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.

Taking longer to trigger a let down?

- Julie Matheney

It is normal for let-down not to feel as strong as baby gets older. Some of us never feel let-down, and some stop feeling the let-down sensation as time goes by. This does not necessarily indicate that let-down is not taking place. Remember, just because you don’t feel it or it feels different over time, or any mean it’s not happening.

Signs of let-down include:

• Uterine cramping during letdown in the first week postpartum

• Baby’s sucking pattern changes from a quick suck-suck to a rhythmic suck-swallow pattern as milk begins to flow

• Feeling of calm, relaxation, sleepiness or drowsiness.

• Sudden thirst

• Leaking from the other breast

• Tingling, pins and needles sensation, itching, nausea, headaches, or negative emotions

Things that can be the cause of a slow or inhibited let-down:

• Anxiety, pain, embarrassment, stress, cold

• Excessive caffeine use, smoking, use of alcohol

• Certain medications

• History of breast surgery where nerve damage that can interfere with let-down.

• In extreme situations of stress or crisis, the release of extra adrenaline in can reduce or block the hormones which affect let-down from a fight or flight response

• Sometimes a cycle is created, where baby fusses and pulls off because the let-down is slow, which makes mom tense up, which makes the let-down even slower, etc.

• It’s normal to have a harder time letting down for the pump than baby.

Later into your breastfeeding journey, you may notice it takes longer to trigger a let-down. This is common and what works early on may change over time. ⁣

Check for possible causes:

• Worn pump parts that need replaced. Replace the valves and membranes often. Check for worn tubing.

• Make sure you’re pumping with the correct flange size. Nipples may become more elastic over time and a different size may be used. ⁣⁣

• Starting your period or are you possibly pregnant? Both can decrease milk production and impact let-downs.

• New hormonal birth control or medication? These may impact supply.

• Check your body. Tension, pain, cold, fatigued or anxiety may block the neurochemical pathways required for milk let-downs. ⁣⁣

⁣⁣

Tips to trigger let down:

• Try a different pump or flange size

• Use heat, breast massage/compressions, or vibrations to prompt milk flow

• Orgasm. The same hormone released during orgasm also causes let down. Studies show having an orgasm can help let down

• Relax. Use slow, deep breaths and meditation

• Singing or humming can also speed let-down

• Gently massage your breasts. Stroke your breast towards the nipple with the flat of your hand or edge of a finger. Gently roll your nipple between your fingers

• Watch videos of your baby. Smell their clothing. Remember the feeling of let down

• Use all of your senses to facilitate let-down. Concentrate on the sight, sound, smell and feel of your baby.

• Take a warm shower or bath prior to nursing

• If you are in any pain, consider taking a pain reliever about 30 minutes before you feeding. Pain can cause stress and inhibit let-down.

• Choose a calm, less distracting setting

• Turn on music or a tv show that you enjoy

• Skin to skin contact with your baby: Undress baby to their diaper and yourself from the waist up. Stay like this for 1-2 hours prior to a feeding

• Eat a favorite snack and drink a comforting beverage like warm tea

• Get comfortable. Sit in a comfy chair or lay in bed. You should be in a comfortable position

• Switch nurse: move baby back and forth frequently between breasts until let-down occurs

• Nurse in a warm bath

• Reverse pressure softening helps let-down for some moms.

• Visualization. Take several deep breaths and close your eyes as you begin. Try to visualize and “feel” what the let-down response feels like for you (if you normally feel anything). Imagine milk flowing or use images of waterfalls. An excellent book on visualization techniques is Mind Over Labor by Carl Jones.

• Distraction: watch TV, read, talk to a friend, don’t watch the pump bottles.

• One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study. (Reference: Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.)

Vernix, delayed bathing, and breastfeeding

- Julie Matheney
My little Peach right after birth

The vernix caseosa is a greasy, cheese-like coating that covers baby’s skin in the womb to protect their skin from getting pickled by amniotic fluid prior to birth. According to present knowledge, vernix production is unique to humans. At birth, vernix may cover the entire skin surface or only be found in body folds. Its color may actually help indicate intra-uterine problems or disease.

