Dear Kathleen- on nipple damage healing and pumping

We receive hundreds of emails and messages daily from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past few weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

My nipples are a wreck following a shallow latch and then thrush with my 8 week old.  After working with an IBCLC that helped fix my daughter’s latch and take care of the thrush, things are improving.  However, my nipples are still cracked and bleeding and I think they just need a break to heal.  The IBCLC I work with suggested I just pump for a little bit until I’m healed and I’m ok with that.  I feel like I’m a bit lacking in the pumping department though and only got 4 ounces the first time I tried with a hospital grade double electric pump and my daughter downed that pretty quickly.  How often should I be pumping to keep up my supply?  How long should I expect healing to take?  How do I pick a bottle that won’t encourage my daughter to prefer the bottle over me?

Thank you so much for your help!

Sore Nipples 

 

Hello Sore Nipples!  I am so sorry to hear that you are still struggling at this point in time! Sounds like you have been through a rough go.  Yes, you and your L.C. are on the right track.  A break from any more trauma is certainly in order.  I am happy to hear that you have a clinical grade pump.  I do hope you have the right size flanges for more comfortable pumpings and for removing the most amount of milk possible.  If your nipples are swelling very much in the tunnel, I would suggest getting the next size flange for more comfortable and effective pumping. Another product, “Pumping Pals”, slipped into any flange, makes pumping even more comfortable and for some moms even more efficient.  You might want to visit their website to see what I mean.  The company is very helpful in getting you the right size flanges to use in your kit and they are fairly inexpensive. With that being said, still many pumps still leave quite a bit of milk on the breast.  For that reason, I suggest “Hands-on Pumping”, that is using your hands to help remove the most milk possible at each pumping.  Please watch Dr. Jane Morton on Stanford University’s website on breastfeeding issue and see her mini-lecture and video of hands-on pumping.

I would like to talk to you more about the condition of your nipples.  If your nipples are still cracked, I would like you to consider treating them with an oral antibiotic.  Mothers with injured nipples longer than 5 days are at a much greater risk of developing mastitis; 75% of moms with open nipples go on the develop a breast infection because of the bacteria in the open areas.  And this seems much more common during the cold weather months.  There was a great study done by two Canadian physicians some time ago that showed the consequences of wounded nipples that were untreated leading to mastitis.  Also, nipples are more difficult to heal when they are infected with bacteria.  For both of those reasons, I suggest speaking with your midwife or doctor about getting treatment for at least 10-14 days.  I don’t think most doctors are aware of this connection, but with your nipples being in this shape so late in the game, I am convinced they are colonized with bacteria.  Yes, I am sure that this makes you worry about yeast, but yeast is much easier to treat than a case of mastitis, which can also lessen your overall milk production.

Mastitis risk with damaged nipples

I do think that getting 4 ounces is about what a baby at this age requires at each feeding.  You will want to aim for about 8 pumpings each 24 hours.  If you are not getting at least 3-4 ounces when you pump, you may want to also consider using some herbs.  You can use fenugreek capsules that are available at most any health food store, 3 caps three times a day. This is probably different that the dose given on the bottle.  I actually find that mothers do quite well using Mother Love’s More Milk Plus, a combination of milk stimulating herbs.  You can visit their website and see if there is a local distributor or order them on-line directly from Mother Love. Nursing teas are a very weak form of any herb, so I don’t recommend them as the primary way to stimulate higher milk production.

Babies typically down a bottle in no time flat and may still act hungry!  This can lead parents to believe that the baby may need more milk.  Four ounces with a slow flow nipple, might help some but keep in mind that many nipples that are labeled as slow flow, really aren’t!  Hopefully, the baby takes 5-10 minutes to drink 4 ounces of milk. There is an old saying, “It takes 20 minutes for the brain to know when the stomach is full!”  So true!  If you are very worried that the baby will come to fall in love with the bottle flow, you might reconsider and have one nursing every 24 hours, but I leave that to your discretion. I think for most babies, if there is a healthy supply of milk, they should return to the breast without too much of a problem.

I wish you every success and very soon!  You are quite a determined mom!

Best wishes,

Kathleen

Kathleen-HigginsKathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  
Share

Dear Kathleen- on breastfeeding moms and nutrition

Daily, we receive hundreds of emails and messages from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past two weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

 

Dear Kathleen,

Somebody recently mentioned breastfeeding moms having poor quality milk because they eat junk.  I am feeding my 6 week old but I don’t eat particularly healthy and I am worried now that my milk may not be as good as I first thought and she may be missing out on vital nutrients – I will of course start eating much healthier (every time I feed I crave something sweet) but I am worried that for the first 6 weeks of her life she was not getting the best milk. Any advice would be greatly appreciated.

Thanks in advance.

Sincerely,

Not a Health Nut

 

 

Dear Not a Health Nut,

Hello!  This is a great question and one that I am sure many mothers wonder about.  The bottom line is that that the quality of your milk is generally not affected by your diet.  Mothers who live in poverty stricken areas around the world and here in the U.S. are able to provide nutritious milk to their infants.

Many mothers find that their appetite is low right after giving birth. Eating small nutritious snacks throughout the day will provide sufficient calories for you.  The fat stores accumulated during pregnancy will provide some additional reserves.

With that being said, eating nutritious foods will help you feel good and maintain your health. Try and avoid eating “empty calorie” foods like sodas, candy and chips! A poor diet will not effect milk production but is more likely continue at your own expense, leading to fatigue and listlessness! To Dieting during the early weeks is not recommended; as most mothers who are eating nutritious foods will gradually lose the weight they gained during pregnancy.

There is no set number of calories that is necessary during lactation.  In the past, there was a recommendation of eating 500 calories above a mother’s regular diet but now this is not thought to be the case.  On the other hand, some mothers, like those who are nursing multiples may need additional calories.  Most mothers supporting nursing multiple babies may need more calories but in many of these cases, she may naturally feel more hungry.

Nutrition and breastfeeding

Dieting

It is not advisable to begin a weight loss program until after two months post partum and weight loss should be limited to 1-2 pounds per week.  Low carb diets are also not recommended as they can cause some dehydration, constipation, fatigue and sleeping problems.

Vitamin and Mineral Supplements for Mothers

It is recommended that mothers get 1000 mgms of calcium (calcium carbonate, being the least expensive with the highest concentration)per day.  This can also be achieved by drinking 3 glasses of milk per day or having several servings of cheese or yogurt.  If you don’t like milk or cow’s milk products, you can either take a calcium supplement or eat other calcium rich foods each day.  These include goat milk or cheese, bone containing canned fish, whole grains or whole grain flours, nuts, seeds and dried fruits.  Green leafy vegetables, with the exception of brocolli, are poorly absorbed. Other calcium rich foods include tofu or soy milk or cheeses, and lime based corn tortillas.

If you eat a vegan diet, which excludes egg and milk products, it is recommended that up to 4 mgms of vitamin B12 be taken daily to avoid deficiencies.  While mothers can take a supplement she can also include foods rich in this vitamin.   These include goat milk and/or cheese, canned fish, whole grains and whole grain flours, green leafy vegetables, nuts, seeds, and dry fruits.  Also, tofu or soy cheese, tortillas made with lime-processed corn.

