by Ashley Georgakopoulos | Oct 11, 2023 | Health Conditions, Infant Care and Breastfeeding
“The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the uppermost part of the breast tissues leading into the armpits. The ducts leading from these, channel the milk to meet behind the nipple inside the areola area, and release.”
Milk flow obstruction often results from milk not fully draining from the breast, causing inflammation and tenderness. If left unaddressed, clogged ducts can develop into more severe issues like mastitis, underscoring the importance of prompt and effective resolution.
Clogged, blocked, and plugged ducts. There are many terms for the same problem. Restricted milk flow, or “milk stasis”, leading from the milk-storing alveoli (those grape-like clusters in the breasts), may lead to a fatty blockage that soon becomes painful, and even infectious mastitis, if not treated quickly enough. These clogs can very well lead to other problems and occurrences, including lower supply thresholds, nerve pain in the breast tissue, lessened pumping output and bruising sensations.
The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the uppermost part of the breast tissues leading into the armpits. The ducts leading from these, channel the milk to meet behind the nipple inside the areola area, and release. Too much compression without proper release, be it due to improper bra fitting or tight, shallow latching, can cause buildup to occur. Poor suction from latching or pumping can also prevent proper drainage which leaves behind the fattier part of the milk and may lead to the same problem.
This “network” is also designed to be tapped into frequently. If milk is allowed to sit and settle for too long, say during block feeding versus feeding frequently and on demand, the risk for blockage to occur drastically increases.
Causes of Clogged Milk Ducts
Some of the most common reasons behind clogs are:
- Poor latching – shallow, weak, uncomfortable
- Restrictive clothing and bras
- Block feeding/feeding schedules
- Incorrect flange fit or pumping technique, if pumping
- Nipple damage/blebs- secondary issues from poor latching
- Abrupt weaning
- Long stretches in between pumping, 4+ hours
- Fibroids in the breast tissue pushing on ducts/channels
- Lowered immune system
- High stress
- Thrush or bacterial infections
Symptoms of Clogged Milk Ducts
Most women can feel the backed-up milk occurring with a clog. Clogs can be anything from a tender knot in the deep tissue to a blocked outlet on the nipple, also known as a bleb. Pain may also occur while hand expressing or having a letdown, as other channels push up against it. While a small fever may occur due to localized inflammation, clogged ducts are mostly a nuisance and a pain more than anything else. Symptoms beyond these are more in line with mastitis, which is an infection of the breast tissue, and need immediate attention. Expressed milk may show strings or a grainy appearance. While this may look unappetizing, it’s completely safe to give to your baby.
Treatment for Clogged Milk Ducts
Treating clogged milk ducts involves a combination of strategies to alleviate discomfort and restore milk flow. Effective methods include frequent nursing or pumping sessions to empty the breast, using warm compresses before feeding to encourage milk flow, gentle massage towards the nipple during feeds, and ensuring proper latch and positioning. Rest, hydration, and over-the-counter pain relievers can aid in reducing inflammation. If symptoms persist or worsen, seeking guidance from a healthcare professional is recommended to prevent complications like Mastitis.
The most common forms of treatment involve warm compression, massage and nursing through it while massaging the area during the feed, however, other methods have also been shown to be effective:
- Epsom soaks – dangling the breasts in a tub of warm water with epsom salt can encourage release of the clog.
- Dangle feeding – lying baby down on a safe surface and dangling over to feed.
- Vibration and gently shaking the breast are both ways to break up a clog.
- Lecithin – a fat constituent found in foods and supplement form, such as sunflower and soy, known to help emulsify fatty milk for easier release.
- Pump – if the baby does not feed well or has already fed, pump immediately after a feed to encourage more thorough emptying and clog removal.
- Stay hydrated – this is important in flushing out potential infectious tendencies.
- Rest- really prioritize rest and recovery.
- Pain relievers can be used, just check with your care provider and utilize resources, like LactMed, for safety while breastfeeding.
- Antibiotics are NOT needed unless it progresses into mastitis.
Another important note – while massage is a primary go-to for dealing with clogs, it’s crucial to realize that the clog is in FRONT of the backed-up milk, which is the knot most feel. Massaging in front of the knot will release the clog faster, while pushing behind it may be adding to the milk back-up.
Prevention
While clogs may happen regardless of effort, there are ways to help prevent them.
