Pumping Log: right vs left

Unfortunately breasts do not come with markers on them. When you are an exclusively breast-feeding mom you never really know how much your baby is getting. We teach in lactation to watch for the signs that tell you your baby is getting enough milk. You look at swallowing patterns, wet diapers, and the overall health and weight gain of your baby. When you are pumping mom though, we are meticulous in knowing how much milk comes out of our tatas. Have you ever actually stopped and looked at that milk? I’m sure you have. I’m sure you analyze every drop that comes out of your body. Did you know that the left and right breast can make different amounts of milk? One research study found that stereotypically moms always make more milk out of the right breast. Which is interesting in light of the fact that most women have a slightly larger left breast. (Click on text to read the research articles) It really goes to show that size does not matter for production. Size is related to fat in the breast tissue and not the actual glandular tissue that produces milk. I love breastfeeding. And I try really hard to rotate which side I start on when I’m breast-feeding my daughter. When I am at work or use a double pump to pump both of the girls at the same time. It has been always consistent for me. My right always make slightly more than my left. Usually not very much more, but enough to be noticeable. And science still doesn’t really know why!! Oh, our fascinating bodies!!! Happy Pumping!!!

Growth charts

Did you know that breast-fed babies and formula fed babies have different growth charts? Breast-fed babies tend to be leaner and gain weight at a slower rate than artificially fed babies. Make sure your pediatrician uses the correct growth chart when weighing and measuring your little one. Many a well meaning pediatrician has inadvertently recommended supplementation to exclusively breast-fed babies bexcuse they’re using the CDC growth chart which was standardized on formula fed babies. In 2006, the World Health Organization released revised growth charts that are representative of healthy breastfed babies throughout the world. Until our doctors are familiar with them, we need to keep ourselves informed so that doctors don’t undermine our confidence to breastfeed our babies.

Healthy breastfed infants tend to grow more rapidly than their formula-fed peers in the first 2-3 months of life and less rapidly from 3 to 12 months. All growth charts available before 2006 (which are still used by many health care providers in the US) included data from infants who were not exclusively breastfed for the first 6 months (includes infants fed artificial baby milk, AKA formula, and those starting solids before the recommended 6 months. The American Academy of Pediatrics revised their  guidelines on introducing solids for parents to wait until 6 months. A lot of. pediatricians will push to start solids at 4 months because they’re not current on the latest guidelines). Since many doctors are not aware of this difference in growth, they see the baby dropping in percentiles on the growth chart and often jump to the wrong conclusion that the baby is not growing adequately. At this point they often unnecessarily recommend that the mother supplement with formula or solids, and sometimes recommend that they stop breastfeeding altogether. This is often a cause of unneeded stress. Next time you’re at your peds office, ask which chart they’re using. For more information on growth charts, see kellymom.com

Pumping Log: back to normal.

Us pumping mamas tend to freak out about how much we pump. Can I get an amen?!? When our supply drops we freak the freaky freak out.  But what if we weren’t pumping. Would we actually notice any of these drops, or what our babies just happily do what they do and not even give us education that something has changed? Would we even have periods because we would be exclusively nursing And supply changeseould be a non issue? Yesterday I took my deep breaths and talked myself off the “I have no milk” ledge. Today my period is officially over. And low and behold my milk supply is back up. Remember, hormones do funny things to our bodies. Do what you can but don’t freak out over every little change. Stay the course. Love yourself. Love your body.

Pumping Log: One of those days

Is been one of those days. Let me tell you about it. I found a cockroach on my breast pumping bag this morning (I had it next to our 1920’s era fireplace where I was pumping last night). I lost my employee badge and can’t find it anywhere. I forgot my lunch on the counter. When I got to work I realized all my pump parts were sitting in the bottle drying rack at home. My stress was so high I pumped less than 3 ounces my first session (I was thankfully able to use the lactation room in the NICU) which only made me stress more. Then I remembered my own advice. Don’t partner with worry or stress. I have to actively choose joy and peace. I made myself a cup of mothers milk tea and a cup of oatmeal (at least those are always in my pumping bag) and took a deep breath. I made sure to eat a good lunch (I had a certificate for a free lunch in the hospital cafeteria) and treated myself to an ice cream for dessert. I’m already up to 3 ounces at my second pumping. Peace comes from within and not from external circumstances. Joy is a choice that needs to be embraced. Breathe in, breathe out. You’ve got this, mama.

