Here is a document that I have created by saving all the breast feeding info I found on the net...
BF Master plan
Week before
? Eat Take probiotic yogurt or lactobacilli supplements to protect your intestinal flora and to help prevent colic and allergy in your baby.
? Carrot
? Dandelion and stinging nettle leaves are diuretic, and can help reduce edema during pregnancy and after birth. They can be plucked from your garden in early spring and eaten whole, chopped into salad, or used to make tea. Stinging nettle can be harvested for salad or cooked as spinach. In your market, you'll find arugula, beet leaves, kale, Swiss chard, spinach, chicory, collard greens and others
? Oats are the most widely used lactogenic food in the US.
? chickpea, mung beans and lentils
? Check out coffee substitutes based on the lactogenic grain barley, such as CARO, Roma, Caffix, Pero or Dandy Blend. These imitation coffees usually also contain chicory or dandelion, plus malt?ingredients that are all lactogenic. A recipe for "Barley Water," a potent lactogenic beverage, is at the bottom of this arti
? Garlic is famous for its medical benefits, and has a long history as a galactagogue
? . In one study, babies were seen to latch on better, suckle more actively, and drink more milk when the mother had garlic prior to nursing(2). If you do not wish to eat garlic, try adding a capsule of garlic extract to a meal eaten about an hour before breastfeeding
? Oats (Avena Sativa
? The oat is one of our most nutritious foods, to nourish the nerves, support the metabolism of fats, and uplift the spirit. In traditional medicine, both the seed and the leaf?called oat-straw?are taken. Oats are prescribed as a nervine tonic in the treatment of nervous exhaustion. In Europe, women traditionally take oats after birth. Oats are taken to increase milk production. Like other galactagogues, oats are antidepressant, antispasmodic, and they increase perspiration
? Then, after birth, begin mothers helper tea
? This tea looks better than the one I?ve ordered www.mumstuff.co.uk/acatalog/MumStuff_Teas_for_Breastfeeding_31.html
MOBI Motherhood Intl. Home > Nutrition > Lactogenic Foods and Herbs
Lactogenic Foods and Herbs
By Hilary Jacobson CH.HU.SI.
Based on her book Mother Food for Breastfeeding Mothers
Getting a good start the first few weeks after birth can be helpful in supporting the onset and development of a mother?s milk supply:
? Get enough to eat.
? Get enough to drink,.
? Eat at least one warm meal per day
? Spice moderately with lactogenic spices, for instance with sea-salt or gomasio, with dill or caraway, or basil and marjoram, garlic.
? Avoid fried or extremely fatty food.
? Take probiotic yogurt or lactobacilli supplements to protect your intestinal flora and to help prevent colic and allergy in your baby(1).
? Get healthy fats such as butter and olive oil, and remember to supplement with essential fatty acids.
? Herbs useful after birth include stinging nettle to rebuild the blood lost during birth, turmeric, to help prevent breast inflammation, oat-straw, to nurture the nerves and to help prevent nervous exhaustion. These herbs also increase milk supply, so keep an eye on your supply and reduce or increase your dosage of these herbs as necessary.
? If you lost a lot of blood during birth, avoid taking ginger for several weeks.
Fennel,Carrot, Beet, Yam kale, Swiss chard, spinach, chicory
oats, millet, barley and rice.
almonds, cashews, and macadamia nuts. butter cold-pressed virgin olive oil
non-alcoholic beer
Ginger beer in later
marjoram basil anise, dill or caraway. Black pepper, taken in moderation, is helpful.
Turmeric One half teaspoon of turmeric a day may help prevent inflammation in the breasts.
Caution:.
Oats are prescribed as a nervine tonic in the treatment of nervous exhaustion. In Europe, women traditionally take oats after birth.. Like other galactagogues, oats are antidepressant, antispasmodic, and they increase perspiration.
Taking large dosages of oats is helpful in kick-starting milk production.
Oatmeal can be taken for breakfast or an afternoon snack.
Oat-straw is especially rich in minerals. It is available as capsules or as an ingredient in so-called ?green-drinks.? Take as indicated on the package.
Fluid extract: 3 ? 5 ml (15 ? 35 drops), three times a day.
Nutritional Yeast start with a small dose
Tahini
Barley Water
Barley-water is used medicinally to treat colds, intestinal problems (both constipation and diarrhea) and liver disorders. It was recorded in Greek medicine two thousand years ago as a galactagogue. Taken for a week or two, it often helps mothers with chronic low milk supply. Make a pot in the morning and drink it throughout the day, warming each cup and sweetening it with a natural sweetener as desired.
Barley-water can be made with whole grain or pearl barley. Barley flakes can also be used, though these have been processed and are possibly less potent than the whole or pearled grain.
Preparation:
? Quick-and-easy: 1/2 cup of flakes or pearled barley can be simmered in 1 quart of water for twenty minutes.
? Long-and-intensive: 1 cup of whole or pearled barley is simmered in 3 quarts of water for up to 2 hours. About half the liquid should cook off. Some recipes call for only 1/2 hour cooking time. However, the longer the barley simmers and the more pinkish (and slimier) the water becomes, the more of the ?cream? will enter the water and the stronger the medicinal effect will be.
? If the barley water becomes too thick to drink comfortably, add in more water.
? When finished, remove from the stove and sieve off the water. The grain is now tasteless and can be thrown out.
? Add 1 tablespoon of fennel powder or steep 2 ? 3 teaspoons of fennel seeds for ten minutes in the barley-water before drinking.
? The traditional recipe calls for fennel seed. I personally find that powdered fenugreek seed is tastier than fennel in barley-water.
Milk Flow www.mobimotherhood.org/MM/article-milkflow.aspx
It?s at the Heart of Breastfeeding
by Beverly Morgan, IBCLC
Throughout a nursing session the general trend in milk flow is from faster to slower. However, it is not a straight line decrease. Like the tide, there is an ebb and flow. Let me explain.
If you?ve done any pumping, you will have noticed that when you start there is a delay before the milk flows. Once the milk ejection begins, the milk flows faster. The milk might even spray, especially if your breasts were firm when you started. The flow will then be steady for a time, gradually decreasing, and temporarily stopping. If your baby keeps nursing, or if you continue pumping, you will have another milk ejection. The flow will rise again with the next ?wave? of milk, but unlike the tide, the flow of milk does eventually stop. Each milk ejection is less forceful and has less volume than the one before. This means that a baby has faster flowing milk at the beginning of a session, when he has a strong appetite, and slower flowing milk at the end, when he is full and sucking more for comfort. Keeping this variable flow rate in mind, the baby?s behavior at the breast becomes a bit easier to read.