- Avoid block feeding or strict schedule regimens that space out expression opportunities more than 4 hours apart
- Don’t pressure “sleeping through the night,” neither mom’s supply or the baby is designed for that
- Ensure proper latching, so as to tap into all of the milk stores
Preventing clogged milk ducts involves maintaining a consistent breastfeeding or pumping routine, ensuring proper latch and positioning to facilitate efficient milk drainage, and avoiding tight-fitting clothing that might impede milk flow. Adequate hydration and proper self-care, including managing stress levels, also play crucial roles in preventing duct blockages. Being attuned to your body and seeking assistance from a lactation consultant if issues arise can further help in proactively preventing clogged milk ducts. Addressing latching issues as quickly as possible will not only help with frequently-occurring clogs, but help prevent them from happening again. If clogged ducts are a common occurrence, rule out latching and mechanical feeding problems.
If pumping, take time to learn proper handling and technique, and just as important, flange-sizing. Just like with a shallow latch or too much compression, a flange that is too big or too small will cause the same problems. Adjust strength settings to a comfortable level to avoid compression of the ducts.
Ashley Georgakopoulos is the Lactation Director at Motif Medical and an IBCLC. Her focus is in the clinical management of breastfeeding and pumping. Ashley is also a mother who has dealt with the obstacles and joys of breastfeeding. She educates families, connects them to resources, and helps the next generation be as healthy as possible: nutritionally and sustainably.
www.motifmedical.com
by Dr. Sarah Dirks | Aug 30, 2023 | Health Conditions, Infant Care and Breastfeeding, Parenting and Child Development
“The pressure used during therapy is less than the weight of a nickel and most of the movements are so slight that they are often missed by the parents as the practitioner moves through the treatment. “
It’s 2:00 in the morning and your one month old newborn has been screaming since midnight. You and your partner have tried everything… nursing/bottle, diaper change, warm bath, rocking, bouncing, white noise, singing, a walk outside… but the screaming seems endless. This continues for several days and you both decide to call the pediatrician. You are told that your baby is perfectly healthy, the screaming is normal, and there is nothing to worry about. Now what? Do you just grit and handle the screams every night? What other options do you have? You still feel like something is off and that your baby is in some pain or discomfort. You and your partner may even feel lost as to what to do next.
Navigating the first year of a baby’s life can be extremely challenging for any parent. Pediatrician, night nurse, lactation consultant, physical therapist, chiropractor, occupational therapist, myofunctional therapist, pediatric dentist… Sometimes it feels like there is an overwhelmingly endless list of people to help your child. Let’s take a deeper look into the option of craniosacral therapy to help you decide if it is the best option to help your child.
What is Craniosacral Therapy?
Craniosacral therapy is a very gentle manual technique used to assess and enhance the function of the structures surrounding the brain and spinal cord. Alleviating tension in these structures can promote improved functioning in the nervous system and subsequently the other bodily systems, which allows the body to respond better to the stressors of life. Craniosacral therapy facilitates the body’s natural healing process and can therefore be used to increase the body’s resistance to disease.
What Can Craniosacral Therapy Help With?
Craniosacral therapy can help infants who struggle with many different ailments. Some of the most common are difficulty gaining weight, latching issues, colic, reflux, gassiness, difficulty sleeping, mouth breathing, torticollis and/or muscle tension (clenching fists constantly or straightening legs/arching back during diaper changes.)
Is Craniosacral Therapy Safe?
The pressure used during therapy is less than the weight of a nickel and most of the movements are so slight that they are often missed by the parents as the practitioner moves through the treatment. With this small amount of pressure it is safe to use on most infants and newborns, however it should not be used in conditions in which a slight change in intracranial pressure would cause instability.
What to Expect During Craniosacral Therapy.
Craniosacral therapy is typically performed in a quiet, calm, dimly lit room with the infant lying comfortably on a massage table. The practitioner will first identify the craniosacral rhythm by placing their hands gently on the baby. They will then feel the baby’s head, neck, torso, and spine while assessing and alleviating tension in the craniosacral system. Many of the movements are so subtle that they can be imperceivable except for the calming effect and relief seen in the child.
What If My Baby Cries Constantly or Doesn’t Sit Still?
