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boric acid suppositories and breastfeeding

Love Wellness. Life-Space Probiotic for Breastfeeding & Pregnancy. Sometime its due to need of medication usage. "You also shouldn't use boric acid suppositories when you are pregnant, bleeding, suffering from pelvic inflammatory diseases, or any sexually transmitted disease," warns Grant. 7-day course of oral metronidazole (L2) or tinidazole (L3). Reinfection is possible, but it is much less likely to occur than recurrent infection. [9] However, women must speak to their healthcare providers before initiating this self-treatment method. In one clinical trial, women with a history of recurrent vulvovaginal candidiasis were randomized to receive 400 mg of ketoconazole for 14 days or clotrimazole in the form of 100-mg vaginal suppositories for seven days.18 One week after treatment, the clinical cure rate was higher than 80 percent in both groups. Each treatment has been assigned a lactation safety rating based on the following scale: Recommended agents for symptomatic BV (first occurrence): Preferred agents for women with multiple recurrences of BV: Recommended agents for Candidiasis (first occurrence): Alternative agents for Candidiasis in women unresponsive to azole agents: Preferred agents for women with multiple recurrences of Candidiasis: *For breastfeeding women, we recommend partially supplementing breastfeeding with formula or stored milk if intravaginal boric acid will be used for more than 7 days, or the infant is high-risk. It promotes vaginal balance by maintaining your vaginal pH in the normal, acidic range. "It's usually used as a second line of treatment after standard treatments haven't resolved the infection. Boric acid suppositories are a holistic solution for vaginal odor. Be sure not to drop the capsule onto the floor or counter beforehand. Boric acid suppositories have been around for hundreds of years to help treat various vaginal conditions like yeast infections and bacterial vaginosis (BV). Bacterial Vaginosis (BV) and Fertility. Keep out of reach of children. Boric Acid Vaginal Suppositories: A Brief Review. How to Talk to Your Partner About Vaginal Fishy Smell Follow up recommended. To limit risk, consider reducing the amount of fresh breastmilk provided to the infant while taking boric acid. These are to be used once daily for two weeks. Q: How does boric acid work? In addition, a wet mount should be examined for evidence of coexisting trichomoniasis or bacterial vaginosis. When estrogen levels fall due to breastfeeding or menopause, the bacteria, lactobacilli, that are responsible for acid production in the vagina start to die off. A duration of greater than 21 days is not recommended in breastfeeding women. Due to high dilution of ingredients in homeopathic medicines they do not create much problem for baby. Rebalance from the inside out with our 7 Day Boric Acid & Herbs Suppositories. Keep reading to learn when boric acid suppositories are safe to use, how to use them correctly, and who should avoid them at all costs. A boric acid suppository can be helpful for many . When purchased online. When to Use Boric Acid Suppositories. In one clinical trial, 74 women with recurrent vulvovaginal candidiasis were treated for an acute episode with 400 mg of ketoconazole per day for 14 days.19 The women were then randomized to receive one of three treatments: placebo, 400 mg of ketoconazole administered orally for five days after the menses for six months, or 100 mg of ketoconazole administered orally each day for six months. Price, and B.A. In a breastfeeding mom, the small boric acid molecule will also easily distribute into her breastmilk. Boric acid suppositories have been used for years to treat recurrent vaginal infections like BV and yeast infections. Jessica Lloyd - Naturopathic Practitioner, BHSc(N), Understanding and using Mayan abdominal massage, Understanding vulval lymphangioma circumscriptum, Use of oral zinc in lichen planus of the mouth and vulva. 8600 Rockville Pike An infant can be infected with yeast during delivery if the mother has a vaginal yeast infection, or the infection may develop later. Copyright 2021 American Sexually Transmitted Diseases Association. Find helpful customer reviews and review ratings for NutraBlast Boric Acid Vaginal Suppositories - 100% Pure Made in USA - Boric Life Intimate Health Support (30 Count) at Amazon . National Library of Medicine Excreted into human milk: Data not available Excreted into animal milk: Data not available Comments:-There is no information regarding this drug on the presence in human milk, the effects on a breastfed infant, or effects on milk production. In this FAQ sheet we will discuss about exposure to The Killer | Boric Acid Suppository while breastfeeding. FOR VAGINAL USE ONLY. When should I use Boric Acid Suppositories? . If a woman with an established diagnosis of recurrent vulvovaginal candidiasis does not respond to an imidazole, infection with a resistant non C. albicans species may be present. If you have an applicator, carefully place the capsule in the applicator. Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy and Breastfeeding, Our Statement on Monkeypox: Infection, Vaccines, and Treatment for Pregnant or Breastfeeding Women, Vitamin D Supplementation and Breastfeeding. Sex Transm Dis 2019; 46:810812. BUY NOW - $21.99. Is boric acid safe to use in lactating mothers with recurrent vaginal infections? Each capsule contains about 600 mg of boric acid. A: All pH-D Feminine Health products are proudly made in the U.S.A. 1.5 How many capsules does the . Iavazzo C, Gkegkes ID, Zarkada IM, Falagas ME. Prutting and J.D. Boric Balance by Intimate Rose contains 100% natural boric acid. It is still used in the treatment of vaginal candidiasis when resistant to other treatment (Iavazzo 2011). Secnidazole 2 g oral granules in a single dose . The absolute infant exposure to boric acid via breastmilk is likely quite small compared to therapeutic doses but is still concerning. Deciding not to wait may cause irritation or a burning sensation for both you and your partner. Antidepressant Use While Breastfeeding: What should I know? First line treatment options have been established by the. See your healthcare provider if your symptoms persist even after ending treatment. Potential infantile side effects to watch out for include changes in mental status, vomiting or diarrhea, jaundice, and rash. If you continue to use this site we will assume that you are happy with it. Our suppositories for pH balance are made with boric acid and tea tree oil for balance, plus cocoa butter for an added boost of hydration and moisture. Bookshelf Boric acid vaginal suppositories are available over the counter to treat vaginal infections. Additionally, continuous boric acid treatment may prevent relapses of vulvovaginal candidiasis. We do not have alternatives for Boric Acid. What is boric acid? Please select a reason for escalating this post to the WTE moderators: Connect with our community members by starting a discussion. Boric acid vaginal suppositories are available over the counter to treat vaginal infections. Boric acid suppositories are a safe and effective way to treat vaginal yeast infections. Hey mom so my baby is two months and two weeks old and I have BV so Ive been using boric acid suppositories and I insert them at night but I am exclusively breast-feeding. 2019 Feb 15;68(5):803-809. doi: 10.1093/cid/ciy554. What is the Pitcher Method for storing breastmilk? Honestly I tried everything and this was what ended up working. Boric acid suppositories are available in the form of solid and oval-shaped capsules, which turn into liquid at body temperature. Women who take oral contraceptive pills have a higher rate of vulvovaginal candidiasis.11 According to one theory, Candida cells have estrogen and progesterone receptors that, when stimulated, increase fungal proliferation.8, Women who are prone to recurrent vulvovaginal candidiasis may have deficient cell-mediated immunity. Trials. To use - insert one (1) pH-D Boric Acid Suppository into vagina as needed, preferably before bedtime. However, if the boric acid therapy is stopped, there is limited efficacy in preventing recurrent infection or data on long-term safety.[6]. Other presenting symptoms may include an odorless vaginal discharge, pruritus, dyspareunia or dysuria. Create an account or log in to participate. One time use wouldn't impose serious harm to your baby. When asked about their personal preference, almost 75 percent of the women preferred the empiric regimen. Find advice, support and good company (and some stuff just for fun). If you experience severe discomfort, discontinue use. Alternatively, vaginal yeast infections are fungal, commonly caused by the Candida species, giving this infection the name Candidiasis. and (2) What are the data on the safety of IBA use in pregnancy? You don't need a prescription to buy them, but it's a good idea to consult with your doctor first," says Dr. Donald Grant, a senior clinician at The Independent Pharmacy. Dosages based on the literature, not on indications given in Physicians' Desk Reference. Boric Acid crystals (H3BO3) NeuEve cares deeply about the health and wellness of our customers. Did you ask your dr about them? Although only 13 of 21 women completed the protocol, the women who ingested yogurt had a threefold reduction in infection. Additionally, receiving oral sex too soon may put your partner at risk of ingesting any undissolved boric acid. . Bacterial Vaginosis (BV) Bacterial Vaginosis (BV) is caused by an overgrowth of certain types of bacteria in the vagina. watery . Doctors generally recommend using boric acid suppositories as a second-line treatment when standard treatment options are not working. Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in reproductive-age females. Otherwise, the Canesoral (fluconzole) 1 dose pill would likely be what your Dr will recommend. Use of this site is subject to our terms of use and privacy policy. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Given these factors, it is important to understand the currently available data on the safety of IBA use. This is not a complete list of side effects and others may occur. Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence. It should only be used as a vaginal suppository when prescribed by a health care provider. It's also unsafe if you're pregnant or breastfeeding. You can create boric acid suppositories at home by filling size 00 gelatin capsules with boric acid (~ 600 mg). Safe for use during pregnancy and lactation. Clinicians' use of intravaginal boric acid maintenance therapy for recurrent vulvovaginal candidiasis and bacterial vaginosis. 53d ed. If you're interested in using boric acid suppositories, reach out to your OB-GYN first as there may be a better alternative treatment option depending on your symptoms. For this reason, it's imperative to keep your capsules in a safe place far away from children or pets. Its unlikely to cause side effects in your baby, but a few babies have had diarrhoea. What are the 12 general lab safety rules. Step 2: Open the suppository and hold to see that it is cold enough to inject by gently pressing within your fingers. FDA does not regulate The Killer | Boric Acid Suppository.There is no credible study done on safety of The Killer | Boric Acid Suppository while breastfeeding, Same holds truth for almost all homeopathic medicines however homeopathic medicines go through a process called potentisation. Virtually everything absorbed via inhalation is eliminated in 24 hours and 96 hours if the absorption was through the digestive tract. official website and that any information you provide is encrypted However, lactating women in particular should consult their healthcare providers before initiating this self-treatment method. If needed, use one (1) pH-D boric acid suppository every 12 hours. Perspiration associated with tightly fitted clothes or poorly ventilated underwear increases local temperature and moisture. The authors of the study concluded that daily ingestion of 8 oz of yogurt containing L. acidophilus decreased the rate of candidal infection. These developmental toxicities occurred below maternally toxic levels in rats (163 mg/kg/day) and at or above maternally toxic levels in mice and rabbits (250 mg/kg/day) from oral dosing. These include BV, vaginal irritation, and pelvic inflammatory disease. Treatment is aimed at relieving symptoms, although many individuals are asymptomatic. In pregnant mice, rats, and rabbits, excessive doses of oral boric acid resulted in fetal weight reduction and malformations. J.D.S. J Womens Health (Larchmt). ), you'll find help and support here. So nothing ever happened? A 1993 in vitro study examined more than 250 strains of C. albicans and found that no strain was resistant to ketoconazole, itraconazole and clotrimazole.6, Although antifungal resistance can cause treatment failure, other factors may contribute to recurrent vulvovaginal candidiasis (Table 1).5,715 Noncompliance with a treatment regimen may result in persistent infection that is mislabeled as a recurrence. The #1 app for tracking pregnancy and baby growth. Below are the common mild side effects of using a boric acid suppository: Watery vaginal discharge; Vaginal redness; Mild vaginal burning; A scratchy, rough, or gritty sensation . Nutricost Boric Acid capsules also provide fast-acting comfort from vaginal pain and . As per your description, you shouldn't worry if you had used it once. + bv simultaneously was 8 months ago and i recently started having the same symptoms i had back then. How I got rid of my BV my experience with the Killing BV treatment. K23 AI125715/AI/NIAID NIH HHS/United States. S.T. Lactating mothers may supplement these infants feedings with formula, stored breastmilk, or donated breastmilk. J Womens Health (Larchmt). While there are many types of vaginal inflammation, two of the most common infections include Bacterial Vaginosis and Yeast Infections. However, most