😳In utero: When swallowed by baby in utero, vernix helps:

• Develop the gut

• Prevents loss of electrolytes and fluids

• Seals the skin to prevent the amniotic fluid from turning baby into a raisin

• Acts as a microbial barrier from pathogens

• Protects skin growing underneath it

😳In birth: The oily texture may naturally lubricate the birth canal to reduce friction as baby makes their exit. It can also help with mother’s perineal healing!

😳 In postpartum:

• Vernix protects baby’s skin from drying out

• Reduced risk of bacterial infections

• Help baby retain heat

😳 In breastfeeding: The scent of vernix might be involved in triggering neural connections in babies’ brain needed for breastfeeding. The immune proteins found in vernix and amniotic fluid are similar to those found in breastmilk. Swallowing vernix and amniotic fluid in utero help coat baby’s lungs and digestive tract, preparing the digestive tract for the similar peptides found in breastmilk. The smell may also help baby find the breast!

The majority of the vernix is absorbed within the first day, so so it’s recommended to wait until after the first 24 hours to bathe baby. Vernix doesn’t fully absorb until day 5 or 6, so it’s best to wait until then.

Weight loss and breastfeeding

- Julie Matheney

Breastfeeding fact: breastfeeding helps you burn calories because it takes calories to make calories. We need on average an extra 300-500 calories per day in our diet because our bodies need approximately 20 calories to make an ounce of breast milk. Not everyone will lose weight while breastfeeding. It depends on and how many calories they take in and how their body uses those calories related to their individual milk production. Food choices, hydration, activity levels, and genetics also all play a role on weight loss while breastfeeding

Weight loss and breastfeeding

- Julie Matheney

Breastfeeding fact: breastfeeding helps you burn calories because it takes calories to make calories. We need on average an extra 300-500 calories per day in our diet because our bodies need approximately 20 calories to make an ounce of breast milk. Not everyone will lose weight while breastfeeding. It depends on and how many calories they take in and how their body uses those calories related to their individual milk production. Food choices, hydration, activity levels, and genetics also all play a role on weight loss while breastfeeding

Perspectives on breastfeeding

- Julie Matheney

PERSPECTIVE

“My hospital nurse told me to feed baby every 2 hours with 15mL and my pediatrician told me to feed baby every 3 hours with 30mL.”

“My IBCLC told me there is a tongue tie but the ENT said there wasn’t one.”

“One consultant told me to use a nipple shield as lo as needed. The other said get off as quick as possible”

“They said don’t let baby feed more than 10 minutes per side, but my baby won’t stay latched that long.”

I hear this all the time in my practice and it can be confusing for families. Why did I get different advice from different people? Perspective. Doulas, midwives, pediatricians, even lactation consultants all come from their own training, education, clinical practice and personal experience. When in doubt, the best person to get lactation advice from is an IBCLC. They have had to go through extensive training and mentoring to become certified in the study of human lactation. But remember: even lactation consultants come from different perspectives.

A hospital based IBCLC typically only works with babies in the first 2-4 days after birth and may see dozens of babies in a week, getting only a short amount of time with each family. A private practice IBCLC may have more time to spend with you but experience and expertise may vary. An IBCLC who is also a nurse will approach breastfeeding differently than one who is also a feeding therapist or who started out as a mother who struggled to breastfeed and became passionate to help others going through what she went through. My best advice is find some one who listens to you, educates on why they want you to do something, and supports you in your journey. Because you have a unique perspective, too.

Lauren Archer, Love of a Little One doula, takes a picture of my midwife and newborn
This is the same image from Lauren’s perspective

Do I need to drink milk to make breast milk?

- Julie Matheney

Humans by design are predisposed to be lactose intolerant. The only reasons Westerners (mostly) lost this intolerance was due to centuries of eating cheese and having their bodies evolve to adapt to consuming it. Lactose is the number one sugar in breast milk. It’s broken down by an enzyme called lactase which is supposed to disappear in early childhood, right around the time we would naturally wean. Asian cultures are predominantly lactose intolerant because their cultures have had cuisine sans cheese and cow’s milk for millennia (think traditional Japanese, Chinese, and Korean dishes. No cheese. No cow’s milk.) Yet in Western cultures it’s occasionally encouraged to drink milk to make milk. There is no scientific evidence to back this up. You do not need to drink cow’s milk or eat dairy in large quantities to make breast milk. You do need to stay hydrated, eat quality foods, and routinely empty the breast.