Iron supplements may be necessary if you are anemic following the birth of your baby for your own health.  Some mothers develop vitamin B deficiencies, experiencing depression, irritability, impared concentration, loss of appetite, and tingling or burning feet.  A daily B complex supplement or taking Brewer’s yeast mixed with juice or milk can reverse these symptoms.

Supplements for Babies

Vitamin D, actually a hormone produced by sunshine is now recommended for breastfed babies.  This vitamin is important for several reasons.  It promotes the absorption of calcium in the baby’s intestinal tract. It is also an important part of a baby’s immune system keeping the baby less prone to infection.  Most recently, a lack of vitamin D has been associated with rickets, a bone softening disease.  There is also an association of low vitamin D with Type-1 diabetes, multiple sclerosis, rheumatoid arthritis and cancer.

Many babies are born already vitamin D deficient. While babies can get vitamin D from sunlight, assuring that they get enough is complicated by the latitude, season, altitude, weather, time of day, air pollution, and how much skin is exposed and whether sun screen is applied.  While a baby who is exposed to sunlight for 30 minutes per week wearing only a diaper or for two hours a week fully clothed without a hat.  Some babies in higher latitudes need even more light.

Because sun exposure is associated with skin cancer later in life, the American Academy of Pediatrics now recommends that all breastfed babies receive 400 International Units of vitamin D throughout childhood.  Formula fed babies do not need this supplement.  Most formulations of vitamin D are combined with other vitamin preparations which are unnecessary for the breastfed baby and may be difficult to give to the baby.  One company, Carlson Laboratories, offers a vitamin D supplement, Baby Ddrops and are available at health food stores and on-line pharmacies.  The baby only requires a single drop, which can be placed on the mother’s nipple for easy ingestion.

Best  wishes to you and your baby!

Kathleen

 

 

Kathleen-Higgins Kathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  
Share

Dear Kathleen- Leakies ask an IBCLC

Daily, we receive hundreds of emails and messages from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past two weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

After pumping, is it ok to feed the baby that milk and then if baby doesn’t finish to save the rest by putting it in the fridge?

Thanks!

Bewildered in pumping land

 

 

Hi Bewildered!

Pretty hard to work to express milk for your baby and then have to toss it out!  Some health care providers say to dump partially drank bottles, or give it at the next feeding.  I think that placing back an unfinished bottle of breast milk back into the refrigerator is just fine. I would suggest removing the nipple and screwing on a clean lid to keep the bacteria from the baby’s mouth to a minimum.  By using a fresh nipple for the next feed you will keep more germs from mixing in with that bottle of milk. I would recommend using the milk within the next 24 hours.  One very small study of just a few moms found that milk could be placed in the refrigerator for up to 36 hours at 4-6 degree Centigrade.  Storing milk in the back of the refrigerator is recommended. If you use the milk a second time, and there is still leftover milk, it is probably best to dump it out.  When milk has gone bad, it does have a rancid smell.

When pumping or feeding your baby a bottle, be sure to always start by washing your hands well.  Also, make sure that all of the pump parts are washed thoroughly in warm soapy water or in a dishwasher and if wet, left to dry on a clean paper towel. Also, try and store just small amount of milk for your baby; maybe just 2-3 ounces per bag or bottle. In that way, there will be less leftover milk to deal with.Hi Bewildered!  Pretty hard to work to express milk for your baby and then have to toss it out!  Some health care providers say to dump partially drank bottles, or give it at the next feeding, but I think that placing back an unfinished bottle of breast milk back into the refrigerator is just fine. I would suggest removing the nipple and screwing on a clean lid to keep the bacteria from the baby’s mouth to a minimum.  By using a fresh nipple for the next feed you will keep more germs from mixing in with that bottle of milk. I would recommend using the milk within the next 24 hours.  One very small study of just a few moms found that milk could be placed in the refrigerator for up to 36 hours at 4-6 degree Centigrade.  Storing milk in the back of the refrigerator is recommended. If you use the milk a second time, and there is still leftover milk, it is probably best to dump it out.  When milk has gone bad, it does have a rancid smell.

Happy pumping,

Kathleen

 

TLB meme breastmilk storage

 

Dear Kathleen,

As a first time mommy (I have a two week old girl), I’m really struggling to seek out why things to happen and don’t happen… maybe you can help? 

To make a long story short, I wanted to nurse my little one since day one she was born. However, I have flat nipples so not only was it extremely painful when she would latch on, but it was also challenging, frustrating and depressing because I refused to even give her a bit of formula. The pain was so strong when she would latch that I would cry every single time and I knew she could feel my frustration because she would stop and look at me. I even dreaded watching the clock because I knew that in a few minutes it was going to be time to nurse again. As the days passed, my baby lost almost 3 pounds under her birth weight because I thought she was getting enough milk from me but it turns out I was barely making any. That made me so sad; I felt like a HORRIBLE mother so because I wanted her to get better, my husband and I decided we give her formula. After she gained a few pounds (almost back to her birth weight), I tried nursing her AND giving her formula but she would no longer latch on to me. She obviously likes the bottle nipple better because she can actually latch on without struggling. I tried everything I could. I’ve tried pumping and nothing comes out. Maybe one drop– if not, two. I’m honestly broken yet content she’s healthy once again. I’ve humbly given up on nursing because my husband and I feel it’s the healthiest decision for her and I. She won’t get frustrated and I won’t dread seeing her precious innocent face. We’re just bottle feeding her now but a lot of questions are going through my mind such as will be baby still be healthy with formula?

I did everything I could and I STILL am. Even though my milk is drying, I’m striving to keep it going by taking some pills that will help my milk come down. I’m doing this with the hope that once my milk comes down FULLY, I’ll be able to pump and mix it with her formula. 

I welcome your advice and encouragement. 

Love,

Disappointed but hopeful

 

 

Hello Disappointed,

I am sorry that you didn’t get the help you needed and suffered so much both physically and emotionally.  Unfortunately at this point, with your milk nearly gone, you need to make a final decision.

I do have questions for you, but in this Q&A format, I can only wonder.  Did your breasts grew during pregnancy?  Is less than an inch of space between them?  If the answers to these questions is no, then you may have insufficient glandular tissue which limits the amount of milk that can be produced.  That could explain the initial weight loss.

Yes, you can relactate but that takes a lot of time and effort and, in my opinion, you need to make a commitment to either go full steam ahead or let it go.  If you decide to relactate, you will need a rental grade pump and pump at least 8 times every 24 hours including during the night, using a double pump kit for about 15-20 minutes.   While some people may suggest teas, cookies and other herbs such as fenugreek, I think you need bigger guns!  You should consider taking the medication Motilium (Domperidone) that is available through compounding pharmacies with a prescription from your OB or midwife. If you are going to get some, I would suggest getting a month’s worth to start.  The typical starting dose is 30 mgms three times a day but can be increased to 40 mgms four times a day.  You can read more about taking Motilium on Dr. Jack Newman’s website.  Understand that pills, or herbs alone will not restart your production.  Your breasts must be stimulated and drained at least eight times each 24 hours.

If you start the Motilium and want to get more, it may be less expensive ordering it on-line through a New Zealand pharmacy.  There is a less expensive version, Domperon (a generic) that is $.12 per pill.  Under the care of your health care provider and with a prescription you can order Domperon online and delivery takes about 10-14 days to get a shipment.

