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Newborns & Time

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Due to the current social distancing, I have some extra time. Ironically, I am choosing to write about time! I receive lots of questions about time: How much time at the breast? How much time between feedings? How long should I pump? 

So much emphasis is put on this topic, but honestly, I don’t find it to be a huge factor in determining how well breastfeeding is going. 

It all comes down to quality over quantity. If baby is at the breast, but not drinking efficiently, or not drinking at all, then time doesn’t really matter. If there is not quality milk transfer happening, then it doesn’t matter how frequently you wake the baby to feed, or how long you keep baby at the breast.

Frequently I hear:

“I am waking baby every X hours and keeping them awake to feed for at least Y minutes, but they are very sleepy. It’s hard to keep them awake.”

Often, these babies are losing -or- not gaining weight well.

When I am talking with a mother in this situation, the two biggest things I will assess and focus on are milk supply and latch. Are there issues with milk supply that could be causing baby to refuse the breast and not be getting enough calories? Is baby latched well enough to nurse and transfer milk? Drinking video.

If latch is poor, and transfer is slow: then they will fall asleep and be hard to keep awake.

If milk supply is low: babies tend to refuse to latch or fall asleep quickly at the breast.

So often, it has nothing to do with milk supply, time at the breast, or frequency of feedings.  All too often, it comes down to the latch. Once baby is latched better, they can better handle the flow, they are more awake and active at the breast, and you can hear audible “drinking” and swallowing. At this point, they typically will drink until they are full, feed when they are hungry, and weights will eventually improve. 

This is why it is so important to seek lactation support early on before milk supply is affected by a poor latch and lack of milk transfer (milk supply blog).

While I don’t suggest moms to stare at a clock and timer all day long, we have to set some guidelines and occasionally nudge these newborns along.  I want to see 10-12 feedings per day with some clustering being ok -and- even normal. The time between a feeding could be very short (clustering) or vary between 1-4 hours. Babies will feed better when they are hungry and when they initiate feedings. 

The composition of breast milk changes throughout the day and can even fluctuate some with daily hormone changes of the mother, causing each feeding to be slightly different. This is exactly why a breastfed baby should be fed on demand and not by the clock. Clustering has a purpose and allows babies to get ready for a longer sleeping stretch (maybe one 3-4 hour stretch) or make up for a long sleeping stretch. 

Visual of on demand feedings. Source unknown.

In conclusion, we have to make sure baby is gaining weight, is happy and healthy, feeding 10-12 times per day, having plenty of wet and stool diapers, and that the latch is efficient. Because if the latch is not efficient, then time at the breast doesn’t matter. 

Let’s be honest, taking care of a newborn is exhausting and there is just not enough time in the day. But if feedings are taking too long, feedings are too frequent, or something just doesn’t feel right, please reach out and seek lactation support!

The ever so popular topic of: Milk Supply!

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As a lactation consultant, I typically get two types of phone calls. One is for “help” and the other is for a “question”. The most frequent topic for a “question” is about milk supply -or- going back to work (and when discussing going back to work, it almost always circles back around to milk supply!). 

There are many things that can cause a decrease in milk supply such as hormone imbalances, certain medical conditions, medications, and more…. but today I would like to discuss the most common issue related to a decrease in milk supply, and that is the concept of Supply and Demand. 

Milk supply is about the frequent removal of milk from the breasts. The more a baby nurses or mom pumps and removes milk (demand), the more moms’ body should replace that milk removed (supply). It sounds pretty simple but unfortunately it is one of the most common concerns keeping breastfeeding moms awake at night. 

Latch….

Typically inadequate milk removal starts with a poor latch. If the latch is incorrect and milk transfer is low, this could cause a decrease in milk supply over time. This occurs when baby is at the breast but the baby is not drinking well from the breast. (video of good drinking)

Common signs that you may be having latch issues or milk transfer problems might be: pain, consistent frequency of more than 10-12 feedings per day, weight loss, decreased urine and stool output, need for nipple shield, or your mommy gut is telling you that something is just not right. If you feel that things are not going well, please seek help as soon as possible (Baby Eyes Lactation Scheduling)

The quicker the latch and milk transfer is corrected, the less likely your milk supply will be affected. 

