Sabotaging your milk supply: working mothers who pump

The number one method to sabotage your milk supply when you go back to work is a caregiver who over feeds your baby. 

Scenario one: Baby is given a full bottle and takes 5 ounces in five minutes. Baby then spits up half the feeding and caregiver tries to give more to “keep it down”. Caregiver tells mom baby is fussy and has reflux. Baby gets put on Zantac and rice cereal.

Reality: there are several factors going on in that scenario that will sabotage a working mother’s milk supply. First, babies are not supposed to take five ounces in a feeding. Their stomach is the size of their fist and should only be taking 1-3 ounces per feeding through the first year of life. Their stomach can only hold so much and if it’s past capacity, the only place for it to go is up. I can eat a whole cake, but I shouldn’t. As an adult, if I overeat I get uncomfortable, too. I either take peptobismol or put on my stretchy pants to wait for the pain to subside. Then I don’t eat that much again.  Babies fuss and spit up for the same reason. We’re over diagnosing babies with reflux that are being fed too much or too fast.

Scenario two: Caregiver gives a baby six ounces every feeding, 3 times while mom is gone, every time the baby cries or wants to suck. Baby appears fussy and wants to suck all the time.

Exclusively breastfed babies should consume 25-35 ounces across each 24 hour day and approximately 20% of their calories should be taken over night. If you do the math, that’s a little over an ounce an hour, or 1-3 ounces every two to three hours. And in accordance to what the baby needs, mom will make that volume. So if caregiver is feeding 6 ounces three times in an 8 hour shift, you’re expecting mom to pump 18+ ounces. In reality, her body will most likely make 6-10 ounces which would be the amount she would make if she were home with her baby. In a few days of over feeding the baby, mom becomes discouraged that she’s not making enough and pretty soon she’ll start supplementing with formula

Babies also want to suck for a variety of reasons: comfort, pain, bonding, nutrition, pleasure, etc. Babies use mom as a pacifier without actually drinking. When babies are away from their mommies is very stressful, so their way to soothe is to suck.

Scenario three: Baby is given 4 ounces and chugs it down in five minutes. Baby is happy to chug down high volume and the caregiver thinks baby is just a piggy and really hungry. Baby occasionally coughs and chokes and milk comes out her mouth.

Reason: Babies have a swallow reflex that is with them at birth. When liquid reaches the back of the throat it triggers the swallow reflex. Babies are obligated to swallow otherwise they will choke or let the milk pool out of their mouths. When you see a baby chugging down milk really fast, it’s not usually because they are starving, but because they are trying to keep up with the flow of the bottle. As I said in an earlier post, there’s really no such thing as nipple confusion, but flow confusion. At the breast, other than during active let down in the first few minutes of active feeding, the baby controls the flow of milk by how they suck. In bottle feeding, the bottle will flow because gravity always wins. Caregivers need to be taught paced bottle feeding. Using a slow flow nipple, feeding baby in side lying, and frequently tilting the fluid away from the nipple to slow the baby from drinking so fast gives the baby more oral control and time to appropriately eat.

There are two kinds of receptors in the stomach: stretch and density. It should take a baby 10-20 minutes to eat from a bottle. This is also how long it takes the stretch receptors to tell the brain that the stomach is full. I can eat a whole pizza really fast, but I shouldn’t. Babies can eat a large volume really quickly, but they shouldn’t. Not only is it not developmentally appropriate, but pretty quickly the high volume needs will sabotage mom’s opinion of her perfectly healthy milk volume. She’ll turn to all kinds of milk makers: cookies, teas, herbs, etc and eventually if she’s discouraged enough she’ll turn to formula, when in reality if the caregiver would slow down feedings and give the rigjt volume, every one would be happy.

Happy pumping!!


Breastfeeding advice from social media: Buyer beware

Asking for medical advise from social media forums, especially mommy groups, is like asking a mother who’s had a baby to deliver yours. Just because she has experience in the field does not make her qualified to give technical advice in that area. She can give you her opinions or share her experience, but she did never be relied on as a trustworthy source when providing care to YOUR child.


Breastfeeding is especially one of those areas that we need to tread wisely into when asking for help and advice. Or culture has hidden breastfeeding from the norm and made it this mysterious, murky action where myths and misunderstandings abound. So much of the information found in quick Google searches are anecdotal, antiquated, or based off formula feeding data which is completely distinct and sometimes totally opposite of true breastfeeding. We should be seeking community support for breastfeeding, but not when medical advice is being solicited.

