Author: Meghan Crovo

Gender Confirmation Surgery

/ Meghan Crovo

Gender confirmation surgeries are any surgeries performed to alter a transgender person’s physical appearance to resemble attributes socially accepted as the gender they identify with. Gender affirmation surgery provides individuals the ability to physically look, function, and move through society in a way that aligns with who they are.

Not all transgender people choose to undergo gender confirmation surgery, but for some, it is a central part of their transition process. Gender confirmation surgery in Tarzana is available to those who feel they would benefit from it.  A consultation with our qualified staff is a great place to find out more information and get your questions answered. 

Facial Affirmation Procedures

Facial gender surgery is a series of procedures that can either feminize or masculinize the face to provide a more gender-affirming appearance. Both surgical and non-surgical options are available so individuals can choose from minimally invasive procedures like injectables to surgeries like rhinoplasty. Forehead, cheek, and jaw contouring are all cosmetic procedures used in Tarzana to support gender confirmation surgery. Lip augmentation and tracheal shaves are additional procedures that generally provide satisfactory results. 

Transfeminine top Surgery

Transfeminine top surgery feminizes the chest via breast augmentation surgery. A trained surgeon enlarges and shapes the chest using implants to create the desired result. Individuals who undergo this procedure have various options to choose from depending on the look they want. 

Transfeminine Bottom Surgery 

Transfeminine bottom surgery aims to transform male genitalia into female appearing genitalia. Tarzana residents interested in male to female bottom surgery can receive vaginoplasty, vulvoplasty, or orchiectomy. What procedure they choose depends on what their goals are.

Vaginoplasty provides the patient both a vulva, which is the external part of the female genitalia, and vagina, the tube that connects external genitalia with internal female reproductive organs. Vulvoplasty creates external genitalia but does not manufacture a vagina. Most people who were assigned male at birth that receive these procedures can achieve orgasms. Orchiectomy removes the testicles and may simplify hormone therapy for individuals who choose this procedure.   

Transmasculine top Surgery

Transmasculine top surgery masculinizes the chest using a procedure called mastectomy. A mastectomy removes breast tissue but leaves muscle tissue. An experienced surgeon then shapes the chest and alters the nipples to produce masculine features. There are many techniques used for this procedure. The proper treatment for the client depends on multiple factors like the amount of breast tissue and whether nipple sensation is a priority.

Transmasculine bottom Surgery

Transmasculine bottom surgery aims to transform female genitalia into male appearing genitalia. Individuals who are assigned female at birth have several options for their bottom confirmation surgery in Tarzan. They can choose to remove their uterus, ovaries, and vagina in addition to creating a phallus. Metoidioplasty and phalloplasty are two ways to produce male appearing genitalia, and both usually preserve the individual’s ability to orgasm.  

Metoidioplasty is a surgery that creates a small penis by utilizing existing genital tissue. Once the clitoris enlarges through hormone therapy, a surgeon will remove supporting tissue and release the clitoris. The clitoris rotates outwards, creating a phallus-like structure. Some trans individuals may choose to have their urethra elongated and vagina surgically closed. Surgeons can also build a scrotum using tissue from labia and add testicular implants.  

With a phalloplasty, a surgeon constructs male genitalia from grafted skin. Surgeons usually take skin from the forearm. The goal is to create a penis of sufficient size, appearance, and sensation with a urethra that enables standing urination. Phalloplasty is a complex surgery and often done using a multi-stage approach. As with Metoidioplasty, the surgeon can create a scrotum and add testicular implants. 

Tarzana Patients Transitioning with Gender Confirmation Surgery 

Our warm staff, inclusive atmosphere, and talented surgeons are available to support you through this challenging and exciting journey. We welcome your questions and embrace your decisions. Whether it is one surgery or many, we can help you decide what you need to move through life as your authentic self. 

Not all transgender people want to or can undergo surgery. It is crucial to know that your gender is valid no matter what your body presents as. The surgeries available to you do not change your gender; they change your body to better match your gender. For those who want gender confirmation surgery in Tarzana, it can be profoundly affirming, but it is not suitable for everyone. We are here to assist you along the path as you decide if surgery is the right direction.

Understanding the Different Types of Breast Implants

/ Meghan Crovo

Understanding the Different Types of Breast Implants

Breast augmentation surgery is common and involves inserting implants into the breast tissue. Patients who want to increase satisfaction with breast appearance in size, shape, or both often seek breast implants. Breast augmentation performed on patients who have suffered a loss of breast tissue due to injury or illness is considered breast reconstruction surgery. Whether you seek breast augmentation or breast reconstruction, understanding the different types of breast implants will help you along this journey. 

Types of Breast Implants

Breast implants have two main categories: silicone and saline. These two categories refer to the silicone gel or the saline water used to fill the outer shell. Patients do not commonly understand that both types of breast implants (saline and silicone) are contained inside a silicone case. This casing comes in different shapes and can either be smooth or textured. 

Saline Implants

A sterile saltwater solution called saline fills these implants. If a leak or rupture occurs with saline implants, a collapse is often experienced, which provides a good indicator of implant malfunction. If a rupture occurs, the saline is sterile and absorbed by the body without issues. Saline is thought by some to create a less natural feel than silicone and may cause a rippling-like appearance under the skin. Saline implants are placed inside the breast tissue and then filled, which requires a smaller incision than its silicone counterpart. They are also less expensive than silicone. 

Silicone implants

These implants are filled with a silicone gel that feels closer to natural breast tissue due to a more viscous consistency than saline. If a leak occurs, it is usually slow, and the patient will not experience collapse. Because a leak does not result in a noticeable collapse, physicians recommend ultrasound or MRI screening of silicone-filled implants to ensure proper functionality. Silicone implants come prefilled and therefore require a larger incision during placement. 

Structured saline implants

These implants are filled with saline and offer the benefits of saline with the natural feel of silicone. Structured saline implants are sometimes understood to be a third type of breast implant. 

Textured implants

Textured implants have a textured outer shell that allows for the surrounding tissues to scar onto the casing. This scaring helps to hold the implant in place, therefore, diminishing the risk of implant repositioning. The textured implants also decrease the risk of capsular contracture. Textured implants can be either silicone or saline. 