Missed feedings……

Life is busy. Moms are tired. Some return to work. Some are just simply away from their baby at times. Here are two common scenarios that I see frequently: 

First, maybe dad or another family member tries to give mom a break by offering baby a bottle. If mom is sleeping or busy doing other things, this could lead to mom missing a feeding or pumping session.

Second, mom is away from baby and misses a pumping session -or- is unable to pump on the same feedings schedule as if she were at home with baby.  

Delaying the frequency of milk removal or missing feeding sessions all together can greatly impact milk supply. If this occurs only once or twice, this may not be a big deal at all, but overtime this could eventually cause a significant decrease. 

Tips for Protecting your milk supply……

  1. Most importantly seek lactation help immediately for any concerns with the latch! 
  2. Follow baby’s lead and nurse on demand. These babies are smart! Cluster feedings are baby’s natural way to boost milk supply when going through a growth spurt –or- when mom needs a boost in milk supply. (They know!)
  3. Avoid the use of pacifier when having feeding issues as this could delay feeding cues and feedings. 
  4. Try not to strictly schedule your baby’s feedings. This can lead to a decrease in feeding frequency and milk removal, and eventually overtime, a decrease in milk supply.
  5. Use breast compressions during the feeding to help maximize emptying and increase milk flow. This may also help infant from falling asleep at the breast due to slower flow of milk. Breast compressions
  6. Pump or hand express when away from baby as close to the home nursing schedule as possible. 
  7. Discuss all medications (OTC and prescription) with your health care providers and pharmacists to assure that there is no affect on milk production.  

Once you have exhausted the above list and still need a boost in milk supply…..

  • Frequent milk removal! By increasing the number of times you pump or nurse, you are giving your body the message to increase your milk production. 
    1. You can allow your infant to cluster feed for a few days. Turn on Netflix, keep baby close to you, nurse frequently, and rest in between. This is often referred to as a “Nursing Vacation” 
    2. You can also mimic cluster feeding by “Power Pumping” once or twice per day. Typically this is done over an hour alternating between rest and pumping. 
  • Galactagogues. This is a fancy word for a substance thought to help increase milk supply. Most commonly you have heard of the herbal supplements Fenugreek and Blessed Thistle. (Herbal Supplement Guide)
  • Along with herbal supplements, there are many food products out there that suggest to have milk increasing affects as well: oatmeal, garlic, spinach, brewers yeast….just to name a few. None of these things are proven completely effective in increasing milk supply.  Honestly, if you want to try a  “milk cookie”, then go ahead…you deserve a cookie! If you want oatmeal…have oatmeal! Extra garlic…your baby won’t mind! Just take care of yourself and remember that moderation is key.

Lastly, when it comes to milk supply, technique/latch is the most important factor. Pumping, clustering, and herbal supplements are all just a small part in the correction of low milk supply.

Traveling and Breast Milk Storage….

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Only a few years have passed since I nursed our youngest child myself.  Now maybe I am just hyper-aware of lactation progress because of my job -OR- just maybe we are REALLY, FINALLY starting to see the changes and support needed for nursing mothers. 

On a recent family vacation, I couldn’t help but notice the Mamava nursing pods located in the airports as well as other various Mother’s Rooms. These areas can be used for changing diapers, pumping, and breastfeeding.  These advancements are great for giving a mother privacy, allowing space for pumping, but overall, just helping bring awareness to breastfeeding to everyone else passing through.

Along with the pods and the infant/family rooms, I also noticed several women nursing in public.  It was discrete and nonchalant! Some mothers were using covers and some were not, but regardless it was NOT a big deal! 

Several years ago, I remember feeling alone and a little anxious when nursing in public. Not that it stopped me at all, but I often times felt like I was the only one and nervous that someone would approach me and say something (we’ve all heard those horrible stories!). Anymore it seems that there are many advancements making it easier and a little less frightening. We are seeing an increase in these pods, mother’s rooms, changing rooms, and now there are even genius clothing lines specifically for nursing moms that make nursing in public a little less panicky and more stylish (and that caused me to kick myself for not coming up with the idea myself when I was nursing!).