Don’t stress if your child is fussy or has the wiggles during an appointment. Some treatments occur while infants are breastfeeding or even with them laying on top of a parent. A skilled therapist has encountered a wide array of baby obstacles and has many options to help calm them. Typically by the end of the session the baby is relaxed, quiet, and/or sleeping.
Dr. Sarah Dirks is a pediatric and prenatal chiropractor, specializing in craniosacral therapy and Webster Technique. She received her doctorate of chiropractic at Los Angeles College of Chiropractic in 2010. Dr. Dirks is in private practice and collaborates frequently with midwives, lactation specialists and pediatric dentists to provide a comprehensive treatment for all of her patients.
She is a wife and mom to a one year old daughter and a three year old son. In her free time she enjoys spending time with her family, as well as swimming, traveling and going to concerts. After having her son, who was colicky, tense, and struggled to gain weight, she began to dive deeper into craniosacral therapy. The technique gave him so much needed relief.
by Jessica Martin-Weber | Nov 29, 2022 | Infant Care and Breastfeeding
**This is a repost of a classic Informed Pregnancy article.
“It is common to experience some discomfort at latch in the first few weeks of breastfeeding. It should go away as the feeding continues. If it does not end after around 30 seconds, you may need to remove your baby from the breast and reposition her. Break the suction by placing your little finger into the corner of your baby’s mouth and trying to latch again.”
“I’m really scared of breastfeeding.” Pregnant with her first child, my friend subconsciously rubbed her 34-week belly as I made dinner. I asked her why. She said she’d Googled and learned that breastfeeding could be extremely painful, particularly if she didn’t achieve “the perfect latch.”
She went on to explain that she had read different blogs and forums about how hard it was to get a good latch, stories of women with bleeding nipples and babies who wouldn’t gain weight. She wanted to know the secret to a good latch and what would happen if it didn’t happen for her.
It’s true that many mothers experience some degree of difficulty in the early days of breastfeeding, but here she was, just weeks away from finally meeting her baby, scheduled to take a breastfeeding class and worried sick that she was facing a world of pain if she couldn’t get that elusive latch.
Earlier that same day, I’d had coffee with a good friend, an International Board Certified Lactation Consultant (IBCLC) at a local hospital. When the topic of the “perfect latch” came up, she surprised me by saying that she thought everyone made too big a deal of the latch.
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“If mom isn’t in pain and the baby has plenty of soiled and wet diapers, why do we need to mess with anything? Sure, if there’s a problem like pain or a dehydrated baby, then we need to fix what we can. But so what if that bottom lip is curled in if it’s not causing any bother?” In other words, if it’s comfortable and it’s working, it’s a good latch. There is a wide range of normal. I love this woman; she often says exactly what I’m thinking.
In general, newborn babies are ready to breastfeed and our breasts are ready to feed them. It just works, and we don’t need to mess with it – it doesn’t have to be a complicated endeavor. Yes, for some women breastfeeding is difficult, but we shouldn’t expect trouble. More often than not, moms need support simply because it isn’t all that common in our culture to see a baby at the breast – we cover up or retreat to a restroom to feed, so plenty of women don’t ever see breastfeeding “in action” until it’s their turn to try it!
Many women look online or join a breastfeeding support group for guidance – proactively seeking examples of successful breastfeeding techniques that in other cultures she might have been exposed to from the day she was born. If a new mom doesn’t seek out or have access to that help, she may not even realize that difficulty with pain, bleeding nipples or ineffective milk transfer to her baby could be related to her latch, and there might be a very simple way to “fix” it.
After I shared a few pictures of my then-newborn daughter’s latch on Facebook, I received several emails and comments from other moms stating that they had never seen what a “good latch” looked like, and had endured pain in breastfeeding because they didn’t realize something was wrong.
If you are ever experiencing pain with breastfeeding that is more than a brief moment of discomfort or lasts beyond the initial latch, please seek out help – pain is usually an indicator of a problem that can be corrected. It doesn’t mean you’re doing something wrong, it just means you might benefit from some help.
I talked with my friend Star Rodriguez, IBCLC of Lactastic Services and WIC peer counselor, for the following lists:
When do you need to consider latch issues and improving your nursling’s latch?
- When breastfeeding is painful beyond the initial latching.
- When there is tissue damage to your nipples.
- When there are weight gain issues for the baby.
