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.

Comparison will steal your peace

- Julie Matheney

Too often we look around to see what everyone else is doing and it makes us feel incomplete, incompetent, like we’re doing something wrong or not doing enough. We see the success of others in parenting, sleep training, their milk supply, pumping, whatever, and it makes us feel like we’ve failed. Comparison is the number one way to have your joy and peace stolen. Stop looking at Becky over there with her oversupply and thinking your normal supply is inadequate for your content and growing baby. Stop looking at Gina over there whose baby has slept through the night since two months and thinking there’s something wrong with your happy child. Stop comparing your tiny but mighty that looks like the rest of your flock to my giant giraffe babies that look like the rest of my herd. You’re not getting a grade. Breastfeeding is not a pass/fail activity. Trust your baby. Trust your body. You’ve got this.

Do I need to wean when baby has teeth?

- Julie Matheney

When a baby is latched correctly, their tongue comes over the gums (and teeth) to cup the nipple and breast. If a baby is latched deeply, they physically cannot bite the breast. They may bite while unlatching or if they slide down the breast because of distraction or behavior. Never fear, you can safely continue to nurse once baby starts teething. I can’t guarantee you won’t get bit, but that’s another post.

Pumping Log: pumping for a toddler

- Julie Matheney

As  babies grow, there needs for milk also change. During the first year of life, after one month of age, babies need 20 to 30 ounces of milk per day. This need does not change until your baby reaches the first year milestone. From 1 to 2 years, babies need approximately 15 to 25 ounces of milk per 24 hour period. They get the rest of their nutrients from solid foods taken right from the table. Interestingly enough, infants need more calories but less protein than toddlers. Toddlers need fewer calories, but more protein in those calories. Just as your child’s nutrient needs to change, so does your breast milk. I have noticed a big drop in my pumped milk supply even though my daughter is still nursing. My daughter still nurses voraciously when she wakes up, kind of nurses when I get home, and usually nurses once in the middle of the night. When I’m home all day with her she does fewer nursing sessions and is SO easily distracted by herself and the environment. But she’s growing, is still having good wet and dirty diapers, and is happy!!! She is like a solid food vacuum.  She LOVES all kinds of berries, fruit, peas and carrots, beans, pasta, cheese and yogurt, chicken, beef, pork, and eggs.  She eats a nice variety with good toddler portions. Happy Pumping!!!

Wednesday: two pump sessions. Approx 4 ounces.

Thursday: 3 pump sessions, approx 6 ounces

Friday: Two pump sessions, approx 4 ounces

Ways to naturally boost milk supply without taking any herbs or supplements:

- Julie Matheney

Ways to naturally boost milk supply without taking any herbs or supplements:

⌛️Empty the breast more often. The more you empty to either baby or pump the more you’ll make!

🕰Feed on demand and not by the clock.

🤱🏽Keep baby in skin to skin contact with you, even as an older baby. This contact has a hormone reaction to naturally increase supply at any age.

💦Drink more water (at least 10-12 glasses per day)

🥗Eat between 2100-2500 calories per day of high quality protein, low in sugar and processed foods

🍷Drink alcohol and caffeine in moderation, and make sure to drink extra water if you do a both dehydrate and can decrease milk supply

🍆Have sex! The same hormone released during orgasm causes milk to be released for let down. Having sex naturally raises the level of this hormone in your body for 24 hours, making it easier to let down milk the next day!

🏝Relax and have a calm routine during pumping. Stress and distraction can inhibit milk let down for some even when there’s plenty of milk in the breast.

🎧Listen to music and place heat on your breasts while pumping. Several research studies have found by doing these things moms can pump up to 30% more milk!

📏Make sure you’re pumping with the correct flange size.

🛌When possible, avoid sleep training. Letting baby wake at night helps keep your milk supply naturally high as milk making hormones are highest at night.

💊Be careful you’re not taking any medications that drop supply like hormonal birth control, antihistamines and antibiotics.

What do my Labor and Delivery have to do with breastfeeding?

