Causes for mastitis

Did you know mastitis may be related to your posture?

Fluid dynamics is the science of how fluids move in our bodies. All of put bodily fluids are supposed to be free-flowing and unobstructed for optimal health. Milk is a fluid that flows through ever narrowing ducts and pores. Lymph is a fluid throughout your body (and breasts) that helps transport waste from cells and tissues in your body to help flush it from your system. It also helps reabsorb milk that doesn’t get emptied to baby/pump. Anything that increases resistance of the movement of these fluids increases the likelihood of plugged ducts or mastitis. Causes for increased resistance:
⭐️ Breast implants or reduction causing scar tissue in the breast
⭐️ Sleeping in the same posture especially on your side where you put pressure on the breast for extended periods of time
⭐️ Tight fitting clothing/bras that constrict movement of milk and lymph between feedings
⭐️ Shoulder injuries where there is inflammation or scar tissue
⭐️ Neck injuries or issues with neck mobility
⭐️ Tension in your body from stress or poor posture for extended periods of time during breastfeeding (bringing yourself to the baby)
⭐️ Not moving the body enough/sitting for prolonged periods of time in the same position
⭐️ Increased overall inflammation in the body such as from infection or excessive fluids from IVs used during labor and delivery or from immune disorders
⭐️ Having very large, heavy breasts which act more like an appendage where milk and fluid can fill the lower quadrant of the breast and have difficulties moving out again

What can you do?
❤️ Shake your breasts!! Get that fluid moving manually with your hands
❤️ Lean over and dangle your breasts to reduce pressure on them and help them free flow
❤️ Practicing yoga works well, especially with poses like downward dog where you’re changing the orientation of the fluid in your breast related to gravity.
❤️ Avoid restrictive clothing and bras
❤️ Get a massage!! Having hands on the body helps get the fluid inside moving in the right direction
❤️ See my video for lymphatic drainage massage

Painful nipples during breastfeeding are common but not normal

Cracked. Painful. Damaged. Nipples. Ouch!!! Did you know the nipple shield you were given at the hospital may be the culprit for your persistent nipple pain? Most hospitals will give out a 24mm cone shaped shield (Medela brand). While this may work for some, for many it will be too big or the wrong shape, causing baby to still bite your nipple through the shield. Those with elastic nipples may have their nipple sucked too far and poke out the holes. Ouch!!! Nipple shield now come in many shapes, sizes, lengths and materials to individualize the shield to get an optimal latch. Not happy with your current shield? Schedule an appointment to find out what other options may work better for you.

If you have cracked, bleeding nipples there is always a reason. Reasons for cracked nipples:
🗡Shallow latch
🗡Very short or flat nipples where baby is not yet proficient at taking a big mouthful of breast
🗡Baby is tongue tied
🗡Breast infection
🗡Pumping with the suction too hard
🗡Wrong size pumping flanges causing friction on the nipple
🗡Wrong size nipple shield
🗡Baby was in an odd position in utero and has tension in the head/neck/shoulders
🗡Baby has torticolis (they prefer to turn their head toward one shoulder and they pull the head in this direction while nursing, twisting the nipple)

To treat cracked nipples:
🧸Get a deep latch every time
🧸Breast milk on the nipple after every feeding
🧸Coconut oil, EVOO, nipple balms, butters or creams
🧸Breast gels
🧸Breast shells or Lacticups keep the nipple from touching clothing when damage is severe but should be limited in use
🧸Dr Jack Newman’s All Purpose Nipple Ointment