Smooth implants

Smooth implants are the softest feeling of the breast implant options and can move within the breast cavity made during surgery. The ability of these implants to move freely often gives a more natural-looking movement when breasts are in motion. Smooth implants are round and can be either silicone or saline. 

Round implants

Round implants are best for patients who desire a more prominent and fuller appearance and offer a higher profile with more projection. Because these implants are entirely round, rotation within the breast cavity is generally not a concern. Round implants can be either silicone or saline and have a textured or smooth casing. 

Teardrop implants

These implants mimic a more anatomically correct shape by starting with less fullness at the top and widening towards the bottom, like a teardrop. Due to the asymmetry of these implants, rotation within the breast cavity may result in an abnormally shaped breast. Because of this, a textured casing is used to help reduce the risk of rotation.  Teardrop implants can be either silicone or saline but have a textured outer shell. 

Gummy bear implants

This different type of breast implant, also called form-stable, contains thicker silicone gel than traditional silicone implants. Gummy bear implants will maintain shape even if the implant case acquires a tear or break and are less likely to rupture and deflate. Gummy bear implants have a firmer feel than other implants. Should rotation occur, the breast may have an abnormal appearance due to the shape of this type of implant. The patient should understand that additional surgery is required to correct implant rotation. 

Understanding Breast Implant Options

If you have considered breast enhancement surgery, you know researching your options can be confusing. Deciding if breast augmentation is right for you starts with learning the basics. Knowing your options empowers you to make choices you are happy with for years to come. While only your doctor can help you decide which implant is right for you, understanding the different types of breast implants can give you the confidence you need to move forward on this exciting path.

OBGYN Care

/ Meghan Crovo

Finding time to get into a well-women exam is hard enough. Finding the right obstetrician-gynecologist to meet a patient’s specific healthcare needs can be even more challenging. The right OBGYN in Leesburg makes individuals feel safe, comfortable, and cared for regardless of age or OBGYN needs. Leesburg OBGYNs offer care for many phases of life, from puberty through menopause and everything in between. 

It is a priority to supply patients with comfortable care in a welcoming and inclusive atmosphere using the latest technologies. The staff is friendly and physicians experienced, so everyone is cared for from the first call to the last appointment. The goal is to offer Leesburg patients a lifetime of comprehensive OBGYN care they will continue to appreciate as their needs change with their age. 

OBGYN Care

OBGYNs train in both obstetrics and gynecology. Because OBGYNs in Leesburg train in various healthcare needs, many women choose to use them as their primary care provider throughout life. Most patients will see their OBGYN once per year for routine care with additional visits if any concerns arise or pregnancy occurs. Joining these two fields creates continuity of care for patients as they can receive treatment from the same few doctors through puberty, pregnancy, and even into menopause.

Obstetrics

Obstetricians, or OBs, provide specialized care for pregnant patients, their unborn babies, labor and delivery, and the subsequent postnatal period. These physicians train to provide necessary prenatal care, to provide safe deliveries and healthy infants. OBs train to recognize complications or abnormalities that might occur during pregnancy, birth, or immediately after and implement interventions as needed. 

Leesburg OBs train to recognize and treat ectopic pregnancies, which is a pregnancy that occurs in the fallopian tubes and can be extremely dangerous. They also manage high blood pressure during pregnancy, a possible precursor to a more severe form of high blood pressure called preeclampsia. OBs are trained to diagnose and treat miscarriages, perform emergency, or scheduled cesarean sections, and care for mother and baby directly following birth to ensure a safe transition for both. 

Gynecology

Most gynecologists also train as obstetricians. The gynecology branch of OBGYN specializes in women’s reproductive healthcare from puberty to menopause but does not cover pregnancy and childbirth. A patient visits their gynecologist for annual pelvic exams and pap tests as well as treatment for a variety of issues outside of routine care. Many patients are surprised to find out their gynecologist can provide vaccinations, weight management, mental health support, or even skin issues like acne. 

A gynecologist can assist reproductive specialists with infertility and conception. They care for patients seeking contraception or treatment for sexually transmitted infections. Gynecologists also diagnose and treat pelvic pain, breast pain, painful intercourse, menstrual irregularities, cancers of the reproductive organs, prolapsed pelvic organs, or any other ailment concerning the reproductive organs, including the breasts, ovaries, fallopian tubes, cervix, and vagina. They support women through menopause and provide several surgeries like hysterectomies or tubal ligations. 

Finding a Leesburg OBGYN

Maintaining the same few doctors throughout an extended time creates patient-doctor trust leading to higher satisfaction. Patients are more comfortable with a doctor they are familiar with, and doctors are more knowledgeable about a patient’s health history and overall concerns when they have seen them for years, not months. Finding the right OBGYN in Leesburg can offer patients a lifetime of contented care.

Ovarian Cystectomy

/ Meghan Crovo

Many women will have or have already had an ovarian cyst. Most cysts go unnoticed and clear without any interventions. However, in some cases, cysts will persist, enlarge, and result in symptoms requiring treatment.

If you suspect you are experiencing difficulties associated with ovarian cysts learning about your options for ovarian cystectomy in Leesburg is a good start. This uncertain time of researching and learning might feel overwhelming. That’s normal. As questions get answered and options revealed, you’ll be able to move forward with fewer unknowns. Our caring staff is ready to help and support you through this process. 

Ovarian Cysts

Ovarian cysts are sacs, typically filled with blood or fluid, that reside on or in the ovary. Cysts are common, usually clear within a few months, and often occur without any indication. However, if a cyst is large enough, Leesburg patients could experience symptoms and require a treatment called ovarian cystectomy. 

Most cysts are considered physiological and arise during a women’s menstrual cycle. These cysts frequently go unnoticed and cause no issues. Other cysts, considered pathological, can cause enough discomfort to prompt a patient to contact their doctor. Rarely will a cyst be cancerous. 

Symptoms

If symptoms do present, a patient might notice the following: 

•        Dull or sharp pelvic pain on one or both sides, and often felt in the lower abdomen

•        Abdominal bloating

•        Heavy feeling in the abdomen

In rare cases, a cyst will rupture or result in torsion.  A ruptured cyst occurs when the ovarian cyst bursts open. If this happens, a patient could have sudden sharp pain, vaginal discharge or bleeding, nausea, vomiting, weakness, faintness, fever, heavy feeling or tenderness in the pelvic area, and pain with sitting. 

