Planning to pump at work? Here’s how to get ready.

Lots of moms wish to continue their breastfeeding relationship once they return to work, and with some diligence, it is quite possible for most moms with the excellent pumps available today. However, it does take some planning ahead. For more information on pumping and working, visit the Breastfeeding and Working section of this site. Here for can find information on your legal rights, choosing a pump, and when to pump throughout your work day.

Note: some experts will recommend that you try to use an alternate feeding method for breastfed babies, especially if they must be left at a very young age or if they have trouble taking a bottle. Because most care providers are more comfortable with bottles, I will discuss only bottle feeding during mom/baby separation here, but if your caregiver is willing to cup or syringe feed and it becomes necessary, contact your breastfeeding counselor or lactation consultant for more information.

There are two crucial things that need to happen on your maternity leave if you want to pump milk for your care provider to bottle feed your baby while you are are away from him at work or school.

1. Master the Deep Latch. Make sure you have a great latch for a while before you start giving your baby a bottle. If you start with bottles too soon, you run the risk of your baby rejecting breastfeeding because getting milk out of a bottle is much easier for the baby than getting milk from the breast.

2. Make sure you introduce your baby to the bottle in advance. Most breastfeeding books and experts will recommend waiting at least a month before introducing a bottle. While you want to avoid nipple confusion and make sure you are getting a good latch, some babies have quite a bit of trouble if you wait this long. Check out the information here about getting your baby to take a bottle if you run into trouble. One tip for introducing bottles – it would make sense that freshly pumped milk would be the perfect temperature, but anecdotal evidence suggests that heating it just slightly makes the baby more likely not to reject it. It’s worth a try – just be sure not to overheat!

Getting Started

Beyond that, a lot of women simply just don’t know where to start with pumping. When to start pumping for your “stash” will depend on how long your maternity leave is, but you will want to pump at least occasionally early on to introduce the bottle. I honestly believe that 3 weeks is more reasonable than a month, and if your baby is nursing well, even two weeks can be a great time to get started with bottles. You don’t want to introduce too many bottles at this point, but if you give one bottle a day, or even one every other day, beginning at two or three weeks, you will give your baby time to accept the idea. If you are lucky, your baby will take to the bottle immediately and with no problem. If she doesn’t, then just calmly keep trying. If she resists the bottle, once a day is a good plan in the early weeks.

In general, you will want to have at least two full days of milk “stashed” for your return to work. If you can have a week’s worth, even better. To get started on pumping, the best thing to do is when your baby is a couple of weeks old, add a pumping session to your daily routine. A great time to do this is during your baby’s morning nap. Because breast milk is generally highest volume in the morning, you are most likely to be successful at this time of day. If your baby nurses just before his nap, try pumping about a half hour after he has finished nursing.

Don’t be discouraged if you don’t get much (or anything) when you first get started. Your baby has given your body cues on how much to make and when throughout the early days of her life if you have been nursing on demand, and some women at this point are producing precisely as much as their baby requires. Don’t be concerned if you get a lot, either. Some women find that they are producing even more than expected. The amount that you pump at each session will vary dramatically from one mom to the next, so don’t be concerned if the amount you are able to pump is much lower or higher than other women you know. It is perfectly normal to pump anywhere from .5 to 5 ounces per breast. In general, pump output will increase over time, so don’t be discouraged if you find that what you are pumping early on is not what you had hoped you would be able to express. If you find over time that you just aren’t getting enough, take a look at the topic on this site on increasing supply for more help.

Ideally, you will have 12 weeks or so of maternity leave – realistically, you might only have 6 or 8. Start building up your stash at least a couple of weeks ahead of time if you have a shorter leave; if you have a longer leave, go ahead and start working on the stash a month out.

Building the Stash

One of the most important things to know when you are beginning to store breast milk is how to correctly store it. You can store it in BPA-free plastic or glass bottles, but the problem with that is that you then don’t have the use of that bottle if it is in the freezer, and it takes up quite a bit of space. A more practical (although less green) option is to buy disposable bags specially designed for breast milk storage, which can be found at most baby supply stores, superstores, and often even in the baby aisle at the grocery store. If you are freezing the milk, you will want to make sure you leave enough room for the milk to expand when it freezes. You also want to make sure you remove as much air as possible from the bag by pinching it at the top of the milk line and flattening the top of the bag before sealing (I did this by holding the bag at the milk line at the edge of the counter and flattening the top of the bag on the counter). Make sure to label the number of ounces, the date, and your baby’s name. I found it helpful to lay the bags flat to freeze so that when the milk is frozen, you can line them up. One thing that helped me keep track of what I had was when I had about 20 bags, I would put them all in a gallon freezer bag and mark the earliest and latest dates of the milk inside, as well as the total number of ounces of all the smaller bags in the freezer bag. This way, if I wanted to inventory how much I had, I only had to look at the outsides of the larger bags.

You will find varying information on milk storage, but within a small margin of variation. Here are some links to information on how long milk can be stored in various settings:

Kellymom

La Leche League

Centers for Disease Control and Prevention

Work and Pump

What time of day to pump while you are on maternity leave and trying to build a stash will vary from mom to mom. As much as you want to sleep every possible minute, you may find it helpful to wake up before your baby in the last weeks before you return to work to pump when your supply is at its peak. One thing that some women find helpful is  to wake before baby does and pump only one breast so that when baby is ready to nurse, one breast will be full to feed him. Because supply is at its highest at this time, this often yields more than pumping both breasts after a feeding or later in the day. To help keep your supply as even as you can, it’s a good idea to alternate daily which breast you pump first thing in the morning.