Reading your baby?s behavior cues
? If he pulls back and milk is flowing out of the breast, it may be that his swallow is temporarily challenged and he is trying to get breathing space.
? He may have learned from experience that the first letdown is too fast and strong for him to handle comfortably, so he pulls away and waits for it to pass.
? He may pull off the breast once the flow starts. He may have been nursing more for comfort; this extra milk was not what he wanted.
? If he pulls his head back and tugs on the nipple of the first breast in a feeding, and you can tell that that breast feels soft now, he will likely be happy to change to the second breast for a faster flow.
? If he tugs or fusses right from the start he may be impatient for the flow to start. He may want the other breast if he knows it is the faster flowing breast.
As you get to know your baby and your milk supply, you can make educated guesses on what he is trying to tell you.
Variable flow from breast to breast
Milk flow varies from one breast to the other, and it changes throughout the nursing session and throughout the day. I consider this variable flow as nature?s way of providing different flow rates for different babies. Often, tuning in to which breast flows faster, and learning what the baby prefers, can add an extra level of enjoyment to breast nurturing.
When working with mothers, I share ?Morgan?s Rule of Thumb for Milk Flow?: The firmer the breast, the faster the flow?the softer the breast, the slower the flow.
Bottle nipple manufacturers and people who bottle-feed a baby have also discovered how important milk flow is to a baby. There are a variety of flow rate nipples available and a mother may need to try many to find the one that flows best for her baby.
Side preference
Not all children have a side preference and there are reasons other than milk flow that can induce an infant to favor one side. For example, a baby may have a broken or cracked clavicle from birth. If so, he will prefer to nurse on the side that does not put pressure on his sore shoulder. If a baby seems distinctly uncomfortable on one side, a therapist may be in order. He may be happy to use both breasts once the restriction or pain that caused his preference is resolved.
For the sake of our discussion here on milk flow, we will assume that there is no underlying physical condition causing the side preference, and that the preference is due to the most obvious cause: the baby?s preference for a faster or slower milk flow.
Supply and demand
Interestingly, the favored side can change from time to time, sometimes because the baby?s flow preference changes. A baby who was having trouble keeping up with a fast flow can now handle it better, and suddenly he prefers the faster flowing breast. A baby who likes a slow flow may nurse on the slower flowing breast more effectively, so that with time both the volume and flow rate increase in that breast. This baby may now switch his preference to the other breast that has become slower flowing in comparison.
Sometimes, the preference for one particular breast remains for the entire duration of the nursing relationship. This preference may be consistent from child to child, or may vary depending on the child. One possible reason for the preference could be that one breast produces the larger portion of milk, and the mother?s children respond to that with a preference.
The more often the baby chooses one breast, the more stimulation and milk removal that breasts experiences. This milk removal and stimulation induces that breast to produce more milk. Some mothers offset the baby?s preference for the faster flowing breast by pumping in addition to nursing on the slower-flowing breast for a time to increase its flow. If the flow rate is too fast for the baby on one side, making him reluctant to take that breast, mother might use a nipple shield on that breast to slow the flow. Strategies such as these can assure that there is demand to drive the supply on both breasts.
Baby?s cues: watch those little hands
Let?s assume the baby is nursing effectively and is generally comfortable with the flow of milk from both breasts. Let?s also assume that mom has the milk he needs. Now look at his hands. Here are some things you might notice.
? Think of his fists and arms as a gas gauge. His arms are up and his hands are in fists when he needs a fill up. His arms are down and his hands open when he feels satisfied!
? Anticipating the nursing session, his hands are held in fists near his face
? They remain fisted during the pre-milk ejection and the first milk ejection phase
? As he's becoming satisfied and the milk flow slows to the post-ejection rate, his hands gradually uncurl and drop down from his face
? If he has gas or is startled out of his relaxed state, his hands may go part way up again. However, his hands will usually not go as far as his mouth and they will usually start to drop again more quickly then at the beginning of the feeding.
Tailored Breastfeeding
You have now been introduced to baby-watching, an important aspect of ?Tailored Breastfeeding.? Tailored breastfeeding is not ?off the rack? but specifically designed for each mom and baby. I coined the phrase ?Tailored Breastfeeding? as a shorthand way of referring to a breastfeeding relationship that is interactive.
Rather than a specific set of rules such as ?switch breasts after 15 minutes,? or ?the baby must spend at least 20 minutes nursing,? Tailored Breastfeeding uses the baby?s behavior as cues to guide the breastfeeding dance. A mother uses her knowledge of how each of her babies reacts to her milk flow and makes feeding decisions that are ?tailor made? to each of her babies. The rules then become less important than the immediate experience for the breastfeeding couplet.
FAST MILK FLOW
Fast Flow Management with ?Tailored Breastfeeding?
Baby behaviors related to wanting slower flow
If the baby perceives that his mother?s milk rate is consistently too fast, every nursing session will seem challenging for mom and baby. When coping with milk flow that is too fast, the baby will show signs that he is working hard:
? He may tug at his ear while nursing
? He may scratch at his face
? He may squirm
? He may try to roll his body out away from the breast
? He may push against his mother
? He does not look as if eating is restful, but more as if it is an athletic event.
In an attempt to decrease the rate of milk flow, a baby may:
? Take the breast into his mouth with a shallow latch especially if the breast is full
? Clamp on the nipple with his jaws especially when the breast is firm with milk
? Bunch up the back of his tongue, pinching the nipple to protect his airway
? Role away form the breast, so his head is facing the breast but his chest is rolled away from mom
Baby?s ease of breathing and swallowing
I have found that when a baby has difficulties with milk flow, his mother often takes the ?blame.? A mother may think she has an oversupply of milk, or milk flow that is too fast or too slow. Actually, her supply and her flow may be average, but her baby may need extra time and support to learn, coordinate and manage the suck/swallow/breathe process. Simply put, a baby?s unease in breathing and swallowing often show up as difficulties handling milk flow.
Breathing difficulties
If a baby has breathing difficulties, fast flowing milk will challenge him. Taking the breast deep into his mouth causes the milk to squirt out of the breast, and pushes the baby to swallow. He may struggle to find time to breathe.
