Having the right pump flange size can make all the difference in your pumping journey. Most pumps come standard with a 24mm and possibly a 27/28mm flange(s). Did you know I’ve only recommended the 28mm flange twice in the last 3 years? And the 24mm only maybe a dozen times out of hundreds of moms? The majority of the people I woke with need a 17, 19, or 21mm flange and often need a cushion to make it a half size. Too much areola in the tunnel can cause swelling that doesn’t let your milk empty efficiently, leading to plugged ducts and a drop in milk supply. (Ever pump but still feel like there’s milk in the breast? Most likely your flange is too big) Measuring your nipples can give you an idea of what size flange you’ll need. Use a ruler at the base of your nipple (not the areola!) and find the diameter. Add ~3mm and that’s a good place to start. Pumping should feel comfortable with no pain or rubbing of your nipples in the tunnel. It’s like trying to find the perfect shoe. It may take trying a few sizes to get the right fit, but trust me, it’s worth it!! Have you measured your nipples yet? Did you know there are still too many lactation consultants (especially in the hospital) who don’t know there are other sized flanges? There are lots of products (inserts, cushions, different shapes and sizes) to help make your pumping experience so much better.
So why wasn’t this considered when pump companies were making flanges? I read some where the original reason they made 24 and 28mm was for the size of baby’s mouth, not nipple size!
Do you nipples stretch a lot and swell into the tunnel? We call those elastic nipples. You may do really well with something like the Beaugen Mom Cushions which help hold the areola back. Or the Pumpin Pal flanges which have a different shape to help with the stretch.
Oxytocin is the hormone responsible for making milk eject or “let down” during feeding and pumping. Milk is constantly being made and collected in little sacs (alveoli) at the back of the breast. When the breast and nipple are stimulated during feeding, oxytocin makes the cells around the alveoli contract in what’s called the milk ejection reflex (MER). This makes the milk that is already in the breast flow for baby.
You can train yourself to have MER through your senses and feelings, such as when you touch, smell or see your baby, hear baby cry, or think lovingly about them. If you are in severe pain, anxious, or emotionally upset, the oxytocin reflex may become inhibited, and milk may suddenly stop flowing well. With support, and recognition, once you feel comfortable and baby continues to breastfeed, the milk will flow again.
Signs that the oxytocin reflex is active:
• Tingling sensation in the breast before or during a feed
• Milk starts to drop when you think of baby or hear crying
• Milk flowing from the other breast when baby is sucking
• Milk sprays from the breast if baby unlatches
• Slow deep sucks and swallowing by the baby, indicating milk is flowing
• Uterine cramping in the first week after delivery
• Thirst during a feed.
If one or more of these signs are present, the reflex is working. However, if they are not present, it does not mean that the reflex is not active. Not every one feels or is aware of these sensations.
Breastfeeding isn’t the only way to get a dose of oxytocin. If you can feel milk in your breasts but are having trouble letting the milk down, try this:
◦ Keep baby in skin to skin contact for 1-2 hours prior to feeding or pumping
◦ Do yoga. A small 2013 study found after 1 month of yoga, people had higher oxytocin levels
◦ Listen to music. Multiple studies have found that listening to music naturally boosts oxytocin. This can be especially helpful when pumping at work
◦ Meditate. This helps reduce stress which increases oxytocin
◦ Touch. Physical touch releases oxytocin. This can be from cuddling, hugging or touching another person you love or getting a massage
◦ Laugh! Laughter really is the best medicine
◦ Sex. This is a hard one depending on where you’re at in your postpartum journey, but orgasm is a key way to boost oxytocin
◦ Pet you pet! Animal touch can release oxytocin just like human touch can
◦ Oxytocin nasal spray. Struggling with severe anxiety and nothing else is working? A prescription for an oxytocin nasal spray can help trigger let downs
Babies are masters at breastfeeding. They will exhibit all kinds of behaviors at the breast that will make you question if you have any milk and wonder what’s wrong with the baby. Most babies discover they have power and control over the breast and that different behaviors get different things. Biting, tugging, gumming, pulling, patting, chomping, shaking the nipple and breast are normal infant behaviors. Repeatedly latching on and off can also be normal when it doesn’t happen all the time. They happen during growth spurts, cluster feeding and teething. And may increase when baby discovers they can get a reaction from you for them. These behaviors increase or decrease the flow rate of milk and help stimulate supply and let down during growth spurts and teething.
