Breastfeeding Blog

10 Tips for Pumping Moms

Whether you’re a working mom, you’re pumping for a non-latching baby or preemie, or if you’re just pumping for the occasional baby sitter/night out, pumping can really suck (pun intended!). I get questions about pumping all the time, so I decided to compile all the…

“Comfort Nursing” Counts Too

Nursing is nursing, whether your baby is drowning in milk, or just lightly sucking. It’s nursing, whether your child does it because he wants a meal, an appetizer, a snack, or dessert. It’s nursing, whether your child is hungry, starving, thirsty, tired, or just wants…

Low Milk Supply: Myths, Causes, and Solutions

10325301_10205468382365306_144080507324062537_n

Besides nipple pain, low milk supply is probably the biggest concern mothers have while breastfeeding. It is also one of the more common reasons cited by mothers for premature weaning.

First, it’s important to know that virtually all mothers—if given the right information and education—can make enough milk for their babies. True low milk supply (as in, the mom’s body cannot produce enough milk) is actually somewhat rare. Still, some mothers and babies do struggle with supply issues and need lots of support.

How do you know if you have a milk supply issue? If your baby is growing appropriately on your milk alone (no formula), then you have enough milk and your baby is getting it!  You can skip this article and go nestle down with your bundle of joy.

It’s important to note that the most accurate way to determine if your baby is getting enough milk is to have your baby weighed naked on a baby scale by your doctor, midwife, or lactation consultant. The other ways that mothers measure milk intake can be useful, but simply aren’t objective enough to determine milk supply issues.

So, whether your breasts feel full; how big your breasts are; and whether you leak milk between feedings are not accurate ways to determine your milk supply. Neither is how big your baby seems to be getting, or even how many pees and poops your baby makes. All of these things are helpful, and can be part of the larger picture, but are too subjective to determine whether or not you have low milk supply.

So, what if something truly is wrong: what if your baby isn’t growing well? Don’t worry. There are almost always ways to remedy milk supply issues. Almost all cases of low milk supply can be fixed by two basic things: more frequent nursing, and good latching. Cases that aren’t remedied this way are usually fixable as well.

It’s important to know the cause, and get skilled help in remedying it. Going out and buying special nursing teas or lactation cookies will do nothing if you don’t know what’s wrong.

Here are some common causes of low milk supply in the first few weeks of nursing (low milk supply after the first few weeks isn’t the focus of this article, though some of the causes overlap), and simple solutions. Again, frequent nursing (with a good latch) will fix almost all of these problems.

  1. Weight loss in the first week of breastfeeding. All babies lose a little weight in the first three days of life, before a mother’s milk comes in. It is normal for a breastfed baby to lose 5-7% of his or her birthweight. When a mother’s milk comes in 3-4 days after birth, the baby should start to gain weight. If this doesn’t happen, a mother should seek help right away so that the problem doesn’t worsen.
  2. Infrequent nursing. New babies need to come to the breast VERY FREQUENTLY—pretty much anytime they aren’t sleeping, they should be nursing. Pay attention to their feeding cues, and put them to your breast anytime they are interested. Newborns average 10-12 nursing sessions per 24 hours. Even after the first few weeks, babies need to nurse frequently to keep up your milk supply. It is also important to keep in mind that babies need to nurse in the middle of the night to keep up a mother’s milk supply.
  3. Poor latching. A baby who isn’t latched on well will not drain the breast completely. Babies need to latch deeply, with a wide, open mouth. Get in-person latching help if you suspect this as the cause of your troubles.
  4. Use of supplements. If you had been concerned about your milk supply and were offering formula supplements, you may have inadvertently caused a milk supply issue. The reason why is that milk supply is a supply-and-demand system: the more milk you take out, the more you make. So if you were giving your baby formula, he or she wouldn’t have been hungry as frequently, and wouldn’t have come to the breast as frequently, thereby driving down your milk supply. It is best to wean off formula supplements gradually, nursing more frequently as you go.

Here are some of the more complicated causes of low-milk. Some of these issues are more easily solved than others. I highly recommend you work with an experienced lactation consultant if you suspect any of these issues.