If your baby has breathing difficulties, you will likely recognize some of the behavior you saw in the list above on too-fast flow. More signs include:
? He may gulp the milk so fast it looks as if he was starving. He may be swallowing fast to clear his airway to breathe. A pattern might be gulp, gulp, gulp, gulp, gulp, gulp, and gulp, gasp, breathe, pause, gulp, gulp, and gasp and so on. A more controlled pattern might be suck, suck, suck, swallow breathe.
? He may drip milk out of his mouth throughout the nursing not just at the end when he is full or the very beginning with the first letdown on an extra firm breast.
? He may fuss if pulled in close to the breast, as he needs breathing room.
? He may pull back and clamp on the nipple to control the flow.
? He may use the back of his tongue, curling it up and pinching the tip of his mother?s nipple to protect his airway.
? He may fuss if his head is held in to the breast, as he does not have the freedom to pivot his head.
? He may nurse more comfortably when he is held with his bottom down and his head up so he can breathe better than if he were in a side lying position.
? He may want to turn his body away turning his head so he can take a controlled breath and then swallow.
Swallow issues
If a baby has a difficult time swallowing he will be challenged by a fast milk flow. He might share many of the same behaviors as the baby with breathing issues.
? He may gulp with each swallow, but it will not be a series of rapid swallows. His swallows will not seem effortless.
? He is likely to drip milk out of his mouth throughout the nursing session. (He may also drool so that his bib or clothing is usually wet.)
? He may tip his head back to help his swallow.
? He may turn his head to the side to swallow
WHAT YOU MIGHT TRY
Managing fast flow
Modifying Baby's Breastfeeding Position
Even small changes in positioning can be a big help for babies struggling with flow issues. Watching your baby?s cues for his physical comfort is an important first step to discovering these subtleties.
In experimenting with positions to help your baby handle fast flow, it can be helpful to reevaluate so-called ?good positioning?. You?ve probably read that good positioning means the baby is tummy to tummy with mom, that he does not turn his head away to swallow, that he opens his mouth wide to nurse, flanging his lips, and that he takes the nipple deep in his mouth.
Here is new information for you. What we in the Western world have come to view as ?good positioning? is actually ?maximum flow positioning.? The baby receives the flow directly to the back of his mouth, and he has no way to avoid, deter, or lower the flow to his comfort level. While this works for most babies, it is not the best position for all babies.
Many times mothers find that to help a baby deal with fast flow they need to break the rules of "good positioning.? Babies with suck, swallow and breathe issues, or babies with GERD-reflux, are examples where this is the case. Even babies with effective breastfeeding skills have times when they prefer the option of a slower flow, for instance, when a mother?s breasts are heavy with milk.
To find your baby?s preferred position, watch his cues and be open to assist him as he shifts and adjusts himself--even if the adjustment is unorthodox.
Remember, while the principals of "good positioning" are useful in resolving some breastfeeding difficulties, being locked into a form and not being mindful of how the baby reacts to it can cause problems. At times, we focus so much on an "effective? nursing position that we don?t get the baby?s subtle message that he is finding it challenging.
Let the baby control the position and latch
? Let the baby choose to turn his head to the breast but keep his tummy turned out if he wants that. Don?t keep turning him back to the tummy to tummy position. Turning his body away from the breast allows him to have a more controlled swallow. The milk will not squirt so deep into his mouth. He may feel less challenged to protect his airway.
? Let the baby pull off the breast whenever he wants to. Some babies want to take a breather when the milk is coming fast.
? Let him stop if he cues you for a break. He may want to burp or pass gas and then resume nursing again.
? Let the baby test the waters. Babies may bob with their heads off and on the breast before they settle in to nurse. They will often bob three times before they settle.
? Let the baby put his little mouth on the nipple and lick with his tongue. Babies do this to assess how fast they expect the milk to flow. Is the nipple wet and spraying or dry and not yet flowing?
The baby will choose how deep to take the nipple and how close to turn into the breast from the feel of the breast and the nipple, based on his experience. Allow him to take the nipple in only as deep as he wants. This is a real leap of faith for a mother who has had her nipple in the vice of a baby?s jaws! He may now start sucking stronger and more rhythmically or be more gentle on the nipple. If he can control the position and latch, a mother may be surprised that he no longer clamps, or pushes his tongue up against his pallet to squish mom?s nipple. He no longer needs these behaviors to manage milk flow.
However, if letting the baby take the lead does not result in less clamping, a mother should look for expert help in perfecting his ineffective suck, such as a Feeding Therapist, CranioSacral Therapist or Chiropractor.
Nipple shields can help to handle milk flow
Sometimes changing the nursing position is simply not enough to fix the underlying challenge. Using a nipple shield can be an additional help because it slows down milk delivery. There are a variety of reasons to use a nipple shield. In this case, we will exclusively explore issues of milk flow. An International Board Certified Lactation Consultant can help you discover if this tool will work for you and your baby. As with other tools, there is a learning curve to use it, and it is not always the right tool for every situation.
A nipple shield is a thin, soft, flexible silicone nipple. It is placed on mother?s breast over the nipple area. The shield can help to hold the flow of milk back if the milk is coming too fast for the baby. The milk can flow into the baby's mouth only as fast as the holes in the nipple shield allow.
Without a nipple shield, the milk will drip and flow away when the baby pulls off the breast. If the baby pulled off and stopped sucking because of a too-fast flow, he may be timid when he begins to suck again. Concerned about triggering another fast flow, he may not suck vigorously enough to start the milk flow.
With the shield in place, if the baby pulls off the breast or stops sucking, the milk will remain in the shield. Once the baby takes the nipple again and starts to suck the milk in the shield will flow right away and he can control the flow. Many babies feel less overwhelmed and challenged, and will begin to suck vigorously again.
A mother?s overabundant milk supply can create special challenges
Having "too much" milk can cause some difficulties. Mothers with an overabundant milk supply are prone to plugged ducts and breast infections from inadequate drainage. Babies can become stressed because they are not getting their comfort needs met. Every time the baby sucks, he gets a lot of milk that he has to struggle to deal with. He may signal that he wants to nurse, but then fuss and become unhappy once the milk lets down. What should have been peaceful nursing session turns into a fretful time.
Even though having too much milk presents problems, the mother may find that others do not recognize her challenges, and that dealing with her issues is a lonely road to travel.