To increase supply and continue building your stash, there are two basic methods women tend to use for collecting extra milk. One is to pump after each feeding. The other is to pump about midway between feedings.

Pumping after each feeding (or after selected feedings). This sends the signal to your body that the milk your baby just drank was not enough, and to make more. Some women will not be able to express much milk at this time, particularly at first, but others will be able to collect a reasonable amount. One downfall of this method would come if you have a tendency toward oversupply. If you already have an oversupply and signal your body to make more milk, you run the risk of engorgement if you miss or delay a feeding, which can lead to plugged ducts or even mastitis. In addition, in cases of great oversupply, your baby may end up getting more foremilk than necessary at a given feeding, which can sometimes cause gassiness, gastric upset, or colicky behaviors. This is not a particularly common concern, but is a concern nonetheless. However, if you tend toward a lower supply, this method may be helpful both for keeping your milk production up long-term and building your stash. A lot of women choose to pump this way to allow their breasts more time to produce milk for the next feeding (although this may not really be necessary – see the next section).

Pumping between feedings. Some women choose to pump between feedings rather than immediately after a feeding. This is probably most helpful in the morning hours to midday, or in the middle of the night (although waking up in the middle of the night to pump extra milk doesn’t sound like a lot of fun to me, and frankly, I don’t think I’d do it). This similarly signals the body to create more milk and can also be tricky if you tend toward oversupply. Some women steer clear of this method with the idea that it will mean that their breasts won’t “refill” in enough time for the next feeding. However, the lactating breast is never entirely empty, and will in fact continue to produce milk even while your baby is feeding. One thing that may be helpful for some women when using this method is to pump only one side, and begin the next feeding with the breast you did not pump.

How much to stash

You will want to make sure that you have enough stashed for at least a couple of days. The amount that a baby needs per day is going to vary for every mom and baby. A very general rule of thumb is about 1.25 ounces per hour of separation, although this will vary. So, for a 9 hour separation, you would want to leave approximately 11.25 ounces. In the early days, until your baby develops a feeding pattern while she is away from you, it is best to send multiple bottles (or bags) of milk in small quantities of about 2 ounces or so so that your care provider can start with a small amount and prepare more if needed. So, for a 9 hour separation, 6 portions of 2 ounces each would be a good place to start. Most breastfed babies will take bottles of about 3-5 ounces throughout their first year of life. Your milk will change to meet your baby’s changing needs; the quantity does not need to increase in the same way a formula-fed baby’s will. For the first day, a few extra ounces to have on hand is a good idea, and a few emergency bags to keep in the care provider’s freezer for use when your daily milk isn’t enough is a good idea as well. Having enough for the first day delivered to go in that day’s bottles, and another day’s worth or more for freezer backup should be sufficient. Be sure to make sure they let you know if the freezer milk is used so you can replace it when possible.

Day-to-day milk delivery.

Most moms will pump each day what their baby will drink the following day. Any extra milk you collect each day can be frozen. There are bags that you can attach to your pump and pump directly into, however it is difficult to measure the amount in the bags and they can be difficult to manage without spilling. An easier method is to pump into a bottle, and pour the milk into bags so you can accurately measure how much milk is in each serving. This also allows you to combine milk from multiple pumping sessions if need be to portion out in the desired amount per bag. Refrigerated milk has a higher health benefit than frozen, so delivering recently expressed milk is more desirable than frozen when possible. If you work Monday through Friday, you can deliver the milk from each work day on the next, using Friday’s milk for Monday. Within a week or two, most babies will start to develop a pattern to let you know how much milk should be included in each bottle or bag. This may never change until they no longer drink from bottles.

Talking to your child care provider.

Some caregivers have had few, if any, breastfed babies in their facility, so it is important than they understand that breastfed babies eat differently than formula fed babies. It is important that they don’t encourage babies to finish bottles when the baby indicates he is finished, as you don’t want to get the baby accustomed to an amount of milk you can’t provide. Babies have a per day need for milk intake – it’s important to make sure that they will want to nurse when you are together as well. In addition, it may be helpful to request that the care provider not give any bottles after a certain point in the day so that you are able to nurse as soon as possible when you come to pick your baby up after work. Even if it feels like an uncomfortable conversation, it’s important to make sure you are on the same page.

Maximizing your stash.

If oversupply is not a concern and you want to work to increase your supply/pump output, there are a few things that can help. First, don’t stop the pump when the milk stops. Letting it run a few minutes after the milk stops signals the body to make more. Second, pump more often. If you are pumping 3 times a day and want to get more, try to pump a fourth time. If you can’t manage to fit in another session at work, pump after your baby goes to bed or before he gets up in the morning. Last, using breast massage and compression, as well as combining hand expression with pumping, can help increase pump output. Here is a great article about hands-on pumping.

Questions? Contact Megan!

You Gotta Get the Latch

You’ve heard the horror stories. The pain of breastfeeding. SORE NIPPLES. Cracked nipples. Milk blisters. Giving up because it was just too hard. Not making enough milk. Baby was starving. Engorgement. Mastitis.

Before I was a mom, mostly when I was pregnant, I heard one horror story after another after another after another about how impossible breastfeeding is. Several people told me that they didn’t make milk or didn’t make enough milk. Several others told me of the horrible pain breastfeeding caused. So many wonderful, bright women, reduced to one sometimes tearful, sometimes defensive or indignant, sometimes angry statement: “I just couldn’t breastfeed.”