- Julie Matheney

All babies are born with innate instincts and reflex to get them to the breast soon after birth. Every baby, when placed skin to skin on their mother immediately after birth, will do the breast crawl and have a first latch within approximately 60 minutes of delivery, even medicated or c-section births. In the first 24 hours, babies are often sleepy. Waking for brief periods to feed and go back to sleep. The second day (and usually the second night) is when babies make up for the first day after delivery, ravenously cluster feeding for hours, much to the dismay of now extremely fatigued parents. But your labor has more of an impact on breastfeeding than you may realize.



We learning and understanding how our bodies prepare for breastfeeding during pregnancy, how what happens during labor and birth sets the stage for breastfeeding, and how the first minutes and hours after birth can have a lasting impact on the entire breastfeeding journey. The way baby is born  powerfully influences the first hours and days of breastfeeding. Unmedicated, vaginal birth sets the stage for problem-free breastfeeding, where biology, instinct and reflex can take center stage. In contrast, a complicated, intervention-intensive labor and birth increases the risk of problems.

How long you labor is really out of your control. The length of your labor may actually increase breastfeeding difficulty. For really long labors (over 24 hours), pushing for 4 hours or more, or very intense short labors, both you and baby may be so exhausted that rest and recovery take precedence over breastfeeding. Baby may be too tired to breastfeed often in the first few days, which increases your risk of not stimulating the breast well which in turn delays colostrum transitioning to mature milk and can decrease the overall volume your breast may be able to make in the future. Long, medically intervened labors also usually mean increased bags of IV fluids, which can cause excess fluid in your body which in turn delays the transition of colostrum to mature milk up to 10-12 days. It can also cause your hand, feet, and breasts to swell with extra fluid, called third spacing, which can make latching baby a challenge. (See my videos on Instagram about reverse pressure softening for help with this).

Events surrounding birth can inadvertently sabotage breastfeeding, as birth is supposed to be a well orchestrated series of events and hormone releases, setting you up for successful breastfeeding. Many of the birthing practices that are considered almost routine (induction, epidurals, separation of the mother and her baby for cleaning, weighing and foot printing) interfere with this hormonal dance resulting in poorer breastfeeding outcomes.

The routine progression of hormonal changes during  labor and birth perfectly prepares the body to breastfeed immediately after birth. During labor, oxytocin surges are responsible for increasingly stronger and more effective contractions. As oxytocin goes up, and the pain that accompanies the strong contractions increases, endorphins are released. High levels of endorphins help you cope with painful contractions and contribute to their becoming more instinctive. As the baby moves down the birth canal, almost ready to be born, catecholamines are released. The surge in catecholamines creates an energy boost and allows the baby is born with high levels of catecholamines as well (; ). This results in a vigorous, alert baby and an energized mother ready to breastfeed for the first time.

 

Skin to skin contact immediately after birth helps these same hormones continue to work in preparation of the first breastfeeding moment. Baby’s body weight on mom’s uterus, baby hand and head movements on her body, and then baby sucking at the breast stimulate even more oxytocin release (). Oxytocin helps the placenta separate and contracts the uterus further, preventing excessive bleeding. After birth, high levels of catecholamine in the baby insure alertness for the breast crawl and first latch. The endorphins present in mom pass on to baby through her breast milk, helping the baby stay calm and relaxed. After the first feeding, these hormones peak and allow both mother and baby 

Prolactin and oxytocin, the. milk making hormones, are released by baby’s sucking at the breast. Prolactin makes milk and oxytocin causes your letdown or release of milk. Prolactin, AKA “the love hormone”, is responsible for nurturing behaviors. Oxytocin makes you feel relaxed, sleepy, or calm feelings during milk letdown. 

All Labor pain-relief drugs have been shown to delay the onset of milk production and increase the risk of breastfeeding difficulties. This was well documented in a 2014 study by Lind et al. Pitocin, unlike naturally occurring oxytocin, does not cross the blood/brain barrier. As a result, the pituitary is not stimulated to release endorphins. Without the pain-relieving help of abundant endorphins, people who are induced with pitocin are more likely to require epidurals. In a vicious cycle, whenever an epidural is given and all pain is removed, naturally occurring oxytocin levels drop, requiring increased amounts of pitocin to continue contractions (Lieberman & O’Donoghue, 2002). Without the high levels of oxytocin and endorphins that would normally be released, a surge in catecholamines does not occur immediately before birth. This hormonal disruption during labor results in women giving birth with relatively low levels of naturally occurring oxytocin, endorphins, and catecholamines. Consequently, the outcome of low hormonal levels is a less responsive mother and baby which in turn impacts vigor at the breast ().

