Pumping for a toddler

The number one complaint I get my mothers going back to work is a drop in supply when they start to pump. They go from seeing tons of milk to very little. Pumping at work is a PITA. You have to be very committed to it and depending on your job it can be stressful or difficult to get away to pump. What most women don’t seem to understand about Breastfeeding is that the more milk you remove the more milk you will make. You can’t just will your body to make the same amount of milk whether you pump once or six times. The science doesn’t work that way.

Through the first year of life, I recommend mothers pump three times on an 8 hour shift and four times on a 12 hour shift. Remember, I recommend leaving the same number of ounces as number of hours you will be gone. If you’re gone 8 hours, you only need to leave 8 ounces. Make sure your caregivers are doing paced bottle feedings and not accidentally sabotaging your milk supply. Mothers can add in additional pump sessions by pumping in the car with the battery operated pump. Once your baby turns a year, and his or her milk needs decrease; as long as they are taking a healthy amount of solid foods mom can drop down to pumping twice or three times a shift.

As your Toddler continues to grow, you can make the decision to add in another milk/milk substitute, continue to pump, or just breastfeed when you are home and have caregivers give water depending on how much you are gone from your older toddler.

My last pump session at work. cheers.

Breastfeeding will working is a large commitment. I know this full well. These are the guidelines I followed with my own daughter. Up until she was 12 months, I pumped 3 times on my 8 hour shift. I had decided at 17 months to stop pumping while at work and just feed my daughter when I was home. However she had other plans 🙂 she constantly asks for May May, which is her word for my milk, while I am gone. So I was back to pumping just once a day and mixing my small amount of breastmilk with flax milk. She eats off of me like a barracuda when I walk in the door. (I think she just wants the snuggles). At 18 months I am now no longer pumping at work. She will nurse when she wakes up, when I come home, around bed time at 6:30, and every once in a while she’ll still wake up around 4am for an early morning snack. This is what my tiny human does. You have to figure out what works best for your tiny human, your family, and your health. Happy pumping!

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.

Fact of the day: lactose intolerance and breastfeeding

Fact of the day: Human milk has one of the highest levels of lactose among mammals: 7%. Lactose accounts for almost all the carbs in breastmilk and provides 40-50% of the energy in the milk. Lactase is the enzyme naturally produced in the body to convert lactose into simple sugar. This enzyme is prevalent in our bodies at birth but it’s production lessens after age 3. Up to 70% of the world’s adult population has a lactase deficiency, which is indicative of the body maturing and no longer needing human milk as the primary source of nutrition. It is rare for children under 3 to have lactase deficiency, reflecting the biologically normal age for weaning.

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: Fenugreek and lactation

Fenugreek is one of the most commonly used galactogogues (supplements taken that are known to increase milk production). Fenugreek seeds (per 100 g) are rich sources of protein (46% of DV), dietary fibre (98% DV), B vitamins, iron (186% DV) and several other dietary minerals. The flavorful herb may be found in many Indian, Persian, Turkish, and Egyptian dishes. It is often the key ingredient in mother’s milk teas and lactation bars. Most mothers typically notice an increase in production 24-72 hours after starting the herb, but it can take two weeks for others to see a change. Some mothers do not see a change in milk production when taking fenugreek. Dosages of less than 3500 mg per DAY have been reported to produce no effect in many women. Interestingly enough, it’s been said if you want to know if you’re taking the correct dosage, you’re supposed to slowly increase the amount of fenugreek until your sweat and urine begin to smell like maple syrup. Got pancakes?

However, like any herb or supplement, be aware of what you are injesting. Some people are allergic to fenugreek, specifically people who have peanut allergy and chickpea allergy may have a reaction to fenugreek. Fenugreek seeds can cause diarrhea, dyspepsia, abdominal distention, flatulence, perspiration, and a maple-like smell to urine or breast milk. There is a risk of hypoglycemia particularly in people with diabetes; it may also interfere with the activity of anti-diabetic drugs. It may interfere with the activity and dosing of anticoagulants and antiplatelet drugs. You should not take it if you are pregnant as it may affect uterine contractions and may be unsafe for women with hormone-sensitive cancers. In summary, those with thyroid, blood sugar issues (such as diabetes), peanut allergies and those taking certain blood clotting medications should avoid fenugreek.

