Category Archives: Experienced-Based Opinions

What to do till the lactation consultant gets there

Baby refusing the breast?
Milk supply low?
Baby not getting enough?

Remember these 3 things:
;
1. Feed the baby!
2. Protect your milk supply!
3. Make the breast a happy place!

Feed the baby.The amount a baby needs depends on his or her age and size. Babies between one to 6 months need around 24 ounces of breast milk per day. A 3 day old baby needs at least 4 oz per day, a 5 day old needs 8 oz, etc. A baby who is latching effectively may actually take more than these amounts from your breast. If your baby is under a week old and you believe he or she is not getting enough from direct breastfeeding, try offering small amounts of expressed breast milk by spoon, cup or finger-feeding with a syringe. If your baby is older and requires more than an ounce at a feeding, you may consider using paced bottle-feeding techniques for giving extra milk.

Protect your milk supply. Breast milk production is controlled by hormones in the beginning, but soon switches to local control. This means the more milk is removed from the breast, the more completely drained, the more it will produce in the next hour. When a baby is not effectively removing milk, this tells the breast that it is making too much. Using hand-expression and/or a rental-grade breast pump after feedings may be necessary to protect or build a supply until baby is able to empty the breast more easily. Research has shown that mothers who have effective breast drainage in the first three days (that is defined as 30 breastfeeds or hands-on pumping episodes in 72 hours) have twice as much milk at 10 days after delivery.

Make the breast a happy place. Keep baby skin to skin as much as possible. Baby should be between mom’s breasts, head facing to one side. Mom should be positioned comfortably, propped up with firm pillows with her back and arms supported. Breastfeeding is more than providing milk for your baby – it is setting up a relationship that starts out as meeting a physical need and transitions to meeting an emotional need between mother and child.

All breastfeeding techniques or assistive techniques should include these three concepts.

Milk Donation

I have heard many questions from moms over the years about what to use in a situation where they don’t have enough milk to feed their babies. I do not support formula companies.  However, I don’t support homemade formulas either.  Neither can come up to the specificity of human milk for human babies.

What I DO support is milk banking.  This can be done for your own child or for others.  Proper handling, labeling and storage of the milk makes this process more useful.  Here are a few helpful hints.

  1. Set out to have an excellent supply.  That means the first hour after birth is critical for baby getting the most volume – and studies are now beginning to show that moms whose babies nurse well in the first hour (or who start pumping and hand-expressing right away if baby can’t nurse) have more abundant supplies and are less vulnerable to negative events later on in their lactation. Make sure your support person is on the same page with you in helping you achieve that early stimulation and milk removal. Mothers who get 30 sessions of effective breastfeeding or hands-on pumping within the first 3 days of birth have twice as much milk at 10 days after birth as those who have less breast stimulation and removal of milk. This has been found in more than one study.
  2. Pay close attention to your baby’s effectiveness in the first four weeks. If baby is not removing milk well during this period of time, the breast will reduce milk production capacity and possibly storage capacity as well. If your baby is not removing milk well, using a breast pump after morning feedings and before bedtime can help protect your supply.  If your baby is not nursing effectively, please see a skilled lactation consultant for assessment.   Medical-grade rental breast pumps (such as the Symphony) are generally more effective in setting up a high supply than personal pumps, which are designed to maintain supply once lactation is established and a healthy baby is nursing.
  3. Store your precious milk carefully. Most women use plastic bags for storage. Use bags that are thick enough and have wide enough seams to reduce breaking and leaking during thawing. Don’t over-fill bags. Get as much air out as possible and lay bags flat for freezing. Label with at least the date of pumping. Use a sharpie on part of the bag that is not in contact with the milk (on the edges) or use a piece of tape for the label. Ink written directly on plastic will leach into the milk inside. Once bags are frozen solid, they can be stacked vertically in a plastic shoe box to keep in order in the freezer. Caution: plastic milk bags that are over-filled or have thin seams can break during freezing or when transporting in the frozen state. When stacking horizontally, put a layer of paper or plastic between rows of bags. If you are shipping milk through Fedex, contact them for information. Styrofoam lined shipping boxes with dry ice can be used to ship milk overnight. Layers of bags should be separated by cardboard or thick paper to prevent puncturing each other during transport.
  4. Think about how much to store and when to share. To avoid wasting milk, don’t put too much in a bag – a maximum of 5 ounces. If you are pumping a couple of ounces at a time, you can add to a previous amount until you get your desired amount, as long as it is all obtained within 48 hours and kept refrigerated until frozen. The best place to store milk is in a separate deep freezer that is not opened frequently. Regular freezers should be turned as low as possible, to the point that ice cream is frozen solid. Do not store your milk in the door of the freezer. Some moms start out storing a lot of milk because they have babies with nursing difficulties. Once those babies have overcome their difficulties, moms find they don’t need the extra stored. At that point, sharing becomes a possibility, and sometimes even a necessity when freezer space becomes low!
  5. What about formal versus informal milk donation? Milk banks have requirements for moms since their customers are NICU’s with very tiny, vulnerable infants whose very survival depends on milk donation.  Milk sharing done between healthy moms with healthy babies can be a little more relaxed. Some medications that are OK for nursing moms may be acceptable for another nursing mom – but unacceptable for a tiny medically vulnerable baby. Eats on Feets, Human Milk for Human Babies and other mother-to-mother sharing sites can help re-distribute milk from moms who are not eligible for milk bank donation to moms whose babies are not eligible for receiving banked donor milk. Tennessee has recently opened its very first Mother’s Milk Bank. Here’s a link to find out more about how to donate and how to help. Check the Mother’s Milk Bank site for more info. http://milkbanktn.org