  1. Tongue Tie. A tongue-tied infant can’t use his or her tongue properly to drain the breast of milk. If your latch looks good from the outside, but your baby still isn’t getting enough milk, it’s worth having a skilled professional look for a tongue tie. The tongue tie can be released by a simple procedure called a frenotomy. Click here for a good summary of how tongue-tie can affect breastfeeding.
  2. Retained placenta. After birth, the delivery of the placenta tells the body to start the process of milk production. If even a small piece of the placenta doesn’t get delivered, milk production can be halted. Signs of retained placenta include excessive maternal bleeding along with low milk supply. The retained placenta may come out on its own, but should be removed by a health professional if it is causing milk supply issues.
  3. Maternal thyroid and hormone issues. Hypo- and hyper- thyroid issues can have an impact on milk supply. Thyroid issues can be present before birth, but can also develop in the weeks after childbirth. If you have looked into the more common causes of your milk supply, but haven’t found a solution, have your thyroid tested. Mothers who suffer from Polycystic Ovarian Syndrome (PCOS), Luteal Phase Defect, or other hormonal imbalances can have lower milk supplies. These can often be remedied by medications as well.
  4. Maternal Diabetes. Mothers who have diabetes are more likely to have their milk come in late, or have milk supply issues. Even women with a pre-diabetic condition called Insulin Resistance are at risk for low milk supply. This is another area to have tested if you have tried all the common tricks. Diets and medication can help here.
  5. Insufficient Glandular Tissue. It is not breast size, but the amount of milk-making tissue in the breast (glandular tissue) that determines how much milk a breast can produce. A small portion of women do not have a large enough portion of glandular tissue in their breasts. Signs of this are breasts that did not grow much during pregnancy, widely spaced breasts, asymmetrical breasts, and breasts with a tubular shape. This is best investigated in-person by a skilled practitioner. Frequent nursing and pumping, along with supplementation may be necessary. There are certain herbs and medications that can be helpful here too.
  6. History of Breast Surgery. Breast reduction surgery, breast augmentation surgery, as well as other breast surgeries can have an impact on milk supply. It depends on the location of the incisions and how much milk-making tissue was removed. There is a wide variety of breastfeeding success rates for women who have had these surgeries. It is best to be seen by a lactation consultant who can help you figure out your best chances for success.

This is not an exhaustive list of causes for low milk supply. And even if you have some of these diagnoses it doesn’t mean that you will have an issue with milk supply. Besides the remedies mentioned, some mothers find that frequent breastfeeding isn’t enough to bring their milk supply to the place where it needs to be. The use of hospital grade (rental) pump in addition to frequent nursing can prove very useful.

Some of these conditions respond well to herbs and medication—the herbs and medications appropriate to each situation is beyond the scope of this article. I highly recommend the book Making More Milk by Diana West and Lisa Marasco, for a detailed list of foods, medications, herbs, and other techniques to increase milk supply.

Even in the more complicated cases, good latching and frequent breastfeeding can make a huge difference, and are the most important ways to work through supply issues. 

It can’t be emphasized enough that meeting with a lactation consultant is a requirement for mothers who are struggling with milk supply. True milk supply is often a complex situation, often involving both maternal and infant factors, so all aspects of the nursing relationship need to be addressed.

Finally, even if you are one of the mothers who end up not making enough milk for your baby to thrive, you should know that breastfeeding isn’t “all or nothing.” Any amount of breastmilk—even a few drops—contains a multitude of antibacterial and antiviral agents and excellent nutrition. And breastfeeding—more than anything—is a relationship, an exchange of love. Even if you have to supplement your baby, breastfeeding can be the glue that binds you together. So define your own goals, get support, and keep at it.

***

Need some extra breastfeeding help and support? Schedule a virtual lactation consultation with me.

***

A version of this post first appeared in Natural Child Magazine

Tips for Gently Weaning Your Toddler

Tips for Gently Weaning Your Toddler

How long to nurse your baby or toddler is a very personal, individual decision. And it’s a choice only you can make—not your friends, your breastfeeding helpers, your mother, or your partner. You know yourself and your child. You know your day-to-day life. You know…

Laid-Back Breastfeeding: Comfortable, Instinctual Nursing for Moms and Babies

There is no wrong way to position your baby at the breast. As long as your body and breasts stay comfortable and your baby is getting enough milk, there’s nothing you need to change. Humans have been breastfeeding since the dawn of time, and it…

Telling Mothers the Truth About Breastfeeding

kerry

I have listened to mothers weep over how difficult breastfeeding is, or how much they hate it, dread it, want it to end.