Being only 2 weeks into this, unless you have insufficient glandular tissue, I think you could bring back your supply with the medication and pumping.  If you decide to move forward and your milk supply is equal to what your baby requires, about 3-4 ounces per feeding, I would urge you to consider an appointment with an experienced lactation consultant. Who knows, your baby may be able to nurse completely or with a formula supplement!

While breastmilk is the biological norm for human infants, your baby needs food and formula will provide her with the nutrition she needs.  What are missing are the live cells that protect her from illness and certain other factors in breast milk that protect against other conditions. As you are finding out, formula is also quite expensive.

While nursing is a loving and bonding experience, you can capture some of this with bottle-feeding. Please be sure to always hold your baby for feedings.  It isn’t long before babies can hold their own bottles and so many bottle-feeding parents take advantage of this.  Bottle-feeding requires both hands and I believe a majority of mothers hand over the bottle to the baby as soon as the baby can hold his own bottle. I think this allows the baby to bond with the bottle instead of their parents.  This may also be the reason that so many bottle-fed babies become overfed and overweight.  Parents simply fill the bottles to the top and the baby just sucks it down.  Consider trying baby-led bottle feeding if you need to continue with bottles and here’s some information about bottle feeding the breastfed baby.

So now the decision is up to you.  I know you will decide what is right for you and your baby, no matter which way you go.

All the best,

Kathleen

 

 

Kathleen-Higgins Kathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  

 

 

Share

Breastfeeding after a C-Section

by Star Rodriguez, IBCLC- this post made possible by the generous support of Rumina Nursingwear.

 

During my pregnancies, I planned for a natural childbirth.  No medications, vaginal, et cetera.  It was going to be awesome.

Except that then I wound up with two c-sections.  So that was unexpected.  And scary.  And threw a big wrench in the whole breastfeeding thing.  I’d planned to have my baby skin to skin minutes after birth and after a natural delivery where I’d have a vigorous, hungry baby.  Now I was exhausted and itchy and pukey and I could barely move.  I had no game plan for this scenario.

My first c-section led to a lot of problems with breastfeeding.  The lovely IBCLCs who helped me fix my breastfeeding relationship actually inspired me to begin this career path.  In this article, I will pass along information that will (hopefully) help you if you are going to be having a c-section and plan to breastfeed.

With most c-sections, mom will get a lot of fluids.  This often translate into an inflated birth weight for baby.  Subsequently, your baby may pee a lot and appear to lose a lot of weight as it gets rids of the fluid (this can also happen if a mom has a lot of IV fluids and delivers vaginally; it’s just even more common in c-sections, though.)  Most doctors and nurses are aware of this, but some are a little less familiar.  Most hospitals have a cut off on weight loss for babies but not all hospitals take the inflation into account, some don’t.  If your hospital does not, and you are asked to supplement, bottles are not always your friend.  Nipple confusion and flow preference are real things.  Not all babies will have an issue, but we don’t know which ones will.  So instead of a bottle, try finger feeding, cup feeding, spoon feeding, supplemented at the breast with an SNS, or something of the like.  You can also ask if your baby can be supplemented with your milk.

Some c-section moms experience a delay in their mature milk coming in.  C-sections are not linked with delayed copious milk production, but traumatic births are.  Some c-sections can be very traumatic.  Also, c-sections are more likely to offer longer separations between mom and baby; some theorize that the less stimulation in the early hours can delay things slightly, too.  The moral of this story is to try to get your baby to the breast as soon as possible.  More and more hospitals are having skin to skin in the operating room for non-emergency c-sections.  If not, ask that your baby be brought to you right away when you are in recovery.  If your hospital has a lactation consultant or breastfeeding expert, see if they can come see you as soon as possible, too, to assist in that latch, especially since you might be tired or not feeling well.  If you still have issues with delayed milk, pumping can help.  Sometimes a 24 hour burst of pumping after most feedings can ramp up milk production and make your body get its act together.

C-section moms can have a lot of soreness.  First of all, don’t ignore the medications that they offer if you’re in pain.  The normal pain relievers prescribed in hospitals are fine for breastfeeding moms to take.  If you’re worried, ask your doctor or nurse.  They will be happy to check for you.  If you are sore and tired, it is often tempting to have someone else feed the baby while you sleep.  No one but you can make that decision, but in those early weeks, skipping feedings can be a problem.  If you do need someone else to feed your baby, again, I highly suggest not using a bottle.  When soreness is a factor, trying an alternate position can also help moms more comfortable in those early days.  C-section moms are often told to use the football hold, and while it is a hold that I love, every mom is different.  If you nurse in a different hold or position that works for you and your baby, great!  In my experience, about 50% of moms that love the football hold post c-section.  The side lying hold is also a great one (where you lie down and pull your baby in to your breast – Miranda Kerr famously released a Tweet of her nursing her newborn this way) but is not always possible right away, since you are probably going to find it hard to impossible to move.

Miranda Kerr breastfeeding

Support for a c-section mom is key.  You just had surgery, and recovery can be hard.  Breastfeeding naturally has a learning curve, and those two things together can feel so overwhelming.  Make sure people are around to help you out the first week or so.  My mother, for instance, made us dinner every single night for a week with my second baby.  It was the greatest thing ever.  I was so not up to cooking yet; I was still trying to figure out how to recover from surgery and handle two kids.  Just make sure that you are getting supportive support, and not unsupportive support and be willing to protect your boundaries, it can make a difference in your breastfeeding journey. 

Finally, many of the moms I see that are up and moving around regularly after surgery do better at breastfeeding.  This is totally anecdotal, and it could just be that those moms didn’t have it as hard as others for whatever reason.  But I do encourage moms to do what they can to feel like a normal human being again.  Walk if you can.  Those fluids that I talked about earlier?  They are still in your body, too, and some can hang out in your breasts, making it harder for the baby to latch well.  Moving can help your body to eliminate those  fluids.  Although I tell you to try to return to some semblance of normal as soon as you can, I am not telling you to overdo it.  Go with your body and how it reacts.  With my second baby, I was ready right away to walk after my c-section.  I felt great.  The second they allowed me, I had a nurse in there helping me up.  Anddddddd then I projectile vomited and almost passed out.  When I thought about it later, I was so gung ho to move nownownow that I ignored a lot of signs that I wasn’t ready yet (sporadic dizziness, nausea, and just a general unwell feeling.)  Don’t force yourself to do things too early and don’t make yourself sick or hurt.  Also, remember to eat and drink to hunger and thirst.  This will help your body to heal and produce the milk that you need.  You don’t have to force yourself to eat extra, just eat what you need.

And if possible, relax.  Be gentle with yourself and your new baby.  Having a newborn is challenging.  Having a newborn and recovering from surgery is that geography between rock and hard place.  Postpartum recovery is important not only to your health but in reality to your entire family, read this on how important taking time to heal birth is for your whole family.  To take care of your baby well you must take care of you.  Your recovery matters and your healing is a key piece in the continuation of your breastfeeding journey.

________________________ 

Did you have a c-section?  Did it impact breastfeeding?  If you had a c-section and breastfed, what helped you and how would you encourage other c-section moms?

________________________ 

 

 

StarbabyStar Rodriguez, IBCLC, RLC is a provider in the Central Lakes, MN area.  She provides services online at Lactastic Services and in person.  She also blogs for The Leaky B@@b and volunteers her services to loss mothers at Stillbirthday.