When mothers give out advice on social media platforms, they are not taking into consideration the whole breastfeeding picture and may inadvertently give advice that could care harm or actually negatively impact breastfeeding. For instance, when a mother of a two month old asks for advice on increasing her breastmilk supply and mother start giving advice on herbs, lactation cookies, or teas, they may not be considering WHY she is needing to increase her supply. Is her baby in the NICU? Is she going back to work and stressed with the pumping process? Does she have. History of sexual abuse that she actually needs to work through? Did her pediatrician have her supplement which impacted her supply? Is she trying to sleep train and sabotaging her own supply? Is she ALLERGIC to the herbs in those teas and supplements? How often is she feeding? Does she have a metabolic or hormonal disorder impacting her supply? Does she have enough glandular breast tissue to even produce sufficient milk supply? Does her baby have a tongue tie? Does the baby simply have a poor latch? These are the questions that are crucial in giving appropriate breastfeeding advice to protect the breastfeeding relationship. The best advice a mother can give on the social media platform is to have the questioning mother contact a lactation consultant.

The gold standard for breastfeeding advice is the International Board Certified Lactation Consultant (IBCLC). There are other forms of lactation consultants that teach and serve out of a variety of backgrounds. The IBCLC is the top most coveted professional because of the extensive education and rigorous testing they need to go through in order to be able to assist lactating mothers. In order to sit for the FOUR HOUR board exam, candidates must have extensive education in specific health science subjects, like nutrition, psychology, and childhood development; 90 college level credit hours of education in human lactation and breastfeeding, and hundreds to thousands of clinical practice in providing care to breastfeeding families. They must also maintain a high level of continuing education courses and continue to sit for the board exam every 10 years.

So when you see moms with questions related to breastfeeding in social media forums that are beyond opinions or personal experience, the best advice is professional advice.

Fact of the Day: Milk Fat: Pump that heavy cream

Human milk changes in its composition throughout lactation as your baby grows and is constantly changing to meet the needs of the baby from the first few days of colostrum to beyond the baby’s second year. The composition of your milk can change  from day today especially as hormones ab and flow with your menstrual cycles. They can change during a given day  based on your stress levels, how often your baby feeds, and how well your baby MDs your breast. But did you know that the composition of your milk can also change during an individual feeding  and from breast to breast?!?!  As the baby eats, protein and fat content rise in the milk. There is actually 4 to 5 times more fat and 1 1/2 times more protein present at the end of the feeding than at the beginning. The baby may consume nearly 18% of their calories between minutes 11 and 16 of a feeding.  The fat content at the beginning of a feeding is around 1% milk fat. By the end of a 15 to 20 minute feeding, the fat content can be as high as 4 to 5%! By comparison, whole milk contains just 3.25 percent milk fat.  Fat content varies from mother to mother and from feeding to feeding. The amount of fat in breastmilk is dependent on the length of time between feedings, the degree of breast fullness, and the length of time the baby sucks at the breast. To put it simply, the emptier the breast, the higher the fat content. The fuller the breast, the lower the fat content. By trying to “stretch” a baby to scheduled feedings actually decreases the fat content in a mothers milk. It is always best to feed baby on demand.

Pumping Log: Medications and Breast Milk Supply

Ugh. Remember my last post about my horrible eye allergy? The doctor put me on steroid eye drops for a week. I looked up the medication the Hale’s book of medications and breastfeeding. Little had been studied in the drug and lactation, but the risk of it passing into my milk was in the safe zone. I never take a risk with eyes, so I diligently took the drops the prescribed 3x per day. But oooooooooh how it impacted my milk supply!!! If you’ve followed my blog, I was doing great Pumping. And average of 12-19 ounces during an 8 hour shift. With these eye drops on board, my supply dropped to barely 1-3 ounces per pump session for a total of 8 ounces of less per day. I was freaking out to say the least.

Two pump sessions worth in the middle of my eye drop treatment. 😑 Only four ounces total.

I added in two extra pump sessions, one before work and one before bed, to give us a little extra umph and getting us to around 12 ounces for while I was gone at work. Herbs, teas, and cookies were not going to do much if anything because this was being caused by a medication messing at a hormonal level. Pumping was my only hope to get through that week. Fortunately my daughter is on solids and is a champion eater. We just made sure to give her extra foods at meal times and she was waking at night more frequently to nurse. Normally I try not to nurse her at night, but this was an important exception. I was also fortunate to have a four day weekend and I just let her nurse on demand.