About oversupply
A mother?s milk supply can be overabundant for many reasons. A mother may arrive at oversupply because she originally overused the strategy of pumping to relieve engorgement. The removal of much more milk than her baby could comfortably hold can result in building a supply too large for her baby's needs. Once a mother gets into a cycle of pumping, she may find it hard to break. The good news is that changes in breastfeeding management can bring the milk supply under control.
Some mothers find that their supply swings from too much to not enough. The mother may find, if she does not sleep enough, eat and drink just the right foods to support lactation, or has more stress than usual, her supply responds with a drop in volume. This rollercoaster can make for a stressful ride.
On the other end of the spectrum, some mothers have hormonal issues such as Polycystic Ovary Syndrome (PCOS), which can cause supply issues. About a third of mothers with PCOS have overproduction, while another third has low supply.
SLOW MILK FLOW
Slow Flow Management with Tailored Breastfeeding
Baby behaviors related to wanting faster flow
When milk delivery is slower than baby wants:
? He may tug at the nipple pulling back his head while holding his mother's breast in his mouth.
? He may clamp down then release then clamp down again chewing at the nipple to get squirts of milk by compression.
? He may appear uncomfortable at the breast, squirming or whimpering.
In an attempt to increase the rate of milk flow, a baby may:
? Massage or knead the breast with his fist or fingers
? Stimulate the other nipple with his fingers to increase milk flow, twiddling the other nipple
? Tug at the breast while arching his back
? Nuzzle his head into the breast rolling his head into the breast like a little goat
Breast stimulation to increase the flow
Breast stimulation is a time-honored method of increasing milk flow. When a baby signals that he wants a faster flow, for instance, during the time of the day when a mother?s supply is lowest, a mother can stimulate one or both breasts to increase the flow. With her free hand, a mother can gently compress the breast the baby is feeding on. She will notice that he begins swallowing more quickly again. A mother can also pump the second breast while the baby is nursing, or stimulate her other nipple to increase the body?s production of oxytocin, the hormone for milk ejection.
It is important to watch the baby to be sure he likes the resulting increase in milk flow. If baby reacts negatively to the increased milk flow, avoid pumping or stimulating the other breast when the breast is full and the flow is the heaviest.
In general, early in the nursing session when a baby?s appetite is heaviest, he will appreciate faster flow. He may want to switch to the other breast even though the first breast has not softened all the way in order to continue having a strong flow. Watch the baby?s behavior to know when to use breast compression to increase his milk flow or when to switch to the faster-flowing breast.
Breast compression can help a baby whose feeding skills are not yet established. When the milk flows more easily, he feels more successful at the breast. Switching the baby from breast to breast, and using breast compression, can help him get more milk then he would without his mother?s help, and build his confidence for feeding.
Breast pumps
Pumps that can be set to pump one breast at a time are good for pumping while nursing when a mother needs to increase her volume of breastmilk to the baby:
? A piston driven electric breast pump such as the SMB or Lact E pumps by Ameda/Hollister, or the Classic? or Symphony® pumps by Medela
? a battery pump such as the Whisper Wear Pump;
? a hand breast pump such as the One Hand Pump by Ameda/Holister or the Harmony? by Medela
Building a supply
A piston driven electric breast pump such as the SMB or Lact E pumps by Ameda/Hollister, or the Classic? by Medela are my recommendations for building a milk supply.
Slow flowing milk can be a frustration to you and your baby. Slow flow often goes hand in hand with low supply.
Discovering whether it is your baby?s technique that is causing slow flow, or if you are having difficulties manufacturing the quantity of milk your baby needs can be frustrating and frightening. It is a typical chicken or egg question. Which came first? Is the baby not breastfeeding effectively so mother has a lowered milk supply, or is a mother? milk supply not developing well resulting in a baby who is not nursing well?
Building milk supply involves learning many new things. Entwined in each learning step are strong and sometimes difficult emotions. For instance, mothers must learn about pumping. They may feel saddened at being plugged into a pump rather than snuggling their new baby. Through trial and error, they learn which pumps work for them, and they watch the precious drops of milk fill the container. Mothers struggle to discover how often and for how long they need to pump?there are no rules that apply to all mothers. They learn about storing milk and sterilizing bottles, and about which bottle nipples flow fast and which slow. They learn about herbs such as fenugreek to build a milk supply, and goat?s rue to grow breast tissue. They learn about mother food that can help support milk supply, and they explore the differences between the medications domperidone and Reglan for enhancing their milk supply. They learn about PCOS and other hormonal issues that can have an impact on milk supply, and they learn about supplemental feeding devices.
It makes many families sad that the quantity of mother?s milk their baby needs is not available. If you are having breastfeeding challenges, we send you hugs. You are not alone.
Importance of recognizing milk flow issues
If milk flow problems are not recognized and addressed, serious problems can develop for the mother and the baby.
? Ultimately, a mother?s milk supply can suffer, and if she does not realize that she is producing less milk, her baby may not get enough nourishment.
? A baby may fall asleep at the breasts in response to a too fast or too slow milk flow. This may be his way of coping.
? He may cry and fuss even before he is at the breast because he anticipates the difficulties to come. It is painful for the whole family and mother often feels rejected when a baby is going through breast refusal.
? His stamina at the breast is reduced when a baby does not gain weight well. Eventually, he may go on a breastfeeding strike.
? When a baby finds a way to feed less than he needs to grow, his reduced feeding can lead to his mother having a reduced milk supply.
Problem resolution with "Tailored Breastfeeding"
Every nursing mother has times when her milk flow does not match her baby?s wants. A mother?s milk flow can change, and may be temporarily too fast or too slow. Perhaps a baby who can usually handle his mother?s milk flow now has a cold and the faster flow is troubling him. Perhaps his appetite is building and he wants more milk. It may also be that he was not feeling well, nursed more for comfort, and built his mother?s milk supply beyond what he wants.
If your baby nurses well some of the time, tugs at others, and he is gaining well without supplements, then the solution for you may be as straightforward as letting him decide when to change to the other breast. While ?switch nursing? is a time-tested way of building a milk supply, this is switch nursing with a twist. Instead of insisting that the baby stay on the first breast for a given amount of time, or until he has completely drained the first breast, the mother follows the baby?s cues for switching. This is part of ?Tailored Breastfeeding.?