Share

What do cars & breastfeeding have to do with each other?

by Kristine Phillips Keller

breastmilk and pump

I learned the answer to this question the hard way with my oldest son. I was not much of a reader but breastfed because both of my sisters did the breastfeeding thing. If they could do it, so could I. However, in hindsight, I pretty much did everything wrong that I could have done. I wanted a nursery (I needed sleep, right?), I wanted pacifiers (he can’t just suck on me or I won’t get any sleep) and I wanted bottles (dads need to help too, right?). I thought, surely I can make all of this work. Boy was I wrong!

Not only did I go into it uneducated, I also have flat nipples. I honestly thought they were broken as they never became fully erect prior to years of nursing/pumping. I also have really naturally dry skin. Early on, I had damage but didn’t realize how bad it was until it was visible, right at Stage III damage (which means skin is literally gone). I was in such pain that I would cry when my boys would cry because I knew what was coming. I would fear nursing them because of the toe curling pain that it took to get them latched on. For the most part, after a minute or two it became bearable. Other times, the entire feeding was excruciatingly painful for me.

At six weeks with my first, I gave into pumping full time. I asked for help from family repeatedly to try and figure out what I was doing wrong and what I could do to correct the latch. No one seemed to be able to offer me the advice that I needed to make direct breastfeeding work and I just didn’t have it in me to bear that kind of pain any more. However, I still wanted to give them my milk…so I continued on with pumping & still continued to have cracked, bloody nipples until a good 10-11 months of pumping.

Around that same time, I was talking with my sister about all of the bloody milk that I was dumping because, even though I was no longer nursing, I still had pretty bad damage on both of my nipples. I just thought that’s how it was going to be for me. She then asked me if I was lubricating before I pumped. My response to her was, “Isn’t that what you do when you have sex?” She laughed & then said yes but that the pump shields were dry. Babies have moisture in their mouth for lubrication but there is no moisture on the pump shield prior to pumping.

I mean, would you ever expect to drive a car with NO lubrication and have things go well? ABSOLUTELY NOT! There must be lubrication to prevent friction… and to prevent damage. After all, isn’t that what our healthcare is supposed to be about these days, preventative care? Well, let me tell you…the difference was night and day. I went from having constantly damaged, bloody nipples to pain free/damage free nipples overnight. It was such a relief to know that there was something I could do to prevent this pain and discomfort.

I started working for WIC 2.5 years ago as a peer counselor and have since applied theory to moms that come to me with damaged or sore nipples. If you lubricate before you latch, you lessen the probability of damage happening from the initial suck (regardless of whether it’s baby or the pump). That lubrication gives both something to slide against instead of that reverse pressure working against dry skin.

I’ve asked numerous breastfeeding professionals and no one seemed to know of any literature that puts emphasis on “lubricating BEFORE nursing or BEFORE pumping”. The only reference that I’ve seen is to use breast milk on sore nipples AFTER nursing. If it works after, why not try it before?

Lubricant suggestions: (you may need to try a few different ones to decide which is most comfortable for you.)

  • Your breastmilk
  • Nipple cream/ointment (suggest vegan and edible, rather than animal based)
  • Coconut oil
  • Olive oil
  • Almond oil
  • Infant massage oil
  • Avoid synthetics such as traditional baby oil

 

Some moms have found that regularly lubricating their breasts and pump horns before pumping greatly reduces the amount of discomfort they experience which in turn helps them let down easier and respond better to the pump.  There’s no need for pumping to be a painful or uncomfortable experience, experiment with different lubricant options to find what works best for you.  I hope this simple tip helps you in your breastfeeding and pumping journey as it has helped me.  How about we pass along this little known tip and prevent the damage in the first place?

__________________________

What pumping tips do you have to share to help other moms?

__________________________

 

Kristine Thanks to her sister, Kristine breastfed/exclusively pumped for her two boys now 3.5 and 8 years old, she pretty much did everything wrong when it came to breastfeeding but managed to get the pumping thing right (after a while).  After experiencing discrimination she contacted WIC about becoming a breastfeeding peer counselor and begin training to become an IBCLC. She sits for the IBCLC exam this summer and looks forward to continuing to help mothers reach their breastfeeding goals.

Share

Breastfeeding beyond Infancy in Developed Countries

By Star Rodriguez for The Leaky B@@b
This post made possible in part by the generous support of Motherlove Herbal Company.
Breastfeeding beyond 12 months

Imagine a mom breastfeeding a baby.  Now imagine her breastfeeding a toddler.  Now a preschooler.  Do you feel uncomfortable with any of those images?  When do you start to feel a little weird?

In developed countries where breastfeeding duration is low and where nursing in public isn’t seen as often, it’s pretty normal to have a point where you begin to feel a little uncomfortable with thinking about breastfeeding a child.  After all, there are a multitude of foods and drink available readily and safely in developed countries, so why on Earth would someone need or want to nurse, say, a three or four year old child?

First, it’s helpful to understand what our natural weaning age probably is.  Katherine Dettwyler, Phd, professor of anthropology looked at natural weaning ages of animals and came up with five possible ranges.  First, she looked at when permanent molars come in, a normal weaning time for primates.  That puts the range at five to six years old for human kids.  Animals also often wean babies based on when they reach about a third of their adult body weight.  This puts human kiddos at four to seven years old.  With some primates, though, adult body size and not weight is the true test; our children would wean naturally, then, somewhere between the end of the second year and the end of the third year.  Some mammals nurse until their babies have tripled or quadrupled birth weight; this would mean human babies would naturally wean somewhere between two to three years old.  Finally, many mammals wean after the baby has been alive for about six times the length of gestation.  Therefore, human babies would breastfeed around four to five years.

Clearly, most of us are not breastfeeding our children until they are six or seven years old in developed countries where they have a plethora of other foods and many social activities.  However, there are a lot of women who quietly report to me that they nursed to two or three years, although they don’t tell their friends or extended families, because “they’d think I was crazy!”  More often than that, I get moms calling me, asking me how long babies should nurse, and what the benefits are to nursing beyond a year.

Sadly, there aren’t a lot of studies on breastfeeding beyond infancy in the developed world.  I’ve been told that this is because there aren’t a lot of women who continue beyond that, and, statistically, that is very true.  I see Leakies every day discussing breastfeeding beyond a year, and there are articles and websites that mention it regularly.  So I think there are more moms out there doing it than we often admit, but it might be difficult to gather them up in one place for a study.

That all said, we can surmise a few things from studies in less developed areas and what we already know about breastfeeding and breastmilk.

First, breastfeeding can foster independence.  Yes, you read that correctly.  Children are learning to be independent, especially through toddlerhood.  I am aware of this every day as my three year old rushes to tell me, “I do it!” and gets incredibly mad if I try to help her, or if she needs help.  Children still are dependent on their primary caregivers, though.  Nursing meets a lot of their dependent, nurturing needs and can help them to feel as though they are able to express their independence while knowing that they are able to be comforted and close to their mothers when they need to be.

Breastfeeding also provides antibodies.  How many toddlers and preschoolers stick everything in their mouths, as often as they can?  How many have no concept of personal hygiene, picking their noses, eating food off the floor, sneezing in the faces of others, and so on?  By continuing to breastfeed, you are continuing to provide them with immune protection tailored to the environment that they are in.  It won’t stop them from ever getting sick, but it can be helpful to some viruses.