It kind of makes you wonder how our species made it.

The first thing I want to say before discussing this is DON’T PANIC. Learning about latching before your baby is born, or learning about latching if you are struggling, can make an intimidating situation much easier to handle. Don’t be discouraged by the information in this post; take it as a reminder of the importance of a good latch, and commit to making sure you work for a good one. A good, deep latch can be achieved by almost all babies!

I don’t want to discredit in any way the struggle some women have experienced. I don’t want to say that none of them truly had low milk production, and I am certain that the pain they experienced was 100% real. What they experienced was real, but the fact of the matter is this – our bodies were designed to breastfeed our young. This is true of humans and ALL mammals. In a society where breastfeeding isn’t the norm, and women aren’t always around other breastfeeding women, or may never have even seen a woman breastfeeding before doing it themselves, of course there are difficulties. When our mothers and grandmothers and sisters and friends aren’t breastfeeding around us, it seems strange to breastfeed. There’s no one to ask if this or that breastfeeding behavior is normal. There’s no one to look over while we’re nursing and say, “huh, my kids didn’t do it like that, does that hurt?” Women take their breastfeeding challenges extremely personally, and why shouldn’t they? They feel like those of us who advocate breastfeeding as normal and natural are telling them that they have failed.

I want to correct that RIGHT NOW. If you tried to breastfeed before and you didn’t produce enough milk, or you had extreme pain, or your baby just didn’t want to breastfeed, YOU DID NOT FAIL. Frankly, it is more likely that either society, your support system, or both, failed you. But the past is the past. You can’t go back and change it. Forgive yourself, forgive society, and if you want to try again, don’t let your difficult first experience keep you from trying. If you seek the help you need, the second time may be completely different.

If you were not able to breastfeed before and want to try with your next child, or you are trying for the first time, I want to tell you a few key things that I hope will inspire confidence in you.

Almost all women can produce enough milk to nourish their babies.

Breastfeeding shouldn’t be painful.

Your baby is hard-wired to breastfeed and your body is hard-wired to provide milk for your baby.

 * * Almost all common breastfeeding concerns can be traced back to one source: THE LATCH. * *

 * * * Master the latch, and you can overcome most common breastfeeding concerns. * * *

Let’s take a look at latch. What exactly does that mean? The term “good latch” is thrown around a lot, and a lot of moms don’t really even know what it means. Lots of moms think that latching just means that the baby is suckling at the breast and transferring milk, but it’s so much more than that. A truly effective latch means that the baby has a substantial amount of breast tissue in his mouth during a feeding, and is stimulating the breast to let milk down and produce more milk.

Poor latch is associated with several breastfeeding challenges. Often nipple pain, cracked nipples, nipple blisters, poor production, engorgement, plugged ducts, mastitis, and baby refusing to breastfeed can be traced back to not establishing an effective latch.

It’s more than the nipple.

An effective latch is established by ensuring that the baby takes much more than the nipple into her mouth at a feeding.

Here’s some ways to work on the latch. First, as hard as it sounds, RELAX. If you are stressed out, your baby will sense it and it will stress her out, too. Second, every time you latch, keep in mind that it is ALWAYS ok to de-latch and start over if it doesn’t feel right. And if it doesn’t feel right, there is probably a problem.

When you go to latch your baby on, you don’t want to center your nipple in his mouth. Doing that will result in not enough breast tissue making it into his mouth and making him have a shallow latch. Think about lining up your nipple with his nose. Tickle his cheek until his mouth opens wide, like he is trying to take a big bite of an apple, then bring him to your breast chin first and quickly roll his mouth over your nipple. Bring him to you, not you to him. The ideal positioning is for your nipple to be going toward the roof of his mouth, not the middle of his tongue. Ideally, the lower lip will first contact the outer part of your areola and the last part of his mouth to make contact will be his top lip.

Here’s some drawings of what it should look like: http://www.breastfeedinginc.ca/content.php?pagename=doc-WL

It shouldn’t hurt to latch. A tiny bit of pain in the first few SECONDS is ok. And yes, most women go through an adjustment period where there is some discomfort as they adjust to the feelings associated with breastfeeding, but it shouldn’t last more than a week or two. Pain after the first few seconds during nursing or pain after nursing is never a good thing. “Toe curling” pain at any time is NOT OKAY. If you are experiencing severe or ongoing pain, something seriously needs to be addressed, and it can be corrected. Once you get that “good” deep latch after having had a poor latch for a period of time, you will probably immediately get a feeling like, “Oh, I get what this is supposed to feel like.

Why don’t all babies latch correctly?

Some babies, if placed on their mom’s belly just after birth, will actually scoot themselves up their mothers’ bodies and latch themselves on with just a hand supporting the baby’s back to keep her from falling. It’s a pretty amazing instinct, actually. Skeptical? Check it out. But we don’t live in a world conducive to letting this happen. We’re in hospitals when we give birth for the most part. A third or so of us have c-sections. We’re impatient. We’re skeptical. We’re clinical. We’re results oriented.

So, our baby’s first latch is most often after baby’s first bath, heel stick, eye ointment, etc. The necessity of the separation there (or lack thereof) is for another post on another day – let’s just accept for now that this is what most often happens.