Torsion is a medical emergency that occurs when the ovary twists on itself. Surgery is required to untwist the ovary. Ovarian torsion can result in tissue death by cutting off blood supply to the ovary. Women who experience ovarian torsion will have sudden and severe pain. Nausea and vomiting are likely as well.  Anytime a patient has sudden, severe pain in the abdominal or pelvic area, they should see a doctor immediately.

Cystectomy Procedure

Ovarian cystectomy is a surgical procedure to remove ovarian cysts. A Leesburg surgeon can remove certain ovarian cysts with a minimally invasive laparoscopic cystectomy using small incisions made in the abdomen. 

A doctor will administer general anesthesia, and an incision is made, usually in the naval.  The surgeon will bloat the stomach with air or gas, allowing for better accessibility to the internal pelvic structures. Two or three more incisions are made for the surgeon to access the ovaries with slender instruments. The surgeon then excises the cysts and removes them through the small incisions. 

Recovery

Minimally invasive laparoscopic cystectomy is an outpatient procedure, meaning most patients will go home the same day as their operation. After surgery, the gas used to expand the abdomen may travel into the shoulder joints and cause a dull ache. Patients may also have tenderness and bruising around the naval and other incisions. The first week most patients feel more tired than usual and will need to rest. Activity can slowly increase as tolerated until the patient has reached full abilities again. 

Minimally Invasive Cystectomy in Leesburg

Finding out you need surgery to treat your ovarian cysts can be scary. We understand this is a stressful time in your life. The goal is to ease that stress by answering your questions, supporting your decisions, and providing a minimally invasive option for your cystectomy. 

Reach out to schedule an appointment if you have been told you need surgery for your ovarian cysts or if you suspect you have symptoms of them. A qualified team is available to answer questions and offer accurate information as you navigate your ovarian cystectomy in Leesburg.

Myomectomy

/ Meghan Crovo

Uterine fibroids, also known as leiomyomas, are fibrous growths inside the uterus. They are noncancerous, nor do they increase a patient’s risk of uterine cancer. Many uterine fibroids go unnoticed and require no treatment. Most cases are not dangerous, even if symptoms do occur. They can, however, cause discomfort and affect quality of life, so accessible healthcare is vital for women experiencing uterine fibroid symptoms. One common surgical technique is known as myomectomy. There are open and minimally invasive myomectomies. 

Anytime surgery is a medical option, it is normal to feel afraid or concerned. Myomectomy in Leesburg is a laparoscopic surgery, which allows for quicker recovery times and shorter hospital stays. Because uterine fibroids often develop in women of childbearing age, preserving healthy uterine tissue is critical. Patients should know all their options and understand the risks and benefits before making a treatment decision. We know this can be a scary time, but our staff is here to discuss all options with you to help determine if this minimally invasive procedure is right for you. 

Uterine Fibroid Symptoms

Asymptomatic fibroids are common. Whether or not symptoms occur can be dependent on size, location, how many fibroids are present. Uterine fibroids can be small enough they are not visible to the naked eye or large enough to distort the uterus. Patients may have one growth or many. If symptoms are present, common ones are:

•        Backache

•        Heavy menstrual bleeding

•        Anemia associated with excessive bleeding

•        Extended menstrual periods

•        Pelvic pain or pressure

•        Constipation

•        Frequent urination

Diagnosis

Once a doctor suspects fibroids, they will likely rely on several diagnostic procedures to confirm their suspicions. The patient may undergo an ultrasound, which allows the doctor to receive images from inside the uterus using sounds waves. The diagnostic tool can give the physician an idea of the location, size, and number of fibroids. Other imaging tests, like MRI, can be used for more detailed images. If heavy or extended menstrual bleeding has occurred, the Provider may also order blood work to check for anemia. After a diagnosis, patients in Leesburg will begin discussing myomectomy options with their physician. 

Minimally Invasive Myomectomy 

Laparoscopic myomectomy is a minimally invasive treatment option for uterine fibroids. A surgeon makes small incisions in the abdomen allowing for the insertion of a thin surgical instrument that can remove the fibroids through the incisions. More significant fibroids may require a slightly larger opening for removal or cut into pieces inside a surgical bag. The surgical bag, along with all the pieces of the fibroid, is then removed through the same small incision as the less sizeable fibroids. This method ensures none of the fibroid pieces remain inside the uterus. 

Because most women who experience uterine fibroids are of childbearing age, preserving healthy uterine tissue during myomectomy is paramount. The laparoscopic procedure does not damage tissue inside the uterus or pelvic cavity. Some types of uterine fibroids can result in reduced fertility, especially if left untreated. Laparoscopic myomectomy provided in Leesburg may be of value for women who intend to become pregnant. 

Recovery

Laparoscopic myomectomy may require a hospital stay in Leesburg of about one night. The patient is then able to recover at home. Home recovery usually involves resting for two to four weeks before returning to normal activities. Sometimes uterine fibroids return, and repeated treatment becomes necessary if the patient has a reoccurrence of symptoms.

Laparoscopic Myomectomy Information in Leesburg

Not everyone is a candidate for Myomectomy in Leesburg. Talk to your doctor to see if it is right for you. The location, size, type, and number of fibroids may change your healthcare options. Trying to navigate the many treatments from medications to surgery, all while managing the discomfort of symptomatic fibroids, can be daunting. Providers are here to help map out options that are right for you.   

Receiving a diagnosis of uterine fibroids may answer questions about your symptoms, but a diagnosis can also generate even more unknowns for you. Friendly staff and knowledgeable physicians understand a diagnosis is just the start of your journey. Treating your concerns can be as important as treating your fibroids.

Endometriosis Resection Surgery

/ Meghan Crovo

If you have been diagnosed with endometriosis, you have likely dealt with terrible pain and heavy menstrual bleeding. Cramps associated with menstruation are normal, but the pain usually found with endometriosis can be unbearable. The endometrium is the tissue that lines inside the uterus. Endometriosis occurs when endometrium tissue grows outside of the uterus resulting in displaced tissue that may cause severe pain and heavy menstrual cycles. It can also reduce fertility. 