Breastmilk remains tailored to the child and is often something that children can take in even when they are ill and not holding much else down.  The calories and fat in breastmilk are not empty calories like many other easily held down liquids (like lemon lime sodas, ginger ales, etc.)

Breastfeeding has analgesic properties to it.  Think about how often young children get bumps, bruises, and owies.  Carrying around something that can help them to feel better about those is a wonderful thing.

As far as moms are concerned, many of the wonderful things that breastfeeding does for mothers are dose related.  For instance, the longer women breastfeed over their lifetime, the more their breast cancer risk is reduced, and that’s certainly not the only health benefit that is tied to duration.  Further, mothers who continue breastfeeding continue to produce milk and subsequently burn a few extra calories, too.  Who couldn’t use, say, an extra cookie a day?

At the end of the day, the length of time that a mother/baby dyad decides to continue breastfeeding is a very personal thing.  Despite the fact that we live in a developed society where extended breastfeeding may not be necessary for survival, it can be a meaningful and beneficial thing to moms and babies.

________________________________

How do you feel about breastfeeding beyond the first year?  

How do you personally determine the duration of breastfeeding with your own children?

How much has cultural expectations impacted how long you were/are willing to breastfeed?

_______________________________

breastfeedingStar Rodriguez is an International Board Certified Lactation Consultant, student, and mother of two in Minnesota.  She has done private practice work, worked with WIC, and now works in a hospital setting.  She is available for online consulting and in-person consults in the Brainerd Lakes area.  She can be reached through the Facebook page of Lactastic Services or you can find more information at www.lactastic.com.
Share

Weaning the Breastfed Baby

by Star Rodriguez, IBCLC for The Leaky Boob
this post made possible by the generous support of Fairhaven Health.

breastfeeding latch

In my practice, I do prenatal consults.  During these, almost 100% of the time, people ask me, “So, how long am I supposed to do this, anyway?”  I typically tell pregnant moms and their families that the American Academy of Pediatrics recommends that you exclusively nurse for 6 months, continuing until at least a year once complimentary foods are introduced.  The World Health Organization recommends nursing until two years of age.  However, I always caution my families that breastfeeding is a very personal thing between a mother and baby dyad and that people typically have an idea of when they are done nursing.  This may vary from what you thought it would be while pregnant, or what it was during other breastfeeding relationships.

There are two different types of weaning.  Baby initiated weaning and mother initiated weaning.  Baby initiated weaning is probably the easiest way to do it.  The baby generally gradually starts nursing less and less until baby just eventually stops.  It’s easy for baby and easy for mom.  Well, mostly.  With either baby initiated weaning or mother initiated, there can be some sad feelings when the breastfeeding relationship ends.  Check out the post on weaning ceremonies to find ways to celebrate the nursing relationship.

A word of caution: some babies exhibit behaviors that we call nursing strikes.  Nursing strikes are not cues to wean.  They are when a baby who is normally fine with breastfeeding, or happy at the breast, will suddenly refuse it and become fussy, often in the first year.  This is typically not a baby signaling intent to wean.  It is usually linked to something like illness, teething, an increase in social behavior, or something like that.  True baby initiated weaning is not usually accompanied by an unhappy baby.

With mother initiated weaning the mother decides, for some reason, to cease breastfeeding.  This is a little harder on most babies, because typical breastfed babies like to nurse.  It is not, however, as hard as some people make it out to be.  I have had patients tell me that they cannot possibly nurse their babies because it will be a very difficult endeavor to wean them.  Trust that if you decide you are done breastfeeding, at any age you can stop, and you will probably not have to spend millions in therapy because of it.

I rarely recommend weaning cold turkey (where you just stop weaning, with no gradual step down.)    There are a few reasons why this is a bad plan in most circumstances.  First, babies don’t often take well to this.  If you suddenly stop breastfeeding and give babies just bottles, most of them will be a little confused and a lot upset.  Secondly, it’s not great for Mom, either.  Moms that wean suddenly often experience engorgement (again!) and can experience plugged ducts and infections.  It’s just not a lot of fun.

There are, however, some medical reasons that you may need to wean cold turkey, nownownow.  First, make sure that this isn’t something that will only interrupt breastfeeding short term.  If it is, you may be able to pump and dump during that time and resume nursing after if you would like.  If it is a long term thing, though, try not to feel guilty or upset.  Many of these reasons for needing to wean are serious emergencies to one’s mental or physical health, and in those circumstances, do not worry about the short term effects to your baby.  No, it is not ideal.  But your baby will not benefit as much from gradual diminishment of breastfeeding as they will from a healthy parent.  If you are in pain from sudden weaning, you can express a little milk when you are uncomfortable until your milk begins to dry up.  You may be able to use other things to help your milk dry up faster, but if you have weaned for a medical reason, you should always check with your medical provider first.

In lieu of needing to wean immediately, most in the breastfeeding community favor the gradual approach.  In this, you replace one feeding, beginning with the least favorite, with something else.  For a baby that is nursing as a form of primary nourishment, such as those that are under a year, you will have to replace that feeding with an equal source of nourishment.  For most babies, this will be formula or expressed breastmilk.  Hopefully, your baby will accept another method of feeding already, but, if not, be sure to keep an open mind.  You may offer the new type of feeding; someone else may offer it; and you can think of various different ways to give your baby nourishment (bottle, cup, sippy cup, syringe, etc., depending on age.)  If you have an older child who is receiving her primary nourishment from other foods, like most nursing toddlers, you can offer things like water (or another liquid) from a cup, a snack, or some kind of redirection.  You can also explain to your child – “We aren’t going to nurse right now, so we’re going to do (whatever) instead.”  Older children may not ask for it, and, if that happens, it is probably better to just not say anything at all.

After you have taken out that first, least important feeding, wait a few days or weeks (base this on the comfort of you and your baby – if your breasts are feeling overfull, or your child is not handling the transition well, you should wait a little longer until you adjust) and remove the next feeding.  That should be the new least important one.  (When I discuss the least important feedings, I mean the one the baby is the least attached to.  For example, often, the most important feeding is right before bedtime, and the least is during the day at some point.  Your mileage may vary, though.)  Again, wait until your breasts and baby have adjusted, and then repeat as needed.  You may find that partial weaning, where you remove some feedings while still allowing others, may be an option, too, if you are weaning for non-medical reasons.

During the time that you are weaning your baby, remember to be gentle on them – and you!  As I stated before, weaning can be an emotional experience for everyone, and the emotions may vary, a lot.  Some people feel happy and disappointed all at once.  Whatever you feel is ok.  Give your child lots of cuddles and kisses during this time.  You will both benefit from this and it will ease the transition.  When it is time to wean, whenever that is for you and your child, many moms discover that the relationship they have with their child changes some and while it is normal to miss what you had, new ways of bonding and sharing time together will emerge for you both to enjoy.

 _________________________

How old was your baby when you weaned?  How did you feel?

_________________________

 

 

 

 

 

Share

Do we have thrush?

by Tanya Lieberman, IBCLC, sponsored by Motherlove Herbal Company.

Having thrush is be painful and frustrating.  And trying to figure out if you have thrush can be confusing.  Here’s our guide* to aid in determining whether you and your baby have thrush. 

Please note that we are not discussing treatment options in this post. For information on treatment please see Dr. Jack Newman’s Candida Protocol.

 

What is thrush?

Candida albicans is a fungus lives in our bodies.  Some conditions such as antibiotic use and illness can cause it to grow out of balance, and this overgrowth can cause painful infections, generally in moist areas such as the mouth, nipple area, vagina, and diaper area.