Weaning from a nipple shield

Did you use a nipple shield to help your baby latch? Want to transition baby off the shield? First, weaning from the shield is your choice. If you like it and it’s comfortable for you, don’t feel pressured to get rid of it before you and your baby are ready. There are risks associated with shield use, like the potential for decreased milk supply. But if that’s the only way your baby will latch right now, give yourselves time and grace to keep trying as baby gets older and more proficient at the breast. As always, if you’re really struggling to get off the shield, find a knowledgeable lactation consultant to help you with the process to make sure something else isn’t going on with baby’s latch.
💡You can always start with the shield on and take it off after your first let down once baby is not as hungry or use it on the first side and offer the second side without it
💡Start by trying without the shield once a day during daylight hours when baby is happy and not too hungry. Catching baby with early hunger cues is imperative. If they’re crying and really hungry, 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 “U” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible. A baby that can’t feel the breast can’t latch to the breast.
💡Hand express to get your milk flowing so baby gets instant satisfaction and reduce the work
💡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
💡If baby becomes frantic or upset during trials, using the shield is not a sign of defeat but continued practice.
💡If at first you don’t succeed, try, try again.

My baby only naps on me.

Most parents are very aware of the AAP guidelines for safe sleep for babies, which includes having babies sleep in the same room as their parents for the first 6-12 months. Did you know having baby sleep in the same room as you also applies to naps during the day? Research shows babies who sleep in a separate room from their parents are at a greater risk of SIDS for both daytime and night sleeps. While 83% of SIDS deaths occur at night, the risk during the day is still there. The safest option is to keep your baby near you while they sleep for the first few months of life.

Here’s three ways to have baby sleep close to you:
👼🏼 Baby Wear: This ancient practice has baby riding on your body like a baby monkey. They may be worn on your chest facing you, on your chest facing out, on your hip or back. Ring slings, soft wraps, structured carriers or baby back packs all work. The movement of your body helps baby be swayed to sleep and the rhythm of your heart and body heat help them stay comfortable and calm. You can still move around and get chores like vacuuming and washing dishes done

🛌 Co-nap: Every new parent I know is sleep deprived to some extent. As they say: eat when baby eats, sleep when baby sleeps, and vacuum when baby vacuums (which means it’s ok to stall a bit on those chores to enjoy those baby snuggles). If you are breastfeeding and bed-sharing, learning side lying breastfeeding can be a game changer. Never co-sleep with baby on a couch or chair. If you plan to sleep at the same time as baby, or fear you might accidentally fall asleep, always lay down on a firm, flat mattress and make sure there are no blankets or pillows around that could cover baby. Those who are not breastfeeding, smokers and others who fall outside the guidelines for safe bed-sharing can put baby to sleep in a bassinet or crib, then lay down in their own bed in the same room.

😴Contact Nap: It’s a term coined by Sarah Ockwell-Smith, author of The Gentle Sleep Book. It means having all or part of one body in contact with another body while one or both sleeps. Skin to skin contact releases oxytocin, the cuddle hormone, to help you bond. And when you’re breastfeeding, this contact also helps naturally boost your milk supply. Its OK to contact nap as long as you mutually want and it WON’T create a dependency to sleep on you in the future.

This stage in parenting is short and babies will eventually stop napping. Make the most of it by keeping it safe (and snuggly).

My baby has blisters on their lip

Most lip blisters in newborns are caused by all the sucking they’re doing to get their milk. They’re often caused by friction on their sensitive lips. The skin of the lip had 3-5 cellular layers, very thin compared to typical face skin, which has up to 16 layers. The lip skin is doesn’t have sweat glands, so it lacks the protective layer of sweat and body oils which keep the skin smooth and moist. This makes the lips dry out faster and become easily chapped.

Lip blisters, AKA:

  • Friction blisters
  • Suck blisters
  • Suck callouses

The sucking reflex starts around week 32 in the womb and is fully developed around 36 weeks. Occasionally a baby may be born with these blisters if they were super active at sucking in the womb.

Babies should latch by cupping their tongue around the breast and creating a vacuum seal in their mouth. The tongue then pumps up to compress the breast to squeeze out milk and then pumps down to generate negative pressure in the mouth to draw milk in like a syringe. The tongue is the dominant organ in effective breastfeeding. The lips actually play a passive role in feeding and should stay soft without the muscles engaged. They are only meant to prevent milk from leaking out of the mouth. Babies get suck blisters/two tone lips from overusing their lip muscles, specifically the one that rounds and closes the lips, called the orbicularis oris.