What latch ‘tips’ can moms try?
- Get into a comfortable position and bring your baby to your level – don’t lean down to theirs.
- Make sure your baby’s body is facing yours, and her arms are not pushing away at you.
- It is best to let the breast fall naturally if possible.
- If you have large breasts OR when your milk first comes in, it may be helpful to hold your breast with your hand.
- Aim your baby’s nose toward the nipple; if it’s necessary to encourage a wider mouth, tickle the very top of the baby’s upper lip with your nipple.
- Your baby’s chin should touch the breast, but her nose should be unobstructed. You should not need to push your breast away from your baby’s nose with a good latch.
- You should be able to hear or see your baby swallowing – short sucks/swallows at first, then longer ones as your milk starts to let down.
- If you’re using a nipple shield, ensure that the nipple and surrounding tissue is being pulled into the shield.
What can a mom do to try to improve a painful or ineffective latch?
- If your baby isn’t opening their mouth wide enough, attempt to show her what to do by opening your own mouth wide. Many babies will subconsciously mimic you.
- Make a “breastwich” – hold your hand in a C-shape behind the areola to help your baby get a bigger mouthful.
- Get your baby as naked as possible for the inviting feeling of skin-to-skin contact.
- Hold your baby securely; a snug, close hold will help.
- Pull your baby in quickly when her mouth is open wide.
- It is common to experience some discomfort at latch in the first few weeks of breastfeeding. It should go away as the feeding continues. If it does not end after around 30 seconds, you may need to remove your baby from the breast and reposition her. Break the suction by placing your little finger into the corner of your baby’s mouth and trying to latch again. Some lactation consultants can show you ways to fix a latch without taking your baby off the breast, but those are easier to learn from being shown rather than told. You may need to put your baby in a different nursing hold or position.
When should a lactation consultant be called?
- If repositioning doesn’t work.
- If you feel sudden soreness after experiencing painless nursing.
- If you feel stabbing or burning pain in your breasts or when your baby latches.
- If you have cracked or bleeding nipples.
- If your latch is not painful, but your baby is not producing a good amount of wet and dirty diapers.
Check out this post by breastfeeding assessment expert Dr. Linda Dahl!
Jessica Martin-Weber is a writer, speaker and creator of TheLeakyBoob.com. In just four years, The Leaky Boob has become the world’s largest online interactive breastfeeding resource, recommended to mothers by several major hospital networks and health agencies. Jessica is a mother to six fiercely independent daughters and also blogs with her husband, Jeremy, at BeyondMoi.com.
by Shannon Hernandez | Nov 22, 2022 | Infant Care and Breastfeeding
** This is a repost of a classic Informed Pregnancy article.
“Learning how to sleep is similar to teaching a child how to ride a bicycle. It’s new and challenging, for both child and parent. As a parent, you know there’s always a risk of a spill or a scraped knee – but still, you take a deep breath, make sure your child’s helmet is firmly in place, and keep pushing forward.”
With a newborn in the house, sleep becomes a precious luxury. Even a short nap feels incredible, and it’s hard to believe you ever managed to stay awake until 3am in college. With a dull headache and an overwhelming desire for anything that might offer a quick “pick-me-up,” it’s no wonder so many new parents guzzle coffee and lunge for stale donuts (carbs!) in the office break room. Yes, your joy in welcoming a new baby outweighs the pains of exhaustion, but when can you expect some relief? How do you get your baby to sleep soundly when every ‘sleep expert,’ from the authors of the ever-growing number of sleep training books to your mother-in-law, gives you contradictory advice?
As a sleep coach for new parents and new babies, I can reassure you that you are not alone; most parents I work with share the same questions and anxieties about sleep. Here are the five questions I hear most often:
When is the right time to sleep train?
Some babies can sleep through the night from a very young age, but most babies are ready for sleep training when they’re around four or five months old. By this time, they’re usually taking in most of their food during the day, making night-time weaning much easier. Your baby’s fine and gross motor skills have also usually developed enough to assist them with self-soothing.
How long will I need to keep feeding my baby at night?