Living with endometriosis can be frightening and debilitating due to the extreme pelvic pain it can cause. Delayed diagnosis is common because it requires a surgical procedure to inspect the pelvic area for endometrial tissue. Endometriosis resection surgery in Leesburg is performed as a minimally invasive laparoscopic procedure that may allow for diagnosis and treatment in a single surgery. 

Symptoms

Endometriosis is a condition in which tissue normally found inside the uterus attaches to organs outside the uterus. It is unknown if this tissue migrates from the uterus or emerges spontaneously. Outside the uterus, this tissue acts as regular endometrium, swelling, shedding, and bleeding just as it would inside the uterus. Because blood has nowhere to exit the body, pain and scar tissue can occur. 

The tissue may be found on the exterior of the uterus, bowels, fallopian tubes, ovaries, bladder, or any other internal organs, although it usually remains within the pelvic cavity. The tissue growing in abnormal areas can pull on internal structures, which may also cause pain. In some instances, two independent organs become bound to one another by the endometrium. 

The most common symptoms of endometriosis are excessive menstrual bleeding, painful periods, pain with intercourse, or infertility. Other symptoms include diarrhea, constipation, nausea, bloating, lower back pain, and fatigue, especially during one’s period. The severity of symptoms is not an accurate indicator of the extent of the disease. Endometrial resection is the only way to diagnose this condition and is done laparoscopically in Leesburg. 

Treatment

Although hormone therapy, like birth control, can help with symptoms of endometriosis, the only way to remove the extrauterine tissue it is to excise it. Endometriosis resection is a minimally invasive surgery performed in Leesburg that may offer immediate symptom relief and restore fertility. 

The surgeon makes a small incision in the naval and inflates the abdomen with gas to make the internal structures more accessible.  The surgeon then inserts a slender tool called a laparoscope to view inside the abdomen and look for adhesions. Abnormal extrauterine tissue is removed through additional small incisions and sent to the lab to confirm suspected endometriosis. The adhesions, and any associated scar tissue, are removed while maintaining the healthy tissue around it. 

For most patients in Leesburg, endometriosis resection surgery is an outpatient procedure. After surgery, patients may experience shoulder pain and discomfort due to excess gas left in the abdominal cavity that rises when they sit up. The gas will eventually dissipate shortly after surgery.  Unfortunately, some people with endometriosis will have a reoccurrence of adhesions and require additional surgery. Birth control and other hormone therapies can help reduce this risk. 

Choosing Resection Surgery in Leesburg for Endometriosis 

Endometriosis is often mistaken for other disorders like pelvic inflammatory disease or irritable bowel syndrome. Often women will be suffering for years before they put a name to their symptoms. After living with the intense pain of endometriosis, a diagnosis can be a relief, but it is understandable to be anxious about your condition and subsequent treatment. Our caring team is here to make each step of this process as smooth as possible and get you back to living your life.  Endometriosis Resection Surgery in Leesburg is minimally invasive, usually outpatient, and a common choice for doctors and patients when it comes to treatment. Whether you are ready to undergo surgery as soon as possible or need time to consider your options experienced, staff are nearby to support you. 

Male Plastic Surgery

/ Meghan Crovo

Although cosmetic procedures have never been gendered, it is no secret women make up most consumers in this industry, but men are catching up. Male plastic surgery in Maryland is more mainstream than it has ever been before. As a result, more and more men are feeling comfortable going under the knife. They realize they can benefit from it just as women have for years. 

Male tailored procedures are becoming more available than ever as demand goes up. It is now more convenient than ever for men to jump into this industry alongside their female counterparts. If you feel unsure of your place as a male seeking plastic surgery, our staff is here to assuage your apprehensions and meet your unique needs. 

Frequently Requested Plastic Surgeries Among Men

Men seek out cosmetic treatments more than the magazines and TV shows illustrate. As more men speak out about their satisfaction with plastic surgery in Maryland, more men obtain it for themselves. Most procedures done on women are also options for men but with modifications to masculinize the outcome. 

Liposuction Surgery

Liposuction removes fat by sucking it out from under the skin and is a common plastic surgery performed on both men and women in Maryland. However, it is done quite differently for each gender. For men, it is not just about looking thinner; it is about enhancing muscles and maintaining or sculpting a masculine physique. For instance, a surgeon might remove belly fat while also heightening obliques.

Eye Lift Surgery

As men age, they often see it first in their eyes. Blepharoplasty, or eye lift surgery, is one cosmetic enhancement technique regularly requested by men. A man might first notice bags under his eyes or drooping eyelids making him look tired. In more severe cases, the patient will experience vision obstruction. Blepharoplasty can be done on upper, lower, or both lids and usually provides significant results for a relatively simple procedure. 

Gynecomastia Surgery

Gynecomastia surgery is a plastic surgery available in Maryland known as male breast reduction. Gynecomastia is a condition in which enlarged breast tissue appears on men and is one of the most frequent procedures performed on men. Treatment for gynecomastia involves a liposuction procedure to remove excess breast tissue and contour the pectoral muscles to create a masculine look. 

Hair Transplant

Most men will experience baldness as they age, some starting as young as 35 years old, which is one reason why men frequently request hair transplants. Today’s hair transplants are nothing like older techniques where large clusters of hair were transplanted together in the exact location. Past procedures did not look natural, and many men found that accepting male pattern baldness was a better option. Today numerous tiny holes are made with fewer hair strands for each hole. The surgeon does the transplant without sutures or scalpels, which results in a more realistic look and quicker recovery. 

Rhinoplasty

Rhinoplasty, or cosmetic surgery on the nose, is another plastic surgery often sought by males in Maryland. Although this is a popular procedure for both men and women, men usually look for a result much different than the result women are after. Many men will request a larger or more prominent nose to appear more masculine. Perfection is not the goal men are seeking; masculinity is. 

Cosmetic Surgery for Men in Maryland

Men undergo plastic surgery for the same reasons women do, which are unique and varied, but overall there is a desire to be more satisfied with their appearance. We understand that Male plastic surgery in Maryland is underrepresented and aim to provide a comfortable and welcoming environment where you can get the look you want with the support you need. 