Think of it like this: try drinking from a straw. You usually put the straw in about 1-2 inches so your tongue and teeth help support it. This gives the straw stability so you can direct the flow of liquid in your mouth. If the straw is only touching the border of your lips, you need to use more of your lip muscles to keep the straw in place and from falling out of your mouth. Your tongue, cheeks, and teeth/gums provide needed support to keep the straw in without over working your lips. Same with the breast or a bottle nipple. The baby’s tongue is supposed to be the dominant muscle in maintaining the latch, with the cheeks and lips playing a passive, supportive role.

Very small blisters that go away in a few days are normal for newborns as they’re learning to latch and suck. Blisters that don’t disappear in the first week or two or that are extensive across the lips are a sign something is going on.

Reasons for lip blisters:

👄 Baby’s in a shallow latch (to breast or bottle) use their lips to hold on to prevent losing the latch. This is the simplest to fix. Fix the latch, the blisters go away. Usually baby is in a shallow latch because of how they’re positioned. Make sure baby is completely touching your body, tummy time tummy with their belly button touching you and not on their back. Baby’s face should be coming straight to your breast instead of turned toward one shoulder.

👄 Lip blisters are a classic sign of tongue/lip tie where the lips are compensating for the lack of range of motion/strength/coordination of the tongue because it’s being tethered to the floor of the mouth.

👄 Premature babies may also get lip blisters as they should still be practicing swallowing in the womb with no expectations. Babies born 34.0-38.6 weeks gestation may look like fully formed babies, but have a lot of maturing and growth to do outside the womb. Their brains would rather be sleeping than eating, and they can fatigue quickly at the breast. They also use those later weeks in utero to practice sucking and swallowing while being fed through the umbilical cord. Premies Also have under developer fat pads in their cheeks. The last weeks of pregnancy help fattening these up. The fat pads support the tongue to make sucking more efficient while decreasing the amount of space in the mouth, this means less suction is needed to draw milk into their mouth. Without the fat pads, babies use alternative muscles to maintain a latch, hence the lip blisters as they’re using their lips more than needed.

👄 When babies are born, there is a lot of pressure on their head and neck. Babies are also supposed to move their head and body around in the womb and again during delivery to help themselves be born. Sometimes they get stuck in a certain position and this can put extra pressure on the baby’s body. If they sat low in pregnancy, we’re always positioned in a certain way, or have little room to move around, we can some times see cranial nerve dysfunction. This can also happen when a baby is pulled out (cesarean, vacuum, forceps). Proper nerve function allows correct muscle movement. If a nerve involved in sucking is temporarily squished, pinched, or strained, certain muscles (tongue, cheeks) can’t function properly which can lead to compensations. See the videos on my YouTube channel for stretches to help baby move their muscles better. If you think baby may have a stretched nerve, chiropractic care, craniosacral therapy, physical or occupational therapy can definitely help.

Sudden drop in milk supply. Could be your period.

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. During this time, as supply dips, the milk flow slows and the milk can taste saltier than normal. 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. 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.
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.
When did your period come back? Did you notice a supply dip?

Tandem breastfeeding

Tandem breastfeeding is when two or more children breast/chestfeed or receive expressed milk at the same time.

It is possible to continue to breastfeed throughout pregnancy; however, there are some important things to know. Some may experience nipple sensitivity or a feeding aversion to the point that they want to stop feeding the older. About 1/2 report their milk supply drops, sometimes significantly. This is from hormonal changes and there is little that can be done to prevent this. If the first baby is less than one year old, supplementation may be required until after the birth of the baby. Milk can transition back to colostrum as early as the end of the first trimester. Colostrum is salty and some toddlers not drink it. Colostrum also acts as a laxative to help newborns poop meconium. It may have the same laxative effect on your toddler, so be warned!

