The New Baby Guide 2021 Edition (for Pregnancy, Postpartum, and Newborn)

Expecting? Have a new baby?

Thousands told us what they wanted in a pregnancy, newborn, postpartum, baby-feeding, baby-sleep, and baby-gear guide and everything they wished they had known before having their baby.

This is that guide.

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Listening to what our fans told us what every parent needed when expecting or had a new baby, we created first edition of The Leaky Boob New Baby Guide and it is the guide of our dreams. But don’t take our word for it, here’s what Kathleen McCue, PhD, CNM, IBCLC had to say about TLB’s guide:

“Single best guide currently available to new families. Honest, concise, informative and all around fun to read! Refreshing to have such a valuable resource by those truly in-the-know.”

At just $1.99, you can get your copy and support The Leaky Boob and see for yourself.

Not convinced? Keep scrolling for a preview of The Leaky Boob 2021 New Baby Guide.

 

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The Leaky Boob 2021 New Baby Guide is a resource for first-time-parents and new-parents-again with checklists, vital conversations to have for partners and with your health care provider, family, work place, and more. The guide provides information as a jumping off point of what collectively hundreds of parents shared they wish they had known before having a baby. With sections on pregnancy, newborn, postpartum, feeding, sleep, and gear, our guide covers the essentials of having a new baby.

Plus exclusive discount codes!

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Tools such as our checklists, vital conversations, and product recommendations support you in making sure you have the important conversations and items you need for your new baby with expert information.

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The Leaky Boob New Baby Guide gets real about aspects of having a new baby nobody ever talks about, like postpartum bleeding, normal newborn behavior, normal sleep, body changes in pregnancy and postpartum, difficulties with breastfeeding, postpartum mood disorders, and so much more.

Think TLB’s New Baby Guide is for you? Don’t miss it! Download your digital copy now.

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Practical must-know information, realistic expectations, and tips from the most experienced parents just like you, The Leaky Boob 2021 New Baby Guide shares what thousands of parents told us they wish they had known before having baby without overwhelming you with boring irrelevant information.

See why our guide has received rave reviews and get yours here today!

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The Leaky Boob 2021 New Baby Guide supports new parents in preparing for their new baby not only with information but with vital conversations and checklists of what is really important to prepare when having a new baby.

What do thousands wish they had known when having a new baby? Find out here.

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The Leaky Boob New Baby Guide can’t tell you the best products for you and your baby but we can tell you some of our favorites and why without overwhelming you with options.

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Looking to Increase Your Pumping Output? Try Parallel Pumping!

by Jessica Martin-Weber with Dr. Kathleen F. McCue, FNP-BC, IBCLC-RLC
This article made possible by the generous support of Littlebeam Nursing Pillows.

Not every lactating parent will find it necessary to pump to reach their breastfeeding goals. Many, however, do find it necessary. Whatever the reason for pumping breastmilk- whether it is to supplement your baby with your milk when you are away from them, to supplement at-the-breast feeds regularly, or in order to donate – efficiency and sufficient milk supply are certainly desired. While the primary way to increase breastmilk supply is to empty the breasts fully and frequently, and usually nothing is quite as good at that as your baby, sometimes other strategies are helpful particularly if you’re looking to increase your pumping output. It is important to note that output isn’t the same as supply and sometimes it is just about getting the milk that is in the breast, out of the breast! Typically, if everything is functioning normally, our sweet, soft, warm, cuddly babies are much better at emptying the breast than a cold, whirring machine pressed against your breast sucking mechanically. Letting down to a breast pump may take time and practice and there are several different aspects of milk let down with a pump that can help such as proper flange fit, lubricating flanges, and utilizing the suction and speed settings on the pump to customize cycles that encourage let down and expression. Without that cuddly, sweet, soft, and warm baby, trying to get letdown can be, well… a let down.

But what if you could have the cuddly warm baby help with both emptying the breast and having more of an output with the pump?

Rather than feeding baby directly from the breast, then pump, then bottle-feed (also called “triple feeding”), pumping one side while baby is latched on the other can cut down on a step if supplementing with mother’s milk is necessary. Pumping one side while baby is latched on the other is called “parallel pumping.” Parallel pumping may cut down on work, save time, and may lead to increased output. Parallel pumping is the breastfeeding version of working smarter, not harder. It is believed parallel pumping yields such results because having baby latched helps with initial letdown (ever leak from one breast when baby is latched and breastfeeding from the other breast?), trigger additional letdowns to the pump, and double stimulation increases the body’s response and increases milk production- much like having twins. My own personal experience with parallel pumping was such that even when my own babies no longer needed my milk, I was responding so well with parallel pumping that I continued in order to donate my milk to other babies. It made pumping seem like less of a time commitment in order to donate as I was able to do it when I was already sitting to feed my baby, and it took less time to pump while having an even higher output.

*Keep reading for tips on getting started with parallel pumping.

The technique of parallel pumping works so well and with such efficiency that many parents have tried it with excellent results. Dr. Kathleen F. McCue conducted a study that is being published in Clinical Lactation journal that looked at satisfaction with the technique of parallel pumping. 

Some comments from patients:

“I was able to sit there and nurse him and also pump so that my husband can do the next feeding, which was fabulous.”

“I felt a sense of accomplishment the first time I did it. [Like,] ‘Okay, look at this. It’s working really well.’ She got into the football hold. I was able to pump, and it did feel like it was maximizing time.”

“Once you get the mechanics down it felt good in a way to feel like you were being efficient, like an efficient use of time.”

“I feel like I’m getting the pumping done simultaneously. Because I’m only pumping one breast at a time I can have one clean flange waiting… for next round. It actually takes a little bit of pressure off of me and I feel like I’m getting more done.”

“It is just efficient, because if my daughter only wanted to nurse from one side then normally what I would do is that I would feed her and then get her down sleeping, and then pump the other side. So, if I could just pump while she was nursing, it’s more efficient that way. That was nice not to have to then, after I get her down, then sit down and have to pump for another 15 minutes.”

Now you have heard how well parallel pumping works, it’s time to get started!