Sometimes being a woman sucks

More specifically, having a period because you’re a woman sucks. Not only are there mood swings and cramps to deal with, there’s also my monthly dip in milk production. Time to make some lactation cookies with extra chocolate chips and a cup of Mrs. Patel’s Milk Water Chai Tea. At least my daughter hasn’t seemed to notice. I was with her the past four days on a mini vacation and she’s been more interested in eating off my plate than my chest. Today I went back to work and knew it would be a lower volume day. Although I always note thamy the milk I pump during my period is a little creamier and more fat sticks to the sides of the bottle. I hope showing these pictures encourages you that is OK to have high and low volume days and not get discouraged. Love your body. Love the process. Worry and stress don’t help anything. Keep eating healthy, drinking plenty of water, taking your prenatal vitamins and taking supplements as needed. Happy pumping!


Pumping Log: the pump room

I’m sure every workplace has their own unique style of pumping room. It is a place of sanctuary and safety for many nursing moms during the day. At the hospital where I work, we have an employee lactation room on the first floor. Inside are two somewhat comfortable chairs, each with its own table, two curtains to separate them, and a sink. We are actually very blessed to be in a baby friendly hospital  where they at least attempt to take care of their breast-feeding moms. I have read about pumping room horror stories, though, of “pump rooms” that are nothing more then broom closets or electrical rooms with folding chairs. The law states that all employers must provide a non-bathroom room for breast-feeding employees. But their definition of “non-bathroom” is occasionally taken liberally. The room in which you pump can definitely impact your milk output. If the room you are in makes you stressed, you will see a decrease in milk production. If you are in a calm environment and don’t feel rushed, your milk will have a higher chance of letting down. Do you whatever you need to do to make your pump room as comfortable as possible. Make sure to surround yourself with plenty of pictures of your baby and since it is your break, if you can FaceTime or Skype your baby.

My hospital’s employee lactation room

I do have a funny story about my work pump room. The tables are older and one of them had a broken table leg. The table looked like it was going to collapse at any second. I put in a complaint through the proper chains. I came in the next day and the table was gone. But the two chairs were facing each other with the table in the middle as if anyone pumping at the same time would have a pump off! I don’t Think the maintenance department quite understood the purpose of the room 🙂 with a quick phone call to HR we were able to get a second table and move the chairs back to the proper positions. What are your funny pump room stories? Feel free to share your pump room pictures.

Let’s have a pump off.

Happy pumping!

Make it a double

They say you can’t over feed a breast fed baby. They’re usually pretty good about taking what they need and stopping when they’re full. This is because of stomach and breast anatomy. Remember how sucking and milk flow rate at the breast are different than the bottle? This directly links to stomach anatomy.

There are two kinds of receptors in the stomach: density and stretch. Density receptors tell you how calorically dense or fat-rich your food is. It’s why at the Cheesecake Factory your belly starts to feel really full after about ten bites of Godiva chocolate Cheesecake but you can eat 3 bags of popcorn at the theater. Chocolate is much richer and calorically denser than popcorn. Stretch receptors tell you how full your stomach is from a volume perspective. Your stomach at rest is on average the size of your fist. That’s true throughout your entire life. But the stomach can stretch. Just like my stretchy pants at Thanksgiving. It can still only fill to a certain capacity. The only problem is, it takes approximately 20 minutes for your stretch receptors to tell your brain that the stomach had stretched to capacity. This is what I call the twenty minute phenomenon. You know, when a group of college boys order a pizza, they each eat a whole pizza in ten minutes and then twenty minutes later feel over full and sick. They as much as they could as fast as they could but paid for it in the twenty minute window. Exclusively breast fed babies don’t typically over eat because again, breast milk flow varies over a feeding. It starts slow, mommy goes into let down, then milk shows, mommy changes the baby to the other side, milk starts slow, mommy goes into let down, 15-20 minutes later the baby’s stomach tells the brain it’s full and the baby stops eating. Anatomy and physiology in perfect harmony.

Unfortunately bottle fed can be over fed. Bottles have these lovely ounce markers on them that tell us how much the baby needs to eat to be full. At every feeding my baby NEEDS to get a full 5 ounces of she will be hungry. She NEEDS to eat 24 ounces in a day or she will starve to death. And when baby stops eating at 3.5 ounces, I just jiggle the bottle or wait a few minutes and jiggle the bottle until baby takes that full feeding. Jiggle, wiggle, look at that she took the full feeding. Instead of listen to baby’s cuts that she’s full, we let the bottle dictate how much baby needs. And we wonder why formula feed babies have a significantly higher rate of obesity. Here’s the thing. Bottles are not the enemy. My daughter takes breast milk from a bottle five days a week while I’m at work. They are lovely devices that do an essential job. But we need to be mindful to not over feed our bottle fed babies.