The medication used in the epidural does, in fact, “get to the baby.” Epidural narcotics or anesthetic drugs cross the placenta and can be found in cord blood. More research is needed, but we are starting to learn the neurobehavioral effects of medicated deliveries. Babies exposed to epidurals have a higher risk of have difficulty with latching on and an uncoordinated suck/swallow response for hours or days after birth (; ). Epidurals are also documented to lengthen the second stage of Labor and increase the likelihood of needing a C-section. The trauma of c-section birth, versus the natural positioning of coming through the birth canal, can make it painful for baby to assume the natural, instinctive positioning for breastfeeding and can make it difficult to latch. 

Elective induction of labor is also a risk to breastfeeding because of the potential of added intervention and the increased likelihood of the baby being born prematurely. The more premature a baby is, even at 37-38 weeks, the more immature and uncoordinated sucking and swallowing can be. Babies practice the coordination of sucking and swallowing in utero without expiation to feed, so the longer they are able to practice in utero, the more coordinated and ready they are to feed at birth.

So now what? You’ve had the baby and had a long, medicated delivery. Knowledge is power. You cannot change your birth story, but you can influence your breastfeeding journey.

  • Keep baby in skin to skin contact as long dn often as possible to help restore your oxytocin levels. Every 60 minutes 1-2x/day has been found to exponentially increase milk supply
  • Offer the breast frequent and often. Work on getting baby into a good position to ensure a deep latch
  • If you are separated from your baby or baby is super sleepy, hand express and/or start pumping. You will want to hand express or pump every 2-3 hours during the day and every 3-4 hours at night. You will get more colostrum from hand expression than pumping int he first three days, but pumping will help stimulate the nipples. Don’t be discouraged if you see little milk from a pump. The stimulation is needed until baby is able to latch
  • Stay hydrated and eat good foods full of protein
  • Use a paced bottle feeding technique and try not to over feed baby if you need to supplement. Always supplement with your own milk first, followed by formula. Babies need very little milk in the first 3 days.
  • Find lactation help as soon as possible to help create a plan to get breastfeeding back on track
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Natural Weaning from the Breast

- Julie Matheney

NATURAL WEANING

Natural weaning is the biological process of gradually decreasing milk supply as baby gets older. This process starts around 7-9 months as baby takes more solid foods and progresses toward sleeping longer stretches at night. It ends when baby finally weans (which may not be until 2-3 years old!!). Natural weaning doesn’t mean that you need to wean baby from the breast. Decreasing milk supply doesn’t mean you’re at risk of losing your supply, either. Your breast is designed to match the stage of development your baby is in. 

Milk supply iss highest from month 1-6 when baby is going through multiple growth spurts. They need to double their birth weight by 6 months. Milk is also the only food in their diet.  Therefore, your milk supply is supposed to be at its highest to meet their nutritional needs. From 6-12 months, weight gain slows but their need for milk volume needs remain stable. It is natural as baby transitions from a full milk diet to a milk+solids diet to then a solids+milk diet that breast milk supply will shift along with it. Your milk supply varies compared to baby’s solids intake and there is a wide range of normal based on your individual baby. Some babies love solids and eat them in large quantities many times a day. Other babies continue on a mostly milk diet until almost 1 year.  At 12 months, milk finally takes a back seat to solids, but still fills in nutritional gaps and acts like medicine against illness. From 12 months on there continues to be a wide range of normal for milk supply depending on your child’s eating and feeding habits. Some babies continue to nurse occasionally over night while others seem to become boob barnacles again and would happily stay on the breast all day, every day.