  • Get comfortable feeding your baby with a variety of holds. Many find the football hold most comfortable for parallel pumping but try different holds and get comfortable with them to see what best works for you.
  • Pillows are your friend. Support your baby’s body with pillows. A versatile nursing pillow such as the Littlebeam Nursing Pillow will allow you to find the best position that works for you and your baby. Use as many pillows as necessary to support your baby at your breast.
  • Choose your pump. A double electric pump may be most efficient even though you’re only using one side to parallel pump. However, some find a single electric or manual pump to be sufficient. A passive silicone suction pump may be a comfortable, effective option as well.
  • Set up and be familiar with your pump before trying to parallel pump. A few pumping sessions with just the pump can go a long way in making the experience of parallel pumping a smooth one. Remember, it isn’t always best to crank the speed and suction all the way up, particularly if it makes you uncomfortable or causes you pain. Instead, use the highest comfortable vacuum setting with the highest speed to encourage letdown, slowing the speed when letdown is achieved. Adjust multiple times through the feed/pumping session for best results.
  • A hands-free-pumping bra is the way to go. Free up your hands to support your baby, use the pump controls, utilize hands on pumping/breast massage, or even just to be able to take a drink while you feed the baby and the pump.
  • Get comfortable. Find a spot that is comfortable with plenty of room for you, the baby, and your pump. 
  • Don’t wait for late hunger cues. Set up before baby is too hungry by catching those early hunger cues and get situated before baby is upset and “hangry.” Have flanges and milk storage container (bottle or bag) washed and ready to go between feedings/pumping sessions.
  • Position pump first. Have the pump placed on your breast before bringing your baby to your breast. It is much more challenging to get the pump in place with a squirmy baby on the other breast.
  • Distraction. Some babies find the pump to be a distraction and may hit or kick the pump, yank tubing, or simply stop feeding to look at it. Have something for baby to focus on such as a nursing necklace or safe toy.
  • Have baby prime the pump! Latch baby before starting to pump then turn on the pump (remember, not too strong- pain interferes with letdown!) and pay attention to your baby. Before you know it, your milk will be flowing!

Want more on parallel pumping? Watch the following video with Dr. Kathleen McCue.

Weaning Off Formula back to Exclusively Breastfeeding

by Shari Criso MSN, RC, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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“Supplementation with formula does not have to be the end of breastfeeding and it may be very possible to transition to exclusively breastfeeding if that is your goal.”

First of all Amy, great job at making it to the 8 week mark! It is a big deal and something to be very proud of. From your questions it is clear that you’re just about exclusively breastfeeding but now we need to help you over that last hump.

What I tell all my clients is that if all you’re supplementing is 1-2 feedings per day of formula and breastfeeding the rest of the time, then in most cases you probably don’t need to do any at all! It is obvious that your body is quite capable of producing adequate amounts of breastmilk, however the continued supplementation will not give your body the opportunity to catch up. What you need to do is feed a little more frequently so that your body can kick inn and start to make more.

If all you’re doing is one or two supplemented feedings a days and your baby is gaining weight adequately, I would immediately start cutting out formula supplementation and begin to encourage your body to make more milk. Those few ounces that you have been supplementing can usually be made of with more frequent feeding or were not really necessary anyway, as many supplemented babies are over fed and encouraged to gain weight faster than they need to.

Typically, it is when I see moms that have been supplementing for weeks and weeks with very little breastfeeding that I am more concerned about the status of their milk supply and the need to build that up slowly by cutting back formula supplement slowly over time with careful evaluation throughout.

However, for you Amy, what I would recommend is to stop the supplementation, increase the frequency of your feedings, allow your baby to stay on the breast longer, drain the breast completely by switching sides multiple times during a feeding (feed both sides and then return to the first side again), do lots of skin to skin and wear your baby as much as you can, and basically let the baby guide you right now.

As for how hungry he is, treat it as a growth spurt. In my online breastfeeding program “Simply Breastfeeding,” I have an entire chapter on growth spurts and what to do when your breastfed baby is going through one. These are times during the breastfeeding journey when you actually are not making enough and it is very NORMAL! These are times when you baby is growing and your body is attempting to catch up with your baby’s needs for more milk. The only way that it can do that is to respond to your baby’s signal of hunger, which is what happens when they start feeding very frequently. During these times, allowing your baby to nurse as long as they want and as often as they want for a few days is the answer. With frequent and “on demand” feedings, your body will kick in very quickly and start to get the message, “Oh…MAKE MORE MILK!”

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Regardless of the reason in the beginning or whether the initial supplementation may or may not have been necessary, it does not mean that you need to continue doing it indefinitely. For most mothers it is a lack of understanding about how much their baby’s need to be eating, how much and how fast they need to be gaining, and how the body responds and makes more milk that causes them to continue to supplement unnecessarily and eventually add more formula which further decreases their breast milk supply. What may start off as a true need under certain circumstances is then replaced with an issue that has been unknowingly created and unnecessarily continued.

Another important thing to understand is that babies should not be weighed weekly. This is huge! When moms and dads ask me, “How much should a baby be gaining every week?” The answer I give is somewhere between 4-8 ounces per week on average. The key point here being, ON AVERAGE. That means, under normal circumstances you are not bringing your baby in every single week to weighed. This is because one week you may only have a weight gain of 2 ounces and you are going to think something is wrong. Then the next week your baby is going to gain 10 ounces cause they had a growth spurt. This is why weighing your baby every week and monitoring so closely can cause you to think your baby is not growing appropriately and cause unnecessary supplementation.

The best way to monitor that your baby is doing well is to keep watching for those wet and poopy diapers, looking out for all the signs that I talk about in my DVD program on how to make sure your baby is getting enough milk, and weighing your baby monthly.

So after a month’s time you’ll go back to weigh the baby, you divide that gain by four weeks, and now you can say to yourself, “Okay, did they gain somewhere between 4-8 ounces a week on average?” If the answer is yes then you’re pretty much in the right spot. Babies grow at their own pace and we cannot be too rigid with this. Breastmilk is just too important to sacrifice that quickly. Just as a baby that truly needs to be supplemented must be addressed and few for their well being, your breastmilk supply and breastfeeding relationship is critical to their short and long term health and must also be protected and supported appropriately.