With all of this, I am just happy to see more acceptance and more advocacy for breastfeeding mothers. I think we have come a long way, even in as little as the past few years. For all of you mothers using the Pods, Mother’s rooms, and/or nursing in public…you are doing your part in making breastfeeding less of “a thing” and normalizing it even more. So, thank you!

Traveling can be hectic in its self, let alone to be traveling with children or traveling and trying to pump/store/transport breast milk. Regardless, there is a lot to think about! Below are my tips for storage and traveling within the US:

  1. First, It is hugely important to understand the (above) basic storage guidelines for expressed breast milk. The CDC has this great table outlining the proper storage timelines for freshly expressed breast milk, refrigerated milk, as well as thawed frozen breast milk. CDC breastmilk storage table
  2. According to the TSA guidelines, traveling with breast milk, juice, and formula for infants is permitted through security checkpoints and is exempt from the 3-1-1 rule. 
    • Notify TSA at the beginning of the screening process that you are carrying breast milk. 
    • Ice packs, freezer packs, frozen gel packs and other accessories required to keep breast milk cool are allowed in your carry-on cooler. 
    • Typically your pump, breast milk, and any cooling packs are going to be screened separately. 
    • If your breast milk is screened, The Food and Drug Administration states that there are no known adverse effects from eating food or beverages screened by X-Ray. 
  3. With a breast pump being a “medical device” it does not count as a carry on item however, if you are traveling with a separate cooler and ice packs, this cooler will be considered as a carry-on. 
  4. You can request a hotel room with a freezer or you can ask the hotel desk for the possible options to store milk in their hotel freezer. I always think it is a good idea, to discuss these options with the hotel prior to booking to see what their accommodations might be. 
    • For packing and thawing purposes, I always suggest storing smaller quantities at a time. Example: It is less wasteful to thaw two 2-oz bags than to have to thaw out a larger 6 oz bag and end up wasting several ounces of precious milk. Plus, smaller quantities tend to lay and pack better in your cooler. 
  5. Once frozen breast milk has been thawed, it has to be used within 24hours.  This can make traveling home with frozen breast milk tricky. You can attempt to keep your cooler cold enough to travel home with frozen breast milk (using ice packs, gel packs, or ice) or you also have the option to ship your milk home. Along with a few other companies, Fed Ex has an actual process for shipping home frozen breast milk!!  
    • If you are traveling for work, some companies will reimburse expenses necessary for shipping breast milk. 
    • Note: there are other options/companies that offer this shipping service as well. It is always a great idea to explore options and pricing based on the area of where you are visiting. 
  6. Lastly, it is very important when traveling to either pump or nurse as frequently as you would if you were at home. When traveling (with or without your baby) it gets very easy to push back feeding times or pumping sessions. For supply purposes, it is very important to try to stay on your normal schedule as much as possible. Breast milk production is all about supply and demand; the more you pump, or the more you feed, the better your production will be. It is best to avoid long stretches between feedings when trying to maintain supply.

Based on previous blogs, you all know that I am always an advocate for planning and being prepared! So, I always think it is a good idea to come up with a plan before travel: Call the hotel to discuss storage options, go over the TSA guidelines before traveling with breast milk, and look ahead at your shipping options.  

Being as prepared as you can be…..

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If you were to ask my husband, he would tell you that I am the worst at packing a suitcase for vacation. My suitcases are always overfilled, I usually have one of those orange “heavy” stickers flagged on my checked luggage, and I have the worst time deciding what to bring (or not to bring). I think it’s a combination of the nurse in me, mixed with the mom in me, which makes me feel impelled to pack for all types of elements. I may get chilly and need a sweater at dinner. What if it rains? What if someone gets sick? What if someone gets stung and needs an antihistamine.On the flip side, my husband and friends never complain when they need something and I am to the rescue! 

You’re probably asking yourself: What in the world does this have to do with lactation?! Just like how I pack a suitcase for a vacation, being as prepared as possible is hugely important for setting up your foundation for lactation. Being an IBCLC from the pediatric perspective taught me very quickly just how important those first days after delivery are. If there are hurdles early on, it can really start a snowball affect and make reaching your lactation goals more difficult. 