Tips to not over feed a bottle fed baby (regardless of what’s in the bottle)

1. Always use a show flow nipple until 1 year of age. Slow flow most closely mimicks the flow at the breast. It also shows a baby down so the brain can keep up with the stomach (aka be mindful of those stretch receptors).

2. Watch your baby’s cues. Does he push the bottle away? Did he become sleepy? Do his hands and body relax? Does he release his iron grip on the nipple? These are signs he’s done. Over fed babies tend to spit up or vomit more because their tummies are at capacity. Don’t try to force in that last half an ounce. Respect your baby and stop feeding. Your baby will let you know if he’s still hungry.

3. In reality, babies only ever need 3-5 ounces of milk per feeding. In the first four to six months when your baby isn’t eating any solids, here’s a simple rule of thumb: Offer 2.5 ounces of formula per pound of body weight each day. For example, if your baby weighs 6 pounds, you’ll give her about 15 ounces of formula in a 24-hour period. Once a baby is six months of age and starting solid foods, offer the breast or bottle first (3-5 ounces), then offer well balanced, nutritious, solids. The solids will provide them the additional nutrition they need. (**Disclaimer : if your baby is not ready for solids at six months, that’s FINE. Your baby is ready to start solids when they can sit unsupported for a good amount of time, uses a pintcher grasp, and has the hand eye coordination of hand to mouth. If your baby is over six months and not taking solids, your baby may need additional milk per feeding.)

4. It is OK for volumes of feedings to be didn’t throughout the day. We take for granted that babies can know their bodies. They can tell us when they’re hungry and when they’re full. Sometimes I’m really hungry in the morning and I eat a Grand Slam breakfast. Other times I only want a piece of toast. It’s OK to have your baby eat a ton one meal and very little the next. Remember, there are no ounce markers on the breast. Exclusively breast fed babies do this all the time. And there’s no amount of nipple jigging that will get them to take more in a feeding.

Here’s the big take away: it’s OK to take the pressure off feeding, especially if your a working mom trying to keep up with pumping. As long as your baby is following their growth curve, making enough wet and dirty diapers, and happy, keep doing what you’re doing. If your baby is not getting enough nutrition, not gaining weight, or unhappy, please have your pediatrician write a referral to a pediatric clinic ASAP or give me a call and we can dialogue through a plan of action.

Happy feeding!!

Pumping Log: pumping is a full time job

I’m a lactation consultant. I’m also a first time mother. My daughter will be nine months old next week. I went back to work when she was just twelve weeks old. I’ve been pumping since then. No one told me how much work that would actually be. Pumping while at work is literally a full time job in and of itself. For most moms that plan to continue breastfeeding after they go back to work, you need to plan to pump when you would typically feed your baby. Feed the baby or feed the pump. That’s how you keep up supply.

But that can be tricky when you’re working. I try to pump three times in an eight hour shift. Every two and a half to three hours. For ten to twenty minutes depending on my break. I’m typing this over my lunch break as hard plastic suction cups suck on my tender bits.  It takes scheduling and planning. Some days are easier than others. Some days the milk flies better than others. The most important thing is to not give up and not get discouraged. In the end the benefits definitely far out weigh the risks. Like reducing my risk of breast cancer. Reducing the risk of allergies, eczema, respiratory and ear infections for my baby. Saving the environment from extra trash. Not to mention saving almost $3000 a year from formula costs. You definitely need to keep your goals and your humor about you to persevere.

This is a comparison of several days. My baby has always had enough. Every once in a while I will pump at night before bed to give me a little extra milk if I have a lower day. As you can see, first pump of the day (on the left) always gives me the highest amount with amounts dropping as the day goes on. That is normal for every mother whether she pumps or nurses.)

what have you found to be most helpful for keeping your supply up while pumping at work? Feel free to comment!!!

Pumping Log: Clogged Ducts

Clogged milk ducts are no fun. My ducts clogged several times when I started nursing. With immediate action, I was able to clear the duct in a few hours and nursing returned to normal.

These are signs that you might have a clogged duct:

  • a small, hard lump that’s sore to the touch or a very tender spot in your breast.
  • redness.

a hot sensation or swelling that may feel better after nursing.

If this sounds like you, YOU NEED TO UNCLOG THAT DUCT. If left untreated, clogged ducts can turn in to mastitis.