Bottle (or Pacifier) Use. After birth comes the numbers. The weight. The bilirubin level. The blood sugar level. If any of those weights concern our medical professionals, they may tell us that our milk is not enough. Again – another post for another day, but it happens. Some women, whose babies don’t have the “right numbers,” are told to supplement, and we undermine the baby’s latch by giving him a bottle. When the baby learns early to latch on to the bottle, he will then try to latch on to mom the same way. This is called “nipple confusion.” A bottle has a more narrow nipple and requires different muscle movements for sucking. Milk flows freely from it, so little initial stimulation must take place to drink from a bottle, whereas the baby must latch to stimulate the letdown when breastfeeding. It is highly recommended by most professionals that bottles and pacifiers be avoided in the early weeks to make sure that babies develop the important deep latch. If supplementation of expressed breast milk or artificial baby milk must take place, alternative methods of delivery such as syringe, tube, spoon, or cup feeding can be considered. 

Pacifiers can be latch-threatening as well. While I could create an entire post on pacifier use in breastfed babies (and probably will at some point), on the subject of latch, I will say that pacifier use can undermine breastfeeding in two ways. First, the latch on a pacifier is more like that on a bottle, and babies who use pacifiers are more likely to have nipple confusion. Second, giving a pacifier to a baby who wants to meet his sucking needs gives mom less opportunities to latch him on at the breast, further undermining her efforts.

Lack of familiarity/education. Some moms are told their numbers are fine, but have never seen what breastfeeding looks like. If you had only ever seen a baby drink from a bottle, it might make sense to think that this is what all babies look like when they eat. So, in some cases, simple lack of knowledge about the need for a deep latch can cause a shallow latch. If you don’t know where the mouth is supposed to go, that the lips should flay, that the nipple shouldn’t be in the center, then it makes perfect sense that your latch looks like what you have seen in bottle feeding babes.

Physiological problems. Most of these are minor, common, and easily overcome. Babies have small mouths. When moms attempt to breastfeed with their round, full sometimes even engorged post-birth breasts, sometimes babies’ mouths have a hard time getting all the necessary tissue. This usually happens after the milk “comes in” a couple to a few days after birth. Mom can often easily correct this issue by hand-expressing or pumping a small amount of milk before the feeding to soften the nipple area and breast tissue just behind it to make it easier for baby to latch on. Occasionally, a baby will have a physiological problem in her mouth that causes trouble latching such as a tongue tie, lip tie, cleft palate, or cleft lip. If you suspect this is the case, seek the help of a professional – see a lactation consultant and/or breastfeeding-friendly pediatrician for help resolving or coping with these issues.

So what happens when you have a shallow latch?

The baby’s lips and/or gums will compress your breast/nipple farther forward than they should, and this can cause a number of concerning things to happen.

Pain. The nerve endings in the most forward part of the nipple are not designed to be stimulated in the same way as those further back in the breast tissue are. And when they are, it hurts. Next time you have a moment, take your thumb and forefinger and pinch the end of your nipple… doesn’t feel great, does it? Pinch about a half an inch up from the end. Still not super pleasant, right? Now compress about an inch and a half back from the end of your nipple, somewhere near just behind edges of your areola depending on the size of yours. Much less unpleasant if you are grasping far enough back. You should feel some fatty tissue beneath where the baby’s mouth should be landing. If you are feeling mostly the skin of your nipple if you pinch where his mouth lands, his mouth needs to open up and go back. Repeated latching too far forward can result in trauma to the nipple and surrounding skin, cracking/blistering of the nipples, and chronic pain during and after nursing.

Poor supply. If your baby isn’t latching well, she may not be removing milk effectively from the breast. Milk removal is the key to signaling your body to make more milk, so if a bad latch leads to less milk removed, that means a bad latch keeps the body from being signaled to make more milk. Lots of moms will spend inordinate time and energy pumping, and filling themselves full of herbs and oatmeal and even dark beer, or whatever their friends have told them will help them make more milk, but never address the root cause: the latch. Now, pumping is important when supply is low, as you want to make sure to remove milk from the breast, but it’s not a permanent solution. And, in fact, if you are pumping and then bottle feeding the baby the pumped milk, you can get yourself into a vicious cycle of perpetuating the shallow latch with the bottle. If you find yourself in this situation talk with a lactation consultant or pediatrician about alternative feeding methods.

A lot of women get into an unfortunate trap where they believe that they simply can’t make enough milk. The fact is, while this is a legitimate concern in a very, very small number of women due to certain medical or hormonal conditions, almost all women can make enough milk to feed a baby. In fact, given the appropriate amount of stimulation and milk removal, most women could make enough milk to feed more than one baby! Low milk supply is generally not a characteristic of the mom’s body. It is generally due to ineffective milk removal, which is often the result of a poor latch (or absence of latch in the case of a pumping mom – the pump removes milk much differently than the baby).

Engorgement, Plugged Ducts, and Mastitis.

When the body continues to make milk but the milk is not being removed from the breast, it can result in engorgement. Engorgement can be very painful. The breast becomes fuller and fuller and larger and larger, and the cells inside stretch to accommodate, which can hurt. This can get mom into a vicious cycle where the baby has a hard time latching because mom is engorged and the nipple area isn’t soft enough, but the milk keeps coming and making the breast fuller and firmer. This is a good time to learn hand expression or dig out the breast pump.

