Dear Kathleen- Too much and not enough, weaning and supply during monthly cycle

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,
 
I have weaned my nursling, it has been 7 days since his last feed and lefty still isn’t getting with the program!  I have a lumpy, very sore, left breast and am unsure what to do.  Is this normal?  What can I do to relieve the pain and discomfort?
 
Thank you!
 
Lumpy Lefty

 

Hi there Lumpy,

Yes, it can take while for both breasts to involute after weaning, even if weaning was gradual.  Your left breast will soften soon, but in the meantime you can try the following suggestions.  You will want to try and avoid any breast stimulation to either breast.  This means taking backward showers or tub baths, avoiding heat to the breast and any stimulation during lovemaking.  You can use Tylenol or ibuprofen to ease any discomfort. Some mothers use cool packs on the breasts for 10-15 minutes a few times a day and some even place chilled cabbage in their bras to help with the swelling and discomfort.  While some mothers chose to express milk from the breasts, this may provide temporary relief, but that will most likely lengthen the total time it takes to dry up completely.

To speed the softening, you can drink sage or peppermint tea.  Earth Mama Angel Baby sells their “Organic No More Tea” which contains these herbs or you can buy dried sage leaves in most health food grocery stores.  Steep a couple of teaspoons of sage in boiled water storing it in your refrigerator.  Drink 2 to 3 cups a day for up to three days.  None of these herbs should not be used if you may be pregnant.  Most mothers do nothing other than wearing a supportive bra and giving it a bit more time.  Please know that it is quite normal for mothers to be able to express drops of milk for many months after weaning.

Feel better soon!
Kathleen
Dear Kathleen,I’m on the verge of tears, disappointed in myself.  My little guy is 4 months old and I returned to work last month, we are exclusively breastfeeding and I pump when I’m at work.  This month my monthly cycle returned and I’m experiencing a drop in my milk supply with it.  Is this normal?  Why is this happening?  I feel so bad, I can’t pump nearly as much as I could before and sometimes he seems very frustrated at the breast.  Will my supply come back up when my period ends?  Is there anything I can do?  I’m having to use the milk I have stored and I’m afraid that if my supply doesn’t come back up I won’t be able to keep up with my son’s needs. Even if it does come back up after my period, if it’s going to be like this every month I’m really concerned that I won’t have enough of my milk when I’m at work and that he’s going to wean early if he’s frustrated even at the breast.  Please help!Sincerely,

Could Cry

Hello Could Cry,

I am so sorry that you are worried and upset!  Let’s see what we can do.  I am hoping that you are getting in at least 7 nursing and pumping each 24 hours and that you are using the best pump possible.  If you are not using a Hygeia or another pump with strong suction such as a rental pump, I would suggest that you try and get one.  I know that many insurance carriers that are providing pumps to nursing mothers, but many are offering mothers poor quality pumps.  For an example, the Ameda pump has very low suction unless you are using it as a single pump.Try to nurse right before leaving for work every day and be sure that you care giver doesn’t feed the baby for two hours before your expected return.  In that way you can nurse just as soon as you get home.  Some mothers find that their babies are simply being overfed while they are apart. Your baby only needs about 1 1/2 ounces per hour for a good feeding at this age.  That means that if it has been 2 hours since the last feed, he will only need 3 ounces by bottle.  If your care provider is overfeeding the baby, let her know that the doctor has recommended that amount.  Using a slower flow nipple can also help slow the feeding and leave your baby a bit more satisfied.When you are home with the baby, try to nurse more often.  Keep in mind that babies at this age do not give early hunger cues.  If your baby uses a pacifier, put it away and offer the breast when you see finger sucking and it has been 2 hours or more since the last feeding. Welcome night time feeds, as nursing in the night increases your milk making hormones the most. When at home you can also pump right after any of your morning nursings and use that milk to feed the freezer.

Milk Supply Drop with OvulationYes, when a mother begins ovulating, it is common for milk production to decline somewhat until the next period starts up again.  With that being said, you can try taking 1000 mgms of calcium and 500 mgms of magnesium every day once you have ovulated and until your period returns.  You can also use herbs to stimulate your production, so long as your breasts are being drained 7 times a day.  Fenugreek can be found in any health food store and the lactation dose is 3 capsules three times a day, not what is written on the bottle.  For a stronger herbal remedy, I recommend More Milk Plus from Mother Love Herbals.  You can visit their website and find a local distributor.  More Milk Plus contains fenugreek and three other milk stimulating herbs.I do hope this has been helpful to you and that you find ways to continue nursing for as long as you and the baby like.

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.  
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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.  

 

 

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