What can you do? Stay calm. Most likely it’s normal and will change with time. Lots of skin to skin time between feedings can help keep baby calm and will naturally increase your supply during growth spurts. Using breast compressions while feeding can help increase flow and help trigger let downs. If baby is teething, give plenty of opportunity to chew and bite on appropriate toys and food items outside of nursing times. If baby is biting to slow flow, try a laid back position and make sure you’re not promoting an oversupply from over use of the Haakaa or pumping at sporadic times. Continue to watch for wet and dirty diapers and know that usually these behaviors are normal and don’t last.
If baby is having these behaviors all the time and isn’t making the amount of wet and dirty diapers you would expect, schedule a lactation consultation immediately.
There are people that will struggle to or never make a full milk supply. From 1 month to 1 year, exclusively breastfed babies average 25oz of breast milk per day. True low supply means making less than this when the breasts are stimulated at least 8 times in 24 hours. Chronic low milk supply is linked to either a greater health concern or something out of your control which you cannot change or fix with cookies, teas or even medications and pumping.
🗝Low milk supply that can be increased with time and support:
💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)
💡Baby not feeding efficiently from lack of oral motor skill or tongue tie
💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)
💡Not feeding or pumping enough, especially over night
💡Scheduled feedings or over use of a pacifier
💡Birth. Many medications designed to help you labor and deliver actually inhibit baby from latching and feeding effectively for hours to days after birth. Hemorrhage or birth trauma can also cause low supply in the beginning
💡Supplementing, especially in the two weeks after birth
🗝Reasons for chronic low milk supply that may NOT increase even with maximal support:
💡Breast or nipple surgery, augmentation, reduction, trauma
💡Insufficient glandular tissue (IGT). Breasts never developed during puberty and look tubular or widely spaced. Signs of IGT include breasts did not grow in puberty, or increase in size during pregnancy. No engorgement in the week after birth
💡Uncontrolled or undiagnosed thyroid disorder
💡Hormone or endocrine disorders, including severe PCOS
💡Hormonal birth control placed/used too soon after delivery
💡Nipple piercing that scars shut instead of staying open
There is a mistaken belief that prescription galactagogues, teas, or herbs can cure ANY chronic low milk supply. Before self-prescribing or taking Domperidone, Reglan, fenugreek, or any other lactation supplement, consider having your serum prolactin levels tested and a full evaluation by a skilled lactation consultant. Continue to follow @lalactation in Instagram or see my videos on YouTube for strategies of breastfeeding with chronic low milk supply.
If you’re still breastfeeding into toddlerhood, no. The World Health Organization recommends breastfeeding until 2 years old. After 2, you can wean to water and table foods or to any kind of milk per your family’s choice. If you’ve decided to wean between 1-2 years, yes and no. Cow’s milk provides a convenient source of a lot of nutrients, including calcium, protein, potassium and vitamin D that are important for building bone and brain development. But if your toddler won’t drink it, has an allergy or intolerance, or your family follows a vegan lifestyle, a well-planned diet can provide these nutrients too. According to the USDA, children ages 2-3 need two servings of dairy per day (milk, yogurt, cheese, or calcium-fortified non-dairy beverage), children age 4-8 need two and a half, and kids 9+ need three. Can you use a milk alternative such as soy, almond or oat? Yes, but they’re not one-for-one swaps. For instance, almond and rice milk have only 1 gram of protein per serving, compared to 8 grams in cow’s.