I recommend that you go back and watch my program and pay particular attention to the chapter on growth spurts. Work with your pediatrician and treat this time just like you would a normal growth spurt. With the right support, patience and understanding of what is normal, I believe you will be on your way to exclusively breastfeeding your little one in no time!

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Find more from Shari supporting your parenting journey including infant feeding on Facebook, or her classes at My Baby Experts©

Thanks for EvenFlo Feeding, Inc.’s generous support for families in the their feeding journey.

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Shari Criso 2016

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. You can find her on Facebook or her own personal site.

Clicking Sound While Nursing

by Shari Criso MSN, RC, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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Question:

From time to time while my baby is nursing, I hear a clicking sound. I try to take her off and re-latch her, but she gets really mad and doesn’t like to be interrupted… what could be causing this?

Answer:

I can’t blame your baby for being mad- who likes to be interrupted when they are eating?

As for the clicking issue… here is my definition of the perfect latch when breastfeeding: the one that doesn’t hurt and the baby gets milk. That’s the perfect latch. So, if your baby is clicking but the baby is not hurting you and seems satisfied, and your nipple come out looking normal and there’s no damage being done, I’d say to either try holding the baby a little closer while nursing, or don’t worry about it. Sometimes, that clicking sound comes from an oversupply, when you have a lot of milk. The baby keeps unlatching because it’s hard to latch when the nipple is so wet. So that’s probably what you’re listening to. But if you’re not in pain, and the baby’s latching, don’t disturb the baby – let her eat!

 

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Find more from Shari supporting your parenting journey including infant feeding on Facebook or at My Baby Experts©

Thanks for EvenFlo Feeding, Inc.’s generous support for families in the their feeding journey.

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Shari Criso 2016

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. You can find her on Facebook or her own personal site.

Ask The IBCLC- Migraines, Blebs, and Teething

by Shari Criso MSN, RC, CMN, IBCLC

This post made possible by the support of EvenFlo Feeding

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Dear Shari,

Help! I’m 8 weeks postpartum with my third child. It was also my third C-section and the third time I’m breastfeeding exclusively. I’ve been having dizzying migraines that sometimes blur my vision, make my ears ring, and make my head feel like it’s in a fog. My OB recommended an excedrin migraine or a little caffeine. That doesn’t often help and I don’t want to take an excedrin or two daily. I’ve gotten the depo shot two weeks ago, and the migraines are still unrelenting. Is it hormones like everyone says? Is there something I can do to help control them or relieve them?

Dizzy Mama

 

Hi Dizzy Mama,

I am sorry to hear that you are suffering so much at a time when your full focus should be on caring for and enjoying your new little one!  As someone who has migraines myself and cared for many women who have also experienced this debilitating condition, I truly feel your pain.  It is not an uncommon occurrence affecting up to 17% of women of childbearing age.  Migraines tend to get better during pregnancy, due to the high estrogen levels.  Although this is not always the case.  Non-pharmacological treatments should be the first choice when treating anything whether you are pregnant or breastfeeding and can be quite effective. Keeping a “headache diary” can help to identify triggers and make lifestyle changes that will work. Unfortunately, some of the things that do trigger migraines are the norm for any new mom such as not eating regular meals or getting good sleep, however knowing this you can make an effort to take care of yourself as well as your baby.  Something that we as moms can forget quickly!  Caffeine can make a big difference in the effectiveness of migraine treatments and is generally safe to use in moderation and as long as it is not affecting the baby.  Excedrin is actually NOT a drug that I would recommend since it contains Aspirin which is transferred into breastmilk.  The baby receives about 4-8% of the mother’s dose.  Breastfeeding women are advised not to use aspirin because of the risk of Reye’s Syndrome in their babies.  As for what prescription medication to take, Imitrex is generally considered safe for breastfeeding as the infant will only receive about 1% of the maternal dose and it is cleared quickly out of the milk.  No short-term problems or long-term developmental issues have been documented in breastfeeding infants exposed to these drugs.  Of course you will need to consult your doctor about this or any other medication, as well as to obtain the prescription.  If your OB is uncomfortable due to lack of experience or knowledge, maybe it is worth seeking a second opinion.  I hope this helps and that you have some relief quickly!

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Dear Shari,

My daughter is 16 months old now. Lately my nipples feel so sensitive and sore and I’m not sure why. I think she may be teething, cutting her molars now, could that be causing this pain? What can I do about it? My plan was to let her self-wean but right now I wish we were done. I don’t want to give up on my goal yet though, how can I get through this and how long will it last?

Feeding a teething baby

 

Dear Feeding,

Congratulations on your great success breastfeeding!  Yes, it is possible that her teething is causing her to clamp down while nursing and causing your nipples to feel sore. If that is what is happening, it is important to pay attention to when she is done “eating” and to remove her off your breast before she has a chance to bite down or rub against your nipple trying to soothe herself.  You can also offer her a cold or frozen washcloth or teething ring to chew on so that she is not using you!  The other thing that I was thinking as I read your question…is to take a pregnancy test   This is actually the very first sign for most pregnant moms!  Nipple pain and soreness all of a sudden after many months of pain free breastfeeding (in the absence of any infection or damage to the nipple) can be the first sign that you are expecting again and it is worth ruling that out first with a pregnancy test.  If the soreness is due to pregnancy, there is not that much that can be done about it since this is hormonal vs. mechanical or technique.  For many nursing moms who become pregnant this is the main reason that they decide to wean their older child, but for others it is not a problem and they can safely continue throughout their pregnancy and beyond to tandem nurse their children. Keep me posted!! xoxo

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Dear Shari,

I have a sort of white dot on the tip of my nipple and it is extremely painful when my baby is latched on that breast. It’s been there for a couple of weeks now, it looks sort of like a pimple. I tried squeezing it but that just hurt more and didn’t do anything. My baby is just 7 weeks old and the idea of this pain lasting until we’re done breastfeeding is so discouraging. Help!