Alyssa Milano and Breastfeeding Shaming

As if moms don’t have enough to worry about – we have a continued attack on public breastfeeding. This is a first world problem – a USA problem. Like so many other “issues,” those trying to build their ratings find something to project their biases and ignorance upon Bz try to get some controversy going. EVERYONE knows that if we were in a developing nation where Western marketing machinery had not yet ruined the culture and economy, breastfeeding in public would not even be a topic of conversation. Babies do not have any sense of propriety (as some would define it). They just know when they are uncomfortable and want their needs met. A young baby cannot understand that someone’s guilt might be stirred up by their need to be tended to in the same general vicinity as the casual observer.
The idea expressed in this commercial needs to be distributed.

If we are to help mothers reach recommended goals of breastfeeding to at least a year and hopefully to two, we must first help them reach their OWN goals – whatever that length might be! And currently, 80% of moms do NOT meet their own goals – whether to breastfeed 6 weeks or 2 years! Baby-Friendly Breastfeeding Initiatives and other similar programs are a first step to getting moms off right. But beyond that, the community must be engaged to support these moms. Breastfeeding should be welcome wherever it is safe for a mom and baby to be. Workplace and social accommodations must be championed. Ignorance can be cured with education. Disappointment when goals are not met must be met with determination to help the next mom – not try to downplay the goal!

If you are a friend or relative of a breastfeeding mom, do what you can to encourage and support her. Educate yourself and your community. The babies of the world will appreciate your efforts!

Adoptive Breastfeeding

I have a particular heart for adoption. I came from a large family where other children were welcomed. My brothers, sisters and extended family have adopted and now I have an adopted grandchild. If adoption is part of your journey and you would like the experience of breastfeeding, I am here to help. Breastfeeding is a normal part of comforting as well as feeding a baby. There are protocols available on the internet to help with bringing in milk prior to anticipated arrival of your child. Check out www.asklenore.com. A lactation consultant’s part in helping adoptive moms is to coach, encourage, make adaptions to the plan as needed throughout the process.

If an adoptive mom is not able to attain full milk production, any breastfeeding time is beneficial to both mom and baby. Donor milk or formula can be used with a lactation aid to supplement whatever mom is able to produce. And bottle-feeding can be done in a baby-led way that is more physiologic.  See information on side-lying paced bottle-feeding.

Tools for Breastfeeding

I often get asked this question by pregnant women: “What are the essential tools I need for breastfeeding?” My answer is almost always this: At least one breast and at least one healthy term baby. That’s it! Provided everything goes well with birthing, you are able to avoid mother and baby separation and you are able to keep your baby skin to skin, things should go well.