So what does this mean? If you’re exclusively breastfeeding you may not notice anything.  You can continue to bring baby to breast for as long and often as baby wants. You may notice baby spacing out feedings or not nursing as long. They may want the breast more when teething or going through growth spurts or developmental leaps. They have days with little interest in the breast. 

Moms who pump (either exclusively or because of work) report overflowing milk in the early weeks, often able to pump 4-6 or even 8-10 ounces in a morning pump session. By 4 months supply regulates and mom gets about 3-5 ounces per pump in place of a feeding. By 9 or 10 months it can feel like your trying to wring out a wet rag to get even 2-4 ounces a pump session. As long as baby has unrestricted access to the breast when your not working and you still have a regular pump routine in place no intervention is usually needed. Every journey is supposed to look different because it is your unique journey.

Photo Credit Jermaine Love
@jermainelove44

One Breast or Two?

- Julie Matheney

SHOULD I OFFER ONE BREAST OR TWO WHEN BREASTFEEDING?

Just as no rule says you must eat the same amount at every meal, there’s no rule that says your baby must eat from both sides every feeding.

  • Factors that play a role in offering one side or two include your individual breast storage capacity, and milk supply, when your last feeding was, and your unique baby’s volume needs.
  • Storage capacity is not indicated by breast size, but by glandular tissue in the breast. People with lots of glandular tissue have a higher storage capacity in each breast regardless of the actual breast size. Their babies may only want one side per feeding as each side makes plenty of milk. Some people have smaller storage capacities and their babies will want to feed off of both sides (maybe even multiple times!) to get what they want.
  • You will get to know your breast storage capacity and how quickly your breasts make milk as you get to know your body and your baby.  Every feeding can also be different. There’s no right or wrong. Sometimes a baby will want both breasts if they’re really hungry and sometimes they’ll want only one when they just want to comfort nurse to sleep. Some times you may feel like you’re offering each breast 5 or 6 times in a feeding, rotating constantly!! NORMAL!!! Trust your baby and your body. You can always offer the second breast/side but don’t feel stressed if your baby doesn’t always want it. 

BREASTS ARE SISTER, NOT TWINS

You may also feel like baby always prefers one side or even does better feeding on one side!! That’s because breasts are sisters and not twins!!!! One side can be bigger, one side can make more. Nipples can even be different shapes and sizes, making one side easier to latch to from purely an anatomical perspective.

  • Around 70% of us produce more milk on the right. Which means 30% make more on the left. 
  • It is VERY common for one side to produce more than the other, often double. This is not a reason to neglect one side. You want to make sure you rotate which side you offer first. This can also cause one breast to be significantly larger than the other especially if you continue to only feed from one side.
  • Babies may prefer one side over the other for various reasons
    • They like to lay with their head in a certain direction
    • They prefer the flow (one side may flow faster or slower than the other)
    • They may prefer the flavor (YES!! Milk can taste different from each side during the same feeding!!)
    • They may have tension in their body from positioning during pregnancy or from trauma during birth.
  • If you want to help balance out a slacker boob, you can try offering the slacker first more often.
  • Ending on the slacker can also help, especially if baby just wants to use you like a pacifier.
  • Pumping the slacker side after feedings can also help stimulate more milk production.

Don’t stress too much about a slacker boob if it’s not an issue. If baby is happy, there’s really no need to fret over differences between your breasts. If you start to notice one side is increasing in cup sizes significantly from the other, schedule a consultation and we can get to the root of why baby only wants one side and we can work on it together.

How Much Breast Milk Does Baby Need?

- Julie Matheney

HOW MUCH BREAST MILK DOES MY BABY NEED IN A DAY?

How many ounces of breast milk should my exclusively breastfed baby be eating at a feeding? This is usually on the top five questions from families. The answer is: that depends.