studies do not support a role for dietary factors in the etiology of recurrences, and adherence to strict diets has not been beneficial.8. Cerveny,Boric Acid Vaginal Suppositories: A Brief Review,Infectious Diseases in Obstetrics and Gynecology 6:191-194 (1998) (C) 1998 Wiley-Liss, Inc.], boric acid has a bacteriostatic and fungistatic action (against fungi and bacteria), but they arent sure why, despite boric acid being a very weak acid that works at about the same pH as the vagina it means it has more to it than just its acidity, which is why its very useful for the vagina. Boric Acid Suppositories. Do we have alternatives for Boric Acid? 234. Miconazole 200-mg vaginal suppository, one suppository daily for three days Miconazole 1,200-mg vaginal suppository, one suppository for one day Tioconazole 6.5% ointment, 5 g intravaginally in a . Can I use yeast infection suppositories while breastfeeding? NOT for oral use. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Federal government websites often end in .gov or .mil. Posted 7/6/20. Lie on your back with your knees bent (you can also stand with your knees bent if that's more comfortable for you). 20062023 BabyCenter, LLC, a Ziff Davis company. Intravaginal boric acid (IBA) represents one of the only options available to treat azole-resistant vulvovaginal candidiasis (VVC) and is included as part of multiple national guidelines (including the United Kingdom and the United States) for the treatment of VVC or recurrent bacterial vaginosis. Information from references 5 and 7 through 15. People who are breastfeeding, pregnant, or planning to become pregnant shouldn't use boric acid suppositories as it can harm the developing fetus. government site. Reinfection is possible, but it is much less likely to occur than recurrent infection. *Estimated cost to the pharmacist based on average wholesale prices (rounded to the nearest dollar) in Red book. Do not use double or extra doses. Although boric acid suppositories are not commerically available, they can be compounded; based on figures from the University of Missouri, the cost for compounding one suppository ranges from $0.75 to $1.00. A.P. Boric acid suppositories contain boric acid, aka hydrogen borate or boracic acid, which can help kill off many viral, bacterial, and fungal infections including: Doctors may recommend using boric acid suppositories in some situations. Terconazole vaginal cream (Terazol) is the agent of choice when infection with a species other than C. albicans is suspected. Infect Dis Obstet Gynecol 1998; 6:191194. 14-day course of nystatin intravaginal suppositories (L1), 14-day course of flucytosine cream (L4) +/- amphotericin B cream (L3). has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UPTODATE; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape. There is not enough scientific evidence to recommend the safe use of boric acid during pregnancy or breastfeeding. A recurrence may also represent an inadequately treated infection. Yes, topical boric acid suppositories are safe to use during pregnancy. It's great to prevent BV, yeast infections and promoting a healthy PH balance. Side effects may include: burning at the insertion site. It is also not recommended for breastfeeding or pregnant women because it can harm the developing fetus. We respect everyones right to express their thoughts and opinions as long as they remain respectful of other community members, and meet What to Expects Terms of Use. Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. Remove the capsule from its packaging. and transmitted securely. With treatment > 7 days, infant risk may start to increase, particularly for infants being exclusively breastfed prior to the introduction of solids. Learn more about, Twins & Multiples: Your Tentative Time Table. Lactobacillus is the most common bacteria found in healthy vaginal flora. Restores a Natural Balance To Vaginal pH. Iavazzo C, Gkegkes ID, Zarkada IM, et al. I want to hear if anyone has any experience with using boric acid suppositories and breast-feeding and if so did it have any effects on the baby . Prutting and J.D. However I would imagine (and read online) that using one vaginal suppository would only result in a negligible amount transferring to breast milk. In potentisation homeopathic preparation goes through repeated dilution and shaking. Boric Acid is a form of the natural mineral boron found in seawater. Group Black's collective includes Essence, The Shade Room and Naturally Curly. "The vagina is an organ which can be adversely affected by unnecessary or ineffective treatments," says urogynecologist Dr. Alexis May Kimble, medical director of the Kimble Center for Intimate Cosmetic Surgery. . 6. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions. Antibiotics are often implicated as a cause of recurrent vulvovaginal candidiasis. In summary, no clinical trial has found that the treatment of male sexual partners prevents recurrences of vulvovaginal candidiasis in women. [7] Symptoms of mild to moderate toxicity include nausea, vomiting, and diarrhea, and symptoms of severe toxicity include dehydration, hypotension, seizures, coma, acute renal failure, and more. Given its toxic nature, its use as a food preservative has been abandoned. carebearcustis member. 2011Abstract; U.S. Agency for Toxic Substances and Disease Registry. Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. For treatment of recurrent yeast infections, medical treatment is done for 2 weeks, and then boric acid can be used twice a week for 6 months to 1 year.1 Fungi or yeast can be found around . So I'd recommend getting a prescription dosage of fluconizole, if it chronic the over the counter won't cut it. Created for people with ongoing healthcare needs but benefits everyone. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. This resource is designed to increase your knowledge and empower you with your health options, not to diagnose, treat, cure or prevent any disease. After six months, patients were switched (crossover) to the other regimen. Recurrent vulvovaginal candidiasis is distinguished from persistent infection by the presence of a symptom-free interval. Based on the study findings, ketoconazole (Nizoral) administered orally once a day, clotrimazole (Gyne-Lotrimin) administered intravaginally twice weekly, terconazole administered intravaginally once a week, and fluconazole (Diflucan) or itraconazole (Sporanox) administered orally once a month have been relatively effective in reducing the recurrence rate for vulvovaginal candidiasis. The absolute infant exposure to boric acid via breastmilk is likely quite small compared to therapeutic doses but is still concerning. Metronidazole (preferred) Our preferred treatment for lactating individuals is oral metronidazole 500 mg twice daily for seven days. If you miss a dose, the Cleveland Clinic recommends using it as soon as you can. Can you take metronidazole while breastfeeding? You need to wait for 12 hours to start nursing again. $34.95 - $23.95 Save $ 11. Infant Risk said that I could probably start nursing again (we spoke a little under 12 hours since I took the suppository.). These periods of 24 and 96 hours can respectively be prudent periods of suspending breastfeeding in case the breastfeeding mother has been seriously intoxicated by inhalation or oral administration. . Although Candida albicans is the pathogen identified in most patients with vulvovaginal candidiasis, other possible pathogens include Candida tropicalis and Candida glabrata. Breastfeeding . The worlds leading research center for medication safety during pregnancy and laction. Using boric acid suppositories intravaginally is considered safe, however, ingesting boric acid may lead to death. Iavazzo C, Gkegkes ID, Zarkada IM, Falagas ME. Be careful with too much usage of ethanol based homeopathic medicines during breastfeeding. J Womens Health (Larchmt) 2011; 20:12451255. Powell A, Ghanem KG, Rogers L, et al. She instructed me to use it 2-3 times a week at night, excluding my fertile week. If used repeatedly, boric acid can strip away the vagina's "good" bacteria, which is important for maintaining a healthy vaginal microbiome. OR. It has been used for thousands of years & is known for . There is a trace amount of boron distributed to . Vaginal irritation, tenderness, or burning, If you ingest a large amount (about 30 g or 50 suppositories-worth), in a short period of time, it can damage your intestines, stomach, liver, kidney, brain, and lead to death, according to the, Twitching (facial muscles, arms, hands, and legs). 600 Mg in 30 vegan capsules. Not recommended. For a 140-pound woman to reach the maternal toxicity level witnessed in a rat, she would have to consume over 10,000 mg of boric acid orally. Similarly, persons with acquired immunodeficiency syndrome are susceptible to systemic candidal infection. the most helpful and trustworthy pregnancy and parenting information. I did end up nursing a little under 12 hours bc my daughter was really being fussy for the breast. Boric Acid Vaginal Suppositories - 30 Count, 600mg (Recommended Dosage) - 100% Pure Made in USA. Boric Acid: the single, fast-working ingredient in The Killer works to balance vaginal pH. More than 50 percent of women older than 25 years have one episode of vulvovaginal candidiasis,1 but fewer than 5 percent of these women experience recurrent