Drinking and Breastfeeding

Milk is made from your blood, so what you drink can impact your milk supply. 

💦 How much water should you be drinking? There are some ridiculous answers out there. If your breast milk production has decreased, helpful people may suggest that you chug tons of water. Your lack of water intake may contribute to but is not completely responsible for your supply drop. Drinking too much water can inadvertently harm your milk supply

💦 When you drink too much water, your body tries to restore the electrolyte balance in your body by dumping the excess water into your urine. This results in water being diverted away from your breasts, which in turn decreases your milk supply. Water dense foods can also be just as hydrating as plain water from the tap. 

💦 You will lose up to 30oz of water through your breast milk to your baby; so do try to drink 8-12 glasses of water a day

☕️ Coffee is safe to drink: 300-500mg of caffeine per day max

☕️ Younger babies (< 6 months), preterm and medically fragile babies process caffeine slower and they may be sensitive to it. 

☕️ If you consistently drank coffee during pregnancy you baby is already used to caffeine

☕️ It takes 15-20 minutes for coffee to hit your bloodstream and is usually completely gone by 4-7 hours. So if you’re concerned or having it for the first time after birth, either breastfeed baby first and then have your coffee or have it while breastfeeding

🍷 According to the CDC, moderate alcohol (up to 1 standard drink per day) is not known to be harmful to baby

🥂 Less than 2% of alcohol reaches breastmilk and typically peaks within 1/2-1 hour after consumption *however* factors such as food, weight & body fat need to be considered

🥂 Alcohol does not accumulate but leaves breastmilk as it leaves the bloodstream. There is no need to pump and dump when consuming limited amounts of alcohol

🥂 If you are feeling like you NEED to consume large amounts of alcohol regularly, speaking to a qualified professional is admirable and a very good option

ALCOHOL AND BREASTFEEDING

Is it ok to have alcohol and breastfeed? The short answer is yes, in moderation. No, you don’t need to pump and dump for 1 standard drink. Yes, those alcohol testing milk strips are kinda dumb. 

Alcohol passes freely into breast milk and peaks around 30-60 minutes after consumption (60-90 minutes if you drink with food) so what you would breathalyze you would “breastalyze”. This does not mean your milk has an much alcohol as you consumed or as a straight up alcoholic beverage. It means you milk has the same amount of alcohol as your blood. For instance, if your Blood Alcohol Content (BAC) is 0.10 (or 0.10%, 1/10 of 1 percent) from drinking, you breast milk has 0.10% alcohol in it. In comparison, a typical beer has 4.5% alcohol, a glass of wine has 15% alcohol, and a shot of vodka has 40% alcohol. 

Let’s interpret that: if you breastfeed while you’re having your first drink, your baby will most likely be finished feeding before the alcohol hits your system. There’s no need to pump and dump your milk. Only time clears the alcohol from your system. If you’re breastfeeding a newborn, premature or medically compromised infant, you’ll want to be more cautious of the alcohol you consume and may want to consider waiting longer to breastfeed than an older baby. Such a small portion of alcohol gets into your milk, if you have an older baby and have only had one drink there’s really no need to wait to pump or feed. 

If you want to have an occasional drink, I will never judge you!!! Go for it!! If you need alcohol, large quantities or alcohol or are struggling with alcohol, please find a qualified counselor to work with ❤️ 🍻

Pumping is not an indication of milk supply

Hey you!!! Yes, you, the one pumping milk at 2am. Just a reminder pumping volumes are not a true indicator of your milk supply and don’t determine your work as a parent. There are many factors that go in to how much you can pump. Pump quality, the flanges you’re using, how you’re setting up the pump session, how long it was since your last session, time of day, medications, and where you’re at on your period all play a role in how much milk you will see in the bottles. 

Pumps were designed after babies and not the other way around. And they’re not usually as efficient as an efficiently feeding baby. A baby with no tongue or lip tie and a strong suck can remove more milk and trigger more milk to be made better than commercially purchased pumps. 

I expect you to be able to pump 1/4-1oz combined from both breasts when pumping after directly breastfeeding and 2-4oz every 2-3 hours when pumping in place of breastfeeding. Your worth is not measured in ounces. Nor is it measured by what that other lady on social media can pump. You’ve got this. Trust your baby and trust your body. 

If you’re struggling with pumping or how to understand the process better, consider taking my Pumped class. Or a personal flange fitting both in person and virtual.