Sometimes they will follow with this question: “But what things do I need to know or know how to do?” My answer is this: Get comfortable with handling your breasts and nipples. Review reverse pressure softening and hand-expression, especially areolar expression. Review breast massage. Watch some YouTube videos on baby-led latch. Talk to your partner about protecting you and your baby so that you have the private time you will need for learning.
Breastfeeding is a relationship between mom and baby. All relationships require one on one time to foster closeness and confidence. Pregnancy is like a Facebook romance where you communicate only with pictures – and the other party can’t speak back to you! You make a commitment to that person before you ever meet face to face, know what they really look like or anything substantive about their personalities. You sign the marriage contract (like an arranged marriage) with a vast unknown before you. You consummate the marriage – and then you begin to learn about your partner.

The next question I may get is this: “But what if there are issues? Are there any products or supplies you would recommend to have on hand, just in case?” Here is my list:

1. Breast pump – double electric. If your baby has some issue that makes it difficult for her to attach and draw milk from your breasts AND you need to establish your milk supply, I strongly recommend temporarily renting a Symphony from your local rental agency. You can use your breast flanges and attachments from a Medela personal pump, but will need to purchase a conversion kit if you have not received one from the hospital. Breast milk supply potential is established in the first four weeks of breastfeeding. Failure to remove milk from the breasts signals lactocytes to shut down production. It is easier to protect your supply from the beginning than to try to rebuild a supply later on. Medela Pump In Styles are my favorite personal pump, but I will admit prejudice. Your insurance company may provide you with this. This style of pump was designed for helping moms transition back to work and for occasional use when you have a healthy nursing baby.

2. Tendercare Hydrogel Pads by Medela. These are sold online, by Target, Baby’s R Us and hospital boutiques. For sore nipples. There are other brands but Medela pads can be cut in half to go further, if needed.

3. Microwave sterilizer bags. These save a ton of time if you need to sterilize/clean breast pump parts, pacifiers, bottles etc. You may never need these for your baby. They make great bags for steaming broccoli and other vegetables if you don’t need them for baby supplies. And they’re reusable!

4. Nursing pads – disposable or re-washable. Soft cotton pads are very comforting especially if your nipples are sensitive but not sore.

5. Bacitracin. A great topical antibiotic for scrapes and cuts and useful, should you need it, for treating nipple trauma.

6. Ice diapers. Make these yourself. Take 4 disposable diapers. Open them out and wet them. Drape them over a cup in the freezer. These are great for soothing tight breasts throughout the engorgement period.

7. Nursing support pillow. There are lots of styles and brands. One of my favorite is the Boston Billow. This can be found on-line and in stores (check with the website). Additional pillows, some firm, some more adjustable, may be needed. Make your own wrist support. This can be made from a long tube sock filled with rice and tied off. The wrist support can be placed strategically to help support your hands, arms and the baby during the first few weeks while baby is unable to support his own head.

8. A comfortable chair for nursing. A small rocker/recliner can be very useful. Combined with an assortment of pillows and supports, this will help you be comfortable and relaxed. A small table nearby can be a place to put your water bottle, nursing pads, and your phone.

9. A support system! The first four weeks of breastfeeding are the most difficult. This is when your breasts establish your production capabilities. 20% of women note that their breasts grew during this period of time rather than during early pregnancy. It is important to have a team (family, professionals, friends) that give you encouragement if you have a slow improvement in supply. Professional support is very important, but it takes a team effort when additional help is required. Even when things go well, moms need help to get rest and recover from childbirth and to nourish themselves. If there are older siblings, they will need attention and explanation, so that mom and baby can adjust to each other.

10. A positive attitude! Breastfeeding can be the easiest or the most difficult thing in the world. Every baby is unique with a unique body and personality. Every mother-baby relationship is unique. If you enter into this relationship with the idea that this baby has good will towards you, and you have good will towards him, any other issues you face will be simply about communication and adaptation. Sometimes you may need interpreters and facilitators, but ultimately with persistence, you will grow to love and understand each other. Good luck and blessings!