Here are several strategies that worked well for me:
-Hot showers or hot compresses (hot washcloth or heating pad over the lump) before nursing (or plank over a bowl of hot water or hot bath or hot towel etc)
-Nurse on demand starting on the affected side.
-NURSE LIKE A COW. Lean over baby on your knees and forearms and let gravity help.
-After nursing, hand-express that boob! Start at your ribcage and squeeze/massage over that duct toward the nipple like you’re trying to squeeze that last bit of veggie pouch out the tip. It can hurt, If you don’t do it, the doctor or lactation consultant will, and it will still hurt like heck. But you can at least feel where it is and when to stop.
-The clogged milk is SALTY and that’s why babe might start to refuse it. Once you find the salty spot, “milk” yourself that way till the salty stuff empties.

Repeat this process each feeding until the lump goes away or you feel it release and your milk flow return to normal. If it doesn’t go away in a day or two, seek professional help to avoid it turning into an infection.

Pumping Log: Nipple confusion??

Nipple confusion. While many moms who are going back to work trying to get their babies to take their milk from a bottle, many of them are also frustrated when the baby refuses to take one. Their baby turns away, arches her back, pushes the bottle nipple from her mouth, chokes, gags, and becomes extremely fussy. Or the baby was doing struggling at the breast, started taking a bottle well, and now no longer wants anything to do with the breast. These are all symptoms that mothers a tribute to “nipple confusion”. As a speech therapist, this term has always bothered me. In my mind confusion means a mood or emotional mental status. Like, I was confused at the directions. I was confused as to where I was. I was confused as to why he behaved that way. Babies are born, natural feeders, they literally come out of the womb wanting to suck. I would like to rewrite the term nipple confusion instead with flow confusion. Babies are not confused about where their milk is coming from, but how it is coming out. The flow from a breast and a bottle are very different. At the breast when a baby is first placed at the nipple, the baby sucks in a very quick, rhythmical suckling pattern. This stimulates milk flow. After several minutes of this quick, high paced suckling, the mother experiences let down. This is a very fast flowing time in the milk phase. During let down the baby’s sucking rate changes to a slow and rhythmical pattern. After several minutes of this, the baby goes back to that high suckling phase. That is because the mothers milk flow has decreased. The baby then stimulates another let down to occur by changing her rate of sucking. A typical mother can experience anywhere from 2 to 4 let downs during a typical feeding. Bottle nipples, however, do not work on a demand-supply basis. As soon as that bottle nipple is placed in the baby’s mouth, it begins to flow. The baby does not even necessarily need to suck if the hole in the tip of the nipple is large enough. The baby could munch mash on the nipple or even just let it flow into her mouth. It takes much. Less work but much more coordination to drink from a bottle nipple. The baby needs to be able to coordinate her sucking, swallowing, and breathing any typical rhythmical pattern.

Differences in the way a baby sucks on the breast vs. a bottle

  • To latch to the breast, baby must open his mouth widely. A baby does not need to open wide to suck on a bottle.
  • When sucking on the breast, baby’s tongue makes a wave-like motion; it begins at the tip of the tongue and moves toward the back. The tongue compresses the breast against the roof of the mouth. A bottle fed baby uses his tongue differently and may lift the back of his tongue to stop the flow of milk and protect his airway.
  • If a breastfed baby needs a rest, he simply quits sucking and the milk flow slows. Milk may flow from a bottle even when baby is not sucking, forcing baby to continue feeding without a break.
  • To breastfeed, the baby needs to take the nipple far back into the mouth to the soft palate and then uses her tongue to compress out the milk (which can take a minute or so before it starts flowing). With a tilted bottle, a baby has gravity on her side: She can suck with her lips and get all the milk she wants right away.
  • Babies aren’t confused about what nipples are for, but they may prefer getting milk faster without having to work as hard or be unable to control the flow and become overwhelmed and shut down.

The truth is, most babies have no problem switching from breast to bottle and back again. Others, specifically those who take a little longer perfecting the art of suckling at the breast, can have trouble transition from breast to bottle — and then back to breast. These babies often have difficulty coordinating the intricate act of sucking, swallowing and breathing. Since we don’t know which babies will do well and which will struggle, most experts agree that you should wait until your newborn has established good breastfeeding habits, usually around three weeks of age and after the two week growth spurt, before offering the bottle. If you’re still struggling with breastfeeding at three weeks and it’s still your goal, hold off on the bottle a little bit longer.

At the NICU where I work, if we have a mom who plans in breastfeeding, we will always use a slow flow nipple. It most closely resembles the flow at the breast to make the transition back and forth easier. We also use various positioning and pacing techniques to help babies get the hang of coordinating their sucking, swallowing, and breathing. A slow flow nipple is always best to start with if you plan to continue breastfeeding