Sometimes the baby?s appetite for fast flowing milk is greater than the fast flowing volume in the breast he is currently using. He will happily settle on the second breast even though he did not drain the first breast yet. He may want to move back to the breast with less milk as his tummy fills. He may move back and forth from one breast to another in each feeding. He may want to move from the first breast to the second even though the milk has not totally drained. Think again of Morgan?s Rule of Thumb for Milk Flow: The firmer the breast the faster the flow.
Generally, later in the day the milk flow is less copious than in the earlier hours of the day. A baby may want to move back and forth twice during late afternoon or early evening nursings, but only want one breast in the morning if his mother?s breasts are super full and fast flowing.
If your baby has drained both breasts and still tugs and wants more after you have let him switch back and forth twice, you can distract him by changing activities for at least 20 minutes. Mom can have a glass of water and a lactogenic snack. If he still wants to breastfeed, the delay and moms energy boost will have allowed for some breast fill-up time. He will be happy to have some faster-flowing milk and will be less likely to tug, but will settle down for some unwind time.
Chronically frustrated babies may refuse to breastfeed
If the milk flow situation becomes chronically frustrating to the baby, he may refuse to breastfeed because he does not feel successful. Sometimes using special feeding devices such as the Lact-Aid® or the Supplemental Feeding System? (SNS) ? by Medela can help the baby feel successful while the underlying problems are addressed.
Recognizing the importance of milk flow to your baby and discovering his preferred milk flow can help you and you baby tailor the breastfeeding relationship. Tuning in to your baby?s body language as it relates to milk flow can help you discover new ways of communicating with your baby. What a great adventure that is!
www.birthandbreastfeeding.com/galacatagogues.htm herb info for colicky babies
Cabbage is really a neat vegetable. There are studies comparing compresses of cabbage and ice packs with similar results. In my practice I see women who use this comfortably. it seems to contain natural sulfur compounds and a natural pain relievers. Just use clean cool leaves. If you are combating engorgement just use it for 20 minutes 3- 4 times daily
HTTP://WWW.ASKDRSEARS.COM/HTML/2/T027100.ASP - HEAPS OF FACTS FOR BF
INCREASING YOUR MILK SUPPLY
OUR ONE-MONTH-OLD DOESN'T SEEM TO BE GAINING AS MUCH WEIGHT AS HE SHOULD. HOW CAN I INCREASE MY MILK SUPPLY?
Remember the three B's of breastfeeding: the breast, the baby, and the brain. To increase your milk supply, the breast needs more stimulation from the baby and making that happen will require some adjustments in your brain. To increase your milk supply, you have to make breastfeeding a priority.
? Increase feeding frequency. Breastfeed your baby at least every two hours during the day. If your baby has been napping for more than two hours, wake her up for a feeding. (See Waking the Sleepy Baby.) Consider waking your baby for at least one extra night feeding, too, especially if you have a baby who sleeps for more than a four or five hour stretch at night.
? Don't wait for your breasts to "fill up" to determine when it's time for another feeding. There is always milk in your breasts for your baby, and more milk is made while you feed. Studies have shown that fat levels in milk are higher when the time between feedings is shorter. This means when you offer the breast again minutes after the last feeding (when your breasts may still feel "empty"), your baby is getting high-fat milk that will help him gain weight.
? Offer the breast more often. The "law of supply and demand" that governs milk production implies that babies will demand the milk they need. Yet, this does not always work. Some babies, especially sleepy babies and those with mellow personalities, may not breastfeed as frequently as they need to without mother doing a bit of prodding. If this sounds like your baby, you need to take the lead and give your baby more frequent opportunities to nurse. Skin-to-skin contact, nap and night nursing, and sling feeding will help to stimulate longer, more frequent feedings.
? Nurse longer. Don't limit the length of your baby's feedings to a predetermined number of minutes on each side. Allow your baby to finish the first breast before switching to the other side. This gives baby an opportunity to fill up on the high-fat hindmilk brought down by the milk-ejection reflex. If you switch your baby to the second side too soon, he'll fill up on the watery foremilk, which will make his tummy feel full but may not give him enough calories to grow.
? Try switch nursing. The advice in the previous point about finishing the first breast first may not work well for babies who suck at a leisurely pace or who fall asleep a few minutes into a feeding. Switch nursing will encourage a baby to suck more vigorously for a longer period of time so that he gets more of the creamier, high-fat hindmilk. In switch nursing, you let the baby feed on the first breast until the intensity of his suck and swallow diminishes. Before he drifts off into comfort sucking, sit him up and switch him to the other breast and encourage him to nurse actively again. When his sucking slows, go back to the first breast, and finally, finish feeding on the other breast. Burp him or change his diaper between sides, if that will help to wake him.
? Try double-nursing. This is an alternative to switch nursing. After you feed your baby and he seems finished, hold or carry him upright and awake for 10 to 20 minutes, allowing any trapped air bubbles to be burped up. This makes room for more milk. Then feed him again on both breasts before you let him go to sleep. Double nursing, like switch nursing, stimulates more milk ejection reflexes, thus increasing the volume and calorie content of your milk.
? Undress baby during feedings. Skin-to-skin contact helps awaken sleepy babies and stimulates less enthusiastic feeders. Undress baby down to his diaper. To maximize skin contact, take off your bra and wear a shirt that you can unbutton all the way down the front. To prevent baby from getting chilled, place a blanket around his back.
? Nap and night nurse. One of the most powerful ways to stimulate increased milk production is to "take your baby to bed and nurse." This relaxes both you and your baby and stimulates longer and more frequent nursings. It also increases your milk-producing hormones and reminds you that breastfeeding your baby is the most important thing you can do at this stage of your life together.
? Sling feed. Naturally, keeping baby inches away from his favorite cuisine will entice him to eat more. Wear your baby in a baby sling between feedings, even when he is napping. In fact, some babies feed better and more often when on the move.
? Get focused. Take inventory of your lifestyle. What activities and worries are draining away energy that could be better spent in caring for yourself and your baby? Are you trying to do too much, so that you're not taking enough time to sit down and feed and enjoy your baby? To make more milk for your baby, you have to make breastfeeding and taking care of yourself a priority. Let go of other responsibilities for a while. Have your partner share in non-feeding infant care, so that you can rest, take a walk, or take a shower.
? Get household help. Get help with laundry, dishes, cooking, and cleaning. If you have a demanding toddler, hire a teen to come to your house after school to entertain your older child and give you a few hours of relief so you can sit and relax and nurse your baby.