As if engorgement didn’t sound frustrating enough, it can often lead to plugged ducts, which is when milk cells collect and form a mass that clogs the milk duct, often leading to painful swelling and redness, nipple pain, and can lead to blood in the milk (which is generally harmless in small amounts). Plugged ducts can lead to mastitis, which is an infection that causes high fevers, chills, pain in the breast, and is just generally something you want to avoid. One of the best ways to avoid mastitis is to ensure that the breasts are emptied regularly.

Take a look at the Mastering the Deep Latch topic on this side for more information on how to achieve a good deep latch.

If you need advice on how to get a better latch, Contact Megan!

Want to Increase Your Supply? Don’t Go to Supplements First

The Internet is FULL of advice of what you can take to increase your milk supply – teas and herbs and foods and so forth. And there is some evidence-based and some anecdotal evidence that some of these things work. However, there is good reason to be cautious in your use of galactagogues, or substances that are used to increase milk supply.

I’m not saying that you shouldn’t use galactagogues. I’m not saying that they don’t work. I’m not even saying that, for the most part, they are not safe. What I am saying is that pumping things into your body without a) addressing the root cause of the lack of supply and b) doing enough research to ensure they are safe in general AND with any other medications or supplements you may take may not help, and may do more harm than good.

Do you really have a low supply? The first thing to look at if you feel that you are experiencing low supply is WHY you feel you are experiencing low supply. For the most part, if your baby is peeing and pooping an appropriate amount and is gaining weight at an appropriate rate, your supply is probably just fine. You can find some great information here to determine whether your baby is getting enough milk here and here. Many moms who think they have a low supply in fact have a perfectly adequate supply, but believe their milk should be more abundant. Before you try in increase your milk supply, be sure to assess whether it is actually in need of increasing.

If you find that you do need to increase your supply because your baby is not eliminating enough and/or not gaining weight enough, there are several things you will want to look at before deciding to introduce a galactagogue.

How often is your baby feeding? The greatest signal to the body to produce milk is the removal of milk from the breast. In addition, stimulation of the nipple and breast tissue and skin-to-skin contact with your baby can be good signals for the body to produce milk. If you are feeling that your milk supply isn’t quite what it ought to be, increasing the frequency of nursing can be super helpful in increasing your supply. If your baby is using a pacifier, try to limit or eliminate the use of the pacifier to allow the baby to nurse more frequently for both nutritive and non-nutritive sucking at the breast.

How long is your baby feeding? Make sure that your baby is the one who ends the feeding, not you. Feeding by the baby’s cues – both when to start and when to stop – will help ensure that the baby is removing as much milk as he needs. Never stop him from nursing while he is actively drinking. He will slow down to a non-nutritive suck when he is no longer removing milk, or he will fall asleep. Sometimes very young babies will fall asleep before they are full. Switching sides and continuing to nurse until he refuses the breast can be helpful.

If you find that you are feeding your baby as often and as long as possible, it may be helpful to hand express or use a pump between feedings a few times a day to help stimulate more milk production. This is a signal to your body that you need more milk, even if nothing comes out.

Are you getting a good latch? Sometimes a poor latch, even if you are not in pain, can lead to poor milk transfer. Take a look at the Mastering the Deep Latch topic on this site – if your latch isn’t up to par, work for a good latch before you start arbitrarily supplementing!

Are you well hydrated? This one’s easy. Drink a lot of water. Period. It’s not likely to hurt, and having eight glasses of water at eight ounces each may not be enough for some women. So drink more water.

Are you pumping often/long enough? If you are separated from your baby during the day and you are experiencing low supply when pumping breast milk, do it more. For some women, pumping every 3 hours simply isn’t enough; try every 2 if you can. Also, don’t turn the pump off as soon as the milk stops flowing. If you stop the pump as soon as it stops, that tells the body “that was enough.” If you let the pump continue to run, that tells the body, “hey, we ran out, but I’m gonna need more than that!” Sometimes if you “dry pump” for a few minutes, you will elicit another letdown and more milk will spray. Sometimes it won’t, and that’s okay too. You are still telling your body you need more.

Get your hands involved in pumping. Breast massage before and breast compression during pumping can be extremely helpful in getting more milk. This article about hands-on pumping gives some great information on how hand expression and breast massage/compression can help enhance the pumping experience.

Are you getting enough calories? Most women, even if fairly malnourished, are able to breastfeed, but breastfeeding burns a lot of calories – to the tune of 300-600 calories a day. Some women find that if they are not getting enough calories, or getting poorer quality calories, their supply dips. If you think you might not be getting enough, try adding a few healthy snacks to your diet.

Get that oxytocin! The hormone oxytocin helps with milk production and the milk ejection reflex. One of the greatest ways to boost your oxytoxin is something you will love doing… snuggle with your baby. Snuggling by itself is helpful, but snuggling skin to skin is even better. Unwrap your baby down to her diaper, take off your top (leave your bra with pads on if you are a leaker), wrap a blanket around the both of you, and get some chill time. Snuggle her for a nap while you read or watch TV. Wearing only your bra, put her in a cloth wrap-style baby carrier in only her diaper while you are doing things around the house. Take a relaxing warm bath together. The more skin-to-skin time you can get, the better!

Make sure you are avoiding supply killers. Some women have found that some mint teas can cause dips in supply. Also many medications, particularly cold medicines and hormone-based contraceptives, can cause dips in supple.

If these are not enough…

If you have tried all of the above (and I mean for more than a day or two, it takes time to increase supply), there are some other things you can try. Anecdotal evidence holds that many women experience an increase in supply by eating oatmeal, drinking an occasional dark beer, or eating baked goods made with brewer’s yeast. While these aren’t backed up by solid evidence, none of them are likely to harm you.

