Author: Julie Matheney

Feeding babies has been my passion since I was ten years old. Almost twenty years ago, I pursued becoming a speech therapist to work with babies in the Neonatal Intensive Care Unit. In working in that setting, I realized I wanted a more intimate approach to working alongside families as they struggled to feed their babies. I became a board certified lactation consultant and have really fallen in love with what I do. There’s nothing better than empowering families to reach their feeding goals, wherever they are in their journey, whether it’s exclusive breastfeeding, combo feeding, pumping or bottle feeding. I offer prenatal breastfeeding classes, virtual, office and home consultations. I can assess for tongue or lip ties, educate on pumps to maximize pumping sessions, transition baby to bottle in preparation for parents going back to work, help increase or decrease milk supply, and assist with all breastfeeding challenges.

Having a baby means you are a targeted market.

- Julie Matheney

Where did 10,000 steps a day to better health come from? The 10,000 steps concept was initially formulated in Japan in the lead-up to the 1964 Tokyo Olympics. Because the Japanese character for “10,000” looks like a person walking, the company called its device the 10,000-step meter. Thus the 10,000 steps a day was not based on science, but a marketing strategy to sell step counters. Modern research has actually shown that 4,00-7,500 steps a day can be just as beneficial to health and a more realistic goal without discouraging people from walking fewer steps than the elite 10,000.

So what does this have to do with breastfeeding? You are being marketed to. Almost everything related to infant sleep and feeding (bottle AND breast) is a pitch to get you to buy something in your sleep deprived state at 2am from Amazon. Don’t fall for the marketing. Is the bottle marketed to look like a breast? Yes!! But in my experience the ones that look like a boob often don’t promote a breast-like latch at all. A cookie guaranteed to make milk? A cookie is just a cookie if you’re not actively moving that milk. A crib guaranteed to help baby sleep longer? It may work for some, but at what cost to development and the breast milk supply…

Yes, it is a fantastic time to be alive. We have more gadgets and gizmos than any other time in history. Some are amazing miracles of science and some are just downright times money suckers that will end up in the back of the closet to gather dust. If a products works for you, awesome!! Not every item will work for every family or every baby. Because we are all unique individuals

Nipple piercings and breastfeeding

- Julie Matheney

Will nipple piercings impact breastfeeding? In my experience, the majority of people who’ve had a piercing will have absolutely ZERO issues with breastfeeding. But every body is different in how it reacts to taking out the jewelry out prior to breastfeeding. Just like with pierced ears,  occasionally the hole left by jewelry will scar closed, or partially closed, which can inhibit milk from coming out certain nipple pores. Often, the longer the time since the piercings were initially placed the better the outcome as the nipple has had time to properly heal. Other concerns may include nerve damage (the piercing happened to go through right at the nerve and damages it) that impacts milk let down or extra holes created by the piercings that lead to milk coming out of unexpected places! I have (rarely) seen mastitis and abscesses from previous nipple piercings, but that is NOT common.

Breastfeeding with the nipple jewelry in place is never recommended as it can make it difficult for the infant to latch-on correctly, increases the risk of choking on loose or dislodged jewelry, and can damage the inside of the baby’s mouth. If you are going to take your jewelry in and out every feeding, make sure you are being extremely careful with hand washing and jewelry sanitizing to reduce the risk of infection. Best practice says take the piercings out for the entirety of your breastfeeding journey. Laid back breastfeeding positions and extra nursing pads to catch the excess milk can help. You may also need to find which direction your baby needs to face if you notice leaking milk from additional holes created by the piercing if they are not in baby’s mouth. Many women go on to breastfeed successfully with a history of pierced nipples, but if you’re having any problems or have concerns, see an IBCLC lactation consultant.

Breast vs Bottle Feeding

- Julie Matheney

Did you know that babies use completely different muscles to feed from the breast than from a bottle? They use more of their tongue and jaw at the breast and more lips and cheeks on a bottle. Breastfeeding is also a more complex feeding process where a vacuum is made in baby’s mouth from the tongue forming a seal against the roof of their mouth. Babies don’t need to create as strong a vacuum in the mouth to still bottle feee, as they can compress the nipple and milk still flows.