 

How is thrush diagnosed?

Diagnosing thrush is difficult, because skin tests are considered unreliable, and the results aren’t available for several days – a lifetime when you have pain!  Most doctors diagnose thrush based on symptoms and not diagnostic tests.  So you may hear that thrush is diagnosed through treatment – if it responds, it must have been thrush!

 

What makes me more likely to have thrush?

You and your baby may be at higher risk for thrush if you or your baby have recently used antibiotics (often used for a cesarean birth), have been ill, or perhaps have been in a very warm and moist environment.  Thrush takes time to develop, and may not be obvious until a few weeks after this trigger, so pain in the first week or so after your baby is born is unlikely to be thrush, and is much more likely to be caused by a shallow latch or one of the other causes mentioned below.

 

What symptoms are strongly associated with thrush?

Mother symptoms:

One study of mothers between 2 and 9 weeks postpartum found that mothers who have two or more of the following five symptoms are likely to have thrush.  Having three or more makes it even more likely.

  • shiny or flaky skin of the nipple/areola
  • burning pain on the nipple/areola
  • sore (but not burning) nipples
  • stabbing pain in the breast
  • nonstabbing pain in the breast

 

And a mother is highly likely to have thrush if those symptoms include:

  • shiny skin of the nipple/areola with stabbing pain, or
  • flaky skin of the nipple/areola in combination with breast pain

 

The study also found that mothers were likely to have symptoms on both breasts, though sometimes not right away.

 

Baby symptoms include:

  • White patches on the baby’s cheeks, gums, palate, tonsils, and/or tongue.  If you try to wipe off these patches they will appear “stuck” there, and may bleed.
  • A yeast diaper rash, which may be red or red with raised dots

 

Can you have yeast inside your breasts? 

Shooting and/or burning pain deep inside the breast is sometimes diagnosed as intraductal thrush – thrush in or around the milk ducts inside the breast.  This diagnosis is controversial, as recent research has found that mothers with suspected yeast infections may actually have bacterial infections or Raynaud’s vasospasm, and that yeast hasn’t been cultured in the milk of mothers with suspected interductal thrush.

 

If it isn’t thrush, what could it be?

Other causes of pain which may make you suspect thrush:

  • Shallow latch
  • Raynaud’s Phenomenon
  • Bacterial infection
  • Mastitis
  • Skin problems such as eczema, psoriasis, dermatitis

 

My baby’s tongue is white.  Does that mean he has thrush?

Babies’ tongues normally have a white coating.  This in itself is not an indication of thrush.  If your baby has white patches on the inside of his cheeks or gums (if you try to wipe them off they may look red or bleed), this is an indication of thrush.

 

My doctor said that my baby doesn’t have white patches in her mouth, so we couldn’t have thrush.  Is that right?

Some babies who have thrush do not have white patches in their mouths.  Some may have a yeast diaper rash and no symptoms in their mouths.

 

I was treated with Nystatin and it didn’t work.  Does that mean I don’t have thrush? 

Nystatin is ineffective at treating thrush in an estimated 68% of cases.  So if the symptoms didn’t go away using it, you may still have thrush.  Consult this guide to thrush treatment for other treatment options.  See this study for more information on the use of Nystatin in treating thrush.

 

My doctor said that since I have symptoms but my baby doesn’t, she doesn’t need to be treated.  Is that right?

If thrush has been diagnosed in either of you, you both should be treated to prevent recurrence.

 

I keep getting thrush over and over.  Could it be something else?

If you have repeated cases of thrush, or if treatment doesn’t resolve your symptoms, you may want to explore whether your symptoms are caused by some other problem instead or, or in addition to, thrush.

 

I think I have thrush.  What should I do now?

Contact your health care provider and explain your symptoms. You may also wish to consult this guide to thrush treatment.

 

*This information is provided for educational purposes only, and should not be construed as medical advice.  For care suited to your own situation, please consult your health care provider.

 

References: 

 

Mohrbacher, Nancy.  Breastfeeding Answers Made Simple: A Guide for Helping Mothers.  (Amarillo: Hale Publishing, 2010), pp. 652-53

 

Jimi Francis-Morrill, M. Jane Heinig, Demosthenes Pappagianis and Kathryn G. Dewey.  “Diagnostic Value of Signs and Symptoms of Mammary Candidosis among Lactating Women,” J Hum Lact August 2004 vol. 20 no. 3 288-295

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including  Motherwear,  Motherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.
Share

Bottle Feeding Breastfed Babies

 

by Tanya Lieberman, IBCLC, with Amy Peterson, IBCLC

We’re very pleased to share an interview about bottles and breastfed babies today. We asked Amy Peterson, IBCLC, co-author of Balancing Breast and Bottle: Reaching your Breastfeeding Goals, to answer our questions.

For those of you who combine bottles with breastfeeding – whether you’re pumping at work, supplementing, or use a bottle for occasional separations – bottle and nipple selection can be confusing. For those of you whose babies refuse bottles, it can be very frustrating!

We hope that the information she shares below is helpful. Amy offers more information on bottlefeeding breastfed babies on her website.

Many bottles are advertised as “easing the transition from breast to bottle” and back again. What do you think of these claims? Are they independently verified?

These claims are very misleading. Just as every mother’s breast has a unique shape and flow, every baby has a unique suck/swallow cycle. What works well for one baby might be terrible for another. Parents need to observe their own baby sucking on a bottle nipple and analyze if the latch and swallow look similar to that on the breast. In our book, we use a tool called the SIMPLE Method that guides parents step-by-step on how to choose a bottle nipple for their own baby’s unique latch.

We are not aware if such advertising claims have been verified. However, we do know that this type of marketing is in violation of the International Code of Breastmilk Substitutes. This international health policy document, adopted by many countries excluding the U.S., is designed to protect families from underhanded marketing ploys such as words or pictures idealizing artificial feeding. Comparing a bottle to breastfeeding—even if it contains breastmilk—is idealizing that brand.

In our professional experience of helping babies combine breast and bottle-feeding, we have found that the nipples which claim to be best for breastfed babies are often the worst choice. The bottle nipples that are best for breastfed babies have a gradual transition from tip to base.

You and your co-author tested 37 bottles. What were the features you were comparing, and what did you learn about the range of bottles that you’d most want parents of breastfed babies to know?

We tested two different aspects of bottle nipples. First, we measured dripping by looking at the number of drips and the size of each drip. Then we hooked up bottles to a hospital grade breast pump to determine how fast bottles flow. After performing these tests, we compared the results to see if bottle dripping and flow rate were related.

The results were surprising. First of all, about half of the nipples, regardless of a non-“no drip” label stopped dripping within five seconds of tipping them upside-down. That was important for us because many bottle companies claim their nipples are “no drip,” implying that bottles that don’t drip are a better choice. To rule out the importance of dripping, we did further testing.

Second, we measured the size of the drip for those bottles that did drip. The most important thing we found was dripping does not equal a higher amount of liquid. Bottles that appeared to drip a lot often had less volume. Frequently it is assumed that a fast dripping bottle has a large amount in the drip. We discovered that a bottle may drip frequently, but with a low output. So, it is impossible to judge the size of the drip with the naked eye. Stated another way, the number of drips doesn’t mean more liquid is coming out.