If you do decide to take supplements, talk to your health care provider and your pharmacist. Supplements and medications can interact, and before you make a costly visit to the supplements aisle of your local health foods store, you will want to make sure that nothing you are considering taking will be harmful in combination with any other medications or supplements you take or medical conditions you have.

The internet is full of well-meaning suggestions on supplements and medications you can take to increase your supply, but a lot of times, supplementing and/or medicating just mask the underlying problem. No advice from the internet can replace the advice you get from your health care providers. Be cautious in choosing to take supplements, and when in doubt, ask.

If you have questions, contact Megan!

Mastering the Deep Latch

If you only learn ONE THING before attempting to breastfeed a baby, learn about latching. If you can master a good, deep latch early on, you can prevent most commonly reported breastfeeding struggles.

I have been working on another post about latch problems, and it occurs to me that before spending time focusing on what can go wrong, it might be more helpful to simply talk about latching and how it works. So this is more of a how-to than a what-if post. In fact, a good deal of my training with Breastfeeding USA emphasized the value of anticipatory guidance… if you have not started breastfeeding, NOW is the time to learn about latching. Getting it right from the beginning is much easier than correcting it later. (But if you’re in THAT boat, don’t worry – that post is coming!).

A lot of women have never seen another mom breastfeed before they themselves breastfeed. In a society where breastfeeding is not the norm past the first few weeks, a lot of moms are in a situation where their moms, their friends, their sisters, etc., didn’t breastfeed. The concepts are unfamiliar, and it can be a little intimidating. But, a few basic strategies can help you develop a good latch with your baby so that you start off successful and continue that way.

Hunger Cues. One of the things that I find a lot when talking with moms is that they report that their baby is so upset that he won’t latch, or he is crying and frustrated at the breast, or he keeps popping on and off in frustration. A good way to head off these things is to respond to early hunger cues. When babies are hungry, they will tell you long before they cry. In fact, waiting for a baby to cry can make latching more difficult. Respond to early cues such as lip smacking, bringing hands to mouth, rooting, and squirming for a breastfeeding position. Just upon waking is often a great time to initiate a feeding, and if your baby wakes up super hungry and crying, you can initiate the feeding during his light stage of sleep near when he would be ready to awaken, when he is twitching and eyes may be closed but rapidly moving. 

Basic latch mechanics.

The basic idea behind a deep latch is that your baby needs to latch fairly far back behind your nipple and compress a fair amount of breast tissue to elicit milk letting down and signal the body to make more milk. It’s a pretty simple concept, but it’s very different than the way a baby sucks on a bottle. So, if you are used to seeing babies bottle feed, this might look a little different to you.

When you go to latch your baby on, you don’t want to center your nipple in his mouth. Doing that will result in not enough breast tissue making it into his mouth and making him have a shallow latch. Think about lining up your nipple with his nose. Tickle his cheek until his mouth opens wide, like he is trying to take a big bite of an apple, then bring him to your breast chin first and quickly roll his mouth over your nipple. Bring him to you, not you to him. The ideal positioning is for your nipple to be going toward the roof of his mouth, not the middle of his tongue. Ideally, the lower lip will first contact the outer part of your areola and the last part of his mouth to make contact will be his top lip.

Here’s some drawings of what it should look like: http://www.breastfeedinginc.ca/content.php?pagename=doc-WL

Something that can be extremely helpful in getting a deep latch is the c-hold, also referred to as a “breast sandwich” or a “breast taco.” Basically, you make your hand into a c-shape to compress the area behind the nipple and make a smaller area for the baby to try to latch on to. Take a look here – making your breast easier to fit into a wee little baby mouth can make latching go much better, particularly if you have large or engorged breasts.

Another thing that can be helpful for moms, especially early on, is pillows. Pillows are your friend. Whatever configuration of pillows it takes to get your baby to the right spot while nursing with you in a comfortable position is the right number of pillows. When my youngest was a newborn, there was a time when I had seven pillows behind me, making a perfectly shaped reclining slope behind me, then 2 pillows plus a nursing pillow on my lap to bring my baby to the right level for me not to have to lean to nurse and still take the weight off of my arms and back. For those of you who are counting, that is TEN PILLOWS. Perhaps this was a bit excessive, but it worked. But three or four, or that great recliner, or the papazan chair, or the hammock, or the futon, or whatever place is most comfortable for you to relax and nurse – whatever your comfy place is, find it. The more you can relax, the more likely you are to achieve a good latch.

It shouldn’t hurt to latch. A tiny bit of pain in the first few SECONDS is ok. And yes, most women go through an adjustment period where there is some discomfort as they adjust to the feelings associated with breastfeeding, but it shouldn’t last more than a week or two. Pain after the first few seconds during nursing or pain after nursing is never a good thing. “Toe curling” pain at any time is NOT OKAY. If you are experiencing severe or ongoing pain, something seriously needs to be addressed, and it can usually be corrected. Contact a breastfeeding counselor, lactation consultant, or other health professional if you are dealing with pain!

This video is a really great how-to on mastering latch.

If you have questions before you have your baby about latching, or you are already breastfeeding and struggling with it, contact Megan and she will do her best to answer your questions and get you on the right track!

Oh No – My Baby Won’t Take a Bottle!