? No pacifiers, no bottles. When there are concerns about weight gain, all your baby's sucking should be done at the breast. Bottles of formula will interfere with the balance between your milk supply and baby's need, so will satisfying baby's sucking need with a pacifier. If it is medically necessary to give your baby supplementary feedings, try alternatives to bottles that don't involve artificial nipples.
? Think baby, think milk. While you are feeding, stroke and calm your baby using a lot of skin-to-skin contact - a practice called grooming. Enjoy his sweet face and the feel of his skin. This will help your milk ejection reflex. The milk ejection reflex squeezes the milk you make out of the milk glands and down into the ducts and milk sinuses where it's available to the baby. Between breastfeedings and immediately before a feeding, imagine your infant nursing at your breast and your breasts pouring out milk to satisfy your baby.
? Try herbs to increase your milk supply. There are no scientific studies that show that certain herbs will make you produce more milk, but some mothers and lactation consultants believe that certain herbs can stimulate your body to make more milk. (See "Galactogogues" for more information.) Remember, though, that an herbal tea or other concoction can not substitute for more frequent nursing as a way to tell your body to make more milk.
? Get professional help. Contact your local La Leche League Leader and/or a professional lactation consultant for tips on increasing your milk supply. A lactation consultant can help you evaluate your baby's latch-on and suck so you can be certain that baby is nursing effectively. Support from a La Leche League Leader or the other mothers in a La Leche League Group will help you feel more confident about your ability to nourish your baby.
? Trust that nature's system works. If you're nursing often enough, and baby is sucking effectively, you will make enough milk. It's rare that a mother is unable to produce enough milk for her baby. And while it may seem that your life is stressful, mothers throughout history have breastfed their babies through war, famine, and personal tragedies. Your body nourished this baby through pregnancy. There's no reason to think that you won't succeed at breastfeeding.
? Massaging your MER. Giving your breast just the right touch can help trigger your MER, especially if your breasts are engorged, your nipples are sore, or your baby is impatient.
- Apply a warm compress to your breast, such as a warm towel or cloth diaper soaked in warm water. Then, with your fingertips, stroke from the top of the breast down and over the nipple, using a light feather touch. This helps you relax and helps stimulate your oxytocin.
- Using a motion similar to the one you use when examining your breasts, massage the milk-producing glands and ducts by pressing the breast firmly with the flat of the fingers into the chest wall, beginning at the top and working in a spiral down toward the areola. Massage in a circular motion a few strokes at a time before moving to another spot.
- While leaning forward, gently shake your breasts, allowing gravity to encourage the stimulation to release milk.
TECHNIQUES ON WAKING A SLEEPING BABY
To help baby awaken and feed more eagerly:
? Try to wake baby during REM sleep. This lighter stage of sleep is recognized by fluttering eyelids, sleep grins, clenched fists, and limbs that are not limp. A baby in deep sleep is harder to rouse.
? Prod baby a bit. Undress both of you from shoulder to waist, and place baby skin-to-skin against your tummy and breast, while you drape a towel or lightweight blanket over baby's exposed back and head. Your own body heat should keep him toasty (a mother's skin temperature automatically goes up a bit while breastfeeding) but not so toasty that he falls asleep.
? If that doesn't work, hold baby upright and talk to him to encourage him to open his eyes.
? Instead of the usual bonding positions (which relaxes babies), straighten out his body and extend his arms - postures that perk up the brain.
? Stroke the palms of his hands and soles of his feet to help him wake up.
? Rub baby's face with a cool washcloth.
? Hand express a few drops of colostrum, your supermilk. Using your moistened nipple, tickle his lower lip to stimulate him to open his mouth. Talk him into continuing to nurse with a bit of gentle chatter while you feed. If he nods off, stroke his legs or pat his back.
? Get in the habit of switching breasts as soon as baby begins to fade. Intersperse a burp or a brief back rub on the way to the other breast. This is called switch nursing.
? If baby drifts off after only a few minutes of sucking, take him off the breast and help him wake up again before latching him on to the other side. Wake him up several times if you have to, until he has nursed well for ten or fifteen minutes. When baby is done nursing, let him simply rest at your breast and lick your nipple, actions that get the milk-making hormones flowing.
When to give supplements with a cup (or a spoon or eyedropper):
? When baby has not yet learned how to latch onto the breast,
? When baby is having problems with nipple confusion
? When it's likely that baby will need supplementation for a relatively short period of time
? When an older breastfed baby refuses the bottle
When to use a supplementer:
? When baby is able to latch onto the breast, but can't get sufficient nourishment from breastfeeding alone.
? When training a baby to suck correctly at the breast (get help from a lactation consultant).
? When the need for supplements is likely to continue for several weeks. (It may take a few days to become comfortable with using a supplementer, which is why many advisors suggest cup-feeding when the need for supplements is only short-term.)
? When you wish to supplement baby at the breast and avoid the time and effort required to give baby an additional feeding after nursing sessions.
? When relactating or nursing an adopted baby.
When to use finger-feeding:
? When baby has not yet learned how to latch onto the breast
? When teaching a baby to suck correctly (get help from a lactation consultant)
A lactation consultant can help you decide which method will work best for you and your baby and can help you locate and purchase special feeding equipment. She will also help create a plan for gradually eliminating the need for supplements.
Mothers have experienced success in boosting their milk supply within 24-72 hours when taking 3 capsules of Fenugreek along with 3 capsules of Blessed Thistle per day.
? Try fenugreek seed capsules or More Milk Plus. We've seen that Nature's Way Fenugreek capsules and More Milk Plus from MotherLove Herbal Company are the best products out there to increase your milk supply safely and effectively, and that is why we sell them at The Nurture Center.
Usage of this herb is safe when used in normal doses of no more than 6 grams per day. It is listed in the US as a Generally Recognized As Safe or (GRAS) herbal.
Mothers Milk Tea
The seeds should be ground up so that water can come in contact with the inner parts when brewed inyo tea. Pour boiling water over the herbs and cover and steep for about 15 minutes. The common dosage is about 1 ounce of herb per pint of water.