As for flow, the term “slow” is not standard. To determine flow, we hooked up bottles to a hospital grade breast pump and measured the amount of liquid collected after 20 cycles. We found there was a wide range of “slow.” For example, the fastest nipple was eleven times faster than the slowest nipple. Following testing, we ranked nipples from slowest to fastest in Appendix C of Balancing Breast and Bottle. This is important because if a nipple flows too quickly, a baby’s suck will become disorganized. Likewise, a nipple might be too slow for some babies. A parent needs to watch their baby’s response to bottle-feeding rather than relying on package labeling. If a parent thinks the bottle is flowing too fast, try a different nipple in the package, and/or try a different brand.

The most fascinating results came from comparing the data of these two tests (drip and flow). Dripping is different than flow; they are not related. Most breastfeeding books suggest turning a bottle over to see how fast it drips in an effort to select a bottle with a slow flow. This suggestion is not accurate. We tested a nipple that dripped an average of 56 times when tipped over, but had a slow flow. Then, we looked at a no-drip nipple and much to our surprise, found it flowed 10.6 times faster. Big difference! Dripping is not related to flow.

Parents are often advised to begin breastfed babies on “slow flow nipples,” but even nipples advertised as “slow flow” can seem very fast. Are there any that are as slow as you think is appropriate?

As mentioned earlier, the term “slow” is not standardized. Nonetheless, it is important to begin with a slow nipple. If a nipple flows too quickly, a baby’s suck will become disorganized. For breastfeeding babies, it is best to choose a flow that mimics mom’s flow. For this reason, it is hard to say one or two brands are “best” since flow varies from mother to mother. Likewise, a nipple might be too slow for some babies. This is why we ranked the bottles and listed them in our book.

It is also important to remember that flow is only one aspect of choosing a bottle. If the baby’s mouth placement is wrong, regardless of the flow, baby will bring bad habits to the breast and still be in danger of early weaning.

For parents who are struggling to get their breastfed babies to take bottles, and who are exploring different bottles, what should they be looking for?

Moms need to consider the nipple shape and their baby’s mouth placement on the nipple. Ideally, the nipple chosen will gradually flare from the nipple length to the nipple base. This shape allows the tip of the nipple to reach far back into the baby’s mouth as the breast does, and then helps the baby to feed with the mouth open. Quite often a “narrow neck” nipple has a shape that reaches far into the baby’s mouth and allows for gradual widening of the baby’s lips.

A shape that often does not work well is a wide neck nipple where the nipple length meets the nipple base at a right angle. This nipple shape promotes what we call “straw” sucking, where the baby’s mouth closes around the length of the nipple and doesn’t open for the base. When babies “straw” suck on a bottle nipple, we often see gaps in the corners of the baby’s mouth which leads to leaking milk, gulping air, etc. This is quite different than breastfeeding.

One bottle feeding method is called “paced feeding.” Can you describe it and explain why it might be helpful to a breastfed baby? What are some signs that a baby is becoming overwhelmed while bottle feeding?

Paced feeding refers to helping a baby eat more slowly from the bottle. Pacing became popular in 2002, before flow had been studied. The idea behind pacing is that by helping the baby rest briefly during bottle-feeding, moms can more closely mimic how the baby naturally feeds at the breast. When a baby breastfeeds, the mother has several let-downs during the feeding. Between let-downs, the baby’s sucking slows and baby can rest briefly. If a baby is feeding from a fast flow “slow flow” nipple, the suck/swallow will be disorganized. Pacing helps the baby have rest periods while bottle feeding that naturally occur at the breast. Now that we know flow can be controlled by choosing an appropriate nipple, we have another technique in our bag of tricks to help babies be more coordinated when feeding from a bottle.

It is important to note that most babies can pace themselves once they master bottle-feeding with the right nipple. How do you pace? First, listen for swallowing while the baby is breastfeeding, noting when the baby naturally pauses and rests. Then apply the same rhythm to bottle-feeding. Also of importance is positioning. With bottle-feeding, support the baby in a more upright position because the flow of some bottles increases when the baby is laying back to feed (another element we tested).

Do all breastfed babies require pacing? No, in fact, imposing pacing can disrupt the natural feeding rhythm of a baby and cause harm when over used. Babies who are “good” feeders, meaning they have a normal, rhythmic suck/burst cycle, do not need pacing. It has been our experience that once a baby has mastered bottle feeding, it is no longer necessary for the parent to impose pacing.

Some signs of a poor bottle-feed include gulping, catch-up breaths, fast feeds, leaking milk from the sides of the mouth or down the chin, baby who has a furrowed brow looking very concerned, and a baby who pulls away from the bottle. For these babies, nipple shape and flow need to be double checked, and this becomes a good time to use pacing. Pacing also is an excellent technique for NICU and other high risk babies that are having feeding difficulties.

Lastly, we would like every caregiver who uses a bottle to know that dripping bottles given before a baby begins sucking usually cause the baby to pull back or flat out refuse the bottle. Caregivers need to be sure the nipple is not dripping when the bottle is offered to the baby. Allow the bottle to stop dripping or keep the milk tipped down in the bottom of the bottle. This topic is further explored on our website.

 

 

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including  Motherwear,  Motherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

 

Share

Your Guide to Relactation

 

Stopped breastfeeding and want to start again?  Here’s our guide to relactation.

What is relactation?

Relactation is re-establishing breastfeeding after stopping breastfeeding, or after a period of very little breastfeeding.

Why would I want to relactate?

Mothers decide to relactate for many reasons, but most want either to resume the breastfeeding relationship, or provide more breastmilk, or both.

What are my odds of successfully relactating?

There is little research on relactation, but the available studies strongly suggest that, with proper support, most mothers can partially or fully relactate.  Below are some studies that offer some encouraging findings about the success of relactation.  It’s important to bear in mind that in most of these studies mothers received help in relactating from trained breastfeeding support people.

One study of 139 Indian mothers who had stopped breastfeeding for at least ten days found that 84% were capable of either full or partial relactation:

  • 61% fully relactated
  • 23% partially relactated (formula supplements reduced by half)
  • 16% were unable to relactate

A recent survey of 84 relactating mothers of infants (on average, 2 months old) in Korea found:

  • 75% of mothers fully relactated (defined as 90% or more breastmilk feedings)
  • 25% of mothers either partially relactated or did not relactate

An older survey of 366 U.S. mothers, mothers reported that:

  • More than 50% established full production within one month
  • 25% required more than one month to establish full production
  • The remaining mothers breastfed with supplements until their babies weaned

A study of 50 mothers of hospitalized infants under four months old, found:

  • 92% of mothers fully relactated
  • 6% partially relactated

 

What factors will influence my success in relactating?

The research on relactation confirms what you might already suspect.  The following factors are associated with more success at relactating:

  • A younger baby
  • A shorter gap between weaning and relactating (sometimes called a “lactation gap”)
  • The willingness of the baby to take the breast
  • Having assistance from trained breastfeeding support people

These factors may influence your chance at meeting your goals, but each mother/baby pair is different, and relactation may still be possible even you don’t meet the most favorable criteria.

 

How long will it take?

Based on the research above, Nancy Mohrbacher, IBCLC, in Breastfeeding Answers Made Simple, recommends that mothers plan for relactation to take one month.

 

How should I measure success?  What goals should I set?