A consultation with our staff can provide you with information about a requested procedure, ensure realistic expectations, and cover any concerns you might have. Contact us to schedule an appointment and start this exciting journey. 

Traveling and the Breastfed Baby

/ Meghan Crovo

With the holidays quickly approaching, many families are wondering how they will travel comfortably with their breastfeeding sidekick. Grandma and grandpa can’t wait to meet the new baby, aunts and uncles anxiously await your arrival, and cousins are thrilled to have a new buddy. Families with babies of any age might choose not to travel, and a baby is a perfect excuse not to, but if you’re just as excited to see grandpa as he is to see you, don’t let your nursling stop you from boarding that plane. 

Traveling with a breastfed baby can be easier than traveling with a bottle-fed baby because everything you need is contained within one very beautiful and very useful gadget called mom. Whether you plan on packing the car or boarding an airplane, here are some tips that will make your travel a little more convenient this holiday season.

In the Skies

Although most airlines will allow you to carry a child under two on your lap at no additional charge, the Federal Aviation Administration (FAA) recommends all children, no matter the age, have their own seat and be properly restrained with an approved child restraint system.1 This means you will be unable to nurse on landing or take off, as sometimes suggested to ease pressure in baby’s ears unless you choose not to restrain your child in his seat. Many moms report that it doesn’t bother baby any more than it does mom. However, if it leaves baby uncomfortable, you can always offer the breast once takeoff is complete. Make sure the car seat you choose is approved both for vehicles and airplanes, or you will not be allowed to bring it onto the plane.

If privacy is important to you, choose a seating location that allows for some seclusion. Airplane seats are very close together, so privacy on the plane can be tricky. Window seats or flights during a less busy time of day can be ways to achieve some solitude. If you choose to buckle your baby up in a car seat, some airlines will require the car seat to be in a window seat, making privacy a little more challenging for mom. 

You are not likely to be harassed while breastfeeding on a flight, but it has happened. When your plane is still on the ground before takeoff, the breastfeeding laws that protect you will be the laws present in the state where your flight is originating from. Once you are in the skies, the laws can be murky. Contact the airline before purchasing your tickets to see if they have any policies that protect breastfeeding mothers. 

If the contact was made via email, you can print the email and keep a copy with you in case any issues arise. If the contact was made via telephone, be sure to get the first and last name of the person you are speaking with and make a note of it. Knowing your state’s laws and your airline’s breastfeeding policies will help you prepare for the unfortunate (and hopefully unlikely) event you are hassled.

Getting through the airport with baby can be an ambitious goal, but it doesn’t have to be. Many moms find a soft infant carrier to be handy. It leaves two hands free, one to pull a suitcase and one to hold the hand of an older child if needed. A soft carrier can also provide you with the option of nursing while walking through the airport or waiting in line to board. 

If you are not comfortable nursing in the carrier, practice, or try another brand that might work better for you. Keep in mind some airports may require mom to take baby out of the carrier before going through security, while other airports allow baby to stay attached to mom. Calling your airport beforehand to find out their policy can help you anticipate the stress of getting through security. If you are more comfortable using a stroller to get baby through the airport, you are allowed to push the stroller to the gate and check it there. 

Don’t forget to pack in your carry-on some extra nursing pads, burp rags, diapers, a change of clothes for baby, a new top for you, baby toys, baby wipes, and some healthy snacks. Also, be sure to wear a top that can easily be pulled down or lifted for ease of breastfeeding. While on the flight, remember all the wonderful ways breastfeeding can make life with a baby easier. If baby is hungry, nurse. If baby is thirsty, nurse. If baby is tired, nurse. If baby is scared, nurse. If baby is crying, nurse. If baby is fussy, nurse. If baby is bored, nurse. Nurse! It’s not just for food. The other passengers will be (or should be) thankful. 

On the Road

Traveling by car with a baby can be challenging because everyone must always buckle in while the vehicle is on the road. This means you can’t nurse baby to sleep while your partner continues to decrease the mileage between you and your destination. Fortunately, there are options. Some families find that hitting the road around bedtime allows for baby to sleep during the bulk of their travels. For shorter road trips, consider leaving just before baby is ready for a nap. 

Plan lots of stops that are more than just getting gas and piling back in the car. Take breaks that allow everyone, including baby, to get out of the car, feel the sunshine, stretch their legs, and breathe some fresh air. Don’t forget a diaper check. Nurse at every stop, even if baby is not hungry, topping baby off can give you an extra hour on the road before you must stop again. 

Some babies enjoy the car, and others do not. If you happen to have a baby who finds car rides miserable, you or your partner can sit in the back with baby. This slight inconvenience for the parent who must now be a backseat passenger can be the one thing that enables you to make it to your destination with your sanity still intact. Sometimes babies find the back seat lonely, but they might find the ride more enjoyable with a familiar face to look at. 

At Grandma’s

Pulling up to an unfamiliar house where you don’t have any of your favorite parenting necessities can be intimidating with a new baby. Bring at least one of your most loved soft infant carriers. Choose the one you can comfortably breastfeed in while sitting in the living room with aunts, uncles, cousins, grandpa, and that one guy you only see at family gatherings but can’t remember his name. This way, you won’t feel like you must exit every time baby needs to snuggle up for food or comfort. Of course, nursing baby is also a great “excuse” to leave the crowd and seek quiet time in your own room if needed.

Nighttime can be the most challenging part of traveling. Trying to establish sleep in an unfamiliar place can make the already difficult job of nighttime parenting an achievement that requires courage, strength, and dedication. Be sure to follow a similar routine with baby on your trip as you do at home, and as always, having baby as close to mom as possible is the best way to address baby’s nighttime needs without excessively disrupting sleep. 

There are ways to ensure a smooth transition from sleep at home to sleep at grandma’s house. If you plan on having baby sleep in a crib, make sure the crib is in the same room as you. Baby will be able to hear and smell the familiarity of his mother, which will undoubtedly bring him comfort in his temporary bed. Pack the sheets you use at home while traveling and maintain a similar routine to the one you do at home. If you bathe baby, sing to baby, and then nurse baby to sleep, continue this practice no matter where you stay.