Owie Nipple

 

Hello Owie Nipple,

I am glad you wrote in to ask this question because it is a fairly common issue that moms will encounter.  It is called a “milk bleb” or a blockage of milk inside one of the nipple pores where the milk comes out of the nipple.  That is why it is white.  A milk bleb is not serious condition, but can cause serious pain in the nipple especially when trying to nurse or pump.

The best way to approach this is to first not wait to do something about it. Left untreated it can cause your breast to become engorged which can lead to a decrease in your milk production as well as mastitis.  The first thing you can try is to soak your entire breast in a bowl of hot water.  Fill the bowl with water and then lean over it and just soak for 5-10 minutes or longer.  Immediately try to nurse your baby or pump after that.  The water will often soften and loosen the plug and it will be sucked out by the baby!  It is perfectly fine for them to swallow.  You may notice after nursing that it is starting to come out.  If you can you can pull it out, but I would not squeeze your nipple to try and “pop” it.  It is not a pimple and squeezing your nipple can cause more inflammation.  If the soaking and suction does not work you may need medical help from your doctor or midwife who can use a sterile needle to remove it.  This is not something that I would do at home (although I know women who have) due to the risk of injury or infection.  Good luck!

 

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Find more from Shari supporting your parenting journey including infant feeding on Facebook or at My Baby Experts©

Thanks for EvenFlo Feeding, Inc.’s generous support for families in the their feeding journey.

________________________

Shari Criso 2016

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. You can find her on Facebook or her own personal site.

Breastfeeding and Solid Foods

by Shari Criso MSN, RC, CMN, IBCLC

This post made possible by the support of EvenFlo Feeding

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Once a baby is taking solids, how often should you offer your baby the breast, and how do you know when to initiate the weaning process?

Once the baby is taking solids, you should still offer the breast whenever they baby wants to eat. You can still breastfeed before each feeding of solids. But as the baby gets older, into the seventh or eighth month, if you wanted to cut out those feeding and substitute a meal, like breakfast, and have a meal of food and then breastfeed between those feeding, that’s totally fine. By the time my children were about 8 months old, I was feeding them three meals a day, breakfast, lunch, and dinner, and I was breastfeeding them maybe 4-5 times in a 24 hour period.

 

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How do I introduce solids and keep my supply up?

And your body will adjust to this. Your body will naturally keep its own supply. It does not need to make the same amount of milk it did in the beginning. Remember, you’re making more milk in the first 6 months of the year than you are in the second 6 months, because your baby will eat a certain amount of milk, somewhere around 3-4, sometimes 5 ounces of breastmilk per feeding, and never increase from there. What changes is that in the second half of the year, they start to eat solid foods, so the actual amount of milk you’re actually producing and feeding decreases in that second half of the year from 6 month to 12 months and beyond. So you don’t need to keep up with your supply; your supply will be adequate for what your baby is taking in. And by nursing more, you’ll just make more. 

Shari Criso MSN, RN, CMN, IBCLC

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Find more from Shari supporting your parenting journey including infant feeding on Facebook or at My Baby Experts©

Thanks for EvenFlo Feeding, Inc.’s generous support for families in the their feeding journey.

____________________

Shari Criso 2016

 

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. You can find her on Facebook or her own personal site.

Ask the IBCLC Breastfeeding Help: Low Supply and Breastfeeding in Pregnancy

The Leakies with Shari Criso, MSN, RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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We’ve asked Shari Criso to share her answers to Leakies questions about feeding their babies. If you have any questions you’d like to ask Shari, leave a comment!

 

My little 4 month old is refusing to take bottles. I’ve started taking him to daycare, and he is refusing bottles, not even taking a full ounce while he’s there for 6-7 hours. When we’re together he’s still drinking well from the breast and nursing frequently at night. His weight is good and we’ve had no issues other than this. I’m worried about him becoming dehydrated during the day. What can I do and what can I tell the daycare to do?

Mama to a hungry but stubborn baby.

 

Hi Mama,

I totally feel your pain and the anxiety that comes when your breastfed baby refuses the bottle and does not eat when you are not around. I had one myself! Reading your question, my first thought is that this transition may take a little time for not only you to get used to leaving but for your little guy to get into a new routine, new people, and a NEW way of eating! This is one of the reasons that I really recommend introducing your breastfed baby to a bottle earlier than most will (like within the first 2 weeks!) which makes this transition much easier. I actually have an entire chapter dedicated to this very thing in my online breastfeeding class “Simply Breastfeeding” because I know there are so many moms that need to return to work and this issue can be so distressing. I know that is not helping you now…so my best advice is this: First, try different types of nipples to see if there is one that he will take over another. Try offering the milk cold instead of warm. Sometimes this can also make a difference (not exactly sure why, but it worked with my own and other mamas I have worked with). Try feeding him in different positions instead of cradling him. Holding him outward and distracting him by moving around, staring at a picture on the wall, etc. Try an infant feeding cup. YES…babies can be fed through a cup and don’t need to take an artificial nipple! Lastly, if all of these things fail don’t stress. This may just take a little time and a few more feedings during the time you’re home and at night. Let him co-sleep with you and try to get as many feedings in that you can while you are together. Watch wet diapers, signs of dehydration and weight loss. If all seems normal, just let it be and allow your baby to adjust at his own pace. In the meantime, you should still continue to pump on schedule as to not decrease your supply and also not get too engorged while you are away.

I hope this helps and that things start to smooth out very soon for you!

Xoxo,
Shari

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Dear Shari,

I am 7 weeks with my 3rd and my son is 8 months old today, so I am still nursing very much so for nutritional purposes. He doesn’t like solids, of course, so I’m lucky if he eats 1 additional solid meal per day. I have noticed a drop in my supply already, just now I was up to nurse him and it took a good 10 minutes before he got a let down and they definitely aren’t as strong. Please tell me it won’t drop any further than it is now, I want to tandem, I nursed my daughter until 22 months so him and I would both be devastated if it just went away!!

You’ve been so encouraging before, thank you!

Not ready to stop!