Fitting Baby In

When you have a baby, everything about life changes. The love of your child may hit you like a ton of bricks. Or, like other love relationships, it may creep up on you slowly. Some parents take the coming baby experience with a laissez faire attitude. They trust they will get through childbirth and child raising by the seat of their pants. Others plan everything, like a military expedition, trying to think of every possibility and plan for every outcome. Others take a middle of the road attitude. Whatever the personal style of the parents, they will be bombarded with all sorts of advice and warnings. Some of it will be useful, and a lot of it, not.

If the parents are “researchers,” they may discover many opposing viewpoints on almost every issue. The “planners” may find this frustrating and overwhelming and make a firm commitment to adopt a viewpoint that causes issues within their relationship with each other and the baby. The “flyers” may find themselves validated when everything goes smoothly or be able to adjust to any bumps in the road they encounter. The key is having two parents on the same wave length – which often doesn’t happen! It’s a good idea for parents to discuss these things before baby comes and be prepared to change strategies if they find that the planned one is not working for them and their baby.

The truth is, babies need love, comfort, security, food, and warmth. Breastfeeding provides that very first connection that simultaneously provides all of a baby’s needs with one activity. The challenge comes in providing those needs for the baby while caring for the mother and father. Here is where family and community support becomes vital.

If you are a laissez faire sort of person, consider the possibility that childbirth may not go in a predictable pattern. It helps to have supportive folks in the wings ready to step in and give a hand if you need it. Have the conversation with family and friends so they understand your point of view, but can plan to be available in case you need a little help with coping in the first days. If you are a researcher or a planner, try to accept that there unforeseen events may occur and contingency plans may be required. Give yourself room to breathe and try not to set impossible goals as a measure of success.

Babies are non-stop needy. They go from having their needs supplied without any effort on their part before birth to a world that is cold, bright, hard and must be engaged to get anything that they need. Babies have massive brains (compared to other animals) but few connections established. Everything must be learned from scratch. Primitive reflexes such as suck, swallow, breathe that are essential to survival are present but baby must associate those with actions that bring food and satiation together. Those associations build over time. Connections between the brain and mouth and neck become more secure by 5-8 weeks. This becomes obvious to parents when baby begins to smile in response to interaction with other humans. In these early days, babies need to be near their mothers, enjoying skin to skin contact and free access to mother’s breasts for nourishment and comfort. Interestingly, this time when baby is mainly reflex-driven is also the time when mother’s milk supply is built and established. Frequent and unrestricted access to breastfeeding has been shown to increase milk supply better than scheduled and limited feeds. Frequent breastfeeding helps to increase hormone levels and sensitivity of lactation tissue to hormones of milk production. For mom to be available, it helps to have household and toddler assistance (if needed) during this early period. Slings and wraps that keep baby close to mom can help reduce stress.

Sometimes parents are tempted to use artificial carriers such as car seats, Rock ‘n Plays, swings and other devices that put baby in a semi-upright position and provide movement and/or noise like the uterine environment.┬áThe thought is that these devices will give parents a break and are harmless. Studies, however, show that babies who spend too much time in these are more likely to develop acquired torticollis, reflux and plagiocephaly. Here’s an article that gives more information about one product. By age 3 months, babies have progressed and gained more head and neck control and can use these products without some of the side effects.

As babies grow and mature, they become more sociable. Stomachs grow and babies can take more milk in at a session and sometimes go longer between feedings. Feedings can also be shorter at times. The unique personality of your baby becomes more obvious as time goes on. Your relationship grows and develops. Most moms find that after 3 months, breastfeeding becomes easy – and so much easier than all the work it takes to bottle-feed a baby. Breastfeeding becomes more than just a way of transferring nourishment to your child – it is a communication tool, a way of comforting, and a way of teaching about relationship.

In most non-Western cultures, breastfeeding to 2 years and beyond is the normal pattern. Of course, older babies do not nurse as frequently as newborns and some sessions may last only a couple of minutes. Extended breastfeeding (breastfeeding exclusively for the first 6 months and thereafter as long as the child desires) is associated with better development of facial structures, reducing the need for orthodontics in children nursed over 18 months. Family-friendly solid foods can be introduced starting at 6 months of age. For more information on introducing solid foods to older babies, check out this website:

Whatever your parenting style, know that it is possible to grow and adapt as time goes by. You are not committed to one style of parenting forever. You can compromise and change as you need to. Love, after all, is the most important gift that you will ever give your child.