When choosing a non-dairy milk, make sure it’s fortified with calcium and vitamin D. Homemade versions won’t have this fortification. Shake milk substitutes well before serving, the calcium settles on the bottom. Look for varieties labeled “unsweetened” as many milk alternatives contain lots of added sugar! If you’re choosing not to offer your toddler cow’s milk, make sure they’re getting a wide variety of fruits, vegetables, beans, grains and protein to get them the vitamins, minerals, fats and protein they need for growth. When in doubt, discuss nutrition with a pediatric dietician
Milk is a very convenient source of calcium, but not essential. It is recommended that a 1-3 year old child have 700mg (2-3 servings) of calcium per day. Eating a diet rich in beans, tofu, spinach, kale, broccoli, kiwi, figs, brown rice, oatmeal and certain fish such as salmon can give your child just as much calcium as drinking milk. No one ever “has” to drink milk. Human milk contains less calcium than cow’s milk, but the calcium in human milk has over twice the bioavailability of the calcium in cow’s milk. Increasing your calcium intake does not increase the calcium in your milk – your milk always has the right amount of calcium for your baby. Getting adequate calcium in your diet is recommended because if you’re not getting enough, your body will take calcium from your bones to provide to your baby, making you more prone to bone fractures. However as soon as you wean, your body regains bone mass and your bones will actually be stronger than before.
Human milk averages 5.9-10.1 mg/oz calcium. 67% of this calcium is absorbed by the body.
Whole milk contains 36.4 mg/oz calcium. 25-30% of cow’s milk is absorbed by the body.
Infant formulas contain 15.6 mg/oz calcium; toddler formulas contain 24-27 mg/oz calcium. Extra calcium is added to infant formulas because of the lower bioavailability of the calcium from formulas as compared to human milk (they aim for baby to absorb the same amount of calcium as would be absorbed from breastmilk).
Toddler formulas have come on the market in recent years touting that they’re great nutrition for the 12+ month group. In reality, it’s all clever marketing. If you supplement baby with formula, there’s no need to switch to a toddler formula at 12+ months. In the second year of life, growth slows. Your toddler doesn’t gain weight or length as quickly as they did right after birth.
If you’re still breastfeeding, your milk adjusts to this based on how toddler nurses; how the breast is emptied tells your body what kind of milk to make. When breast milk is the primary diet, like in the first 6 months, your milk is made for growth and immunity. When your toddler is taking lots of table foods and nursing, your milk is made for development and immunity.
At 1 you don’t need a fancy toddler formula or cow’s milk. If you’re exclusively formula feeding, switching to whole cow’s milk is fine. While cow’s milk is a convenient source of calcium, protein, fats, and vitamin D, there’s no need to switch to that, either. As long as your child takes a wide variety in their diet and has a good source of calcium (yogurt, cheese, dark leafy greens like spinach, fortified cereals or juice, soybeans, etc), just choose what you offer your child wisely. If you’re still breastfeeding, know your child is getting good nutrition from your milk suited to their growing needs. If you’re concerned about your toddlers diet or they don’t eat a wide variety, consult your pediatrician or a pediatric nutritionist for advice and help.
Oatmeal is commonly recommended to breastfeeding parents as a breast milk booster. Many report pumping more milk on the days they have oatmeal for breakfast instead of something else.
🥣Oatmeal is a good source of iron. Anemia/low iron levels can result in a decreased milk supply as breast milk is made from your blood.
🥣Oatmeal is a comfort food. Comfort foods tend to encourage let-down which boosts milk supply.
🥣Many of the herbs known to increase milk supply also decrease cholesterol levels. Herbs that both increase milk and decrease cholesterol include fenugreek and alfalfa, which are found in many lactation products. Oat bran, found in oatmeal, can help lower cholesterol
But you don’t HAVE to eat oatmeal to make breast milk. I’ve known more than a few moms who are choking down oats even if they hate them. There are other things you can eat that are just as supportive.
🥬Eating foods high in iron or being supplemented with iron can help you make more milk. Especially if you had a large blood loss at birth or tend to be anemic. High iron foods include beans (they won’t make your baby gassy), dark leafy greens, red meats, dried fruits like raisins and apricots.