You may want to spend some time reflecting on your motivation for relactating.  Is it important to you to provide as much breastmilk as you can?  To have the feeling of closeness you have with breastfeeding?

You might set a goal of full breastfeeding, or you might set a goal of partial or any breastfeeding.  Some moms, who don’t think that their babies will return to the breast, set a goal of pumping and providing as much breastmilk as they can by bottle (exclusive pumping).  Some mothers want the breastfeeding relationship back, and aren’t concerned with how much milk they provide.

Interestingly, one survey of relactating mothers found that “Milk production was less often a goal and, when so specified, it was likely to influence the mother to evaluate her experience negatively and to result in difficulty in achieving a total milk supply.”

There is no right or wrong way to set goals for relactation.  And you may not want to set any goals at all.

 

How do I relactate?

There are two, related parts to relactation:  bringing back a milk supply, and bringing the baby back to the breast.  These are interrelated projects, as the best thing for your milk supply is to have a baby nursing frequently, and a baby is more likely to return to the breast if there is plenty of milk there.

But the first, and probably the most important thing, is to seek some support.

Get support.

We strongly recommend seeking out sources of support for this process.  As we note above, the mothers in the studies cited above were typically receiving skilled help with relactation, and this may have influenced their success rates.

You may want to consult with a lactation consultant (IBCLC), La Leche League leader, a breastfeeding-friendly pediatrician, or other trained breastfeeding support person (see links at the end of this guide for sources of support).  A well-trained support person can help you uncover reasons why breastfeeding stopped, troubleshoot as you work on relactating, and connect you with good resources to help you meet your goals.

Trained help is important, but don’t underestimate the power of support from other moms, family, and friends.  Having more people on your team can make a big difference in breastfeeding success. You may find attending a La Leche League or other support group meeting helpful.  WIC breastfeeding peer counselors are another good source of mom-to-mom support.  You may also want to discuss your goals and motivation with some friends or family members (especially your partner), and ask for their support and encouragement.  Relactation requires time and effort, and having support is key.

Explore what happened.

It helps to explore why breastfeeding stopped.  If it was a problem with basic breastfeeding management (poor advice, infrequent feeding, etc.), relactation may be a simple project of restarting what you were doing before.  If breastfeeding ended because, in spite of “doing everything right,” you didn’t produce enough milk, and your baby became unwilling to breastfeed, there are more issues to explore.  If you stopped because of pain, learning more about latch, and exploring the possibility of issues like tongue tie, are worthwhile topics to consider.

You may find it helpful, particularly in cases of unexplained milk supply problems or behavior in your baby, to explore these issues with a lactation consultant (IBCLC).  You’ll find a link to find one at the bottom of this guide.

Bring back your milk supply.

Empty your breasts frequently.  If your baby is willing to nurse, feeding frequently is the single most effective thing you can do.  Aim for at least 10-12 feedings every 24 hours.  Feed on both sides, and feed long enough to drain each breast well.

If your baby isn’t taking the breast, or is doing so infrequently, use a pump to stimulate your milk supply.  Ideally you should pump at least every three hours (though many mother find it more manageable to take a break at night).  Double pumping provides more stimulation than pumping one side at a time.

Ensure effective feedings.  If your baby is nursing, make sure that he or she is taking the breast deeply into the mouth, and that you feel comfortable when nursing.  A shallow latch and/or pain can mean that your baby isn’t feeding as effectively as possible.  Get help correcting this from a trained breastfeeding support person.

Pump after feedings.  If your baby is nursing, try pumping after feedings with a hospital grade breastpump.  Since milk supply seems to be calibrated based on how empty your breasts get, pumping after feedings can be an effective way to increase milk supply.

Use breast compression. When nursing and/or pumping, use breast compression to fully empty your breasts and keep your baby engaged while nursing.  This is a particularly effective way to get good feedings with a baby who is sleepy at the breast.

Consider a supplemental nursing system (SNS).  Using an SNS allows a baby to receive formula supplements at the breast while stimulating your milk production by nursing.  There is also some evidence that substituting feeding methods other than bottles – such as cup, spoon, SNS – increases the chances of relactation success.

Use the power of skin.  Holding your baby skin-to-skin (your baby in just a diaper on your bare chest) boosts your milk making hormones.  And it feels great!

Take a galactagogue.  There are both herbal supplements and prescription medications which increase milk supply.  Some herbs are particularly helpful with glandular and hormonal causes of low milk supply.  Consult with a lactation consultant and/or your health care provider about which may best suit your needs.

Bring your baby back to the breast.

Get skin-to-skin.  Skin-to-skin contact is immensely powerful in establishing breastfeeding, and it can significantly aid the process of relactation.  Hold your baby (wearing only a diaper) on your bare chest as often as you can.  You may find that he or she begins to self attach (see next point).

Use Baby-led Breastfeeding, Laid Back Breastfeeding positions, and co-bathing.  Research is increasingly pointing toward the importance of baby’s innate feeding instincts in the establishment and re-establishment of breastfeeding.  Babies are able to crawl, scoot, and wiggle their way to the breast all on their own from birth, and new research is showing that babies retain this instinct long after the newborn period.  Baby-Led Breastfeeding involves positioning babies in a way that allows them to crawl to the breast.  Biological Nurturing, or Laid-Back Breastfeeding, involves reclining to breastfeed.  See more about the Laid Back Breastfeeding position and its ability to take advantage of babies feeding reflexes.  Some lactation consultants have also found that taking baths with your baby (called remedial co-bathing) can help in re-establishing breastfeeding.

Ensure a good latch.  As mentioned above, a deep latch will allow your baby to receive the most milk, and will keep you comfortable.  Seek help from a trained support person if getting a good latch poses a challenge.

Breast compression.  Keep your baby engaged at the breast by squeezing your breast when your baby is nursing.  This is particularly effective if your baby is sleepy at the breast.

Consider a nipple shield.  Some babies who have had many bottle feedings will nurse if the mother uses a nipple shield, as it makes the breast feel more like a bottle.  For some babies, it can be hard to wean from nipple shields.  Seek help from breastfeeding support person for assistance in using and weaning from a nipple shield.

Use a supplemental nursing system.  SNS can persuade babies to return to the breast because they get a greater flow when they nurse.  And as noted above, they can help increase milk supply by keeping all sucking at the breast.  Seek help from breastfeeding support person for assistance in using one.

Focus nursing around strategic times.  Try nursing when supply is higher, such as nighttime and morning.  Offer the breast for comfort when you know that your baby is already full, or when your baby is sleepy.

Consider pre-feedings.  Some babies will nurse if the “edge” has been taken off their hunger.  Try giving your baby an ounce of formula just before attempting a feeding at the breast.

Ensure that your baby continues to thrive.

If you are reducing formula supplements while relactating, we’d suggest:

  • Reducing formula supplements gradually.  Kelly Bonyata, IBCLC, of kellymom.com recommends initially reducing formula supplements by one ounce per day (not per feeding).
  • Doing frequent weight checks to ensure that your baby continues to grow normally.  Checking for swallowing and monitoring diaper output can also provide some information about your baby’s intake.

 

What are some good resources for more information and support?

  • Lowmilksupply.org.  Comprehensive online source of information on increasing milk supply
  • KellyMom.com:  Relactation and Adoptive Breastfeeding:  The Basics

 

 

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including MotherwearMotherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

This resource page was made possible by Motherlove Herbal Company.

 

Share