the United States, about one in three babies are delivered by C-section, a rate that has risen dramatically in recent decades. Some hospitals perform the surgery on nearly seven in ten women delivering babies.

An ideal C-section rate for low-risk births should be no more than 15 percent, according to the World Health Organization.

Dr. Dominguez-Bello’s study involved 18 babies born at the University of Puerto Rico hospital in San Juan, where she recently worked. Seven were born vaginally and 11 by elective C-section. Of the latter, four were swabbed with the mother’s vaginal microbes and seven were not.

Microbes were collected on a folded sterile piece of gauze that was dipped in a saline solution and inserted into each mother’s vagina for one hour before surgery. As the operations began, the gauze was pulled out and placed in a sterile collector.

One to two minutes after the babies were delivered and put under a neonatal lamp, researchers swabbed each infant’s lips, face, chest, arms, legs, back, genitals and anal region with the damp gauze. The procedure took 15 seconds.

Dr. Dominguez-Bello and her colleagues then tracked the composition of microbes by taking more than 1,500 oral, skin and anal samples from the newborns, as well as vaginal samples from the mothers, over the first month after birth.

For the first few days, ambient skin bacteria from the delivery room predominated in the mouths and on the skin of C-section babies who were not swabbed, Dr. Dominguez-Bello said.

But in terms of their bacterial colonies, the infants swabbed with the microbes closely resembled vaginally delivered babies, she found, especially in the first week of life. They were all covered with lactobacilli.

Gut bacteria in both C-section groups, however, were less abundant than that found in the vaginally delivered babies.

Anal samples from the swabbed group, oddly, contained the highest abundance of bacteria usually found in the mouth.

The results show the complexity of labor, said Dr. Alexander Khoruts, a microbial expert and associate professor of medicine at the University of Minnesota. “It cannot be simplified to a neat, effortless passage of the infant through the birth canal,” he said.

As the month progressed, the oral and skin microbes of all infants began to resemble normal adult patterns, Dr. Dominguez-Bello said. But fecal bacteria did not, probably because of breast or formula feeding and the absence of solid foods.

The transfer fell short of full vaginal birth-like colonization for two reasons, Dr. Dominguez-Bello said. Compared to infants who spent time squeezed inside the birth canal, those who were swabbed got less exposure to their mother’s microbes.

And all infants delivered by C-section were exposed to antibiotics, which also may have reduced the number and variety of bacteria colonizing them.

A larger study of vaginal microbial transfer is underway at N.Y.U., Dr. Dominguez-Bello said. Eighty-four mothers have participated so far.

Infants delivered both by C-section and vaginally will be followed for one year to look for differences in the treated and untreated groups and to look for complications. Thus far the swabbing has proved entirely safe.

The procedure is not yet recommended by professional medical societies, said Dr. Sara Brubaker, a specialist in maternal and fetal medicine at N.Y.U. Until more is known, physicians are hesitant to participate.

“But it has hit the lay press,” she said. “Patients come in and ask for it. They are doing it themselves.”

Dr. Brubaker is one of them. When her daughter was born three and a half months ago, she arranged to have her baby swabbed.

Zika virus: Study supports link to microcephaly

In what experts describe as another piece of evidence linking Zika with the risk of birth defects, researchers on Wednesday reported finding the virus in the amniotic fluid of two pregnant women whose foetuses were diagnosed with microcephaly.

 

In a study in the Lancet Infectious Diseases journal, the scientists said their finding suggests Zika virus can cross the placental barrier, but does not prove it causes microcephaly, a condition in which babies are born with abnormally small heads.

 

More research is needed to understand the link, they said.

 

"This study cannot determine whether the Zika virus identified in these two cases was the cause of microcephaly in the babies," said Ana de Filippis, the doctor who led the study at the Oswaldo Cruz Institute in Rio de Janeiro, Brazil.

 

"Until we understand the biological mechanism linking Zika virus to microcephaly, we cannot be certain that one causes the other."