Assuming you have a healthy baby who was born at term (after your 37th week of pregnancy), you can begin feeding your baby more during the day as early as six weeks after birth. As you gradually get towards the recommended 24 ounces of milk or formula during the day, night feeds can slowly be weaned out. If you’re breastfeeding, you can estimate how much milk your baby is taking in each day by pumping one morning feed and one evening feed, and using the average to estimate your milk supply. You can also use a scale to measure how many ounces your baby is eating at the breast.
Why does my baby keep waking up at night?
If your baby no longer needs night feeds and doesn’t have any medical conditions like acid reflux, teething or a virus, it’s likely she has not yet fully developed her self-soothing skills. It’s normal for all of us – babies and adults – to wake in between sleep cycles. But unlike a new baby, most adults have developed the skills to self-soothe. We roll over on our side, fluff our pillow, kick off our blanket or put another one on. Helping your child learn to self-soothe will help them (and you!) to get back to sleep quickly after waking during the night, and mastering self-soothing will also help your child to feel more confident and independent as she grows.
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If I co-sleep, will my baby have a harder time sleeping through the night?
I’ve worked with many parents who co-sleep. Some of them share a family bed for several years, while others plan to co-sleep with their new baby for a few months. Where your baby sleeps is secondary to learning to self-soothe, without interventions such as nursing or being picked up and rocked back to sleep. As your child grows older, where they sleep becomes more important; all children benefit from the security and routine of knowing where they belong when it’s time for bed. But teaching your child to self-soothe is far more vital to getting a better night’s sleep, and can be learned in bed with you.
Is it bad to let my baby cry?
This question always comes up as I work with parents. I believe the answer depends on whether your baby has had all her needs met before being put down to sleep. Learning how to sleep is similar to teaching a child how to ride a bicycle. It’s new and challenging, for both child and parent. As a parent, you know there’s always a risk of a spill or a scraped knee – but still, you take a deep breath, make sure your child’s helmet is firmly in place, and keep pushing forward. You run alongside your child until you feel ready to take the leap and let go as she finds her balance, and it feels amazing to see your child’s joy at riding a bike ‘all on her own.’
All children need to know that their parents or caregivers are there with them, and they are not alone in a new learning process – whether they’re learning to ride a bike or learning how to sleep. I suggest staying with your baby as she learns to sleep, being present and quietly supportive as she learns to self-soothe. When your baby is crying, it’s not easy to resist the urge to intervene – to keep your hands on the bike. But as long as you are there with her, I’d advise you not to hold her back from her personal achievements by interfering with something she’s capable of doing herself. For me, the ultimate answer is no, it’s not ‘bad’ to let your baby cry and fuss during the learning process, but I prefer for babies not to be alone as they struggle to learn and eventually master the skills they need to self-soothe.
I realize I’m yet another of the sleep ‘experts’ I mentioned earlier, and it’s simply not possible to give you personalized advice and work through trial-and-error to find what works for your family and your baby in one short article. Having a sleep coach who is well-educated in child development is key to successfully getting a new family back to sleep. The exhausting days and nights with a sleepless newborn will be over before you know it, but the healthy emotional development you promote will benefit your child throughout her entire life.
Check out this post on asthma and pregnancy by Dr. Nate Fox, MD!
Shannon Hemandez is a birth coach, postpartum doula and owner of Dream Team Doulas and has served thousands of families in Los Angeles and Orange County over the past 15 years. In 2008 Shannon started sleep coaching after researching infant sleep and child development. Shannon is known as LA’s baby whisperer and she enjoys being the mother of four children that have inspired her in her work to strengthen families. For inquiries write to shannon@dreamteamdoulas.com.
by Jenna Pastuszek | Oct 12, 2022 | Family and Relationships, Infant Care and Breastfeeding, Mental Health
” I assumed that since my body had chosen when to eject its womb occupant, it would also do its job to produce milk on time. You know what they say about assuming.”
I’ve never liked my boobs.
I remember learning about breasts in sixth-grade health class, hearing that as soon as a girl got her period, she’d get boobs to go with it. Yes, you now have bloody underwear once a month, but in exchange, you get nice round melons! Sounded like a good trade to me!
When I eventually got my period two years later, no boobs came with it. The bloody gift continued to show up, but my melons never got round. They looked more like pointy pyramids wearing mosquito bite hats.