Breast milk is made from your blood

The food you eat and the water you drink do not magically go directly to your breast milk. What you eat and drink goes first to your stomach to be broken down and then into your intestines to be absorbed and processed. Your digestive system breaks nutrients into parts small enough for your body to absorb and use for energy, growth, and cell repair. The muscles of the small intestine mix food with digestive juices from the pancreas, liver, and intestine. Special cells in the walls of the small intestine absorb water and the digested nutrients into your bloodstream. Your blood carries molecule-sized components such as simple sugars (carbohydrates), amino acids, white blood cells, enzymes, water, fat, and proteins throughout your body. As blood passes by the breasts, milk glands pull out these nutrients for milk production and pass some of them to your baby. Not all molecules are small enough to pass through into milk. (That’s why some medications are safe to take while breastfeeding and some are not. Molecules that are too big can’t get into the milk while really small molecules can.) 

Nuts, seeds, beans, and grains all have plant based proteins. Meat and dairy are animal based proteins. Both plant and animal proteins carried in your blood can make it into your milk. Sometimes these proteins can affect baby’s digestive system, causing symptoms like reflux, gas, colic, and blood or mucus in the poops from iritations to baby’s intestinal lining. Diary proteins are the most common cause of upset in the stomach, however research suggests that the proportion of exclusively breastfed infants who are actually allergic to something in their mother’s milk is very small. Fussiness and gas alone are not  enough to diagnose a cow milk protein allergy. 

In general, there are NO foods that need to be avoided because you’re breastfeeding. Every baby is different in the foods they are sensitive to. IF your baby always seems to have a reaction when you eat a certain food or a large amount of a certain type of food, cutting back on it or cutting it out temporarily may be helpful. 

Breastfeeding nipple facts

Most (not all!!) mammals have nipples as they feed their live young milk from their bodies made in mammary tissue. Marsupials and eutherian mammals typically have an even number of nipples arranged in pairs on both sides of their bodies, from as few as two to as many as 19 pairs. Some 5,600-6,000 species of mammals feed their young milk, and thus have mammary glands, but not all mammals have breasts (or nipples!!). In humans, the areola surrounds the nipple in a round shape and comes in varying sizes, on average 3 to 6 centimeters. The little bumps around the areola (called Montgomery glands) secrete an oil that smells like amniotic fluid to help baby use smell to find the nipple to latch on. In the center of the areola is the nipple, again in a wide variety of sizes shapes and lengths, and can be 10 to 27 millimeters (mm) wide by 1 to 10 mm in height. Its skin is similar to the areola, but has no oil glands. It has 4 to 20 pores where milk can come out. The skin of the nipple rests on a thin layer of smooth muscle, called areolar muscle fibers which are distributed in two directions: radial and circular. The muscle of Sappey responsible for circular fibers and the muscle of Meyerholz, formed by the radial fibers. Contraction of these muscles is responsible for the erecting of the nipples during stimulation and breastfeeding as well as the ejection of milk from the breast. How tight or loose these nipple muscles are may contribute to why some of us leak more than others and some don’t leak at all, but there is no way to exercise these nipple muscles!

Mastitis treatment

Mastitis is a common complication of lactation that at it’s most basic definition is inflammation or swelling in the breast. This inflammation often starts with an unresolved plugged duct where milk has either not be moved soon enough (like from baby sleeping longer at night or not pumping enough at work) or from the wrong size pump flange that does not allow milk to empty efficiency. Mastitis may happen with increased maternal stress or a change in the family  routine. This may be when guests are visiting, during the holidays, or when returning to work. It is not always easy to tell the difference between a breast infection and a plugged duct. They have similar symptoms, and both can get better within a day or two.

Regardless of why it started, The diagnosis of mastitis is generally made by your symptoms. It is characterized by one sided breast tenderness and redness (often with a noticeable lump in a certain area), accompanied by a fever of 101°F (38.5°C) or greater. You may feel fatigued and symptoms of the flu like, chills, nausea or vomiting, body aches, and headache. The breast will also often have a wedge shape, redness in an area accompanied by breast fullness and tenderness in the same spot. 

For treatment strategies, check out the latest video in my IG subscription or on my LA Lactation YouTube channel!

Birth control and dropping milk supply

Any birth control with a hormone in it can drop your milk supply. Hormones in birth control pills prevent pregnancy by:

  • Stopping or reducing ovulation (the release of an egg from an ovary).
  • Thickening cervical mucus to keep sperm from entering the uterus.
  • Thinning the lining of the uterus so that a fertilized egg is less likely to attach. 