 

Dear Not Ready To Stop,

First, congratulations on your new pregnancy! Having you children close in age has many benefits and can also present certain challenges as you are experiencing, however this does NOT need to be the end of your breastfeeding relationship with your older child. Many, many mothers are able to continue breastfeeding safely during pregnancy and way beyond, going on to tandem after birth. Most moms will have a decrease in their milk supply during pregnancy. This is especially common in the second trimester but can start as early as the first. It is thought that increased levels of Progesterone during pregnancy is what causes the milk supply to drop. This typically begins to resolve towards the 3rd trimester and especially at birth when the placenta is delivered and prolactin levels rise. AS always, it is important to continue to offer the breast to your nursling frequently and not decreasing “demand.” This will only add to your decreased production. Co-sleeping and night feedings can help here. Be careful on any herbal supplements that you are considering as they may help your supply, but they are not all safe during pregnancy. Always consult your doctor, midwife, and lactation consultant. The decreased supply may actually encourage your little one to start taking mores solids, as he will naturally be hungrier. This is fine as long as your are getting in at least 3-4 feedings per 24 hours. Take this opportunity to experiment with new and yummy foods, and keep trying even if he rejects it at first. It can take 5-7 “rejections” of a certain food before a child will accept and even learn to love it. As always, monitor wet diapers, signs of dehydration, weight loss, etc. Most of all, try not to stress. This is temporary and your milk WILL come back so that you can go on to provide for both of your babies! 

All the best to you and your family.

Good luck,
Shari

AskTheIBCLC_26JUL16

Dear Shari,

My little is almost 6 months old. My supply has taken a huge turn for the worse. I am barely producing anything. I Had a huge over-supply in the beginning. This has all started about a month ago. I know that you are supposed to adjust and pump more of what baby needs close to 3mo plus. Well I started doing that. Was pumping like 20-25 ounces a day.. Then it decreased to 10-15 and now I’m at 1-6… The past two days have been around 2 ounces the whole day. I have done pretty much everything I have read to do. I have also switched pumps. I have tried switching flanges. Replaced membranes, replaced hoses. I know stress is a horrible killer for your supply. I honestly am not stressing. I do not feel stressed, do not feel worried. I have a freezer full of milk so I know my little girl will have momma milk for a while longer even if I am done producing. I just would like to know if I am done ya know. I have tried nursing her more too. Day before yesterday I nursed her more and she didn’t seem satisfied at all. Today I nursed her more and she seemed fine. What is going on?

I appreciate any light you can shed on this!

Dwindling supply and hungry baby.

 

Hello Dwindling,

It sounds like you are trying to pump in addition to fully nursing your baby at the breast. It is completely normal for milk supply to fluctuate and for there to be times when your supply may seem lower. This will naturally happen as your child ages and also during times of growth spurts when they are eating ALL THAT YOU HAVE! That will of course leave less to be pumped. Normal growth spurts occur around 2-3 weeks, 6 weeks, 3 months, and 6 months. There is also a very common decrease that happens around 6 months postpartum for many moms. This can be due to hormonal changes, the return of you period, nursing less frequently, returning to work, introduction to solid foods, etc. I talk about this a lot in my online class “Breast Pump & Briefcases,” as it is something that so many breastfeeding and pumping mothers face. It is important to understand that while there may be times where you are able to produce way more than your baby is eating (which leads to being able to pump a lot of extra feedings for storage or donation…like your freezer full of milk), there will be other times where you may just be making exactly what your baby needs in the moment and not any more. This is not abnormal, and also not a problem as long as you feel that your baby is getting what she needs at the breast (which it sounds like she it). Your pumping and storing may have to take a back seat until the growth spurt is over. This will usually pass within a few days of concentration and baby led feedings. Small but frequent feedings whenever the baby wants to go back to the breast without supplementing, will usually have your supply back within a few days. Delaying feedings or supplementing with your freezer supply or formula during theses times will have the opposite effect, delaying the decrease or decreasing it further. This is SO important to understand. There are also foods like oatmeal and herbal supplements like Fenugreek that can help during these times, but I would always consult a Lactation Consultant before using anything. 

I hope this helps you and congrats on doing such a great job feeding your little girl!

Much love,
Shari

 ____________________

Shari Criso 2016

 

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. You can find her on Facebook or her own personal site.

Ask the IBCLC Breastfeeding Help: Relactating, Back to Breast After Bottle, Once Low Supply Always Low Supply, and More

The Leakies with Shari Criso, MSN,RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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We’ve asked Shari Criso to share her answers to Leakies questions about feeding their babies. If you have any questions you’d like to ask Shari, leave a comment!

 

Dear Shari,

I started breastfeeding my son when he was first born but we had a lot of difficulties and ended up switching to formula. He’s 2 months old now and I don’t think I have any breastmilk left but I’m really sad about stopping. Is there any way I can get him back on the breast and get my supply up for him? Is that possible or should I just accept that I screwed up?

Sad but hopeful

I am so sorry that you had so much difficulty.  This is unfortunately not uncommon and there are so many moms that face the same challenges having them stop breastfeeding way before they want to. You DID NOT screw up!  You did the best that you could with the information and support that you had.  This is not your fault although I know how disappointing it is. There are two questions you are asking here…One, is it possible after 2 months to get your baby back on the breast from the bottle, and two, can I increase my supply to go back to exclusive or partial breastfeeding?  The answer to both of these questions is YES…but it will take some work and the right support.  If you have been pumping and feeding your baby a combination of breast milk and formula, increasing your supply back up to exclusive breast milk is very doable.  It will require frequent pumping and/or feeding (possibly with a supplemental nursing system) and also supplements that can help to increase your supply.  If you have not been pumping at all, re-establishing your supply or “relactation” is possible but will also require work with pumping, feeding and supplements for you.  Getting your bottle fed baby back on the breast after 2 months is possible although not always.  I highly recommend that you seek out an experienced IBCLC that has worked with moms in this situation before and get the proper counseling and support.  This is not something to do on your own, as time is really of the essence if you want to have the best chance at success.  Lastly, there are lots of moms that exclusively pump and are still able to feed their babies breast milk even though they are not nursing at the breast.  Of course your baby will greatly benefit from this for as long as you are able to do it and for as much or as little as you are able to provide.  This is a third option to consider.