 

References:

Kellymom.com

[Bingel 1991] Bingel AS, Farnsworth NR. Higher plants as potential sources of galactagogues, in Wagner H, Farnsworth NR, eds. Economic and Medicinal Plant Research, Volume 6, Academic Press Ltd, New York, 1994: 1-54.
[Brinker 1998] Brinker F. Herb Contradictions and Drug Interactions. Sandy, OR: Eclectic Medical Publications, 1998, 70–1.
[Dugue 1993] Dugue P, Bel J, Figueredo M. Fenugreek causing a new type of occupational asthma. Presse Med 1993 May 29;22(19):922.
[Hale 2002] Hale T. Medications and Mothers’ Milk, 10th Edition. Pharmasoft Medical Publishing, 2002, p.277-279.
[Heller] Heller L. Fenugreek: A Noteworthy Hypoglycemic
[Huggins] Huggins KE. Fenugreek: One Remedy for Low Milk Production.
[Korman 2001] Korman SH, Cohen E, Preminger A. Pseudo-maple syrup urine disease due to maternal prenatal ingestion of fenugreek. J Paediatr Child Health 2001 Aug;37(4):403-4.
[McGuffin 1997] McGuffin M., Hobbs C, Upton R, Goldberg A. American Herbal Product Association’s Botanical Safety Handbook. Boca Raton: CRC Press, 1997.
[Ody 1999] Ody P. Herbs to Avoid During Pregnancy from Herbs for a Healthy Pregnancy. Los Angeles, Calif: Keats; 1999.
[Ohnuma 1998] Ohnuma N, Yamaguchi E, Kawakami Y. Anaphylaxis to curry powder. Allergy 1998 Apr;53(4):452-4.
[Patil 1997] Patil SP, Niphadkar PV, Bapat MM. Allergy to fenugreek (Trigonella foenum graecum). Ann Allergy Asthma Immunol 1997 Mar;78(3):297-300.
[Reeder 2011] Reeder C, Legrand A, O’Conner-Von S. The Effect of Fenugreek on Milk Production and Prolactin Levels in Mothers of Premature Infants. J Human Lactation 2011;27(1):74. Abstract only.
[Rice] Rice LA. Fenugreek, in Herbal Supplements in Pregnancy
[Swafford 2000] Swafford S, Berens B. Effect of fenugreek on breast milk production. ABM News and Views 2000;6(3): Annual meeting abstracts Sept 11-13, 2000

 

Fact of the Day: oxytocin and the milk ejection reflex

There two important hormones for breast milk production: oxytocin, which is your cuddle hormone, and prolactin, which is your milk maker. During suckling, milk ejection, or “let down”, occurs when oxytocin released into the circulation reaches the mammary glands. Maternal oxytocin is not only released into the circulation by suckling and skin-to-skin contact, but may be released when the mother sees and hears her newborn or simply thinks of him or her. Oxytocin release can even be conditioned to other stimuli, meaning your milk ejection reflex may occur even in the absence of suckling (Tancin, Kraetzl, Schams, & Bruckmaier, 2001). If you’re a Pumping mom this is important to grasp. Try building a routine with your baby during breastfeeding that you can carry over into pumping. Maybe it’s a song you listen to, a smell like lavender or vanilla, or holding a particular blanket. By bringing this into the pump room you can help stimulate oxytocin to help with let down.

Pumping Log: When to throw in the towel

I’ve never been a super pumper. I’ve diligently pumped three times a day at work for the last 8 months. I’ve almost always made just enough for the next day of feedings. Sometimes I’ve even had a conservative stash in the freezer for low pump days or when my husband and I want to go out. There are definitely times when I have to work on my supply to keep it up enough to feed my daughter. Oatmeal for breakfast, teas at lunch, a Guinness with dinner, more tea before bed. Pump. Breast massage. Pump. Repeat. It’s exhausting. Especially since my uninvited monthly visitor has me with a low supply. As I come up on my daughters first birthday, I’m torn.  Continue the schedule I’m on with the highs and lows of constant pumping? Drop the pumping and only breastfed when I’m home and offer something else while I’m gone? Or gradually wean all together? The professional side of me (the crunchy, granola, die hard side) says, “Stick it out!!! It’s not that bad!! Breast is best!!! Your baby needs your milk!!! Show your boobs who’s boss.” While the personal side of me screams, “Screw it! You’re working so hard! Give yourself a break. You went a whole year. You did the best you could with the support you had. Some other milk won’t kill your kid. She’s eating like a champ and she won’t even notice.” I get it now. I understand why some moms give up breastfeeding, especially working moms. I also get why mom’s push through and keep going. We all just want the best for our babies. I’m still on the fence. We’re T minus 1 month to the big one year birthday. I’ll keep you posted on what I decide. But for now, Happy Pumping!!

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.