Bottle feeding is not a developmental skill. There is no age when a baby needs to take a bottle if breastfeeding is going well. Historically, babies went from breast to cup. Bottles are a relatively new invention with the formation of rubber nipples. It is developmentally appropriate to start open cup drinking by 6 months. That means if you’ve been exclusively breastfeeding and need to go back to work or your baby is starting table foods, you can skip the bottle and go straight for a cup. Starting with a small cup, like a medicine cup, shot glass, or @ezpzfun Tiny Cup are great ways to start. Your baby has been watching you drink from a cup for months and understands how it works. Straw cups are also great at this age and many babies will get the hang of it in a few tries. Using a straw cup like the Honey Bear has the advantage of you being able to squeeze the milk up to baby to teach baby how to get the milk by sucking.

When did you start cup feeding? Want to learn more? I have many videos of cup and straw feeding on my YouTube channel. Link in bio!

#cupfeeding #cupfeedingbaby #honeybear #honeybearstrawcup #6monthsold #6monthsbaby #6monthsoldbaby #breastfeeding

Weaning from a nipple shield

- Julie Matheney

Nipple shields are a commonly used tool in the lactation world. They may help a premature baby latch to give the baby time to mature and learn how to suck, prevent nipple damage from a tied baby, or be used when a nipple is flat/inverted (either from normal anatomical variations or because the breast is fluid overloaded from interventions during birth).  While there are many benefits to using a shield, are also risks, like the potential for decreased milk supply. Hopefully if you were given a shield, you were also given an exit strategy for weaning off of it. With any tool, make sure the reason you were given one has been addressed (giving a premature baby time to grow, doing oral motor exercises and a tie release, education that fluids during labor and delivery can temporarily make breast tissue swell and make nipples look shorter or flatter than they naturally are, etc). When you are ready to wean from one there are multiple strategies to help:

💡Start with the shield on and take it off after the first let down once baby is not as hungry/use it on the first side and not on the second side

💡Try without the shield once a day during daylight hours when baby is happy and not too hungry. Catching early hunger cues is imperative. If they’re crying, try a different time

💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible

💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch

💡Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible

💡Hand express to get milk flowing to keep baby interested

💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby

💡Try a different shield like the Lovi or Dr Brown’s which are thinner and give you more stimulation

Breastfeeding Rage

- Julie Matheney

Navigating the realm of breastfeeding grief is a poignant journey that many mothers undergo, a journey often unspoken. Whether faced with unexpected hurdles, feelings of inadequacy, or the necessity of early weaning, the emotional weight can be profound. The image of the envisioned breastfeeding experience might clash with reality, evoking a sense of loss. In these moments, seeking support becomes paramount. Opening up to friends, family, or professionals allows for a healing dialogue. It's crucial to validate these emotions, understanding that not every breastfeeding journey follows the expected path. Every mother's experience is unique, and the love and dedication as a parent remain the constant, irrespective of the breastfeeding narrative. Let's cultivate a compassionate space for sharing these experiences and supporting one another through the intricacies of breastfeeding grief. 💙🌸

Social media is filled with pictures of overflowing bottles and serene mothers cradling their content newborns to their breast. For many, though, the breastfeeding journey may not be what was planned for or expected, leading to intense emotions that go beyond frustration. Postpartum mood disorders, including postpartum rage, are on the rise. Postpartum rage, characterized by intense, often unexplained anger, can be heightened when breastfeeding expectations are unmet. It's crucial to recognize that this anger may, in fact, be a form of grieving as well. Whether hindered by physical challenges, birth trauma, societal pressures, or other unforeseen medical complications, the gap between expectations and reality can be a source of profound sorrow. Acknowledging breastfeeding rage as a potential facet of grief allows for a deeper understanding of these complex emotions. Seeking support, both emotionally and professionally, becomes paramount in navigating through these feelings.

#BreastfeedingRage #GrievingProcess #MotherhoodRealities #BreastfeedingGrief #MotherhoodJourney #SupportEachOther

Can you overfeed a breastfed baby?