For those moms that are trying to make that final transition back to exclusive breastfeeding, here is a great video clip from my WebTV Show on “Weaning off formula back to exclusive breastfeeding” 

 

 

Dear Shari,

I was hoping you could tell me what could be causing me to feel nauseous when I nurse? It’s really bad at night, but always there when she nurses?! Is this normal? Will it go away? It is really putting a damper on breastfeeding because I feel sick every time.

Please help!

Feeling sick to my stomach

 

Hi…I know this feeling that you are describing since I had it myself when both of my babies nursed!  It is amazing how everyone feels different when they breastfeed.  Very often moms will have some sort of sensation or reaction to their milk letting-down.  It can feel different in different moms, and if you don’t feel anything it does not mean that you are not getting a let down…don’t go there!  This can be felt as nausea, which is usually caused by the hormones that are released when your baby begins to suckle.  Moms may feel something like nausea, slight dizziness, lightheaded, tingling,  etc… at the onset of the feeding and then it will subside as the baby continues to feed.  As I said this is not the same for everyone and it sounds like you may be feeling it the whole time. There is not much that you can really do about this since it is hormonal.  You may want to try a hard candy, closing your eyes and relaxing with the feeding, or maybe some fresh air or a fan, etc… Also, make sure that you are not hungry or that your blood sugar is not low, which will also cause you to feel nauseous, just as it can during pregnancy!  I wish that I had more to offer except that this is quite normal AND it may not last.  Your body (and your baby) is changing every day.  What you are experiencing one day may be completely different the next.  Hope it resolves and you can enjoy the experience a bit more.

Here is a video about relieving nausea (or morning sickness) in pregnancy…although the hormones that are causing it are different, the conversation about hypoglycemia may be helpful and especially for all the pregnant mamas out there. 

Q&A2_14JUN16

 

 

Dear Shari,

I am 12 weeks pregnant with my second babe. With my son I wasn’t able to breastfeed, my supply never came in. I tried oatmeal, mother’s milk tea, and lots of water. But nothing helped. I really want to breastfeed with this one. Does anyone have any advice or suggestions that could help this time around? Anything I can do beforehand to make sure my supply comes in?

Thank you so much for your help.

Concerned but hopeful in the midwest.

 

Hi…It is great that you are asking these questions NOW in preparation for your baby’s arrival.  Way too often, moms will wait until their baby is born to educate themselves or try to find the support that they need.  This can be difficult when you have just given birth, trying to breastfeed and care for a newborn!  To answer this question it is important to identify what actually happened last time, identify any underlying medical issues, and also be cautious in comparing one experience with the next.  So yes there are real situations that can cause your milk to not either be delayed in coming in, have a decrease in supply, or not come in at all.  You need to discuss this with your doctor or midwife (and also consult with an IBCLC) to make sure that underlying causes are identified and addressed if they exist such as a hypothyroid, or IGT for example.  Sometimes the birth itself can be a cause for a delayed or insufficient supply…large blood loss, retained placental fragments, etc…can cause this among other things. Lastly, it is important to remember that while it is very possible to have a real situation with insufficient milk supply, my experience is that MOST issues are either perceived or created from the concern and then the unnecessary supplementation.  It is SO important to understand that your milk will take days to come in, that the drops of colostrum that you are producing is all your baby will need, and that babies are not really supposed to eat large volumes of milk in the first few days and are supposed to lose weight!  This misinformation and misunderstanding, mostly in the medical community, is what creates fear and doubt for moms and causes unnecessary supplementation, decreased feedings at the breast, and can cause the exact issue you are trying to cure.  Most importantly, get the information you need and really understand what is happening and what is not.  Yes the teas and the supplements can be helpful, but without the knowledge it will not make much of a difference.  One of the best ways to prepare yourself for success is to watch my online breastfeeding class “Simply Breastfeeding” where I go over this discussion on milk supply in the first week as well as so much more!

____________________

Shari Criso 2016

 

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters.

Increasing Breastmilk Supply With Pumping For Milk Donation

by Jessica Martin-Weber and Dr. Pamela K. Murphy

This post made possible by the support of Ameda

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When my 4th baby was just a few months old, a friend of mine who had adopted a little girl from Vietnam asked me for breastmilk for her daughter. Her own milk supply was dwindling and after over a year of pumping after inducing lactation even before she had her daughter, her body was done producing milk and the effects of Domperidone had left her struggling with weight and energy issues. Initially they introduced formula but her daughter reacted with painful eczema head to toe. Convinced she needed breastmilk, my friend asked me to help her little girl.

Breastmilk truly is amazing and while many babies thrive on breastmilk substitutes, the healing nature of breastmilk is something that can’t be denied. We know it can help save lives, particularly the most fragile of our society. Giving breastmilk is giving the gift of life and health for another to thrive.

Milk donation gift ameda meme

I’ve always responded well to pumps, particularly if can hook up and get busy doing something else. But my supply was well established for my own baby and because I had a job that allowed me to bring my baby with me, I wasn’t pumping very much for her. I was more than willing to help my friend but I wasn’t sure how to get enough milk for two babies with my supply regulated for my one. I decided to see what I could do.

Having a tendency to easily develop over-supply and then have issues with mastitis, I knew I needed to be careful with this process. After talking with a couple IBCLC friends, I began to add pumping sessions to each of my existing feedings to slowly increase my supply and not interfere with my baby getting what she needed first. It worked so well that 2 years later with my 5th baby I intentionally increased my supply to donate to human milk banks and two other friends who had adopted little ones and with my 6th, as soon as my supply was established I began again for another friend’s baby and the Human Milk Bank Association of North America.

To get my supply up for those babies and to donate to a milk bank I started adding 10 minute pumping session to the end of my breastfeeding sessions. Then I started pumping one breast while feeding off the other. Two feedings a day I started increasing my pumping time to 20 minutes after my baby would finish which would be long enough to cycle through another let down. Sometimes this meant that I would pump with maybe just a few drips for 5 minutes or so or even without anything at all and then I would get another let down. The first feed of the day I always pumped one breast while my baby was on the other and in just a few days I had increased my supply so much I needed to pump into a large milk storage bottle. By 3 weeks I had added 2 full and one half pumping sessions in my day and by a month I was pumping one breast and feeding off the other 3 feedings a day (the first one in the morning was always my highest output) and then pumping 3 full sessions in between feeding my baby. By that point I was pumping enough milk in a day to completely supply another baby’s feeds and have some extra for back up. When I wanted to increase my supply again, I followed a similar pattern with extending my pumping times and adding a pumping session in the morning but it was adding an extra pumping session before bed that led to the morning pumping session to increase even more in just 3 days time.