Beware of Holiday Weaning

Holiday weaning is a phenomenon we often see around the busy holidays but can happen anytime throughout the year, traveling or not. Moms get very busy shopping for presents, planning and attending holiday parties, and handing baby over to grandma to say hi. With all your family in town for Christmas, it’s easy to leave baby with Auntie while you head to get groceries for the Christmas party. 

The long lines and traffic can turn a short trip into an all-day outing, leaving Auntie the only option of offering baby the bottle of expressed breastmilk you left behind for an emergency. Meanwhile, you are unable to pump and perhaps get engorged. You get home, but baby already has a full belly of milk and doesn’t want to nurse. You don’t mind because you’re busy putting groceries away anyway. 

Then you start getting the pies ready for dinner and are a bit thankful for being able to do so without the distraction of your baby. The next day begins a similar process. After a few days of this, you are likely to experience a dip in milk supply while baby has become accustomed to the bottle and pacifier she has been receiving over the last few days and may not cue for the breast as much. In some cases, baby will refuse the breast altogether. And so, the term holiday weaning emerged.2

Tips to avoid holiday weaning2

  • If you need to run errands, consider bringing baby, especially a younger baby since they seem to be more vulnerable to the disruption in nursing.3 Younger infants are also portable in a comfortable wrap, so don’t forget your soft carrier. Practice nursing baby in the carrier before you head out to run your errands.
  • Carry baby in a soft carrier even when at home so baby can stay close and breastfeeding cues don’t go unnoticed. A sling or other soft carrier is a great way to give baby unrestricted access to the breast, therefore protecting the nursing relationship and your milk supply.4
  • Have those family members who are offering to watch baby run the errands instead.
  • Send your partner off to the store, or have your partner bake the pies. You’re a new mom. You have an excellent reason to ask for help.
  • Have a potluck-style dinner to save on cooking and prep time.
  • Agree to limit gift-giving between family and friends so that you don’t have to spend so much time shopping.
  • If limiting gifts is not an option, shop online.

Avoiding holiday weaning is ideal, but if the holiday chaos and traveling stress send you stumbling into the grasp of holiday weaning, don’t worry; you can recover.

Tips to surviving holiday weaning5

  • Lots of babywearing. I hope you brought that soft infant carrier I’ve mentioned five other times.
  • Lots of skin to skin.
  • Keep baby close during the night and the day.
  • Avoid artificial nipples like pacifiers and bottles.
  • Allow all of baby’s sucking needs to be met at the breast.
  • If the baby is completely refusing the breast, remember the most important thing is feeding baby and protecting your supply. Pump or hand express your breastmilk and provide it to baby using an alternative feeding method. If a bottle must be used, practice paced bottle feeding.6
  • Take a bath with baby.
  • Offer the breast when baby is asleep or sleepy.
  • Remember you are wooing baby to the breast. Keep the interactions comfortable and peaceful. Never force baby.

Wherever you go and however you get there, remember you are the expert in mothering your baby. Trust yourself as a mother and trust your baby. You and baby are a dyad designed to be together, to connect, and to communicate. Follow your instincts, and your holidays are sure to be enjoyable for the whole family, including baby.

References:

  1. Child Safety. (n.d.). Retrieved September 28, 2014, from http://www.faa.gov/passengers/fly_children/
  2. Cortez Barry, L. (2004, June-July). How to Avert Nursing Strikes during Special Occasions. LEAVEN, Vol. 40 No. 3, 56-56.
  3. Ritter, N. (2009). Holiday Weaning. New Beginnings, Vol. 28 No. 3,  30-31.
  4. Travel Recommendations For The Nursing Mother. (2010, April 21). Retrieved September 29, 2014, from http://www.cdc.gov/breastfeeding/recommendations/travel_recommendations.htm
  5. Brussel, C. (2001, July-August). When Baby Won’t Nurse. New Beginnings, Vol. 18 No. 4, 136-138.
  6. Wiessinger, D., West, D., & Pitman, T. (2010). Tear-Sheet Tool Kit. In The womanly art of breastfeeding (8th ed.). New York: Ballantine Books.

Dysphoric Milk Ejection Reflex

/ Meghan Crovo

You sit down to nurse. You’re tired and looking forward to relaxing with your squishy new baby snuggled comfortably against your chest. You can’t wait to hear those reassuring sounds as he sucks, swallows, and breathes. You are ready. Ready to soak up the warm touch of your baby’s smooth skin, to stroke his back gently with one hand while supporting him with the other. You are ready to feel his tummy move in and out against yours as you enjoy the surge of oxytocin that will pulse through your veins, telling your breasts it’s time to nurture your baby.

You have your water, your snack, and a good book. Baby latches on, you lean back, you relax, and take a deep breath as you comfortably melt into your couch, but as you exhale, you feel like something is not right; maybe you feel homesick or even helpless. You don’t know why or where this is coming from. These negative feelings, ranging from mild to severe, envelope you tightly as you struggle to understand how they could take up residence deep in the pit of your stomach while doing something you enjoy so much, breastfeeding.

A minute passes, baby begins gulping, and you know your milk has let-down. Everything feels right again. In fact, you may even forget about these feelings, but next time you sit down to nurse or even if your milk let-down occurs without a nursling at the breast, you are reminded, yet again, of these passing emotions that you struggle to understand. If this sounds familiar to you, then you might have Dysphoric Milk Ejection Reflex or D-MER.

As a new mother with my first baby, a boy, the description above is my experience. After several months the symptoms improved significantly and pretty much disappeared as we nursed into toddlerhood. By the time I was pregnant with my second baby, I had completely forgotten these poorly understood emotions. Then she was born, and the uncomfortable feelings were knocking at my breastfeeding door again.

Despite laying in my own bed or sitting on my own couch, every time I placed my brand new baby girl to the breast, I felt homesick. It would fill me up with a mild sense of doom I just couldn’t shake. The feelings were brief, so I accepted them and moved on. I began to expect these feelings just as much as I expected to see my baby start gulping. I knew they would visit just before I felt the familiar sensation of a milk release (note: not all women feel a milk ejection reflex) and expected them to leave within a minute or less.

These unexplained poorly understood feelings were consistent and predictable. In fact, they were so predictable. Even when baby wasn’t at the breast, I could tell if I was going to have a let-down because I would suddenly feel that all too frequent ickiness that started in the pit of my stomach and consumed my body like a virus.