This is an entire days worth of pumping. Less than eight ounces for the day.

Two days after the drops were done, my supply came back. The take away is this: if you’re on medications that are altering your supply or if you suddenly notice a change in milk supply and are trying to figure out what changed while trying to breastfeed, don’t give up. Keep pumping and add extra pumps if you need to. If your baby is under six months or not on solid foods, you may need to supplement or nurse more frequently during the night until your supply increases or returns to normal.

First pump of the day today and pumping is back to my normal volume!!!


Fact of the day: conjunctivitis and breast milk

It happened for the first time in my life. I woke up two days ago with really red eyes, but I thought it was just allergies. I had forgotten to take my eye makeup off the night before and figured my eyes were just bothered. I had also started using a new brand of makeup remover that I noticed was leaving my face really dry. Then yesterday I woke up to completely bloodshot, watery, goopy eyes. UGH!!!!!! It looked like an allergic conjunctivitis. I did what any nursing mom probably would do… I put some breast milk on it. If you’ve been around the mothering world long enough, you’ve probably anecdotally heard of putting breast milk in the eye for anything from clogged tear ducts to pink eye. So I figured I’d go there first. It definitely took the itch away, but after an hour of really no relief I did what everyone really should do: sought professional help at the doctors. The doctor said it was most likely an infection from the eye make up since it was affecting both eyes. A shot of cortisone in the butt and a box of eye drops later, today my eyes are almost back to normal. But now I was curious. The old wives tale says breast milk is cure all, but what are the facts? For your reading pleasure, here’s the current research.

The horrifying selfie I took to send to my mother from the urgent care center
Me after 24 hours of antibiotic eye drops. Almost completely better. That mascara and eye liner has been thrown out and no contacts or eye make up for a week

Read more

Pumping Log: Got Milk?

It’s struck again. My monthly reminder of my womanhood and with it a drop in my milk supply. It’s a good reminder, though, for every mom out there that a sudden dip in milk supply doesn’t mean anything is wrong. It just means you have hormones. Congrats. 🎈🍾  When I’m breastfeeding from the boob I don’t notice any difference. My daughter doesn’t seem to want to nurse more frequently or longer. I really only notice it when I’m pumps. “My poor supply” I think to myself. And yet I would never know except that I’m working. On these weeks I usually just eat more oats, make sure to stay hydrated, drink an extra cup of Mothers milk tea, and add an extra pump session at night. And wait for the crimson tide to stop messing with my liquid gold.

First and second pump of the day.
Third pump of the day after a cup of chamomile tea.

Pumping Log

Everyday is a new day with its own stresses and joys. The more we can take time to enjoy each day, the less we are prone to worry and stress, the better it is for our overall health as well as our milk supply. The past few days I have been working in the neonatal intensive care unit at my hospital. It is my favorite place to work. I love coming alongside mommies and their new babies and helping them feed them in their most critical time. My job on the acute floors can sometimes be stressful. I am helping elderly patients and families make end-of-life decisions. I assess patients feeding skills and decide if the patients can still eat and the options they have for nutrition and hydration. This definitely impacts my milk supply. I always see more of my own milk when working in NICU. Of course when some of those hungry babies cry I can occasionally feel my mommy hormones stimulating my own letdown. Where is your happy place? Have you noticed certain aspects of your environment or work impacting your milk supply? Where do you find your peace when pumping? This really does make a big difference. Happy Pumping!!

I use whatever containers I have clean!! My pumping always decreases as the day goes on.

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 : Storage

We’ve talked a bit about increasing milk supply and about pumping. So now that we have all this yummy milk, what are we going to do with it? Let’s talk about milk storage.

The U.S. Centers for Disease Control and Prevention (CDC) offers ranges of time that milk can safely be left at for certain temperatures. Use this link to go directly to their website. But there is a simple rule that fits within these ranges and is easy to recall, even when you’ve had less sleep than a college kid in finals week. Just remember 5-5-5.

  • 5 hours at room temperature. If the room is very warm (more than 85 degrees F), 3-4 hours is a safer time range.
  • 5 days in the fridge (the back of the refrigerator is the best place to store your milk since it is the coldest.)
  • 5 months in a regular freezer (the separated compartment in a typical fridge/freezer unit) According to the CDC, milk frozen for longer than the recommended time ranges is safe, but may be lower in quality as some of the fats in the milk break down.