Whats that smell?

- Julie Matheney

SWEATY AND STICKY

Do you feel hot, sticky, sweaty, sopping wet and a little stinky? Welcome to motherhood. It does get better. There is an actual biological point to leaking from every pore and that weird stench that accompanies it.

Not all of our senses are developed at birth. It would overwhelm our littles too much to go from a dark, wet environment to such a bright, crazy world to actually have every sense developed like ours. Their vision isn’t great and they have no depth perception. But they have a fully developed sense of smell. They have been getting to know your odors since their womb days. Your amniotic fluid was constantly changing in its scent based on what you ate and drank and your unique hormone combination. All that leaking you’re doing postpartum has a similar scent which serves to orient your baby back to you. Your body odors are familiar to your baby and it makes them feel safe and secure that they are with their birth person and not someone else. Your leaking smells also stimulate their hunger, which is why baby may constantly root when on your body even if they aren’t hungry. Did you know that the breast secretes an oil from those little bumps on your areolas that smells just like amniotic fluid? This helps baby locate dinner when they are ready to eat. Showering is normal, but avoiding the use of scented products can actually be very helpful and calming for your baby. While you may find your body odor unbecoming, know that to your baby it makes you feel like home.

Caffeine and Breast Milk

- Julie Matheney

Caffeine is safe to take while breastfeeding in moderation (up to 300mg per day). Only about 1.5% actually enters breast milk. Caffeine enters your bloodstream about 15 minutes. It peaks in your blood within 60 minutes and has a half-life of 3-5 hours. The half-life is the time it takes for your body to eliminate half of the drug. The remaining caffeine can stay in your body for a long time. The half-life of caffeine is about 97.5 hours in a newborn, 14 hours in a 3-5 month old baby and 3-5 hours in a baby older than 6 months. Because caffeine takes much longer to clear out of a young baby’s system it is possible that high caffeine intake can make a baby irritable. If baby is sensitive to the caffeine now, they may not be when they’re older. Cut caffeine now and try again in a few months.

So if you drink a cup of coffee with 100mg of caffeine at 7am, you’ll have 50mg of caffeine in your bloodstream at 10am. Your baby would get 1.5mg of caffeine.

Every baby is different in how they react to caffeine. If you drank coffee while pregnant, your baby had an IV of caffeine (called the umbilical cord) and is already used to having it in their blood stream. If you didn’t drink coffee or switched to decaf, your baby may have a more noticeable reaction when you drink coffee. When drinking coffee after birth, go low and slow. There’s nothing you can do to decrease caffeine in your system except time. Start with a very small cup first thing in the morning and see how your baby reacts. Drinking your morning cup of coffee while your breastfeeding gives you the most time for the caffeine to peak and start decreasing before your next feeding.

Nipple Damage: Now What?

- Julie Matheney

It’s normal to experience nipple tenderness for the first few days after delivery. Tenderness peaks between the 3-6th days postpartum and then should resolves by the end of the second week. Any damage to the skin of the breast or nipple should be taken care of immediately to avoid further damage or infection.

Painful breastfeeding is not normal.  The first step to decreasing pain while breastfeeding is to identify what’s causing it. Usually the simplest way to reduce nipple pain is to make sure baby is in the right position. Baby’s tummy should be touching mom’s body, with the belly button touching. Baby’s arms hug the breast and their face comes straight to the nipple. Baby’s Head should be straight, with their ear, shoulder and hip making a straight line. Their head should be slightly extended backward to allow the nose to pop up off the breast. Pulling baby in closer through the shoulders usually helps get a deeper latch.  If nursing is still painful, even with careful attention to latch and positioning, there may be other things at play. Usually there is a tongue/lip tie, tension in baby’s body like from a long labor and delivery (greater than 24 hour labor and/or more than 4 hours of pushing), or tension on baby’s body from intrauterine position (sitting really low for a large portion of pregnancy or being breech). Having the tongue tie released and/or doing tummy time and bodywork on baby should resolve the pain. If you’re working on release and baby’s body, consider the temporary use of a nipple shield to protect nipples, until damage is resolved and the underlying cause of the damage is managed.