- Julie Matheney
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Can you overfeed a baby? The answer is absolutely yes. You have a tiny human with a tiny human stomach. All of our stomachs can stretch to hold more capacity than what we actually need to take. The question is, is over eating a problem? We’ll take a look at this and strategies to understanding if whether your baby is over feeding and if it’s a problem or not.

Now we all know that it is very easy to overfeed from a bottle. Bottles have a hole in them that are instant and constant and absolutely yes, many bottle fed babies are over fed. Many times parents are watching the volume in the bottle instead of watching the baby for baby’s cues that they are ready stop. It also takes 20 minutes for the stomach to tell the brain that it’s full, so it is very easy for babies to take the large volume in a short amount of time and eat more than their stomach needs to, before the brain knows that it’s full. The mouth can still be hungry while the stomach is full so babies may show cues that they are still wanting to suck which parents interpret as cues that Baby wants to continue to feed, and because the stomach can stretch and hold more than it needs to, parents often overfeed from a bottle.

The big question is, can babies overfeed at the breast? The breast works different than a bottle. The breast needs to be stimulated to release milk and milk is released in multiple waves that take time to be triggered. Most young babies will take 15 to 30 minutes at the breast, which allows their tummy time to tell the brain that it’s full. As they age and become more efficient; they learn to listen to their stomach to help guide when to stop feeding.

It is still possible to overfeed at the breast. We usually see this for two reasons: either from the mother side or from the baby side.

On the mother side, the most common reason for overfeeding is the mother has an over supply of milk. There are several reasons for having an oversupply. First, it may be caused by using a Haakaa or a breast pump and overstimulating the breast to make more milk than it needs. This also drives up the letdown response, which makes milk flow faster than if the baby were just feeding at the breast without the over supply. In this case, baby takes too much milk too fast. Mother may also have an oversupply being driven by certain medications. The most common medication I see driving over supply is Zoloft. There are also different medical conditions that can be the reason for an oversupply such as a prolactinoma, which is a pituitary gland tumor, or uncontrolled thyroid disorders.  This would be diagnosed by a physician after bloodwork and other medical imaging. Lastly, some new parents who don’t have as much experience with babies may also interpret every cue as a hunger cue. Some babies are totally willing to keep eating even if they are full. If you offer me a cheesecake, I will totally eat the cheesecake even if I don’t need it. Some babies are also like this, they will always latch when offered the breast. Every time baby is put down to sleep in the crib, they cry. Or they sleep for 10 minutes and cry to be picked up. But these cues get misinterpreted as the baby is still hungry and the baby is put back to breast. Some babies are very willing to go back to breast and keep feeding.

Overfeeding  could also be on the baby side. Certain tongue ties will stimulate the breast into an over supply. These babies often use a quick suckle pattern which initiates the let down reflex from how the nipple is stimulated. These cases are complicated in that the tongue may be restricted in a way that the mother doesn’t have much nipple pain or damage, but her body is compensating for the baby not having full range of motion of the tongue. Babies with reflux may also over feed at the breast. They often want to nurse more to keep swallowing, which helps keep milk in the stomach. Breastmilk is a pain reliever and many babies with reflux learn that they would rather be swallowing milk down than bringing it back up as reflux. So frequently feeding helps them swallow more often, but it becomes a vicious cycle.

When does overfeeding actually become a problem? If baby is having a lot of negative symptoms related to feeding, and over feeding is determined to be part of the root, addressing the reason WHY there is overfeeding would be appropriate.

If the baby has digestive discomfort, and has a lot of reflux/excessive spit up/projectile vomiting with pain, severe gas or digestive pain, we would want to address over supply or other issues, causing this discomfort. If the baby is having green, frothy/foamy or watery poops, this is also a sign of too much milk too fast. These kinds of watery or green poops may be a sign of lactose overload, where baby is accessible too much foremilk due to an oversupply.

Another symptom to watch for that would lead us to believe overfeeding is a problem would be baby coughing, choking, or leaking milk during the feeding. If the baby just physically cannot keep up and is constantly struggling during the feeding, there would be a reason why we would want to reduce milk supply to help baby feel more comfortable at the breast. Although this may also be a symptom pointing back to a tongue tie driving the over supply, so just bringing supply down would not necessarily be the best answer in this case. We would want to determine if the oversupply is causing the coughing and choking or if an inefficient tongue is contributing to baby not being able to swallow efficiently.