infection.2 Vulvovaginal candidiasis is considered recurrent when at least four discrete episodes occur in one year or at least three episodes occur in one year and are not related to antibiotic therapy. When used correctly, boric acid suppositories can treat yeast infections and other vaginal infections. Vaginal boric acid is for use only in the vagina. Press on the plunger at the end of the applicator to push the suppository in, then remove the applicator. Then the woman is reevaluated. Potential infantile side effects to watch out for include changes in mental status, vomiting or diarrhea, jaundice, and rash. I know some mothers have used them without any side effects so you & baby should be fine. 129. Workowski KA. The systemic 36 mg (6%) is distributed throughout the womans blood plasma compartment. Read the Comment. Intravaginal boric acid (IBA) represents one of the only options available to treat azole-resistant vulvovaginal candidiasis (VVC) and is included as part of multiple national guidelines (including the United Kingdom and the United States) for the treatment of VVC or recurrent bacterial vaginosis. Q: Where are pH-D Boric Acid Suppositories made? . Both may have symptoms of vaginal itching, burning, and discomfort; however, the two infections are accompanied by different discharge colors and odors. for vaginal infections; however, there are limited recommendations specific to therapy during lactation. Can you take boric acid suppositories? About 4 months ago, i started using boric acid capsules intravaginally every one or two days, which seemed to completely flush away any yeast like discharge, and create an extremely watery one but if i stop using it, my discharge returns to a very thick and clumpy state. Many women have recurrences once prophylaxis is discontinued. 7. We find that, despite gaps, available data suggest IBA use is safe, at least when used in doses commonly described in the literature as being prescribed by clinicians. If symptoms recur . Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. Not risky for breastfeeding or infant. Use is contraindicated. Topical miconazole (L2, OTC) or metronidazole (L2). The boric acid has a half life of 12-24 hours. now Im freaking out but Ive used it for 4 nights in a row. Submitted: 12 years ago. Follow the steps that are given below when you are ready to insert boric acid suppositories: Step 1: You should first clean your hands thoroughly with lukewarm soapy water and dry them with the help of a clean towel. I am leery of using boric acid with my bacterial vaginosis treatments because I am breastfeeding. Boric acid vaginal suppositories: A brief review. Clipboard, Search History, and several other advanced features are temporarily unavailable. Vaginal absorption is 6% (Prutting 1998). Efficacy of Boric Acid in Treatment of Vaginal Infections, Safety of Boric Acid in Lactating Mothers, While there are many types of vaginal inflammation, two of the most common infections include Bacterial Vaginosis and Yeast Infections. Is it safe to take boric acid while breastfeeding? In treating vaginal infection, the recommended 600 mg boric acid vaginal suppositories have primarily local effects in the vagina, demonstrating only 6% systemic absorption in clinical studies. Using the applicator or your fingers, gently insert the suppository as far as it will comfortably go into your vagina. Boric Acid For Vaginal Health. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Although the initial infection is sometimes diagnosed over the telephone, clinical evaluation of recurrent episodes is essential. Boric acid suppository use has not been studied in pregnancy. Her ped suggested I could start in the afternoon. Uses Users report improvement in vaginal health and reduction of: Vaginal irritation, discomfort, itch Abnormal vaginal odor Abnormal vaginal discharges Relieves symptoms of internal and external itching, irritation, burning, and discharge associated with vaginal yeast infections. They dont know how safe boric acid is for infants and thats why they dont deem it safe for use while nursing. Boric acid is highly poisonous when taken orally. If needed, use one (1) pH-D boric acid suppository every 12 hours. Hopefully this can help anyone else who makes the same mistake! Tinidazole 1 g orally once daily for 5 days * Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and diaphragms). Schwetz. This topic will present the treatment options for various groups of . Boric Balance vaginal suppositories are considered gentle, safe, and effective support for Bacterial Vaginosis and yeast infections.

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boric acid suppositories and breastfeeding