  • Some babies are grazers. They like smaller, more frequent feedings to keep their tummy from being too full or uncomfortable. Their feedings can range from 1-3 ounces of breast milk and they may feed 10 or more times a day.
  • Other babies are bingers. They like a big, full tummy and may take 3-5 or even occasionally 6 ounces of breast milk but not as often. They may feed only 6-8 times a day and have longer sleep stretches. Their tummy doesn’t mind being stretched fuller and their bodies tell them it’s ok to go longer between feedings.
  • A helpful question to always be asking is: how many times a day is baby feeding? From one month to one year, babies take between 19-32 ounces of breast milk a day. The average is 25 ounces in 24 hours. There’s a range because, just like us as adults, some days we want to eat more than other days depending on the activities of the day, growth spurts, cravings, and even babies emotionally eat sometimes. Trust your baby to know their stomach better than you do. 
  • Babies get hungry frequently: 8-12 or more times a day. They drink so much breast milk because they grow so rapidly. They will double their birth weight by six months and triple their weight by a year. Imagine how much you would need to eat to double your weight in six months! You may feel like you feed your baby all the time, and you are. Every 1-3 hours in the first few months is normal!! Every feeding is different and breast milk volumes taken vary throughout the day. Sometimes you want a snack and sometimes you want a buffet. 
  • How is pumping going for you and can you keep up with his volume needs? Pumping is never an indication of your breast milk supply, it just indicates what your pump can empty from you. So many people have their breast milk supply sabotaged by baby being overfed from a quick flowing bottle, not enough time spent during the feeding, or interpreting baby’s cues wrong.
  • If your milk supply is keeping up with their demand there’s no problem. If you’re concerned about your baby’s feeding habits, definitely schedule a consultation with me.

Oxytocin

- Julie Matheney
Positioning tools and devices

Oxytocin is a hormone produced by the pituitary gland in the brain. It increases relaxation, lowers stress and anxiety, lowers blood pressure, and causes muscle contractions. Oxytocin, also called the mothering, cuddle or love hormone, is involved in social relationships, bonding, trust, and love. Breastfeeding stimulates the release of oxytocin from your brain.  When your baby latches on to breastfeed, the nerve cells in your breasts send a signal to your brain to release oxytocin. The oxytocin causes the muscles around the milk-making glands in your breast to contract, squeezing the breast milk into the milk ducts. The milk ducts then contract to push the breast milk through your breast, out of the nipple to your baby. This is called the let-down reflex. As baby continues to breastfeed, more oxytocin is released and milk continues to flow. You may experience 2-14 let-downs in one breastfeeding session! The release of oxytocin while you're breastfeeding may make you feel sleepy and relaxed. It can raise your body temperature and is one of the reasons you may feel so hot while nursing. It might also make you feel thirsty or even give you a headache!

Oxytocin can cause your milk to let-down when you're not breastfeeding. Hearing a baby cry, thinking about your baby or even smelling something that reminds you of your baby can trigger oxytocin flow and make you leak!! While oxytocin is responsible for the let-down reflex and the release of breast milk from your body, it has nothing to do with the amount of breast milk that you will make. Prolactin is the hormone that does that. 

Some people feel the oxytocin release (aka Let-Down) and others don’t. Both are totally normal!

Signs of let down include:

  • Tingling or a pins-and-needles sensation in your breasts. It could be a light sensation or even an electrical shock feeling.
  • Hearing baby swallow while at the breast.
  • Leaking milk from the other breast
  • Uterine cramps when breastfeeding, especially the first week.
  • Feeling happy and relaxed after you feed your baby.

Factors that inhibit oxytocin release and let down include: pain, breast surgery or trauma, stress, illness, fatigue, fear, embarrassment, drinking or smoking. 

Some mothers may breastfeed and let-down milk just fine to baby but struggle to release milk to an electric pump. A quality double electric breast pump will have two modes: a quick cycle/light suction or "stimulation" mode, and a slow cycle, hard suction of "expression" mode. By alternating several times between these modes in a pump session, you can trick your body into thinking baby is feeding to stimulate more let-downs of milk. When pumping, you can also help stimulate your body to let-down more often by:

  • Watching videos or looking at pictures of your baby
  • Smelling something that reminds you of your baby (a onesie, your baby shampoo or soap, lavender)
  • Listening to calming music
  • Using heat before and during pumping
  • Massaging your breasts before and during pumping
  • Eating a snack or drinking water while pumping

 

Foremilk/Hindmilk and Making Fattier Milk

- Julie Matheney
IMG_9459

How can I make fattier milk? I get this question a lot. Fat in breast milk changes constantly both throughout the day and as baby ages. It is predominantly influenced by how full/empty the breast is which tells your body how old your baby is. Newborns nurse around the clock and have a higher milk fat content than toddlers who may only nurse a handful of times a day and are getting their fats from table foods. Your diet does not usually have an effect on the quantity of fat present in breast milk but it can change the type- saturated, trans, monounsaturated, polyunsaturated.