The Pill (estrogen and progestin) tricks your body to think is pregnant so it won’t ovulate. Estrogen based pills will drastically drop milk supply, just like pregnancy does, and should be avoided while breastfeeding unless your weaning. Hormonal IUDs (Mirena, etc), arm implants (Nexplanon, etc), and the mini pill (progestin only) are often recommended as the best form of BC while breastfeeding because most research says that they don’t impact milk supply. Many who use these methods don’t experience any supply drop. For some, though, any hormone based BC will drop milk supply, some times drastically. Every body is sensitive to different levels of hormones. If you have an IUD or arm implant placed and notice a drop in supply, the only way to increase supply again is to remove them. Increased pumping or herbal supplements will usually not be enough to increase supply again because you’re working against hormones. If you’re considering a hormonal based IUD and aren’t sure if your supply will drop, consider taking a few rounds of the mini pill (progestin only) which is the same hormone in the IUD and implant. If your supply drops, you only have to stop taking the pill and your supply will rebound much quicker. 

Benefits of skin to skin contact for newborns

SKIN TO SKIN 

Babies are needy. The need to be on your body and all of their instincts and reflexes are designed to get them there. Their neurological system is immature at birth and still needs to develop.  Being on your body:

 🧠 Accelerates Brain Development:

Holding baby on your body increases the development of essential neural pathways, which accelerates brain maturation

🌞Calms, Soothes & Reduces Stress:

Having your baby on your body soothes baby so much that babies’ cortisol levels (stress hormone) are measurably lowered after only 20 minutes of being held skin to skin. And, remarkably, their pain is reduced when held skin to skin

😴 Improves Quality of Sleep:

Development of mature brain function in infants depends on the quality of their sleep cycling. During skin to skin, most infants fall asleep easily, and achieve what is called “Quiet Sleep”, a natural deep sleep for 60 minutes or more

💉Enhances Immune System:

Baby’s immune system is stimulated when placed skin to skin. Your mature immune system passes antibodies through your skin to baby. Being on your skin also increases baby’s skin hydration, which provides a protective barrier from harmful bacteria entering baby’s skin

⚖️Stimulates Digestion & Weight Gain:

Skin to skin contact reduces cortisol and somatostatin in babies, allowing for better absorption and digestion of nutrients, while decreasing gastrointestinal problems. With a reduction of these hormones, baby’s bodies preserve brown fat (the healthy fat babies are born with), helping to maintain birth weight and keep a warm body temperature. As a result, baby’s body does not have to burn its own fat stores to stay warm, resulting in better weight gain. After just one hour of skin to skin, the infant’s digestive system is restored to the right balance for optimal GI function

When I’m your body, baby’s body learns to self-regulate, resulting in a regular and stable heartbeat and breathing pattern

❤️ Synchronizes Heart Rate + Breathing:

Deep breathing and breastfeeding

Put your oxygen mask on first. When there is an emergency on a plane, we are instructed to put our mask on first before helping others. This is also critical when caring for our babies. You’ve just gone through one of the most traumatic experiences your body could physical do: give birth to another human being. You’re healing a dinner plate sized wound on your uterus while sweating like a pig and not sleeping for more than a few hours at a time. There are so many physical, social, and emotional changes happening to you all at once it can be easy to just ignore all of them to focus your energy into your new tiny human.

Deep breathing is one of the easiest, most convenient tools to reduce stress, anxiety, and pain. And who doesn’t have all of those after the trauma of giving birth and dealing with all of the physical, social and emotional changes of bringing a tiny human into their life? Laying on your back, feet up against the wall and focusing on intentional breaths is one of the simplest ways to reset and promote balance in your body again 

Deep breathing:

❤️ Decreases stress, increases calm. Stress and anxiety makes your brain release cortisol, the “stress hormone”, which decreases oxytocin, your milk let down hormone. Deep breathing slows your heart rate, allowing more oxygen to enter the blood stream which relaxes your brain and lowers cortisol. This results in higher oxytocin and thus more milk

🧨Relieves pain through endorphin release which can help while you’re healing your lady bits (or those cracked nips)

💎Detoxifies the body by stimulating the lymphatic system. Carbon monoxide is released by breathing. 70% of the toxins in your body are cleared just by breathing

🚗Increases energy. More oxygen= better body functions and that improves stamina. Who doesn’t need that for 2am feedings?

🩺Lowers blood pressure. Relaxed muscles allows blood vessels to dialate, which improves circulation and lowers blood pressure

💊Fully oxygenated blood carries and absorbs nutrients and vitamins more efficiently, improving your immune system against viruses and bacteria. This also helps improve digestion! 