 

Many scientists believe Zika, a mosquito-borne disease that is currently sweeping through the Americas, may be a risk factor for microcephaly in newborns, as well as for a serious neurological disorder in adults called Guillain-Barre syndrome.

 

The World Health Organization has declared the Zika epidemic spreading from Brazil a global public health emergency and called for urgent studies to establish with its association with rising number of cases of suspected birth defects can be proven.

 

De Filippis' study noted that the number of suspected cases of babies with microcephaly in Brazil in 2015 has increased twenty-fold compared with previous years. At the same time, Brazil is reporting high numbers of Zika virus infections.

Babies born with microcephaly are at risk of incomplete brain development.

 

The condition has previously been linked to a range of factors including genetic disorders, drug or chemical intoxication, maternal malnutrition and infections with viruses or bacteria that can cross the placental barrier such as herpes, HIV, or other mosquito-borne viruses such as chikungunya.

 

For this study, de Filippis' team investigated the cases of two women, aged 27 and 35, from Paraiba in northeastern Brazil.

The women had symptoms of Zika infection - including fever, muscle pain and a rash - during their first trimester of pregnancy. Ultrasounds taken at approximately 22 weeks of pregnancy confirmed the foetuses had microcephaly.

 

The researchers took and analysed samples of amniotic fluid at 28 weeks of pregnancy. While the women's blood and urine samples tested negative for Zika, their amniotic fluid tested positive for the virus genome and for Zika antibodies.

"Details of the Zika virus being identified directly in the amniotic fluid of a woman during her pregnancy suggest ... the virus could cross the placental barrier and potentially infect the foetus," de Filippis wrote.

Jimmy Whitworth, a Zika expert and professor of international public health at the London School of Hygiene & Tropical Medicine, said the findings "strengthen the body of evidence" pointing to Zika as a cause of microcephaly in Brazil.

 

But he noted that while studies of this sort can show associations, they can't show direct causation.

The Importance of Skin to Skin Contact

There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby's temperature is more stable and more normal, the baby's heart and breathing rates are more stable and more normal, and the baby's blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother's.

We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their needs for oxygen, and keeps them more stable in other ways as well.

From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in "Breastfeeding - Starting out Right", a baby who latches on well gets milk more easily than a baby who latches on less well. When a baby latches on well, the mother is less likely to be sore. When a mother's milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does not have a lot of milk (but she has enough!), and a good latch is important to help the baby get the milk that is available (yes, the milk is there even if someone has "proved" to you with the big pump that there isn't any). If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.

To recap, skin to skin contact immediately after birth, which lasts for at least an hour has the following positive effects on the baby:

• Are more likely to latch on
• Are more likely to latch on well
• Have more stable and normal skin temperatures
• Have more stable and normal heart rates and blood pressures
• Have higher blood sugars
• Are less likely to cry
• Are more likely to breastfeed exclusively longer

There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other's company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother's partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there "just in case"). The eyedrops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.

Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. The need for an intravenous infusion, oxygen therapy or a nasogastric tube, for example, or all the preceding, does not preclude skin to skin contact. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby's health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin to skin contact is still good and important for the baby and the mother for all the other reasons mentioned.

If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast because three hours have passed. The baby not interested yet in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in babies refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the "obvious next step" is to give a supplement. And it is obvious where we are headed

7 BREASTFEEDING TIPS FOR MOMS-TO-BE

It’s tempting to get so wrapped up in planning and thinking about our labor and birth (and the nursery color scheme!) that we can easily forget that we actually have to care for our sweet littles once they’re out.

One of the biggest areas of concern for first-time-moms is breastfeeding. And it should be – it’s a huge deal both in terms of nourishment and comfort of the baby, as well as commitment and work for the new mother.

Unfortunately breastfeeding—as natural as it is—can also be difficult for some.

Every woman experiences it differently – some with very little problem, others with challenges they never even dreamed of.

Although there’s no way of knowing for certain how exactly your body and baby will respond, there are a few measures you can take to prepare yourself.