Other time ranges that don’t fit as neatly within the 5-5-5 rule, but are still helpful:

  • Human milk can be stored for 6-12 months in a chest or upright deep freezer.
  • Human milk can be safely stored with ice packs in insulated storage bags for up to 24 hours.

As part of my routine, if I work the next day, I put my milk into separate bottles and stick them in the fridge when I get home from work. That way my husband can feed them to my baby the next day while I’m at work. If the next day is a day off, I put my milk into disposable milk storage bags to stick in the freezer until the next time I work. The bags are labeled with the date they were pumped and always put in order from oldest to newest milk. This method saves going through a bunch of milk bags and saves both time and money. There are several brands of milk storage bags. I’ve found I really like the Dr Dudu bags. They’re larger size and with the double zipper I don’t need to worry about leaks in my lunch bag during the work day.

Milk from different pumping sessions/days may be combined in one container – use the date of the first milk expressed. I frequently pour all of my milk from one day of work into a larger bottle. This helps even out the calorie count and fat content since we know different pumping seasons yields different milk content. Avoid adding warm milk to a container of previously refrigerated or frozen milk – cool the new milk before combining. Breastmilk is not spoiled unless it smells really bad or tastes sour.

Safely Thawing Breast Milk

As time permits, thaw frozen breast milk by transferring it to the refrigerator for thawing or by swirling it in a bowl of warm water. You should avoid using a microwave oven to thaw or heat bottles of breast milk. Microwave ovens do not heat liquids evenly which could easily scald a baby or damage the milk. Bottles may explode if left in the microwave too long. Excess heat can also destroy the nutrients in your milk. It is recommended that you do not re-freeze breast milk once it has been thawed. Although I read on that if the milk had only been partially thawed and there are still ice crystals in it, you can safely refreeze the milk and thaw it on a later date.

When the fat in your milk separates in the fridge or freezer, make sure you swirl the milk to incorporate it back into a smooth, creamy mixture. Breast milk has living components in it which help protect your baby’s gut and promote digestion and immunity. Shaking breast milk actually denatured, or breaks down, the shaped molecules of the protective proteins, leaving them in pieces. Lactoferrin, lysozyme, and other protective components work their protection magic when they are in their original shaped molecular structure.

Other helpful website for breast milk storage

Pumping Log : Boosting Supply

Every working mother I know it’s concerned about her milk supply. We are terrified that if we don’t make enough milk while at work our babies will starve to death. I’ve had my moments of discouragement where I, too, feel like a failure as a mother because I had a low pumping day. Of course this stress only causes a further decrease in supply which becomes a vicious cycle of stress and poor pumping. While I can’t turn my boobs on line a faucet to pump specific amounts of milk each pump session, there are several things I do to promote the best possible milk supply.

1. Hydration. The best hydration is to drink to thirst. Since times in the busyness of my day, though, I forget to stay well watered. I keep a water bottle in my pumping bag and try to drink while pumping. I also work feeding patients. So each time I go into the kitchen at work I try to grab a cup of water.

2. Nutrition. Eating the right kinds of foods also help with adequate milk supplies. Fresh fruits, vegetables and plenty of protein help keep my body working at its best. Oatmeal is also a staple in my diet. Oatmeal contains a protein that may increase prolactin, the hormone that facilitates milk production in mammals. Other whole grains such as quinoa and sesame also contain this same protein.

3. Supplements. Fenugreek, mothers milk tea, and fennel are all known galactogogues, a fancy word for milk makers. I try to drink a cup of tea every night. I’ll admit I’m not the best at taking the fenugreek, but I definitely notice a boost in my supply when I do. Another supplement known to help breast milk production is brewers yeast. Brewer’s yeast comes from a single-celled fungus and is a byproduct of beer making, though it can also be grown as a nutritional supplement. A good source of iron, chromium and selenium, brewer’s yeast also contains several B vitamins, though not B-12. Brewer’s yeast has a history of use as a galactagogue, which is a food, herb or medication that increases milk supply in nursing mothers. Some mothers find drinking a single beer can immediately increase milk supply (although drinking beer is best left to evenings or weekends). You can also buy a powdered brewers yeast from the store or Amazon. It can be added to smoothies, cookies, or other recipes. Here’s one of my favorites!!