Once the new baby comes, some will feed both children together at the same time, rotating which side they start on each time. Others may take turns to feed one child at a time. If the babies are of different ages, they’ll usually feed the newborn first to optimize milk supply. Many tandem feeders say that breastfeeding their toddler helps with the transition of having a newborn.

Hands on pumping

Removing more milk from the breasts

One easy way to increase your milk output with pumping is by breast massage and compression while pumping. One study found when mothers used their hands while pumping they were able to get 48% more milk than without using their hands! Their milk also had more fat in it

Steps to hands on pumping:

1. Massage both breasts. Massage both breasts using small circles in a spiral pattern (similar to a self-breast exam). Milk is made at the back of the breast, so focus on the back and sides of the breast. Stroke the breasts from the chest wall down toward the nipples. Use a light touch to help you relax and to help stimulate your let down.

2. Pump both breasts at the same time (double pump). Start in the stimulation (fast/light suction) mode of your pump. Gently compressing your breasts while pumping. Pay special attention to areas where you feel lumps (these are full milk ducts). Using medium pressure, stroke your breast from the outer margin in toward the pump to empty the ducts. After 1-2 minutes switch to the express (slow/higher suction) mode for 4-6 minutes. Switch back to the stimulation mode for another 1-2 minutes and then back to the expression mode for another 4-6. Keep alternating settings until milk flow slows to a trickle.

3. Massage your breasts again, concentrating on areas that still feel full.

4. Finish by either hand expressing your milk into the pump’s nipple tunnel or single pumping (one breast at a time) whichever yields the most milk. Either way, during this step, continue to compress the breast from chest to nipple on each breast, moving back and forth from breast to breast several times until you’ve drained both breasts as fully as possible.

How do I let down milk?

The breast is a gland made up of connective and fatty tissues. There are small clusters of milk making cells in the back of the breast called alveoli. A hormone made in your pituitary gland called Prolactin causes your alveoli to take nutrients (proteins, sugars) from your blood supply and turn them into breast milk. Oxytocin causes the cells around the alveoli to contract and eject your milk down the milk ducts. This passing of the milk down the ducts is called the “let-down” (milk ejection) reflex. Most of us will have multiple let downs in a single feeding/pumping session but in general only feel the first one, which is the strongest.

Let down is usually triggered by stimulation of the nipple, either from baby’s mouth or a breast pump. Some people feel their let down like:
📌Pins and needles
⚡️An electric shock

Some people never feel their let down. They know they’re in let down when:
🥛Leaking milk from the other breast
🤱🏽Baby audibly swallowing milk

Others may let down just fine for their baby and struggle to let down for their pump. The let-down reflex also may occur if a feeding is overdue, if you hear a baby cry, or if you think about your baby. You can teach yourselfg to let down by training your body to respond to a sound, smell, or event. You can also trigger more let downs when pumping by alternating between the stimulation and expression modes on the pump.

What do my baby’s cries mean?

In the early weeks after delivery, babies rely on instinct and reflex. They are in tune to what their body needs and respond in the only way they knew know how, through crying or cueing. Babies are also born with an underdeveloped biological clock and circadian rhythm that takes months to mature. Being on your body and at the breast actually helps regulate and develop those systems.

Breast milk digests very quickly compared to formula (in about 90 minutes) and exclusively breast-fed newborns will feed 10 to 12+ times in 24 hours as that milk digests quickly. Most babies want to take 2-4oz per feeding For most parents, their body makes this exact amount, which is a perfect match to their babies. It’s unrealistic for most to either make or want to eat 5-6oz feedings. Obviously there are ALWAYS exceptions to this. It’s just not the majority. Your body naturally has higher milk making hormones at night, so supply is at its highest between 2-6am, helping babies take shorter feedings to help them transition back to sleep sooner. Did you know that night milk also has hormones in it to help set up baby’s circadian rhythm?