Babies gaining weight too quickly or faster than expected can also be a symptom that baby is being overfed, however, this is my symptom of least concerned. If the baby is gaining happily with no digestive discomfort, poops are a normal color and consistency, and is not leaking, coughing, or choking during feedings, fast weight gain alone would not be a concern. Many typically feeding babies with mothers with a normal supply can gain weight quicker than anticipated and then level off in weight once they become more active or distracted.

Yes, it is occasionally possible for breastfed babies to overfeed. If there there are symptoms happening (recurrent plugged ducts and mastitis for mother from an over supply, nipple pain and damage, coughing/choking baby, digestive discomfort or concerns with poop), working with an IBCLC lactation consultant can help determine what the root is (excessive pumping, medications, tongue tie, reflux, etc) to help balance the dyad for happier feeding.

How much breast milk does a newborn need?

- Julie Matheney

For the first few months after delivery, when hormones are balanced and the breast is well stimulated, the breast makes lots of milk. Research shows at any given feeding, breastfed babies take 65-80% of the available milk in the breast. When feeding is well established, most babies eat until they are full, not until the breast is “emptied”. In fact, the breast is constantly making milk and can never truly be emptied. Your body knows a young baby is growing quickly and frequently cluster feeding, so your body has milk available all the time. This is why people can create a stash. They are pumping the extra milk that baby leaves behind.

Efficient and frequent milk removals helps to produce more milk quickly. The extent to which the breast is drained during a feed is what research has shown to drive milk production. The more often a breast has milk moved from it, the faster milk is made to replace that milk. The longer you go between feedings, the slower milk is eventually is made. Breastmilk fat/calorie content is also driven by a similar mechanism. The fuller the breast, the lower the fat content of the milk; the body thinks baby is dehydrated and focuses on hydration. The more often milk is moved, the higher the fat content of the milk; your body knows baby is in a growth spurt or needs higher fat to help sleep. If you go multiple days with fuller breasts where less milk is being moved, supply will drop to protect the breast from sitting milk which has a higher risk of inflammation that causes plugs and mastitis.

As baby ages, this extra milk goes away and your body makes what baby is routinely taking. Because your body AND your baby become more efficient. If you think baby isn’t moving milk well, and supply is suffering for it, it is important to address it as early as possible.

Research: https://publications.aap.org/pediatrics/article-abstract/117/3/e387/68590/Volume-and-Frequency-of-Breastfeedings-and-Fat?redirectedFrom=PDF

#breastfeeding #breastfeedingsupport  #lactationconsultant #lactation #milkproduction #pregnancy #postpartum

Why does my breast pump hurt? Can my breast pump cause plugged ducts and mastitis?

- Julie Matheney

You would think that the stronger a breast pump can suction, the better. But before you crank that pump to the highest setting, make sure you know the benefits (and risks) of doing that. Breast pump suction power is measured in mmHG (millimeters of mercury), the standard unit of measuring vacuum pressure. Studies were done on babies sucking at the breast and breasts pump suction levels are based off what we know of how babies remove milk from the breast. The suction level, or vacuum, is different than the cycle speed, which is how fast it pumps. This is why breast pumps should have two settings: cycle (speed) and vacuum (strength). Most pumps will cycle at 40-70 cycles per minute. This is based off of the average number of sucks a baby does at the breast in that same amount of time. Every baby sucks are their own pace and with their own vacuum strength.

Every pump has its own max suction strength that it can reach. “Hospital grade” pumps generally have maximum suction levels in the 300+ mmHg range while personal grade pumps are generally in the 200+ mmHg range. This doesn’t necessarily make a pump better or worse. The highest suction level on most pumps are actually above the comfort zone of the majority of pumpers. Most people feel comfortable expressing in the range of 150 – 200 mmHg regardless of whether the pump can reach 250 or 350 mmHg at its max. Using the suction too high, especially in combination of the wrong size flanges, can hinder milk flow and be the root cause of plugged ductsmastitis, dropping milk supply and breast/nipple damage!