You’re committed to breastfeeding. You’ve read the books. You took the class. You talked to your midwife or lactation consultant, and everyone told you DO NOT give your baby a bottle until he is four weeks old. Maybe they even said six weeks. You were dutiful, you didn’t use a pacifier, you didn’t give any bottles, but now you are staring down the barrel of having to go back to work or school, or you just plan want to be able to leave your baby to go to the gym or the salon or girls’ night out, and you want him to be able to take a bottle.

Everyone told you early on that if you give your baby a bottle, she might get the dreaded nipple confusion because drinking from the bottle is so much easier for baby and she might prefer the bottle and then refuse to nurse. So it seems like a no-brainer that when you sit down with her and try to give her that first bottle when she is a month old that she will smile up at you in pleasure at how easy it is to remove the milk from the bottle.

So you pump. You have a bottle warm and ready to go with, oh, 3 ounces, and you snuggle up in your regular nursing place and sweetly offer your milk to your little one. And he LOSES IT. Purses his lips. Wrinkles his nose. Fusses. Screams. Chokes. Gags. Turns red, then purple with anger at this preposterous mom-substitute.

All that fear that your baby would prefer a bottle to your breast, and here you are, frustrated and heartbroken because you know your baby is going to need to take a bottle at some point, and she’s just got NO INTEREST in that idea.

So what do you do?

If you are pregnant or have a baby under 4 weeks:

There are some things you can do ahead of time to try to prevent this problem. I’m not going to swear any of this will work, but building your arsenal of tools here is a good idea, so you go in prepared.

The first thing I will say is going to go against a lot of what you have heard, and a lot of experts will disagree with me, but if you KNOW you will have to give your baby a bottle, and you are pretty confident that you are getting a good latch... don’t wait a month. The longer you wait, the less likely you will have a perfectly peaceful transition.

Now, if you are having latch problems in the beginning, or if you have any serious supply issues, you really do want to make sure you have that well under control before you let your little one take a bottle. It really can cause problems if your little one hasn’t become a little milk junkie and begun to love nursing. I will be brutally honest about this – some moms simply have a harder time with this than others. Some babies are boob junkies by a few days old with an awesome latch. Some babies at four weeks are still causing mom problems by latching poorly. If you have the second kind of baby, don’t trap yourself into thinking that time will fix it. Time won’t fix it. FIXING it will mean discovering the problem and probably getting some assistance. Call your local breastfeeding counselor, lactation consultant, OB, midwife, etc.

But the babies with trouble with taking a bottle tend to be the boob lovers. The milk junkies. The mama-addicts. And the older they get, the less likely they are to be fooled by the mom-substitute (bottle). Waiting until 4 weeks can create a challenge in babies who latch well and seem to really enjoy nursing. They know that nursing is what they are designed to do. They know it is the normal way to eat. It’s snuggly and warm and they’re with their awesome cuddly mamas, and it’s just natural. Waiting to give THOSE babies a bottle may haunt you in the future.

Now, I’m not saying when they are 2 days old, give them 3 or 4 bottles a day just to make sure they can take it. I’m just saying that when they are somewhere in the 2-3 week range, start trying. Don’t overdo it – one every couple of days will help them get used to the idea and should be infrequent enough that they continue to prefer nursing.

Another thing you can do ahead of time is make sure they spend at least some quality time in the arms of someone else. Let them know they can be nurtured by someone that is not you. Let them get used to the smells of dad or partner or grandma or friend. Let them get used to the feeling of being held and loved by other people.

If you are already there, and your baby doesn’t want a bottle:

Get out. The first thing you MUST remember is that most babies who don’t immediately take a bottle are going to have a hard time taking one if mom is there. GET OUT OF THE HOUSE. They can quite literally SMELL YOU THERE! They aren’t going to be fooled by the bottle if you are just in the other room. Go away. Grocery shop, get a pedicure, go to a movie, whatever. Let dad or grandma do it.

But what if the baby cries? He might. He might cry a lot. But it’s not like you are leaving him alone in a room and walking away. You are leaving him in the arms of someone who loves him and can comfort him in other ways besides feeding. It WILL be okay. He will not starve. You won’t be gone that long, because let’s face it, the separation will make you all anxious and twitchy. Get out.

Be patient. Some babies will get it on the first try. Some just won’t. Don’t get too worked up. If you stress, she will stress. Soothe in as many ways as possible and try to keep it low key. Just like with nursing, you want to try at the earliest signs of hunger so baby won’t be wayyy too hungry when it’s time to try. Limit your attempts to 10 minutes. Anything past that with a mad baby is going to piss her off further and make it that much less likely to drink the bottle the next time you try. Try again after she has been calm awhile. Or go ahead and nurse, and try again at the next feeding or the next day.

Make it like nursing: Some babies do much better with taking the bottle if the caregiver makes it as much like nursing as possible. Hold the baby in the same way. Give the bottle in the position you generally nurse in. Give the bottle at the same time your baby would normally nurse.

Make it different than nursing: Some babies do much better if taking the bottle is treated as a completely different activity than nursing. It will be clear pretty quickly if you try the above technique and it bombs. Go to a different room. Try a different position (I always ended up getting my boys to take a bottle sitting up in my lap with their head on my chest and facing away). Try going outside if the weather is nice. Whatever it takes to be different.