Breastfeeding- Ameda

Here’s what I learned in increasing my breastmilk supply to donate:

Don’t focus on the output. The volume isn’t the point and it will take some time before you see it so focus on why you’re doing it, remember that babies don’t actually eat that much, and every single drop counts.

Baby helps. Your baby is your ally in increasing your supply. Skin-to-skin contact doesn’t just feel good and provide your baby with neurological stimulation that is beneficial for their development, it also tells your body to make milk. And if you can pump while they are feeding from the other breast, your body will be more willing to give up more milk.

Ask and it shall be given. Your body will give what it can when you ask it to. Unless you have some physiological barrier, if your body is asked for more milk, it will make more milk.

Hands-free. Pumping isn’t fun for most even it comes easily. Going hands-free can help free up your mind to focus on something else and help you feel more productive or at least entertained in the process.

Hands-on. It helps to be distracted but taking a little time with each pumping session to be hands on with some hand compressions at the breast (like a breast massage) can significantly increase your output and send the message to your breasts to make more milk. This video is an excellent demo of how to do so.

Be patient. The process takes time and responding to the pump may be an adjustment for your body. That’s ok. Don’t rush the process.

Wean off. When it’s time, whatever the reason (and please respect your boundaries and stop when you need to), wean off slowly. Supply increase is real and not draining the breast could lead to infection and mastitis is even worse than pumping so stop slowly.

Celebrate. This is hard work and it’s a sacrifice of love. Celebrate that. Celebrate babies getting human milk.

Not everyone is going to want to increase their supply to that amount for donate but every little bit helps. You may not be able to add so many pumping sessions to your schedule but you still want to donate. If you choose to donate, do what you can and resist the urge to compare with others. Every single drop really does count.

Dual pumping- Ameda

So you want to get started increasing your supply to donate, Dr. Pamela Murphy, PhD, CNM, IBCLC shares with us some helpful information and tips to get you started:

Will pumping to increase supply take milk away from mom’s own baby?

Not if you pump after breastfeeding or in the middle of a long period when your baby isn’t breastfeeding (like a long nap). If you are trying to stock up some extra milk for when you are apart from your baby or to donate, pump 1-2x a day after breastfeeding or in the middle of a long sleeping stretch. Your body will start to make more milk to meet your new demands, just like when your baby goes through a growth spurt and breastfeeds more. This cluster-feeding helps increase your milk supply! Just keep in mind, be patient, it can take a few days to see your milk supply increase.

How do our bodies just start making more milk when we start pumping more?

Hormones! The more often you drain your breasts of milk, the more milk they make! Breastfeeding and pumping stimulates the release of prolactin, a hormone that increases your milk supply. Isn’t is amazing how nature works! Check out this quick video to learn more.

Should moms take medication, herbs, or eat certain foods to increase their supply for donation?

Normally you do not want to take anything to increase you milk supply unless you have to. Very few moms need to take anything to increase their milk supply if they are draining their breasts often. Medications, herbs and foods that help increase milk supply are called galactogogues and work by increasing the hormone, prolactin, which helps your body make breast milk. If you decide that you want to try to increase your milk supply to donate more milk, talk to your healthcare provider or lactation consultant to figure out what galactogogue might work best for you. Keep in mind that galactogogues can cause side effects, health complications or allergic reactions for you or your baby. And most milk banks won’t accept milk from a mother on certain medications, including herbs used to boost supply. If you are donating to a family directly, be sure to disclose if you used any herbs or medications to increase your supply so they can make an informed decision. Here are some additional tips about your diet while breastfeeding.

What kind of pump should moms use? What should they avoid? 

Once you have established your milk supply use a quality double electric pump like the Ameda Purely Yours. It really depends though, every woman is different and responds differently to different pumps. Some actually prefer hand expression and get more milk that way but most will do better with a double electric. A single pump or hand pump may make it harder for you to keep up with your pumping schedule since it will take longer to drain both breasts at the same time. Here is some more info about choosing the right breast pump for your situation.

How to store milk intended for donation?

Check with your milk bank to see if they have special guidelines. Some general guidelines are to always use clean pump parts and wash your hands. Collect your milk and store in either a bottle or milk storage bag. Do not store milk from more than one pumping session in the same bag. Here is some additional information about pumping and storing your pumped milk.

Anything else to keep in mind regarding being a milk donor? Even if you cannot produce enough to donate remember that milk banks are always looking for volunteers. You can still do you part to help babies! If you are a social media user, follow non-profit milk bank accounts and share and interact with them, believe it or not this is an excellent way to raise awareness and increase the number of women who donate when they become aware of the need. Find a milk bank near you.

____________________

Are you a breastmilk donor? How did you get your supply up? What tips would you add to our list to encourage other donors-to-be?

_______________________
Pam headshot- Ameda

Pamela K. Murphy, PhD, MS, CNM, IBCLC has worked with birthing and breastfeeding families for more than 15 years. Her lactation practice extends from the preterm/high risk infant to the healthy newborn both in the inpatient and outpatient settings. She has published research on pregnancy, nutrition and lactation in peer-reviewed journals including Breastfeeding Medicine, JAPNA, the Journal of Midwifery and Women’s Health and Advances in Neonatal Care. She is shown here with her once breastfed & beautiful daughter Audrey.

“Let Love Flo” Infant Feeding Q&A With An IBCLC

The Leakies with Shari Criso, MSN,RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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We’ve asked Shari Criso to share her answers to Leakies questions about feeding their babies. If you have any questions you’d like to ask Shari, leave a comment!

Hi Shari,

My baby is due in about a month and I’ll be returning to work full time at 6 weeks postpartum. I heard that I’ll need to introduce a bottle right away for my baby to accept one. But then I heard that if you introduce it too soon my baby will have nipple confusion. I’m confused now. When and how often should my baby be given a bottle while I’m on maternity leave? Is there anything Any clarity you can offer would be great, thank you!