Think of it like drinking from a milkshake with a narrow straw. When you suck too hard, the straw starts to collapse on itself and the shake is really hard to drink. Milkshakes move better with gentle, consistent sucking that doesn’t collapse the straw. Milk ducts are like compressible straws inside the breast that move milk from the milk-making glands called alveoli to your nipple pores in your nipple to your baby. Not only does everyone have a different number of these ducts, but the diameter of the ducts also varies from person to person. Too much breast pump suction compresses the areolar tissues which pinches off the ducts and actually decreases the flow of milk to the pump. With time this can cause milk to back up in the breast, increasing the risk of plugged ducts. This can also foster inflammation and risk damage. This also leaves milk behind which eventually can drop your overall milk supply. Having the right size flange AND using enough suction to move milk but not compress the ducts is essential to a happy pumping journey.

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What to expect after tongue tie release

- Julie Matheney
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My baby has a tongue tie and we’re going to have it released. What should I expect?

First, having a tongue tie clipped isn’t always a magic fix to breastfeeding issues. While 80% of mothers report a significant decrease in nipple pain after the procedure, there is still a recovery and healing proceess that needs to take place. That tissue under the tongue has been there since 8 weeks gestation and depending on how baby has learned to use their tongue, some unlearning and relearning is necessary. Bodywork, suck training and lactation support are still crucial for the few days to weeks after the procedure is done. But what should you expect as a parent.

Day 1-3 your baby will feel sore and tender. They may be fussier than usual. A white patch will form where the surgery was done. Baby may have difficulty latching to bottle or breast, so have an alternative feeding plan ready such as cup or finger feeding. Reflux and gas often get worse before they get better. For the first week, baby is relearning how to use their tongue. Your provider should talk to you about stretches to do several times a day to help prevent the tongue from reattching. Our bodies like to heal together, so this is very important. Some minor bleeding may occur, but if you see lots of blood notify your provier right away. Pain management is often needed for the first few days, but many babies can taper off of this.

From week 2-4, the white patch will shrink and may turn yellow as it heals. Eventually a new frenulum will form. This anatomical structure helps anchor the tongue to the floor of the mouth, but the new frenulum should allow the tongue to move freely in and out, side to side and up and down. Everyone sees progress differently, but symptoms should be improving at this point. Many babies will still need bodywork or lactation support.

Why is my baby a lazy feeder?

- Julie Matheney

We are a survivalist species. Our babies are born with instincts to survive. They cry when they are put down because they know they are vulnerable to temperature and can’t feed themselves. They use their senses to find their food source and are familiar with their parents over strangers by sound and smell. They have reflexes to help them learn critical motor patterns for development.

When a baby isn’t feeding well, it isn’t because they are lazy. Lazy is a character trait for someone who volitionally doesn’t want to do something. If a baby didn’t feed well, historically that baby may not survive. We need to find the reason why they aren’t feeding well and address that.

Reasons a baby may not feed well at birth may include:
⏱️Prematurity. When a baby is born before 36 weeks, there is often a lot of support and expectation set that baby may need time to learn to feed. But 37 and 38 weekers are the great pretenders. They look like full term babies but often don’t feed like them. They may need 4-6 additional weeks to figure out how to feed because they really needed those extra few weeks to practice sucking and swallowing in utero without the expectation to coordinate swallowing as well
💊Medications. Medications cross the placenta to baby, and while most are safe, babies can have withdrawal symptoms from certain meds after birth, making them sleepy. These could be medications given during labor and delivery or even medications mother was taking during pregnancy. As these medications clear from baby’s system, they will perk up. Other medications, like SSRIs, can continue to make babies sleepy
👅Tongue and lip tie. The tongue needs to move in and out, side to side, and up and down. Babies need to protrude the tongue over the gums and keep it out while pumping the tongue up and down to effectively move milk from the breast. Ties can restrict this movement and make it challenging to feed.

If your baby isn’t feeding well and you’re being told they’re lazy, ask why. That isn’t a valid reason. If you’re struggling to feed your baby, work with a baby feeding expert: the IBCLC lactation consultant. #newmom #newborncaretips #prematurityawareness #prematurity