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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It doesn’t have to be all or nothing

by Kari Swanson

full term breastfeeding

My daughter was placed on my chest immediately after my obstetrician finished stitching up my c-section incision. She latched onto my breast and started breastfeeding right there in the operating room. Last month we celebrated her third birthday. She knows that babies have mama milk. She also knows that big girls have mama milk until they are ready to stop having mama milk. I expect that sometime between now and the time she is around 5 years old she will gradually wean.

Some might consider the fact that my daughter is 3 and still receiving breastmilk to be extreme, but anthropological evidence indicates that this is biologically normal for a young hominid primate. That being said, it is probably no surprise that I consider myself to be a lactivist. I believe that human breastmilk is the biologically normal food source for human infants and I volunteer as an admin on The Leaky [email protected]@b in order to support other breastfeeding mothers and to help normalize breastfeeding in a culture that has largely lost sight of the real reason women have breasts.

What may come as a surprise to some is that my daughter and my son before her received formula in addition to breastmilk. Why? Because I work full time outside of my home and I am among the unlucky few who truly do not respond well to breast pumps. For whatever reason my body just does not give up the gold for a machine despite my supply being more than adequate. After a time, despite numerous tips and tricks, pumping whenever and wherever I could, I ceased to be able to pump enough milk to entirely meet my babies’ nutritional needs while they were separated from me while I worked.

With my daughter I was fortunate to be able to spend 3 months home with her after she was born, and to spend 3 months thereafter working half time. I pumped at home before returning to work and I pumped before work, during work, after work, and on non-workdays once I returned to work. I had a small stash of milk in the deep freezer when I returned to work, but it was quickly depleted. When I first returned to work and pumped I easily had enough milk by the end of the day to send to the daycare without dipping into my frozen milk stash.

I determined how much milk my daughter needed in her daycare bottles using an iPhone app called “Breast Milk Calculator.” The app uses the baby’s weight, age and number of feedings in the previous 24 hours to suggest how much milk he or she needs per feeding. Using the app I determined exactly how many ounces she needed per bottle. The number of feedings was based on the number of hours she was away from me and how frequently she would normally nurse.

But, just as it had when my son was a baby, my pumping output dwindled over time. Eventually I was pumping less than an ounce per side per pumping session. I used up my entire frozen milk stash. Despite my best efforts at around 6 months I was no longer able to pump enough to send only breastmilk in my daughter’s daycare bottles. So, I sent as much breastmilk as I could and to make sure she had sufficient nutrition I sent formula too.

When my daughter was a newborn she, like her brother, needed supplementation. They both had jaundice and they both lost more than the usual amount of weight after birth. Although her condition was better than her brother’s had been (he was a very sleepy 37 weeker with more severe jaundice), my daughter was also a slow gainer. So, the IBCLC we saw recommended supplementation while I built up my own supply. When my son was a newborn he received formula supplementation, but my daughter received donor breastmilk, or as we referred to it “Auntie milk”—because our milk donor was my sister who was still breastfeeding her toddler son at the time my daughter was born.

By the time my daughter was in daycare full time and my pumping supply could not keep up with my daughter’s demands my sister’s son had weaned. I considered donor breastmilk, but decided against it. My strong, healthy baby did fine on formula, and I felt that the relatively limited supply of donor milk in my area should be available to babies for whom formula was not an option, babies whose mothers could not breastfeed them at all or whose health really warranted the exclusive use of donor milk. So, we chose formula instead.

I already knew exactly what formula I would choose for my daughter if I reached this point, because I had read quite a bit of research about formula before I had my son. I looked up numerous scholarly research articles and reviews of the literature about formula on PubMed. At that point I knew I wanted to breastfeed, but I had been given the somewhat unhelpful advice that my desire to breastfeed and to go back to work full time were “setting [myself] up for failure”. So, in case that was true I did all of that research about formula and based my decision on what I had read. (Bear in mind that my son was born in 2004 and donor milk was not as prevalent, except from milk banks by prescription and at a rather high price.) Despite many assertions otherwise, infant formula is an acceptable, nutritionally adequate alternative to breastmilk and is a much better choice than the milk of any other mammal or milk made from plants.

Eventually both of my babies received only formula in their daycare bottles. Both times the amount I was able to pump became miniscule compared to the amount they needed and the stress and frustration of pumping so little became too much for me, so I stopped. They both did fine on the formula they received part of the time, so I felt comfortable giving them as much as they needed while they were separated from me. My daughter had breastmilk exclusively, either at the breast or in bottles, for more than 6 months. They were around the same age when they started receiving formula alone in their daycare bottles: 7-8 months. Despite this both of my babies continued to breastfeed whenever they were with me. They never experienced nipple confusion, expressed a preference for the bottle, or had nursing strikes. They both stopped receiving formula when they no longer needed bottles at daycare.

So, yes I am a lactivist. I believe breastmilk is the biologically normal food for human infants. But, breastfeeding doesn’t have to be all or nothing.

 

You can read more from Kari over on her site and enjoy her thoughtful, thorough writing and beautiful photography.

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Did you respond well to breast pumps?  Have you had to supplement?  If so, what did you use?  Were you able to supplement and still reach your breastfeeding goals?

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