Here are just a few things that I think are important that will help you be as prepared as possible for those first few days, and even weeks after delivery:

  1. Take a prenatal class and understand the basics of breastfeeding. Get to know the holds. If you think it would be helpful, practice the holds with a stuffed animal or doll. You don’t need to know the scientific composition of breast milk, but it will be helpful to understand the difference between colostrum and mature milk and when and why that transition will occur. (Prenatal classes available for schedule:  https://babyeyeslactation.com/scheduling/ )
  2. Colostrum: I really wish we could get away from saying phrases like: “is your milk in yet?” This implies that colostrum is not milk. Colostrum is milk, its just very highly concentrated milk. It is enough for your baby; it just needs to be given on demand and frequently. Baby’s stomach is only the size of a marble (5-7ml capacity) after delivery, so this highly concentrated colostrum is the perfect food at that time. Baby will be receiving colostrum right after delivery until approximately day 4/5 when the mature (more abundant) milk transitions.
  3. Limit visitors. I know everyone wants to come and visit but it is really important to set aside time to focus on babies first few feedings and maintaining a good latch. It is important to know that these feedings are typically frequent and this frequency is important to stimulate the mature milk to transition by days 4-5. With visitors, it is very easy for the frequency of feedings to be delayed or early feeding cues to be missed. 
  4. Feeding time. “How often and how long did the baby feed?” will be asked frequently in the hospital. Babies should feed on demand about 10-12 times per day. How long the feeding lasts, typically depends on how good the latch is. If baby is not latched well (therefore not “drinking” or transferring much milk) then time is really not that important.  (Video link of good latch and drinking at the breast https://ibconline.ca/breastfeeding-videos-english/ )
  5. Latch: The phrase “No Pain, No Gain” does NOT apply to breastfeeding. If the latch is not correct, then mom is going to be in pain and baby is probably not going to be getting the milk as efficiently as they could be. There are a lot of things new happening at the breast, so there will likely be some tenderness, but there should not be any fist clinching or breath-holding by mom when baby latches. Again, this is NOT ok and will likely not “pass with time”. So, please seek lactation support quickly if this is occurring. 

I understand that no one really wants to anticipate that breastfeeding isn’t going to go perfectly, so my best advise is to be as prepared as possible by understand the basics of the breastfeeding process and understand when to seek support. Use your mommy gut, and if things just don’t feel right or seem highly complicated, then find a lactation consultant quickly. The sooner these breastfeeding hurdles are resolved, the smaller your snowball will be. 

So before baby arrives, start learning the basics and try to get your “suitcase” ready 🙂

Superhero Cheerleader

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I can honestly say that I never thought the day would come that I would be sitting here blogging!! With math and science as my strengths, I would never say that I excelled much at writing. I used to hear: “you can’t write the way you talk”.  Well…. hopefully that doesn’t apply to blogging! 

There are several reasons why I chose to give this scary and intimidating thing a whirl. First, I want to be able to reach more mommas. Therefore, help more mommas. Simple! Secondly, I want to be a good resource for families when they are “googling” their breastfeeding questions (We all do it!!).  Lastly, I just want my patients, families, and even those healthcare professionals referring patients to me, to know me a little better. So, here I am!

I am sure all of you have read diligently through my bio on the website ;)….but in case you missed it, my professional experience has always been in pediatrics: from RN, to APRN, then adding on IBCLC. I too nursed two babies, so I know first hand just how hard and also rewarding this experience can be. The combination of my personal breastfeeding experience along with my professional experience, I grew really tired of seeing soooo many women out there struggling with breastfeeding and having nowhere to turn. That’s when I made the choice to further my education and focus on lactation.

Some people might think that working with emotional women would not exactly be ideal. I see things differently. After the birth of one of our children, my husband made a comment that really stuck with me. He told me how incredible the strength and instincts were of a new mother. He described it as being a “special power”. 

You see, my job allows me to witness this “special power” over and over again. 
Each time I witness this motherly instinct take over, it amazes and motivates me to keep learning and keep being the support system that every woman needs. I have worked with some of the MOST incredibly strong women, have witnessed their dedication, have seen their strength (even when they couldn’t), and have been there when they overcame their hurdles. These women are real-life superheroes!

“Superhero cheerleader” may not be a professional title or any special initials behind my name, but I will wear that hat proudly!