🥄Flax seed and chia seeds can work just as well as oats. They can be added to cookie recipes, used as an egg substitute in homemade breads, and are tasty and filling in smoothies.
🥕Here’s another list of seemingly random foods that are actually known to boost milk supply: Garlic, carrots, barley, asparagus, brown rice, apricots, salmon, sweet potato, almonds, moringa, chickpeas, lentils, beets, tofu, watermelon, and grapefruit.
Herbs. Supplements. Boobie boosting bars and milk making teas. There’s a lot of products on the market now to help increase your milk supply. Vitamin C is great for preventing a cold, but too much can give you diarrhea. Iron is amazing for keeping you from going anemic and feeling weak, but too much makes you constipated. Fenugreek is known to help boost milk supply, but if you’re on thyroid medication, are hypoglycemic, or have a peanut allergy you shouldn’t take it. Every person is different in how they respond to herbs and even foods. I’m not opposed to lactation supportive products. But if you’re going to buy any of those products guaranteed to help you pump gallons of milk a day, here’s my best advice: 💡Do your research. Know what’s in it and any possible side effects 💊If you’re taking any prescription medications ask a pharmacist about drug/herb interactions. 💉Start with the smallest dose possible and gradually increase the amount you’re taking 🧪Don’t add in 10 different supplements at once. If you have a bad reaction you won’t know which one is from. Start with one at a time. 🩺Try them at home and first thing in the morning, on a weekday before you go back to work if possible. You wouldn’t want to have a bad reaction at work or when the doctors office or pharmacy are likely to be closed. 🧫We all can have different reactions and side effects to herbs and supplements. Some women find that taking fenugreek has the opposite effect and drops milk supply. Some women may notice an increase in gassiness in baby with certain herbs. If you notice any weird side effects, stop taking the supplement. 🤱🏽There is no replacement for frequently removing milk from the breast. The best way to make milk is to frequently feed your or pump your milk from your breasts 🔑If you’re struggling with low supply, schedule an appointment with an IBCLC to help get to the real root of the supply issue and form a plan to get back on track. 🗓If you take something for 3 days and don’t see a milk increase, most likely the herb isn’t effective for you. If you see a decrease within 3 days, stop taking it.
Some of my favorite places for herbs while breastfeeding:
Side lying while breastfeeding is one of my favorite positions. It’s easy on my back and arms and the baby tends to get super comfortable. It can take a while to figure it out. Check out my YouTube video on how to get a perfect side lying latch
Breastfeeding going well and all of a sudden you feel like your milk is gone? Go pee on a stick. A drastic drop in milk supply when breastfeeding has been going well can be a sign of pregnancy, even if your period hasn’t come back yet. Research shows it is safe to continue breastfeeding while pregnant and does not increase the risk of miscarriage. So there no reason to wean unless you’re a high risk pregnancy (if you are told by your health care provider that you can’t have sex, you shouldn’t breastfeed. If it’s safe to have sex, it’s safe to continue breastfeeding.) If so you are not alone—far from it.
Key points to remember when breastfeeding and pregnant:
• Milk will shift from mature milk back to colostrum around 14-20 weeks of your pregnancy to prepare for the birth. Babies under 6 months may not get enough milk from the breast alone while toddler eating solids may do fine. Monitor weight gain for babies under 1 year
• Colostrum is saltier than mature milk. Some nurslings are fine with the taste shift and others may self wean
• Aim for a total of about 600 to 800 extra calories — 300 for the fetus and 300 to 500 for milk production.
• Nipples may become extremely tender during pregnancy, especially at the beginning, due to hormone changes
• Breastfeeding aversion while pregnant is normal (feelings of stress or anxiety or wanting to stop breastfeeding)
• If your toddler always nurses to sleep, you may want to find other sleep routines to make putting older one to sleep easier when you have the new baby.
• As your belly grows, you may need to experiment with new breastfeeding positions.