HERE ARE SEVEN SIMPLE WAYS TO HELP YOU GET READY FOR TAKING ON THE BREASTFEEDING LEARNING CURVE.

1) GET EDUCATED.

Attend a breastfeeding class, find some breastfeeding resources online, read an informative book, and/or ask to speak with a lactation consultant if possible. You can’t put a pricetag on good information and it will help empower you for the journey and task ahead! Learn about the benefits of breastfeeding, the mechanics of it, the stages of how your breasts and milk change and develop, as well as the common difficulties that women encounter (latch issues, engorgement, blocked ducts, mastitis, etc). The more you know, the more likely you are to perservere in the event that things get off to a rocky start. (One of the best comprehensive online resources I’ve found is www.kellymom.com)

2) GET TALKING.

As much as you’re able, try to share your desires to breastfeed as well as how it all works with your partner. Talk about your reasons/motivations, your goals and level of commitment, as well as how it all works. Also talk about some of the potential issues that commonly arise and the fact that the first several weeks can be tricky. (Assure him that it normally gets easier and more “normal” by about week six, if not sooner.) It will help him to feel a little more included as he looks on from the outside to this special part of parenthood reserved exclusively for mothers. If he feels informed and included he’s much more likely to support you (and understand why you are trying to stick with it in the event a problem arises). Ideally, get him to attend a breastfeeding information workshop with you.

3) GET FRIENDS.

Try to find two or three mom-friends who have sucessfully breastfed their babies that you can call on when you need to. Most likely you will have questions as you go and you’ll need real-time support in some form or another – whether it’s another woman to problem-solve with or just for a word of encouragement in a moment of difficulty. Experienced friends can be a lifesaver.

4) GET SOOTHIES.

Buy some soothies or other similar gel pads that can be refrigerated between uses. These simple pads help sooth sore nipples between feeds and are especially helpful during the first few weeks while your breasts are adjusting to all of the changes. (And your sweet little cherub/barracuda!) An experienced friend sent me some when I had my first baby and they were the best gift I didn’t know I needed!(Tip: if you can’t find gel pads in a store near you, or just don’t want to spend the money, you can also use frozen cabbage leaves to accomplish the same cooling sensation.)

5) GET SUPPLIES.

Have a box of breast pads on hand to absorb excess milk so you don’t get stuck with embarassing leaky boobs in public (or have to do any more laundry than you absolutely have to). You should also pick up a small tube of Lansinoh nipple cream (or another recommended brand) in case you get sore, cracked nipples. Be warned though – don’t go stockpiling these things because you may not end up needing them. (Leaking isn’t a given – I never did end up using more than a few breast pads. Of course that did mean a couple of my friends were very grateful for my unused donations!)

6) GET SUPPORT.

Literally. As in… nursing tanks or bras! I’m personally a big fan of nursing tank tops. They are so comfortable and easy to get started in since you don’t have to mess with both a bra and a shirt at once. (Invaluable for those first few weeks and the steep learning curve.) Use them on their own or use them under another shirt so that your belly isn’t exposed when you lift up your normal shirt (awkward!). I used nursing tanks around the clock when I started breastfeeding since they also provide a comfortable way to remain supported at night. Two years later  you can still catch me sporting these tanks. LOVE them!!

7) GET COVERED.

Many people aren’t comfortable with public breastfeeding. If this is you, buy or make a nursing cover. It will help you feel more private and confident to breastfeed in front of others if you have a simple cover-up that allows for privacy without getting in the way of you and baby. A nursing cover allows you to see your baby (and see as you adjust yourself), and the strap that goes around your neck leaves you hands free to hold and adjust as needed. I used my nursing cover all. the. time. during my first few months breastfeeding and have since bought them as baby shower gifts for nearly all of my pregnant friends. (Warning: there comes a time when most babies disdain these covers which limit their curious, growing minds and ability to look around while they feed! By then you should be much more comfortable with your own abilities and body anyway, so most likely it won’t be a drama.)