2 parts Fennel
1 part Nettle
1 part Blessed Thistle
1 part Fenugreek
1/2 part Hops
www.lactationinstitute.org/MANUALEX.html - manual expression
www.traditionalmedicinals.com/ for mothers milk tea
La Leche League ? Doris 01582 560624- Runs meetings in Flitwick
NCT ?Sue Webster is new, can?t do counselling yet
Caroline in Northampton ? maybe call her if we need her £45 per private 2 hour visit
How to use feeder www.medela.com/NewFiles/pdfs/SNS_Ins_3-langIns.pdf www.expressiva.com/jb/baz_category_products.asp?p_cat_id=2&p_cat_NAME=TOPS&start=1
nursing tops
Nursing When Well-Endowed FAQ
- Use The Football Hold.
the Football Hold, the one that works best for larger women). Just remember that many traditional breastfeeding advisors don't always understand the special needs of the very well-endowed woman, and it is up to you to experiment and find what works best with your body type.
In this hold, the baby is held to one side, under your arm, like a football when running good for endowed women, for women who have had C-sections, The key to success is to use lots of pillows to bring baby to your level instead of leaning your breast into your baby.
Be sure your back is well-supported with pillows as well, and raise your knees with a small footstool.. Tuck the baby under your arm so that his head is on your lap pillow, cradled in one hand, and his bottom is against the back of the chair (his legs may need to be bent upward at the hip so that he is not arching his back by pushing against the back of the chair while trying to latch on).
Support your breast gently with your other hand, keeping your fingers away from the areola. Pre-express a small amount of milk to be sure your nipples are erect and to entice baby's sense of smell, then tickle your baby's lips with your nipple. When he opens VERY wide, pull him in quickly for a latch, being sure his lips cover most of the areola (the dark area around the nipple) and not just the nipple itself. Both his upper and lower lips should be flanged outward and you should soon hear the sound of swallowing.
If there is a problem, reposition as often as necessary, and expect to have to retry fairly frequently since both you and the baby are learning new skills. This is completely normal. Over time you will find how to latch on quickly and efficiently.
- Be Sure Baby Latches on to the Areola, Not Just the Nipple.
Your areola is the dark area surrounding your nipple. It probably got much darker during your pregnancy in order to help your baby find and focus on it, since babies see strong contrasts of color much better. Milk is stored behind the areola in milk 'sinuses.' These need to be squeezed/massaged in order to activate them into ejecting the foremilk, and to signal the body to make more milk (the hindmilk). It is very important to be sure that the baby latches on to most/all of the areola, not just the nipple. If the baby gets only the nipple or not enough areola, the baby will not get enough milk and will miss the all-important rich hindmilk. Often, the nipple itself is damaged with this kind of inadequate coverage, and is a common source of soreness in breastfeeding. Be sure, too, that the fingers supporting your breast are well-back from the areola during the process of latch-on. Fingers that are too close to or touching the areola interfere with baby getting enough areola in its mouth. This is especially a problem for women with very large areolas, so these women must take special care to keep their fingers back from the areola when supporting the breast.
moms with larger areolas will have coverage of most of the areola. It's hard to know in the latter situation whether enough areola is in baby's mouth, but the results will tell you. If baby is swallowing and seems to be getting enough milk, and if mom is not experiencing soreness and most of the areola seems to be covered, then all is probably well. If coverage seems inadequate, the problem is probably that baby is not opening wide enough and mom is settling for an inadequate opening. Baby must open WIDE in order to get enough coverage, so wait till his mouth is nearly the size of yawning before pulling him in for latching. This is not easy to wait for at first, but will become so with practice
-tickling his lips or cheek repeatedly with your nipple may help encourage him to open up. When you see him opening the appropriate amount, be ready to attach very quickly as things can change fast! Be patient if it takes many tries to get the baby on well at firstthis is a new skill for him! And if you do have to re-attach repeatedly in order to get the latch right (this is very common), be sure to detach by breaking his suction first with your little finger so you do not damage any vital breast tissue. Just slide your pinkie into the corner of his mouth between his gums until you feel and hear the suction release.
signs of dehydration (not enough wet diapers, sunken fontanel, etc.---
Mature milk can sometimes take extra time to 'come in', especially after a difficult, highly-medicated birth (and especially after a C-section), but the pre-milk (colostrum) is usually enough to sustain a baby during that extra time and is the ideal first food for baby (it is baby's first immunization, is full of antibody protections, helps protect baby's intestines against harmful bacteria, helps baby produce his first meconium stool, and is easily digestible). Colostrum is usually yellowish or clear and does not resemble milk, so don't panic if your first 'milk' doesn't look like you thought it would. It is so highly concentrated that not much is needed, so don't worry if not enough seems to be there at first---this does not indicate what your production will be once your mature milk comes in. Many women assume that if a baby cries even after nursing, he is still hungry and needs supplementation, but babies cry for many reasons and sometimes for no reason at all except to be comforted.
Check thoroughly for other reasons and resist the temptation to supplement unless the baby is showing signs of needing it. They also can help with ways to boost your production (including herbs) while supplementing so that you do not have to give up on breastfeeding.
Using unnecessary supplementary bottles early on is a common source of breastfeeding 'failure' but it is very tempting in the vulnerable post-partum state, so it happens a lot. In addition, many doctors and hospitals routinely order extra bottles and give pacifiers, setting up such 'failure', and often send free formula samples home with mom, which can be a difficult temptation to resist. Even pediatricians and new mom support groups often have free formula samples prominently on display. These free samples are unethical and a violation of World Health Organization Code, but they are still quite common. This kind of sabotage from health professionals is an outrage, but it DOES exist. Formula companies even send unsolicited
cases of free formula in the mail, New mothers who intend to breastfeed have to be very careful to avoid falling into this seductive marketing trap. Take the formula to your local battered-woman's shelter or donate it to a friend who is already bottle-feeding. Studies clearly show that giving free samples to mothers who intend to breastfeed shortens the breastfeeding period markedly.
, be sure to always NURSE FIRST and then use one of the alternatives to bottles (such as syringes, cups, spoons, or eyedroppers) that can help preserve the breastfeeding relationship (see section on "Never restrict nursing time"). Don't use bottles (or pacifiers), as many babies easily become nipple-confused and are not able to switch sucking techniques between breast and artificial nipple. In difficult cases, a supplementary nursing device such as a "Lact-Aid" can provide baby with the nourishment he needs while still preserving breastfeeding and stimulating supply (see a nursing manual for further information). Lact-Aids are reportedly MUCH better than any other supplemental nursing systems; contact Lact-Aid International, In short, do not rely on your doctor to help diagnose or rectify supply or suck problems; they are often too unaggressive in their approach and they usually have little training in lactation. You need a lactation specialist, and you need it as EARLY as possible. The same is true if you are experiencing soreness. Nursing manuals can only go so far in helping you with positioning; it often takes the eye of an experienced professional to detect subtle problems that need correcting, or to identify other potential problems such as thrush or plugged ducts. Don't let the problem escalate by delaying treatment. Furthermore, a lactation specialist can help you clearly determine whether supplementation is medically necessary and help you preserve breastfeeding, if desired, even when supplementation is necessary.