When your nipples are already damaged:

Step one: Wash and Rinse Damaged nipples are prone to bacterial infection. Washing and rinsing damaged nipples can help prevent this type of infection. When bacteria grows in a wound, they create a bio-film that lengthens healing time. Baby’s saliva also fosters this bio-film. Washing cracked or fissured nipples gently twice a day with a gentle, fragrance free soap (not an antibacterial soap) and rinsing them with water can help remove the bacterial bio-film and allow faster nipple healing. Stop washing with soap once the nipples are healed. After every feed, rinse nipples with either clean water or a saline rinse. You can make your own saline rinse by mixing ¼ rounded teaspoon of sea salt with 8 ounces of warm water. Soak your nipples in this solution for 30-60 seconds. Soaking for longer may actually over hydrate your skin and increase cracking.

Step Two: Moist Wound Healing after washing and rinsing and/or soaking your nipples, dry and apply your antimicrobial ointment of choice. This could be virgin coconut oil, Dr Jack Newman’s All Purpose Nipple Ointment, or medihoney. There are other nipple balms and butters on the market. Make sure the one you’re using is antimicrobial. While you may think airing the nipple out will help scab the nipple over, Keeping cracks covered with some type of ointment promotes moist wound healing which is better for the sensitive nipple tissue which is a different kind of tissue than the rest of your skin. A non-stick wound pad, reusable breast pad, or a cooling breastfeeding gel may be placed over the ointment to keep your nipples from sticking to your bra or clothing. Ointment should be applied like chapstick, in a thin layer. Gently wipe off any leftover ointment before baby feeds. Disposable nursing pads should be avoided as these do not allow for good air flow and the quick wicking material tends to stick to nipples. Wool breast pads are preferable for their antibacterial and air flow properties.

Monitor for Infection Contact your primary caregiver physician and an IBCLC lactation consultant if you have any signs of infection like increasing redness, fever, or pus. If you have a fever of 100 degrees or greater for 24 hours, or bacterial infection which will require oral antibiotics. Research suggests that taking probiotics containing lactobacillus fermentum and lactobacillus salivarius can also help treat bacterial infections of the breast.

My baby mouth breathes: when should I be worried?

- Julie Matheney

Babies are obligatory nose breathers. They should be breathing through their nose all the time. This is how they can have their mouth full with a nipple during breast or bottle feeding and still breathe. Mouth breathing isn’t as efficient as nose breathing — especially when it comes to oxygen absorption in the lungs. And breathing through the nose helps to filter out bacteria and irritants from entering the body. Babies should be breathing through their nose all the time, especially during sleep. And snoring with mouth breathing is NEVER normal.

Mouth breathing as an infant can indicate several things:

🤢Nasal congestion from an illness or allergies

😛Tongue tie

👀Large tonsils/adenoids

👃🏽Deviated nasal septum

🧠Learned habit

Prolonged mouth breathing can cause:

• Atypical development of the mouth, nasal passages and face

• Poor quality sleep

• ADHD

• Increased risk of asthma

• Swollen tonsils

• Dry cough

• Inflamed tongue

• Teeth issues, like cavities and bad alignment

• Foul-smelling breath

If you notice baby mouth breathing regularly (other than when sick), please make an appointment with a health care provider to help figure out the root cause.

• Stay away from your baby’s known allergens

• Gently push the chin upward to close baby’s mouth when sleeping

• Consult with a doctor as soon as you notice baby breathing through their mouth consistently

• Put a humidifier in their room to prevent their mouth from drying out

• Have tongue tie revised and work on suck training exercises, tongue posture, and body work for proper body posture to correct habits baby made from compensating for the tie