Just as it slowly left me with my first baby, it faded with my second. It wasn’t until I stumbled upon an article about D-MER did I know that what I was experiencing had a name or even that it existed beyond my own experience. It was my “a-ha moment!” A physiological reaction to a drop in dopamine!1

What is Dysphoric Milk Ejection Reflex? 

According to D-MER.org “Dysphoric Milk Ejection Reflex is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.”2

Most women describe symptoms as lasting less than one minute. It is important to note this is not a psychological response but rather a physiological one.3 Many women with D-MER have been treated for post postpartum depression or other anxiety disorders without success.

Understanding the pathophysiology of D-MER is essential to helping women cope with, and treat, this condition. Since there has not been much research on D-MER it can only be theorized what is happening based on analyzing the symptoms of women who are experiencing this condition and comparing it to what we know about lactation and the milk ejection reflex.

The theory that fits all the pieces together best is that an abnormal dopamine drop occurs with the milk ejection reflex, causing a brief dopamine deficit. We know dopamine regulates prolactin by blocking its release. Therefore dopamine must drop for prolactin to rise, which is an essential part of lactation.

What we don’t know is when and for how long dopamine drops. It is theorized that this known and normal drop in dopamine occurs just before the milk ejection reflex. For women experiencing D-MER it is thought that dopamine drops to inappropriately low levels, thus causing the known symptoms of said condition.4

Women with D-MER may experience widely varying degrees of dysphoria. Some women may feel a little homesick, while others, in very rare instances, may experience suicidal thoughts or feelings of self-harm.

One thing that remains consistent from one mother to the next is that the symptoms will come and go quickly and are always associated with the milk ejection reflex whether baby is at the breast, mom is pumping, or mom experiences a spontaneous milk ejection reflex without physical stimulation.5 

According to the Australian Breastfeeding Association, the most commonly reported symptoms are hollow feelings in the stomach, anxiety, sadness, dread, introspectiveness, nervousness, anxiousness, emotional upset, angst, irritability, hopelessness, and something in the pit of the stomach.5 For most women, symptoms will last for about three months, while others might experience a longer duration. Less commonly for some women, symptoms of D-MER will last throughout the entire breastfeeding relationship.6

Not having D-MER with a first child is not a guarantee a breastfeeding mother won’t have it with a subsequent child; women with D-MER may experience it with every child or with just one.6 Women who are experiencing D-MER without knowing what it is may find the symptoms, even mild ones, quite difficult to manage. Not understanding what is happening can leave a mother disconcerted or distressed and could lead to premature weaning.

Since D-MER is rare and not widely understood, it can often go undiagnosed. For this reason, education both to women and healthcare professionals is critical. Many women who have suffered from D-MER find education to be the only treatment necessary, especially in mild to moderate cases. Simply labeling and understanding what she is experiencing is often enough to manage the brief dysphoria a mother feels with each milk ejection reflex.

For severe cases where the mother is at risk of weaning even after education has been offered, certain medications can effectively treat D-MER.7 Since anything that increases dopamine will help mitigate symptoms of D-MER, lifestyle choices should not be ignored when considering a treatment plan; everything from diet to physical activity could theoretically help a mom with this condition.7

All women who suspect they are experiencing D-MER should seek help from a trusted medical professional familiar with this condition.

Link to published article can be found here.

References:

  1. Depression or other negative emotions upon milk let-down (D-MER), Viewed 9 April, 2015 <http://kellymom.com/bf/concerns/mother/d-mer/&gt;
  2. Defining D-MER: What It Is, Viewed 9 April, 2015  <http://www.d-mer.org/Home_Page.html&gt;
  3. Heise AM, Wiessinger D. Dysphoric milk ejection reflex: A case report. Int Breastfeed J. 2011 Jun 6;6(1):6.
  4. D-MER (Dysphoric Milk Ejection Reflex): What is it? by Alia Macrina Heise, from Breastfeeding Today, Issue 4 (November 2010), pp. 18-20.
  5. Dysphoric Milk Ejection Reflex (D-MER), Viewed 9 April, 2015 <https://www.breastfeeding.asn.au/bfinfo/dysphoric-milk-ejection-reflex-d-mer&gt;
  6. Cox S, (2010), A case of dysphoric milk ejection reflex (D-MER), Breastfeeding Rev, 18(1):16–18.
  7. Management of D-MER, Viewed 9 April, 2015  <http://www.d-mer.org/Management_of_D-MER.html&gt;

The Importance of Colostrum

/ Meghan Crovo

When a mother brings her baby to the breast, many things happen concurrently with breastfeeding. Skin-to-skin contact occurs every time the baby sucks at the breast, which helps warm the baby up and stabilize the heart and respiratory rates.1 Oxytocin is released, decreasing mom’s chance of hemorrhage immediately after birth and increasing bonding as mom and baby get to know each other.2,3 Bringing baby to the breast also gives mom and baby a chance to recalibrate from a stimulating new life. These steps together form an engaging dance between mom and child, a dance that comforts, warms, and protects baby. Among all the steps of this dance, there is one that is only available to baby during the first few days of life, although present since mid-pregnancy. It is consumed briefly and only in small amounts, but its impact is vast. Colostrum.

Low in fat but high in protein and immunoglobulins, colostrum is extremely easy to digest and acts as a laxative. The laxative effect of colostrum is essential for an infant working on passing his first stool, meconium. The passage of meconium and subsequent early stooling will assist with the removal of excess bilirubin before being reabsorbed back into the bloodstream. Since jaundice is the product of elevated bilirubin concentrations in the blood, infants who do not pass meconium quickly are at greater risk of jaundice due to the reabsorption of bilirubin present in the infant’s stool.4 Colostrum gets to work immediately by assisting baby’s very first bowel movement!

Baby’s gut is permeable during the early days to weeks of life, leaving your baby at greater risk to allergens and pathogens passing through the loose junctions between gut cells.5,6,7 Once these allergens escape the gastrointestinal tract and enter baby’s bloodstream, sensitization can occur, leading to serious food allergies or other illnesses.5 Present in breastmilk are various types of human growth factors, including epidermal growth factor, nerve growth factor, insulinlike growth factor, and somatomedin C, with epidermal growth factor having the highest concentrations in colostrum.7 These growth factors work to seal the loose junctions in the gut, so baby isn’t as vulnerable to his new microbial environment.5,7

Sealing baby’s gut isn’t the only way colostrum helps to ensure the health of a brand-new infant whose immune system is relatively immature.8 While in utero baby receives immunoglobulin G or IgG via mom’s placenta. IgG is useful but works only in baby’s circulatory system.9 Another immunoglobulin, secretory Immunoglobulin A, or sIgA, is highly concentrated in colostrum and works where baby is most likely to experience pathogenic insult, the mucous membranes of the throat, lungs, and intestines.9 Colostrum has 13 grams per liter of this valuable immunoglobulin, while mature milk has 1 to 3 grams per liter. That’s a big difference!10,11 Even with this drop in concentration, it is important to note that overall daily production levels of sIgA remain consistent for the duration of breastfeeding. However, as your colostrum transitions to mature milk, the sIgA concentrations are diluted with other essential nutrients baby needs to grow.10,11 Considering that baby’s immature immune system is experiencing the world of pathogens for the first time, it makes sense why sIgA concentrations are so high initially—small amounts of milk for a small tummy but large amounts of immunoglobulins for a large world.

Even in amounts small enough to be measured in teaspoons, colostrum is just what baby needs to fill up his little tummy. A baby’s stomach is quite small during the first day of life, about the size of a shooter marble; this means no more than a few drops to one teaspoon (5 mls) is all baby needs to be satiated.12,13 As a new baby contentedly suckles at the breast, he enjoys a feast that fills up his tiny tummy with the exact volume and content he needs. Although 5 milliliters may not seem like a meal to mom, it is undoubtedly a complete meal for baby on his first day of life. Due to the rigid nature of the newborn stomach, consuming more than the small amount a mother’s body makes will result in regurgitation as baby gets rid of what his inflexible stomach cannot accommodate.14 So while mom blows raspberries on that smooshy belly, she can know that, like puzzle pieces, her colostrum and baby’s stomach are a perfect match!

With this knowledge of infant anatomy, one can understand the importance of a low volume but nutrient-dense food for infants during the first few days of life; it also gives a clear reason for all those short but frequent feeds baby asks for. Frequent feeding, along with infant growth, relax the stomach, and by the end of the first-week baby will enjoy larger meals of 1.5 to 2 ounces.12,13,14 By one month, there is quite a bit more variation. Some babies will continue to enjoy just one-and-a-half ounces per feed, while others will take four-and-a-half ounces.12,13,15 This means if a baby prefers meals on the smaller side of normal mom is likely to receive requests from baby to feed more often. Some mothers report feeding their babies every hour. These early weeks can seem like a lifetime. The days are long, but the year is so very short, and soon enough mom will be the one bugging her toddler to come sit down and eat.

As milk transitions from colostrum to mature milk, mom will likely notice some changes in her breasts and her baby. Baby’s sucking pattern will evolve to include more gulping. Mom’s breasts may begin to leak or feel fuller.16 Some mothers report no noticeable changes in their breasts while others report discomfort and engorgement, but the most notable changes will be in baby’s bowel movements. During the first day or two baby’s stools will be a thick, greenish-black meconium. The few days that follow, the stools will become less black and green to yellow as mom’s breasts fill with mature milk. The entire process of milk transitioning from colostrum to mature milk usually takes three to four days, with the visual changes in baby’s stool taking about one week.4,17

Like a couple learning the tango, mom and baby need each other to engage in their dance. A woman’s body is designed to feed her baby, and her baby is designed to receive food from her. This dance starts on the first day as mom’s colostrum helps baby acclimate to life outside the womb and continues throughout the breastfeeding relationship. Sometimes it will be graceful, and sometimes they will stumble. Each step pieced together, each partner giving and taking. At the end, there is a dance filled with conversations without words and beautiful nuances that contribute to baby’s physical and emotional development. From the time mom and baby take their first steps as a breastfeeding dyad to the very last nursing session, they are dancing with endless purpose.

Link to published article can be found here.

References:

  1. Moore ER et al. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants (Review). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003519.pub3/pdf on March 26, 2015.
  2. Uvnas-Moberg K. Neuroendocrinology of the mother-child interaction. Trends In Endocrinology And Metabolism: TEM 1996 May;7(4):126-31.
  3. Ross HE, Young LJ. Oxytocin and the neural mechanisms regulating social cognition and affiliative behavior. Front Neuroendocrinol 2009 October;30(4):534-47.
  • Fisher, Denise. “Breastmilk: Composition and Function.” Educational handout. Health e-learning. n.d. Online.
  • Mohrbacher, Nancy and Kathleen Kendall-Tackett. Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers. Oakland: New Harbinger Publications, Inc, 2010. Print.
  • Vukavić T. Timing of the gut closure.  J Pediatr Gastroenterol Nutr. 1984 Nov;3(5):700-3.
  • Jack Newman, MD, FRCPC 2011, How Breast Milk Protects Newborns, Viewed 1 June, 2015

<http://kellymom.com/pregnancy/bf-prep/how_breastmilk_protects_newborns/>

  • Huggins, K. The Nursing Mother’s Guide to Weaning. Boston, MA: Harvard Common Press, 2007.
  1. Picciano MF (2001) Nutrient Composition of Human Milk
  1. Slusser W et al. (1997) Breastfeeding update 1: immunology, nutrition, and advocacy
  1. Scammon RE et al. (1920) Observations on the capacity of the stomach in the first ten days of postnatal life
  1. Kent JC et al. (2006) Volume and frequency of breastfeedings and fat content of breast milk throughout the day
  1. Zangen S et al. (2001) Rapid maturation of gastric relaxation in newborn infants.
  1. Saint L et al. (1984) The yield and nutrient content of colostrum and milk of women from giving birth to 1 month post-partum
  1. 2011, When Will My Milk Come In, Viewed 1 June, 2015

<http://kellymom.com/bf/concerns/mother/when-will-my-milk-come-in/>

  1. “Is my breastfed baby getting enough?” Educational handout. La Leche League International. September 2008. Print.