Make sure they know what it is. Imagine you have been nursing happily along for a month, and then someone tries to put a cold piece of silicone in your mouth. You don’t know what it is, you don’t know what comes out of it, you just know that it’s not mom and you don’t want it. A nursing baby isn’t going to immediately recognize a bottle as something that has food in it. Try keeping the nipple in your bra for a while so it smells like you. When the bottle is ready, dip the tip of it in the milk so when it comes near baby’s mouth she can smell and taste it. Sleep with a burp cloth in your shirt and have whoever is giving the bottle wrap it around the bottle so your smell is nearby. Anything that can associate the bottle with you OUT OF YOUR PRESENCE is a good thing.

Bait and switch. This method is often recommended  for moms who are trying to get babies to latch after having been too used to the bottle, but it works this way as well for some moms. If you can get your little one nursing happily, especially at a sleepy time, try gently removing the baby from the breast and slipping the bottle in. Sometimes babies will take to a bottle if they start getting the milk right away in this situation. Try dipping the nipple in the milk first to make the transition a little more seamless.

Don’t give up too easily. Hungry babies will eat. I will tell you that in my own life, I had a miserable time with this with my first son. We tried for 2 months to give him the bottle. We didn’t try often enough – -one every 4 or 5 days, and I was usually in the house somewhere – but we gave is what I thought at the time was a reasonable effort. He refused the bottle the first 3 days of day care. Everyone was miserable. He nursed ALLLLLLL night long those first days, and I was going back to work and pretty tired already. Night nursing is not a bad thing, and is more or less inevitable for most moms, but 5-6 feedings in a night because little man didn’t want to drink a bottle is pretty untenable. On the fourth day of day care, he gave in. He drained his bottles all day, and pretty much never looked back. In fact, I had a terrible time weaning him OFF the bottle eventually! I have heard of a few rare cases where babies simply wouldn’t take a bottle away from mom, but in general, if a baby is away from mom for long enough and often enough because she is at work or school, the baby WILL give in and take a bottle. But it really is more pleasant to master the bottle ahead of time if you can!

Keep it warm. Milk straight from mom’s breast during nursing is super warm. Just the right temperature, in fact. If you are giving a bottle, the milk will cool as it sits out. Sometimes babies will take a bottle at first and then stop in a minute or two. Try running it under warm water or letting it sit in a pot of warm water for a minute or two. Sometimes babies just want the comfort of the warmth. My younger son liked his bottle milk very warm. If I pumped fresh milk for a bottle, he still preferred it if I warmed it up a tad first! Just make sure to swirl (NEVER shake) the milk to even out the temperature and test it on the inside of your wrist to make sure it’s not too hot.

Still have questions? Contact Megan if you need more assistance!

Every minute of the day nursing – WHY, GOD, WHY???

Several moms have asked me questions on this topic, so I thought it would be a good topic to address here. Some nursing moms will come to a crossroads where it seems like their baby is wanting to nurse EVERY.SINGLE.MINUTE, and, understandably, they start to worry.

Is he getting enough milk?

Is she latched on well enough?

Is my milk too low in calories for him?

Is she in pain and nursing for comfort?

It can be a moment of sincere panic for a mom who has been nursing every 2-3 hours and all of a sudden her little nursling never wants to unlatch. But the great news for moms in this situation is that, for the most part, it is TOTALLY NORMAL. Even better, it’s TOTALLY TEMPORARY.

I’m sure everyone has heard the term “growth spurt,” but a lot of us don’t have any context for what that means until we get to a critical breaking point when it seems like all of a sudden, our babies want to eat every 30-60 minutes, not sleep, nurse longer than normal. And this might come with fussiness, frustration, less sleep, squirminess, and just in general a tough few days.

But there’s the beauty of it.  A few days. 2-3 days in most cases, a week at most. Babies need to grow rapidly sometimes to help with their development. You can expect a growth spurt to happen at predictable intervals – 3 weeks or so, 6 weeks or so, 3 months, 4 months, 6 months, and 9 months. When these growth spurts happen, your baby is sending very important signals to your body. Baby nursing all the time = “HEY BODY – SEND MORE MILK! WE’RE GROWING HERE!!!” The quantity and type of milk will develop to meet your baby’s developing needs, and that’s pretty amazing. Don’t set your watch by these guidelines – every baby is different – but in general, these are about when you can expect the growth spurts to occur. And as frustrating as they are, they are important and very helpful to furthering your breastfeeding relationship.

A lot of moms are tempted to supplement at the 3 week mark or the 6 week mark when this comes up because they feel like their baby must not be getting enough to eat. TRY TO RESIST THIS URGE. Every feeding you skip is a missed signal to your body to make more. If you absolutely can’t stand it and you just have to take a break, make sure you pump or hand express milk for EVERY MISSED FEEDING. Pumping is not as effective as your baby, but it’s better than a completely missed feeding.

So, how do you know if your baby is truly having a growth spurt and that you really are providing plenty of milk? There are a few important clues to look for. First, output means input. If your baby is peeing and pooping enough, then he is most likely getting plenty of milk. Second, moisture. If she has a moist mouth, tongue, lips, etc., she is likely plenty hydrated. If nothing in these two areas seems amiss, things are probably just fine.

Still not convinced? So, you have ready about growth spurts, but you are still freaking out just a little bit? Call Megan, another breastfeeding counselor in your area, a lactation consultant, an OB or midwife, or a trusted breastfeeding-friendly medical professional. They can talk you through what is happening and help you figure out if everything is ok as it ought to be. And I promise, they would rather you call and feel better about it being nothing than not call and be panicked. They are there for a reason!