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!
Author: Julie Matheney
Feeding babies has been my passion since I was ten years old. Almost twenty years ago, I pursued becoming a speech therapist to work with babies in the Neonatal Intensive Care Unit. In working in that setting, I realized I wanted a more intimate approach to working alongside families as they struggled to feed their babies. I became a board certified lactation consultant and have really fallen in love with what I do. There’s nothing better than empowering families to reach their feeding goals, wherever they are in their journey, whether it’s exclusive breastfeeding, combo feeding, pumping or bottle feeding. I offer prenatal breastfeeding classes, virtual, office and home consultations. I can assess for tongue or lip ties, educate on pumps to maximize pumping sessions, transition baby to bottle in preparation for parents going back to work, help increase or decrease milk supply, and assist with all breastfeeding challenges.
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.
Hunger cues for baby
How do I know my baby is hunger and not just fussy, has a wet diaper, or is lonely and wants to be picked up? Babies have a limited communication repertoire when they are first born. Every cue can look the same. It does get better with time as you learn your baby and your baby grows and matures. In general, young babies go through stereotypical phases of hunger cues. Some times we can miss these cues when the baby is swaddled or in a crib or bassinet away from where we are.
Early
- Licking or smacking their lips
- Opening and closing their mouth
- Sucking on their lips, tongue, hands, fingers, or anything within reach
- Time to get your breastfeeding pillow and grab a snack and some water!
Active
- Rooting around and attempting to latch on anything nearby their mouth
- Hitting you on the arm or chest repeatedly and/or grabbing at your clothing
- Trying to get into a nursing position
- Fidgeting/squirming
- Becoming fussy
- Breathing fast: get ready for them to start crying!
- This is the best time to latch!
Late
- Crying
- Moving their head frantically from side to side
- You’ll need to calm the baby before attempting to latch!
Many newborns are very sleepy after birth and may actually need to eat more often than they exhibit hunger cues. Newborns should be offered the breast anytime they cue hunger, which can be between 1-3 hours since the beginning of the last feeding. Watch the baby and not the clock. Don’t make the baby “wait” until some mythical hour to be fed. Feed the baby when the baby is hungry.
Hand sucking is not as reliable an indicator of hunger as baby ages. Starting at around 6-8 weeks, baby will begin to gain more control over their hands and will begin to explore their mouth and everything else in their environment with their hands. Babies also suck on their hands during teething. Symptoms of teething can sometimes occur weeks and even months before the first tooth erupts.
My baby is waking at night: Is this normal?
There are many reasons why your baby would wake more often to feed at night. Regardless of what you find online or from well meaning family and friends, there is no specific, developmental weight or age when a child no longer needs to feed overnight. There is no scientific or medical standard or recommendations for when a baby no longer needs nutrition at night. Society also says babies shouldn’t need tended to at night time and that we should teach them, often from a ridiculously early age, not to need us at night. In reality, we are not in control and neither are our babies. We’re in a mutual relationship where we are learning what our babies need and when they need it. Reasons why babies wake to feed over night:
💡Growth spurts
💡Developmental leap
💡You were gone at work and they missed you or want breast milk straight from the breast
💡Teething
💡They were distracted during the day because the world is an amazing place to learn in and they’re making up for calories over night
💡Sickness
💡They had a bad dream or are scared without you
💡Because they’re human
Per current research, 78% of babies wake up at least once a night and 60% of waking to feed until 1 year (Brown, 2015). That’s NORMAL. Between 12-18 months your toddler may still occasionally wake to feed. Or they may just need an adult to help them transition back to sleep. It’s not until 24 months that the human baby has matured enough to not consistently need an adult to help them transition back to sleep over night and should be getting all of their calories during day time hours.
Physiological Flexion
We know that active muscle tone begins to develop at around 36 weeks gestation. Between 36-40 weeks, the baby is curled up in a smaller and smaller space, developing stronger muscles by pushing up against the ever constructing walls of the uterus. Babies born at gestational term have a tightness to their bodies called physiological flexion from being in this position. Physiological flexion provides some passive stability for the newborn baby to use as their learning to move around a world that is impacted by gravity. Because of this flexion, and being in that tight space, many babies come out with tension in their bodies and sometimes asymmetries in how their body moves or looks. Many also will have a head turn preference to one side based on how they sat inside your body. How a baby was born, how long the pushing stage was, and interventions like forceps and vacuums can also cause tension in baby’s body which can in turn impact breastfeeding. This can make the head, neck and shoulders or jaws tight which in turn can make for a chompy/clamping or shallow latch. Or for a baby that’s not comfortable feeding on one side or in certain positions.
I recommend a lot of oral motor and body exercises for the babies I see in my practice to help stretch them out and release that tension after birth. Whenever exercises are being done, it’s best to do them on a calm, happy baby. If your baby starts calm and becomes agitated or doesn’t tolerate the exercise, stop!! You’re either doing the stretches too hard or the baby isn’t ready for that exercise. Something else is going on that needs addressed first. We don’t want to cause an aversion or unnecessary stress. Don’t just push through. This is part of respecting your baby’s cues. If a provider is having you do exercises and your baby is always crying or fussy, speak with your provider about how to modify the activity to match baby’s skill level.