I have helped mothers get through to the other side of breastfeeding, which usually includes varying amounts of pleasure and love.

But I have also helped mothers make the decision to end breastfeeding.

I never gloss over their feelings of loss and regret: these are feelings they need to feel and work through.

I don’t think it’s helpful to tell a mother she shouldn’t feel these feelings, that she needs to move on, or that breastfeeding doesn’t matter anyway.

A mother’s breastfeeding experience lives in her bones. Most (but not all) mothers have a visceral and primal urge to breastfeed. When it doesn’t happen for whatever reason, it can feel earth-shattering.

This is not a feeling EVERY mother has, but when a mother has it, it shouldn’t be disregarded. Women need support to work through these feelings.

I also never downplay the benefits of breastfeeding. I never say breastfeeding isn’t important for babies and mothers. It is. Its short-term and long-term health benefits are confirmed by research (despite recent claims in the media). Every major health organization stands by this.

I will not lie to a mother and tell her breastfeeding doesn’t matter. Because it does, and she usually feels that it does, even though weaning may be the best decision for her and her family.

I believe I can relay this to a mother who stops breastfeeding without hurting her feelings or shaming her. How? By being a good listener, by showering her with love, and by honoring her feelings.

Here’s what else I tell a mother who chooses to wean:

There is more to mothering than the food that you feed your child.

Breastfeeding is just one of the many choices you will make as a mother, and it is the sum total of choices that contribute to the health and well-being of your children.

Breastfeeding is not the only way to bond with your baby.

You are a good mother. You are loved. You are doing your best. You are following your heart, and that is the best thing you can do for yourself and your child.

But I can do all that without diminishing the power of breastmilk, breastfeeding, and her feelings about it all.

Regret is a human emotion that is OK to feel. Disappointment is too.

I am sorry that some women have felt hurt by friends, lactation professionals, doctors, or others when they had to make the difficult decision to end breastfeeding, or when breastfeeding didn’t work out for whatever reason.

But we don’t need to skip over the facts about breastfeeding, or sugar-coat a woman’s feelings in order to be empathetic. Women are most empowered when they are given the whole truth, when they are armed with facts, when they are encouraged to feel the whole range of their feelings, and when they are allowed to speak their truth.

***

Need some extra breastfeeding help and support? Schedule a virtual lactation consultation with me.

25 Things I Want Breastfeeding Moms to Know

1. We’ve all had days when we wanted to give up. 2. There are breastfeeding helpers out there who won’t judge you. Keep looking till you find one who makes you feel safe and supported. 3. Breastfeeding isn’t all or nothing. 4. Breastfeeding looks different for…

Is It Normal Not to Like Breastfeeding?

Many mothers start off thinking of breastfeeding simply as a feeding method. In those first few weeks, they want to be sure they are doing it right—and, of course, that their baby is getting enough to eat. Sometimes the technicalities of nursing can wear a…

How To Get Through a Nursing Strike

3129076234_29f24646bb_o

Scenario 1: Your eight-month-old seems to be teething. He bit you while nursing and you screamed at the top of your lungs (ouch!). Now your baby cries when he comes to your breast, and refuses to nurse.

Scenario 2: Your four-month-old had a cold last week and was too stuffed up to nurse. Then you had a busy week—lots of plans out of the house—and your baby wouldn’t sit still to nurse while you were out. Today she arches away from the breast every time you sit down to nurse. You were already stressed out and now your stress is skyrocketing.

Scenario 3: Your fourteen-month-old seems too busy to nurse lately. He’ll sit on your lap, latch for a second, and then run off laughing. He would rather eat snacks or drink water from a sippy cup. Last night you were staying at your in-laws’, and he was restless and pulling off the breast even while nursing to sleep. Today he’s flatly refusing the breast altogether and you are concerned he’s weaning.

Sound familiar? These are just some examples of what might happen if your baby is experiencing a nursing strike.