🤸‍♀️Supports good posture. When you breathe in, your lungs expand which pulls your diaphragm down and straightens your spine. You definitely need to lengthen your spine and release that neck tension from being hunched over while latching your baby

The risks of not addressing maternal mental health include:

✏️Poor infant growth, language and cognitive development 

✏️Poor gross and fine motor development

✏️Less efficient breastfeeding or weaning from breastfeeding earlier than desired

✏️Poor infant sleep and increased maternal stress. 

When considering antidepressant use during lactation, while most medications are considered safe for mom and baby, there is no “zero risk” option. However, the benefits of using a medication to help decrease depression and anxiety usually outweigh the risks acostares with taking a medication. If a mother has been on a certain med prior to breastfeeding and it worked well for her, it would be reasonable to resume that medication while breastfeeding. Sertraline (Zoloft) is a first-line drug for breastfeeding, due to documented low levels of exposure in breastfeeding babies and the very low number of adverse events described in case reports. Prozac is generally considered safe to take while breastfeeding; however, research shows that the average amount of the drug in breastmilk is higher than with other SSRIs. 

When taking any medication, you want to monitor for side effects both in you and the baby. Most common side effects when taking antidepressants are:

🥛 Changes in milk supply

🛌 Sedation/sleepiness in baby

Poor feeding or weight gain in baby

Antidepressants can work well to help you feel balanced again. Work closely with an IBCLC while starting antidepressants to help continue and feel supported in your breastfeeding journey

Weaning blues: why do I feel so emotional from weaning baby from the breast?

If postpartum depression weren’t enough, it’s also possible to be depressed and have mood shifts from weaning from breastfeeding. During breastfeeding, oxytocin, the cuddle hormone, is released every time milk lets down. This feel good hormone helps reduce the risk of postpartum depression. Prolactin, the hormone that actually makes the milk, also brings a feeling of well-being and relaxation. There is very little research on the subject, but it’s hypothesized that when you wean, the decrease in prolactin and oxytocin can make some feel moody, sad or even angry. The faster the weaning process the more abrupt the shift in hormone levels, and the more likely to experience feelings such as being tearful, sad or mildly depressed. Some also experience irritability, anxiety, or mood swings. These feelings are usually short-term and often go away once hormones stabilize. Some will also feel relieved and happy once it’s over and they can move on into the next stage of parenting. And that’s OK, too!!

If you are weaning and experiencing mood swings, you’re not alone! Remember, it takes at LEAST a full 40 days for those with an established milk supply to no longer see milk when they hand express or stimulate the breast. Your milk making cells are going through a cellular death called involution where they literally change from milk making cells back into breast fat cells. Some find it takes 1-3 period cycles after weaning for their hormones to reset and feel “back to baseline” which coincides with when this process is complete. It will get better!!

Some times being aware that this is a hormone shift and not something in your head is enough to bring peace in the process. Find your coping mechanisms. Reflect on your journey. There are herbs and supplements that can help in the process (set up a consultation to discuss which ones are right for you as they are NOT one size fits all). And if needed, seek professional counseling. 

Pregnancy and breastfeeding

If you’re still breastfeeding and become pregnant, your mature breastmilk will transition back to colostrum around the end of the first trimester in preparation for whenever the new baby is born. By 4 months gestation, the placenta is large enough to suppress most milk production. Your body will prioritize your fetus over your nursling in terms of milk and produce the appropriate milk for the more vulnerable child. Colostrum is a high protein, laxative milk to help newborns poop out meconium. It is saltier in taste and thicker in consistency. Many older babies don’t care if it tastes different, but some will and may wean themselves. The supply is not likely to be able to support an infant 10 months old and younger. But if the older infant (11+ months) or toddler is eating solids and drinking other liquids, those babies may not care if they are getting milk or “dry nursing” until the next baby comes. Some choose to supplement younger babies with donor milk or may transition to formula until the new baby arrives and then continue to tandem feed with their own breastmilk again. 

Pregnancy hormones can make breasts and nipples more sensitive and uncomfortable. And these sensations often will make one want to wean or experience a nursing aversion. Toddlers may still aggressively want to nurse and it’s ok to put boundaries on your nursing. 

The typical things recommended to increase supply (additional feeding/pumping, herbs and supplements, etc.) are not appropriate and are ineffective since the placenta will continue to increase in size. Hormones supported by the placenta are what impact milk production and there’s not much you can do to combat the hormone shift as it’s needed to support the pregnancy.