- Support The Breast When Nursing.
Be sure to support the breast with your hand in the "C" hold or with a rolled-up washcloth, especially in a cradle position. Some women find that they only need the "C" hold for latching on in the football hold, while others find they need to use it to support the breast constantly throughout the whole feed, no matter what hold they use. Experiment to find what works for you.
The "C" hold is where you use one hand (preferably your outside hand--the hand on the same side you are nursing from) to support the breast. Place your palm under your breast gently, keeping the fingers well-away from the areola (if you can place the edge of your hand against your chest wall and still be able to support the whole breast, this is desirable, but some women need to 'cheat' away from the wall a bit in order to support the breast adequately). Lightly curve your thumb around the side and top of the breast, forming the letter 'C' with your hand. Again, keep the fingers and thumb well-back from the areola, since fingers that are too close can interfere with baby's latch-on and cause him to not get enough areola in his mouth. This causes soreness in the mother, and baby is unable to access the milk sinuses behind the areola (dark area around nipple), thus not getting enough food.
Using the outside hand (i.e., the left hand if you are nursing on the left side) allows greater control over the breast than the inside (opposite) hand since the tendency in larger breasts is to fall to the outside, but use whichever hand works best for you. While the advantage of the outside hand is that it offers greater control, it does make a traditional cradle hold impossible, since this is the hand and arm usually used to hold the baby. An alternative may be to use the "cross-cuddle" hold, where the baby is supported by the opposite hand while you use the outside hand to guide the breast. Women who are moderately well-endowed may be more successful with this than those who are exceptionally endowed, but it's worth a try! Some people find a 'sling' under the breast helpful, while others find this idea distasteful. Usually, a hand or washcloth is enough, but it's vital that the hold be very gentle, as pressure from the hand may cause problems with clogging of the milk ducts or even mastitis in susceptible women. Keep it light!
- Always Bring the Baby to the Level of Your Nipple.
Always bring the baby to your breast, never your breast to the baby. Never lean into the baby. Don't be afraid to use lots of pillows by your side or on your lap in the football hold, and don't forget a few pillows behind your back to support it too. A reading pillow or lumbar support pillow behind your back is especially helpful. When using the cradle position, try letting the older baby rest between your legs instead of on top of them in order to bring him to the right level, or order a special nursing pillow to help baby be at the correct height (these are available in larger sizes; see the Clothing FAQ on this website). If your back hurts when nursing, you are probably trying to lean into the baby too much instead of bringing the baby to your level.
- Set Up a Nursing Station.
Wherever you will be nursing frequently, set up a nursing station, complete with pillows, footstool, recliner if desired, flat surface for glass of ice water or one-handed healthy snacks, extra burping cloths, etc. Have one station upstairs and one downstairs, or as needed. It is important not to have to constantly fetch pillows and rearrange them whenever baby needs to nurse, and it's terribly inconvenient to have to get up in the middle of a nursing session to get a glass of water (staying well-hydrated is critical to mom's supply). Consider getting a plush recliner for wherever you nurse the most; they are heaven for many well-endowed nursing moms.
- Find a Way to Sleep and Nurse.
Sleep is a very precious commodity to a new mom, so find a nursing position you can sleep and doze in. Some well-endowed women are able to nurse when prone, but others find it too difficult. It is very difficult to describe without illustrations how to nurse when prone, but basically, mom is on her side in bed. It is important that her back not be at a 90 degree angle (
l ) to the bed, but at about a 45 degree angle instead (either
\\ or
/ depending on whether she wants to nurse from the top or bottom breast). She should use pillows behind the back to support herself in this position. Baby should be tummy-to-tummy with her. Mom then places her fingers beneath the breast and lifts upwards (if using the lower breast) or (for the top breast) leans over while supporting the breast and latches baby on when he roots with a nice wide mouth. (Remember, good areola coverage is vital!)
A few mothers find it easier to have baby 'upside down' so that baby's feet are near mom's head and his belly is opposite her face. This is more uncommon but if it works---great! Another possibility is the "Australian" hold, where mom lies flat on her back on the bed. She latches baby on to the breast while the rest of baby's body is held gently at an angle to her side, halfway on and halfway off of her body. Some feel that this position is better saved for when baby is older and has better head control, but not everyone agrees. Other women just sit up in bed, being sure they have adequate back support, and doze while nursing in a sitting position. Your partner can be your backrest!
Most women find it easiest to nurse at night if baby sleeps with them (be sure your bed is not too soft and that there are no gaps where baby could become trapped, don't use a waterbed, etc.). Other women find that having baby in a crib or bassinet beside the bed allows them to sleep better while still offering quick access in the night (this is called a 'sidecar' arrangement). Others prefer that baby sleep in its own room in a crib, but this means getting up every time baby needs to nurse in the night. In this situation, you may wish to invest in a plush recliner for your bedroom or nursery. Then use pillows to support baby and your back, lean back, and nurse in the football hold while you grab some winks. This is also very comfortable for the end of pregnancy when a good sleeping position is hard to find, or if heartburn is a problem! Recliners, whether used in the bedroom or living room, are a terrific aid for a well-endowed nursing mom, so if at all possible, you should definitely plan to get one, preferably in the latter stages of pregnancy.
It is vital to feed baby frequently at night (don't expect baby to 'sleep through the night' for quite a while yet), so experiment to find whatever arrangement best fits your situation and still allows you to grab some sleep. Try all of these suggestions and find what works best for YOU.
- Buy a GREAT-Fitting Nursing Bra!
Goddess 510, Leading Lady 491, Motherwear 'Extra Support' are all good large-cup nursing bras, and Custom Couture's . Bra back extenders are often a must in late pregnancy and early engorgement in order to extend the fit for a temporary increase in size at these times, and they can easily be removed after engorgement when you find your regular long-term nursing size. Oftentimes, a nursing bra may feel a bit uncomfortable at first, due to the expansion of your ribcage due to baby, but an extender can ease this transition. However, if your bra is very uncomfortable, return it immediately