I often get questions about foremilk/hindmilk as related to making a fattier milk. But what is fore milk/hindmilk? Is that even a thing? The breast only makes one type of milk, however, because of the way milk is released during a feeding, the fat content can change. Fats make up about 3-5% of the nutrients of breast milk and each ounce of contains about 1.2 grams of fat. Milk is made in the alveoli, which are grape-like clusters of cells at the back of the breast. Once the milk is made, it is squeezed out through the alveoli into the milk ducts, which resemble highways and carry the milk through the breast to the nipple. As milk is produced, fat globules in the milk stick to each other and to the walls of the milk ducts. As time passes, milk gradually moves toward the nipple as the breasts fill, pushing the thin watery milk forward while leaving the denser and fattier hindmilk behind (because the fat is sticking to the walls of the ducts). Shorter time between feedings or pumping a help keep the hind milk at the front of the breast. Think of it like turning on a faucet in the sink. 

At first, the water comes out cold and then gradually gets warmer until it is hot. If you come back a minute later and turn the faucet on again, it will still be relatively warm. However, if wait an hour, the water will be cold. You’ll have to wait for it to warm up again. Breast milk fat is similar.

When the baby first latches on, the higher-water content foremilk is released. Little by little the milk becomes fattier as fat globules are pulled down from the ducts. Frequent feedings or pumping mean the milk doesn’t have time to “get cold.” There is no switch that gets flipped – the change from foremilk to hindmilk is gradual. There is less foremilk for your baby to go through before they get to the fattier milk. Basically, the less time in between feedings, the higher the fat content at the beginning of that particular feeding.

Here are the best strategies to help increase the fat in your milk:

📌Nurse or pump more frequently. The fullness of the breast makes the most difference with the amount of fat in your milk. The fuller the breast, the more water content is in your milk because your body thinks baby is dehydrated from going a long time without feeding or that you have an older baby that is getting fats from table foods. The shorter amount of time you go between feeding or pumping, the higher the fat content in your milk. You will see a smaller volume, but a higher fat content.

📌Drain the breast. Let your baby completely finish on one side before switching to the other side. Emptier breast’s have higher milk fat content. 

📌Use your hands. Compressing and massaging the breast from the chest wall down toward the nipple while feeding and/or pumping helps push fat (made at the back of the breast in the ducts) down toward the nipple faster. 

📌Eat more healthy, unsaturated fats, such as nuts, wild caught salmon, avocados, seeds, eggs, and olive oil. 

📌 Increase your protein intake. This helps increase overall milk supply, which = more  fat for your baby. Lean meats, chicken, fish, eggs, dairy, nuts, and seeds are the best dietary sources of protein. Vegetarians if you do not get enough protein from your food alone, consider adding a protein supplement in your routine.

📌Sunflower lethicin. Often used to relieve frequently blocked ducts, this supplement works by decreasing the stickiness of breast milk by mixing the fatty parts of breast milk with the watery parts to make it “slide out” easier. Some people believe that this helps increase the fatty acids in milk at the beginnings of feedings, too. 

Switching baby too quickly from breast to breast while they are still actively sucking means that they aren’t getting enough time to let the fattier hindmilk unstick from the milk ducts.

 

TAKE AWAY:

Depending on your nursing pattern, it’s possible for fat content to be higher at the beginning of a particular feeding than it is at the end of other feedings. The longer the time between feedings, the lower the fat content at the beginning of the next feeding. If feedings are closer together, you’re starting off with a higher fat content. 

Because every baby varies in the amount of time it takes him to receive his fill of the higher-fat milk at the end of the feeding, it’s important not to switch breasts while baby is actively nursing.