Jamie, Nipple confused in California

 

Hi Jamie,

Congratulations on the upcoming arrival of your little angel! The question about when to introduce your breastfed baby to a bottle is one that can be confusing with the enormous difference of opinion that is out there even among lactation experts. Some will say that you should wait at least 6 weeks before introducing any artificial nipple to your breastfeeding baby due to the potential risk of “nipple confusion” or preference for the bottle over the breast…while other advice will encourage you to introduce it much earlier so to avoid rejection of the bottle. In my experience, waiting too long to introduce the bottle to your breastfed baby does increase the chance of rejection and this is really difficult on a mom who needs to return to work. By 3 weeks most babies will develop a “nipple preference” either way. The advice that I always give to my breastfeeding who want to introduce a bottle, is to wait until your milk has fully come in and when your baby is breastfeeding well and regularly without any issues. This timing can vary for different moms. Some will achieve this as early as a week or two after birth. When this happens I encourage mom to pump or hand express a small amount each day (no more than 1⁄2 ounce) and then feed it to the baby in a bottle. After that they can finish the feeding at the breast. You are not replacing the feeding, but rather you are consistently introducing the bottle to the baby early when the baby is more likely to accept it and less likely to reject it. This should be done daily until the baby is 6 weeks old. Then you can pump and replace a full feeding if you choose to. This method is very effective in supporting a breastfed baby to accept a bottle, while at the same time continuing to breastfeed without issues and interfering with your milk supply. For more information and instructions there is an entire chapter about this in my full online class “Simply Breastfeeding” on my website. I hope this helps!

 ____________________

Dear Shari,

With my first 2 babies I had horrible oversupply and developed mastitis within the first two weeks postpartum and the recurring frequently throughout the first few months. It was horrible. I’m so afraid of it happening again, is there anything I can do to avoid it? The idea of battling mastitis off and on for the next few months is enough to make me not want to breastfeed this time around even though I really want to. While I’m so grateful to have plenty of milk for my babies even though my first two had slight tongue ties, I’m really afraid of dealing with mastitis again. Please help me.

Ready to quit, again,

Lisa, in Florida

 

Hi Lisa,

I am sorry that you struggled so much with your prior breastfeeding experiences! It can be so difficult and stressful when you are trying so hard and encountering so many challenges! Most breastfeeding moms do not fully understand just how difficult it can be to have TOO MUCH milk and the ensuing issues like mastitis that can occur, unless they are experiencing it. In my experience, oversupply can sometimes be more difficult of an issue than under supply, although neither are easy! There are a couple of things that I would recommend. First, make sure that you are not pumping in the early days and weeks to empty the breast after the feedings. This is a BIG mistake that moms make or are encouraged to do, and this can lead to oversupply. Also, feeding your newborn on one side at a time will help to bring down your supply quicker. Lastly, one of the most common reasons for mastitis that I see is constriction or pressure on the breast tissue from improperly fit bras or the use of underwire bras, especially early on and when the breast is full and engorged. This extra pressure on the full breast can cause plugged ducts and inflammation, which can lead to mastitis. Nursing frequently, warm compresses, not pumping, and avoiding pressure on the breast, will all help to normalize your supply and hopefully prevent you from developing mastitis. See this video for further information on the issue of “oversupply” that may help. Good luck to you!!

Shari's Q&A- image1

Hi Shari,

Is it possible to not make much milk? With my son I was looking forward to breastfeeding but it just didn’t work out. I was heartbroken, I had tried so hard, used a system to supplement at the breast, had my son’s slight tongue tie revised, ate oatmeal every day, did everything I could find to do. I saw an IBCLC and she told me I may not have enough milk making tissue. My breasts aren’t very small but they aren’t very round or close together and they never changed in pregnancy or even after giving birth. I couldn’t express any milk with a pump, well, never more than a few drops and hand expression wasn’t any better. Breastfeeding is really important to me but I can’t handle seeing my baby lose weight when they should be gaining and it was really hard to see that I was failing my baby while hearing from everywhere that breast is best and I just needed to try harder. Could I be too broken to feed my baby? Is there anything I can do this time?

Thank you for taking time to answer. Heartbroken Heather from West Virginia

 

Hi Heather,

First of all, you are not broken! I can feel your heartbreak in not being able to breastfeed your baby the way you wanted to. It can be very frustrating and even depressing to try everything you know and still not be able to produce enough milk for your baby. To answer your question…Yes, unfortunately it is possible for a mom to not make much milk and this can be caused by a variety of reasons. This could be caused by hormonal issues that exist and go untreated (such as PCOS or Thyroid dysfunction)…it can be caused by failure to establish an adequate milk supply after birth from improper latch, formula supplementation, or even an undiagnosed tongue tie in the baby, etc…and it can also be caused by a condition call Insufficient Glandular Tissue (IGT) where the breast does not have enough glandular tissue to produce a full milk supply. This is something that can be identified during pregnancy, but cannot be determined until after the baby is born and all attempts to produce a full supply are unsuccessful. As a mom that is experiencing this it can be so difficult to keep hearing people offering advice on the very things that you have been trying all along! There are some things to try and consider all with the support and advice of an experienced Lactation Consultant. There are medications and herbs (such as Goat’s Rue) that can sometimes help. Make sure you are addressing and treating any underlying hormonal conditions with your practitioner that may be possible. Lastly, whatever amount of breast milk you are able to produce is still going to benefit your little one. It is definitely not all or nothing! If you are producing some breast milk, you may choose use a supplemental nursing system to deliver the supplementation (donor milk, infant formula, etc…) to the baby and continue to breastfeed at the breast. This can also be done if you are not producing any breast milk but still want to maintain the physical closeness of the act of breastfeeding. Either way always remember that this is not your fault! You are a great mom regardless of HOW or WHAT you feed your baby…and the most important thing that you can ever provide to your child is your love, which is always abundant and overflowing!! For more information, see this video clip. Sending you lots of love!

 ____________________

Shari Criso 2016

 

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters.