Tag: breastfeeding

Why does my breast milk supply drop during my period?

- Julie Matheney

Did you know that many of us will notice a supply drop right before our period is going to start and lasts through the period? This is caused by hormone shifts in your body. As supply dips, the milk flow slows. Research shows that the composition of breast milk changes around ovulation (mid-cycle). The levels of sodium and chloride in the milk go up while lactose (milk sugar) and potassium go down. So, the breast milk becomes saltier and less sweet during this time. Some babies become frustrated with this change. They may grab the nipple with their mouth and shake their head back and forth. Pop on and off the breast. Knead or beat the breast with their hands or become extra fussy at the breast. They may even cluster feed and act as if they’re still hungry. They’re trying all the strategies to get your milk to flow how they prefer.

Also around the time of ovulation and just before the start of your period, estrogen and progesterone levels change which can affect your breasts and your breast milk. When estrogen and progesterone levels go up, it can make your breasts feel full and tender.

Higher estrogen levels can also interfere with milk production. Studies also show that calcium levels in the blood go down after ovulation. The lower level of calcium may also contribute to the drop in the milk supply. Lower levels of calcium may also cause your nipples to feel sore, making breastfeeding during your period uncomfortable or sometimes painful.

This is a temporary dip but can be surprising the first time it happens. Remember: this dip can happen once or twice before you actually have a period as your hormones are shifting back into baby making mode. If your baby is older than 6 months and eating lots of solids, you may not notice a difference. The strongest behaviors are seen under 6 months when babies need an exclusive milk diet. You may also notice the dip if you’re a pumper.

Having your period start again may not have any effect on your baby or your milk supply. Some babies continue to breastfeed well. Others will not like the taste of the breast milk or the drop in the amount of breast milk that can happen when your period returns. Your baby may:

  • Become fussier than normal
  • Want to breastfeed more due to the lower milk supply
  • Breastfeed less because there is less breast milk and it tastes different
  • Nursing strike

What can you do about it? Knowing it can happen is the first step. Stay well hydrated and eat quality nutrition. Many find adding in a calcium/magnesium supplement (1000mg of calcium/500mg magnesium per day split into 3-4 “doses”) can help combat the drop. Others find adding in lactation specific herbs or supportive foods help. Iron rich foods like dark leafy greens and red meat and milk making foods like oatmeal, almonds and fennel can really help. Keep offering the breast or pumping frequently. It will get better and your supply will come back up as soon as your hormones shift again after your period. It usually only lasts a few days.

Word to the wise: You can release an egg from your ovary (ovulate) before your period returns. If you’re involved in an intimate relationship, and you’re not using birth control, you can get pregnant again without ever getting your first period even while you’re breastfeeding. If you notice a very drastic drop in milk supply, consider taking a pregnancy test.

Maternal vaccines and breastfeeding

- Julie Matheney

Did you know babies routinely get antibodies to anything you’ve been vaccinate against? Babies get temporary disease protection from you in this way. When you are vaccinated, your body has an immune response that makes antibodies to what you were vaccinated against. Antibodies are then secreted in breast milk to your baby. The type and quantity of these antibodies, and whether they provide any protection for baby after they are swallowed, are dependent on the vaccine received and maternal factors that influence immune system function such as genes, age and health.

Antibodies in breast milk have not been shown to reduce baby’s response to their own immunizations. However, some studies suggest that breast milk may improve baby’s immune response to some of the vaccines they receive.

If you do decide to be vaccinated while breastfeeding, there is no need to pump and dump your milk. Or to stop breastfeeding for any amount of time. When considering the vaccine, or any medication, most want to know whether a dangerous amount of a substance will be filtered into our milk and cause harm to our baby. For most drugs, so little gets to the baby that there’s really very little theoretical risk. Even if a drug or vaccine does end up in breastmilk, anything that goes through breastmilk also then has to go through baby’s gut before reaching baby’s bloodstream. The mRNA molecules in the Pfizer or Moderna vaccines, if they made it into your milk, would have to survive baby’s stomach acid first.

While breastfeeding, it is highly unlikely that an intact lipid from the vaccine would enter your blood stream and be passed directly into your milk. If it does, it is even less likely that either the intact nanoparticle or mRNA could be transferred into your milk. In the unlikely event that mRNA is present in your milk, it would first go through baby’s digestive system and would be unlikely to have any biological effects. The vaccine is supposed to trigger an immune response in your body. It helps your body recognize the virus when you’re exposed and fights the virus early, reducing the severity and length of illness. Once your immune system recognizes the SARS-CoV-2, the virus that causes Covid-19, antibodies are made to protect you and those antibodies may pass into the breastmilk. Researchers have already found Covid antibodies in the breastmilk of previously infected women, though they don’t know yet how much protection these antibodies give babies.

Choosing to be vaccinated is a personal risk/benefit decision to be made between you and your health care providers. If you do chose to be vaccinated with the COVID vaccines, there is no need to pump and dump for concerns of your milk harming your baby.

The Second Night

- Julie Matheney

Second Night Syndrome : What absolutely every parent should be warned about in pregnancy.

Second night syndrome. I hate the word syndrome. It implies something is wrong. For nine months your baby has been in your belly. Heard your voice. Felt your body move. Listened to the rush of your blood flow past and heard the gurgle of food digesting. Their existence controlled by the cycles of your body. Then the intensity of labor and delivery propels them into a new world that sounds, smells, and moves differently. The sheer exertion of being born often makes babies as tired as their mothers. It is typical for babies to have a deep recovery sleep about 2 hours after birth (after their 1st breastfeed).

On the second night, however, most babies will want to frequently nurse. This helps with two transitions: meconium to soft, seedy yellow poops and colostrum to mature milk. This cluster feeding catches many parents by surprise and leaves them wondering if baby is starving. Unless baby is not latched well or efficiently feeding, this is normal and the cluster feeding will help transition your milk.

Many babies, though, don’t want to be put down during this process. Each time you put them on the breast they nurses for a little bit, go back to sleep and then cry when placed in the crib. A lot of moms are convinced it is because their milk isn’t “in” yet, and baby is starving. It isn’t that, baby’s awareness that the most comforting place is at the breast. It’s the closest to “home”. This is pretty universal among babies. When baby drifts off to sleep at the breast after a good feed, break the suction and take your nipple gently out of their mouth.

This is also protective of SIDS. You’re exhausted from labor and delivery and just want to sleep. But night time is when newborns are most vulnerable to respiratory complications and SIDS. By waking you frequently at night, you are waking frequently to check on the well being of your baby when they’re at their greatest risk of infant death. Waking regularly at night for the first few months to feed also helps babies from getting into too deep of a sleep state which can cause them to stop breathing. Instead of seeing the loss of sleep as a negative for you, consider the positive reason it has for baby.

Don’t try to burp baby, just snuggle baby until they fall into a deep sleep where they won’t be disturbed by being moved. Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every ½ hour or so. If they start to root and act as though they want to go back to breast, that’s fine… this is their way of comforting. During deep sleep, baby’s breathing is very quiet and regular, and there is no movement beneath the eyelids. That is the time to put them down.

Second night syndrome. As described above, when all is going well it is normal for baby’s to cluster feed on the second night to help milk transition and poop out meconium. Some babies do not efficiently feed, though, and intervention may be necessary.

🩺Medical interventions and pain relief during labor and delivery, maternal health complications like PCOS, uncontrolled diabetes or hypothyroidism, or large blood loss during delivery may delay the transition of your milk.

🧸If your baby not latched well, has a tongue tie, or hasn’t figured out how to coordinate sucking to actually transfer milk from the breast, intervention may also be necessary.

🖐🏽The first line of defense is hand expressing your milk frequently. Hands are better at expressing colostrum than a pump, although a pump is a great way to stimulate milk to be made.

🥄Dripping your milk into baby’s mouth from a spoon or small syringe can help jump start the feeding process.

❓If you have any doubt about either your milk supply or your baby’s ability to breastfeed well, reach out to a qualified IBCLC ASAP to get to the root issue and get you back on track.

♥️There is no shame in supplementing your baby if needed during this time of learning. Remember, you can always use your milk first by using your hands or a pump if baby hasn’t figured it out yet.

Best bottle for the breastfed baby

- Julie Matheney

DON’T FALL FOR THE MARKETING

There are lots of bottles on the market. And so many of them are marketed to be “most like the breast”. Let me tell you a secret. There is no bottle that works like the breast. Don’t fall for the marketing. The breast is a complex organ that works with hormones, compression, suction, positive and negative pressure. It is controlled by the baby and how the baby sucks. Baby can make your milk flow or not depending on how they suck. It is never empty and constantly making more. It is hormone driven. A bottle is passive. It has a hole that will drip when turned over. Your nipple changes shape to fill baby’s mouth. Your nipple can help fill a high palate. your nipple and a good portion of your areola/breast also need to be in baby’s mouth in a deep latch for milk to be transferred. Your nipple should go in round and come out round. Baby’s tongue should cup and protrude past the lower gums and stay out to massage your nipple/breast in their mouth Baby has to change the shape of their tongue to accommodate the firm bottle nipple. Baby can chomp or mash the nipple and doesn’t need to keep the tongue out because they can compress milk out. Baby can also latch just to the tip of the bottle nipple and still get milk.

We can make the bottle work like the breast, though. By slowing the feeding down or “pacing” the feeding, we can help baby go back and forth between bottle and breast. You want a straight nipple that tapers wide at the base for a “deep” latch. If your baby is just latched to the tip of a bottle nipple they can still get milk. But then their muscles will learn to latch shallow and that’s often why you’ll get a shallow latch with a “small” mouth at the breast. The bottle nipples that are already pinched or tapered are also not good choices. If your nipple came out of baby’s mouth looking like, that you’d have damage within a few days. If your baby struggled at the breast and will only take a bottle nipple that looks flat and pinched there is usually something going on in baby’s mouth and the bottle nipple is compensating for it. Tongue tie is the most common culprit.

LATCHING TO A BOTTLE

Having an optimal latch at the breast reduces nipple pain and prevents damage. Your nipple should go in baby’s mouth round and come out round. If we want to encourage good latch when breastfeeding, we want to do the same when bottle feeding. This helps baby go back and forth without “confusion”.

This can be difficult when a bottle nipple abruptly changes in shape from narrow to wide. Bottle nipples like the Playtex Baby Ventaire Bottle,Tommee Tippee, Avent Natural, Nuby Comfort, and Chicco Naturalfit have narrow nipple tips and wide bases. Babies usually end up latching onto the tip and sucking it like a straw. If baby’s cheeks dimple or suck in when feeding from these bottles, they’re drinking but not demonstrating a wide latch and optimal mouth posture. If they had that same mouth posture on your nipple, they would cause pain and damage. Baby’s don’t drink from the breast like a straw. Conversely, they may try to fit the base of the nipple in their mouth and end up with air pockets where the tip meets the base. This can result in breaking the suction and swallowing excess air while feeding. Nipples like the Nuk Simply Natural and Mam are not round, but pinched or flat. If your nipple looked like that coming out of baby’s mouth we’d be talking about deeper latch or tongue tie.

Bottle nipples that gradually change in shape from narrow at the tip to wider at the base promote a deeper latch. If the nipple stays narrow at the base, like the Similac nipples many hospitals give at birth for supplementing, you’ll want baby’s lips to be able to come up almost to the collar (plastic o-ring base). If the nipple is sloped to gradually widen at the base, baby will be able to get the nipple deeper into their mouth with no air pockets. My favorite sloped nipples include the Pigeon SS Nipple, Lansinoh, Dr Brown’s Original Narrow, Dr Brown’s Wide Neck, Munchkin Latch, and Evenflo Balance, which promote a deeper latch mouth on the nipple.

So what does this mean?! If your baby is already bottle feeding and going back and forth from bottle to breast, don’t sweat it! No need to change anything! If your baby is struggling at the breast and preferring a narrower or non-round nipple, having a full oral motor assessment may help you get back to breast.

Can I breastfeed while sick with COVID?

- Julie Matheney

Breast milk for COVID+ mothers contains protective antibodies and no live virus.

There are multiple studies being conducted on breastfeeding mothers who are COVID+. What happens to their milk? A recent multi-institutional research team led by University of Idaho found that breastfeeding women who have COVID-19 transfer milk-borne antibodies to their babies without passing along the virus.

It was a small study where researchers analyzed 37 milk samples submitted by 18 women diagnosed with COVID-19.

🦠None of the milk samples were found to contain the virus

🦠2/3 of the samples did contain two antibodies specific to the virus.

🦠The results indicate that it is safe for moms to continue to breastfeed during a COVID-19 infection with proper precautions.

If you’re actively sick with COVID and still breastfeeding:

🧼 Wash your hands before feeding your baby or pumping

😷 Wear a mask while feeding to prevent coughing directly on your baby

💧 Drink plenty of water

😴 Rest and sleep to let your body heal

💊 Taking Vitamin C, D and zinc have been found to be very beneficial

My baby’s weight gain is slowing

- Julie Matheney

WEIGHT GAIN

While your young baby is supposed to gain on average an ounce a day (30gm), weight gain slows as baby ages. From 4-6 months babies should only gain 3-4 ounces per week (90-120gm) and from 6-12 months babies should only gain 1-2 ounces per week (30-60gm). If you have been tracking baby’s weight gain and see the scale slowing down, don’t be alarmed if your baby is older. Continue to watch for lots of wet diapers and consistent pooping. Trust your baby and trust your body.

Where has my breast milk gone?

- Julie Matheney

Some times we can sabotage our own milk supply from little things that we don’t understand will make a difference. Here are the top ways to accidentally drop your milk supply:

😳Putting baby on a feeding schedule in the first 3-4 months

😳Watching the clock instead of feeding baby on demand

😳Sleep training in the first 3-4 months after birth

😳Waiting for your breasts/chest to feel full to pump or feed

😳Not pumping when baby is getting a bottle

😳Letting partner feed a bottle in the middle of the night to get more sleep (and not getting up to pump)

😳”Topping off baby” after feeding, especially during the witching hour phase. (I’m not talking about when supplementing is necessary or if you’re on a triple feeding plan because of true low supply or baby weight gain. Supplementing after breastfeeding can be needed, but you would also be pumping at that time)

😳 Not pumping enough when returning to work

😳Using the wrong size pump flanges

😳Using a poor quality pump (insurance companies have to provide you with one, but that doesn’t mean they’ll give you one of quality)

😳Going back on hormonal birth control at your 6 week postpartum checkup

😳Taking nasal decongestants or allergy medications

While these seem like normal recommendations from many parent groups or even your health care providers, these subtle things can sabotage milk supply. Your body works on a demand and supply basis. The more you empty or demand from the breast/chest, the more milk it will make. Want to increase supply? Increase the number of milk removals, give young infants free access to feed on demand, and watch out for medications, hormones, of pumping traps that can sabotage your success.

Vitamin D supplements and breast milk

- Julie Matheney

VITAMIN D

Were you told by your pediatrician to give your baby vitamin D drops? Vitamin D is absolutely critical strong bones, because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease where the bone tissue doesn’t mineralize properly, leading to soft bones and skeletal deformities. Recent research also tells us that vitamin D is key in maintaining our immune systems for regulating both infection and inflammatory pathways. If you shun the sun, have a milk allergy, or follow a strict vegan diet, you may be at risk for vitamin D deficiency. Known as the sunshine vitamin, vitamin D is produced by the body in response to skin being exposed to sunlight. It is also occurs naturally in a few foods like certain fish, fish liver oils, egg yolks, and fortified dairy and grain products.

Our bodies are designed to make very large amounts of vitamin D through exposure to the sun (10,000—20,000 IU in 24 hours, after 15—20 minutes of summer-sun exposure in a bathing suit/45—60 minutes of exposure for those with darker skin tones). However, in an effort to decrease our risk of skin cancer from over exposure to the sun, we’ve limited our ability to keep our vitamin D status at a normal level from absorbing it directly from the best source. That said, those living where clouds often cover the sky or in cities with polluted air quality will have a hard time getting sun exposure for natural vitamin D. People with darker skin tones are more likely to have low levels of vitamin D, as well, due to the increased pigment in their skin. They require nearly four times the length of sun exposure in order to penetrate the skin to manufacture vitamin D.

Vitamin D is essential for babies. Your pediatrician cannot tell you to put your baby in the sun, even though that is the best source of vitamin D, because of the risks of skin cancer. So they should have advised you to give your baby 400 IU of vitamin D each day, usually given by drops in the mouth.

All formulas sold in the United States have at least 400 IU/L of vitamin D; so if your baby is drinking 32 ounces of formula, vitamin D supplementation is not needed.

But what about from breast milk? Human milk is a very poor source of vitamin D, usually containing less than 50 IU per quart. This is why the AAP recommends all breastfed infants be supplemented. This does not mean there is anything wrong with the milk, but an issue in the recommended amount of vitamin D the lactating parent should be taking. This goes back to the sunlight recommendation. If you were getting 15-45 minutes of sunlight (depending on how dark your skin tone is) 3-4 times per week, your body would have plenty of natural vitamin D to pass through your milk to your baby. Many who live in the US either don’t live in a location where that’s possible year round (hi, Chicago in January) or maybe can’t get out in the sun because of needing to work. The Academy of Breastfeeding Medicine (a global organisation) recommends that “The breastfeeding infant should receive vitamin D supplementation for a year, beginning shortly after birth in doses of 10–20 lg/day (400–800 IU/day) (LOE IB). This supplement should be cholecalciferol, vitamin D3, because of superior absorption unless a vegetable source such as ergocaliferol vitamin D2, is desired. … Vitamin D also may be delivered adequately through human milk.” Research has shown that as long as you as the lactating parent is taking 6,400 IU of vitamin D daily, there is no need to supplement the baby as your milk will have adequate amounts.

Breast milk supply drop at six months

- Julie Matheney

SIX MONTH DROP

For the first six months after birth, baby is supposed to be on an exclusive breast milk diet. At six months and beyond your breast milk goes through a major change. The volume of milk slowly drops because baby is eating and drinking other foods. They may also be sleeping longer at night and are more active during the day. Your milk is super smart and shifts with this drop to have more antibodies and a higher fat content. The breast makes milk based on how it is emptied and what your hormones are doing based on how old baby is. Your hormones are also shifting and you may start your monthly cycle again. Many experience a further dip in supply around the time with their period. If you’re exclusively breastfeeding, you may notice baby pulling or tugging on your nipple or using their hands to beat your chest while feeding. If you’re pumping, you may slowly start to see less milk each pump session. Usually months 5-7 are the hardest from a baby behavior perspective and it settles out again as baby eats more table food and your hormones adjust. If breastfeeding is your goal, just keep offering the breast and pumping often.

Tandem breastfeeding

- Julie Matheney

It’s common for a toddler, or an even older child, to ask to breastfeed after a new sibling is born. Toddlers who were weaned immediately before or during pregnancy may be especially curious. Many just want to know if you’ll say yes – or they may just want your attention or “babied” themselves. Continuing to breastfeed, or letting them try to breastfeed again after weaning, can ease the transition of gaining a sibling. They are less likely to be jealous of the baby who is always with mommy if they can nurse alongside them. Nursing your older child once the new baby arrives can reduce engorgement when colostrum transitions to mature milk and can protect milk production if your newborn is not feeding effectively. If you say yes to a weaned child, many will just touch, lick or kiss the nipple, some will have forgotten the mechanics of how to breastfeed and won’t have further interest. Others can successfully breastfeed again. If you are happy to nurse your toddler, go for it. If it is overwhelming, it is still your body and you get to decide when and for how long toddler is allowed to breastfeed. You may prefer nursing your baby and your toddler separately or together. Breastfeeding is normal and it is normal for children to be curious and want to breastfeed at 2, 3, or even 4 years old.

When you give birth your body will continue to produce colostrum, with milk becoming plentiful after around 3-5 days. As with your first baby, breastfeed at least 8-12 times per day to establish your milk supply. Some will feed their newborn baby first or encourage the older sibling to nurse less until breastfeeding has been well established to ensure the newborn has full access to breast milk. Look out for feeding cues and give your newborn unrestricted breast access to help ensure they get plenty of milk.

Some times if your toddler is breastfeeding frequently, they may lose interest in solid foods for a while from increased milk intake. They may have looser stools. This is normal and should regulate with time.

It can take a while before your body adapts to the needs of two different feeders. You may feel lopsided if one breast drains more than the other. Eventually things will even out and you’ll find your rhythm. Alternating breasts for each feed helps with development of newborn vision and keeps the size of your breasts balanced. However, some mums find that giving a toddler his ‘own side’ works for them.

You will not run out of milk, your body will make more to accommodate however many nurslings there are.