First, how do you distinguish a nursing strike from weaning? Basically, any baby or toddler who suddenly refuses the breast is having a strike. It doesn’t really matter how old your baby is. Certainly any child under two years won’t just stop nursing suddenly without due cause. Even older toddlers can have nursing strikes. Natural weaning—even if it is pushed along a bit by a mom—happens very gradually, the child dropping nursing sessions one by one, over many weeks or months. So, when in doubt, assume your baby or toddler is having a nursing strike.

The first thing to know is that almost all nursing strikes resolve in time. Babies actually want to nurse, but something is upsetting them when they strike, and once this is resolved or forgotten, nursing will resume. In order to get through the strike, you need some faith, good support, and lots of patience. It can sometimes take a few days (or even weeks, in some cases) to resolve completely.

Even though it might take a bit of detective work, almost all nursing strikes begin with some kind of stressor that make nursing unhappy for your baby. The most common ones are illness, teething, developmental changes (both mental and physical), changes in routine (moving, busy family life), biting (especially if the mother reacts by screaming, and startling the baby), and high-stress situations in the family. Sometimes it’s a little more subtle than these situations, and often is a combination of things that push things over the edge for your baby, and result in a strike.

Remember that something is bothering your baby. It is nothing you did wrong. Even if you screamed while being bitten, or were “too busy” or “too stressed,” there is no reason for guilt here. These things happen in our lives. Like I said before, nursing strikes almost always work themselves out in due time.

So what to do once you have identified it as a nursing strike?

First, it’s important to protect your milk supply and feed your baby. Some babies will refuse the breast completely; others will still nurse for some sessions, but refuse the others. Unless you are dealing with an older toddler, you will need to pump or hand express in order to keep up your milk supply. Your baby needs to be fed the pumped milk to get adequate calories.

It’s preferable to feed your with non-bottle nipples (you can try a small cup or a spoon). If that isn’t possible, and your baby will only take a bottle, try paced bottle feeding to make bottle feeding most compatible with breastfeeding. If your baby uses a pacifier, see if you can use it less, or not at all—some babies will come back to the breast by first using it to pacify, so you don’t want to rely on artificial nipples right now.

Babies who are refusing the breast have a memory of something that happened during breastfeeding that upset them, and you want them to move past this memory. So now isn’t the time to force the breast. Definitely continue offering it—but if your baby cries when you do, this may not be the best strategy.

When your baby gets upset at the sight of your breast, a good strategy is to offer the breast when the baby is less aware of what is happening. My favorite time to do so is just when a baby is waking up from sleep because the baby is in a semi-conscious state then. You can also offer the breast in the middle of a sleep cycle, when the baby stirs. If you don’t already share sleep with your baby, now is a good time to do so, even if it’s just a temporary thing. Sleep without a shirt so your baby will smell you—he or she might latch on without your even knowing.

Lots of skin-to-skin usually helps. You can just hold your baby against your breast periodically without offering, without trying to “make things happen.” You want to remind your baby that the breast is a safe, cozy place. A weekend napping in bed together, skin-to-skin, often cures a nursing strike.

Other tricks include nursing in the dark, nursing in a baby carrier, nursing in the bathtub, or nursing outside. Just changing up the nursing routine can be helpful so that your baby can forget whatever caused the strike.

I highly recommend you talk to a breastfeeding counselor, or an understanding friend. When a baby refuses your breast, it can cause a whole lot of stress for you, and being able to talk it through can be immensely helpful. Often your baby will pick up on the relief in your body, and begin to relax as well, which will help end the strike.

So have faith, take your time, go back to basics, and get tons of support. I know how devastating it is when your baby refuses the breast. It’s hard not to take it as a personal rejection. But it will be OK. It’s just a nursing strike, and will be over soon.

Photo courtesy of www.flickr.com/photos/okbends/

***

A version of this post first appeared in Natural Child Magazine

***

Need some extra breastfeeding help and support? Schedule a virtual lactation consultation with me.

10 Breastfeeding Myths Debunked

I have been helping women breastfeed their babies for six years, and have been nursing my own children for over eight years, but I am still floored when I hear some of the things women are told about breastfeeding—from their doctors, midwives, friends, grandmothers, Dr. Google,…