In college, I did everything I could to make it seem like I had bigger boobs. I wore push up bras. I wore two bras at once. I even wore these giant silicone inserts that my roommates and I lovingly referred to as “the chicken cutlets” until one night I got too drunk, went home with the captain of the swim team, and woke up to see the chicken cutlets prominently displayed in broad daylight. That was the last time for me and him AND for me and the chicken cutlets.
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In my 20s, I learned to cope with the hand (boob) I’d been given. I accepted that I’d always need to have clothes tailored to adjust for my unproportioned mounds. I found sticky circular cups to peel on underneath bralettes to give my body a more feminine silhouette while foregoing underwire. I even learned to laugh at how small they were alongside other people, like the time I was doing a musical and the sexagenarian male artistic director presented me with a giant pink push up bra to wear under my costume. “Don’t worry, Jenna. My wife tried this on for me last night, and it’ll help you get into character.” Fantastic.
These are not mine
Before getting pregnant, I found it easier to simply pretend that they weren’t there. I felt so ashamed of their pathetic presence that I even told my husband to stop asking me to take my shirt off when we had sex. It didn’t matter to me that he thought they were nice. To cope, I had written them off as dead.
When I got pregnant, one of the first symptoms I had was rapid breast growth. The skin pulled painfully taught and tingled and was sensitive to the touch. My nipples were so itchy, and when I looked down at my chest, I was convinced that I was staring at someone else’s areolas. Who’s missing a pair of boobs, I thought, because these are not mine.
Nursing wasn’t something I was super enthusiastic about given my lifelong breast trauma, but I was set to do it for the added health benefits for me and my baby. So I was disappointed when at 35-weeks, my OBGYN told me that my baby was Frank breech, and if he or she did not flip, I was going to have a c-section. I was nervous that scheduling the arrival of my child would affect breastfeeding if my milk didn’t come in quickly enough. After trying everything to get the baby to flip (spoiler alert- he didn’t…#Leo), I accepted my fate and scheduled my operation. As luck would have it, I went into labor spontaneously four days prior at 39w1d. I assumed that since my body had chosen when to eject its womb occupant, it would also do its job to produce milk on time. You know what they say about assuming.
Squishy and unreliable
My boobs continued to betray me into postpartum. My milk didn’t come in fast enough to prevent my son from losing over 10% of his birth weight in the hospital, so on day 3, we had to supplement with formula. It turned out that he was born with an upper lip and a posterior tongue tie, so latching was a frustrating experience for all: he, because he was working too hard to get the meager sustenance that was there, and me because he was gnawing like a weasel at my sore cracked nipples.
By the time we got the ties and latch sorted out, my child had made up his mind:
Why go back to something soft and squishy with unreliable output when a plentiful plastic bottle is an option?! He even faked falling asleep to get out of breastfeeding! Multiple times! Whether it was the hormones or not, this was the most painful rejection I had ever experienced- even worse than my sixth-grade crush Jason Miran rejecting me and my mosquito bites at the school dance.
Befriending my boobs
On the drive home from the hospital, I realized I had to befriend my boobs. It was as if they were on strike because of my reluctance to accept them for what they are. I sat down at my breast pump and decided that unlike middle school, I refused to let my son’s rejection define me. My breasts are a [small] part of my motherhood experience, but they are not all of it. Whether round or pointy, on display or hidden, elastic or inverted, over full or empty, I will still be a good mother. A good mother with a great set of tits.
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Jenna Pastuszek (she/her)is a professional actor, singer, voice over artist, musical theatre educator, and voice teacher. Jenna has performed in theatres across America in a variety of mediums, including her acclaimed solo shows GET HAPPY! and ME,MYSELF & BARBRA. She is a voiceover artist, voicing household brands like Starbucks Cafe, Pepsi, Amazon, KIND Bar, Target, IKEA, Crest, Toyota and more. She is the Co-Founder of Innovative Voice Studio, where she trains Broadway performers and works with leaders across industries through Innovative Performance. Previous faculty positions include The University of the Arts, New York University, The American Academy of Dramatic Arts, The American Musical Theatre Academy, and Musical Theater College Auditions. Pastuszek received her Masters in Teaching in Elementary Education and a BA in History and minor in French from the University of Virginia and her Masters in Vocal Performance and Advanced Certificate of Vocal Pedagogy from NYU Steinhardt. She is an Estill Voice International Master Trainer and a graduate of Seth Godin’s altMBA. Learn more at www.jennap.com.
