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.

What is that stench?!?

- Julie Matheney

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.

Photo credit Lauren Archer
@loveofalittleone

Coffee while breastfeeding

- Julie Matheney

An average cup of coffee contains 95mg of caffeine, but some types contain over 500mg. That’s important to be aware of when breastfeeding as it’s generally considered safe to drink up to 300 mg per day— about 2–3 cups of coffee or 3–4 cups of tea.

The caffeine content of coffee depends on many factors, such as:

• Type of coffee beans: different varieties of coffee beans naturally contain different amounts of caffeine.

• Roasting: Lighter roasts have more caffeine than darker roasts.

• Type of coffee: caffeine content can vary significantly between regularly brewed coffee, espresso, instant coffee and decaf coffee.

• Serving size: “One cup of coffee” can range anywhere from 30–700 ml (1–24 oz), greatly affecting the total caffeine content.

• One cup of brewed coffee (8 oz) contains about 70–140 mg of caffeine, or about 95 mg on average

• One shot of espresso is generally about 30–50 ml (1–1.75 oz), and contains about 63 mg of caffeine

• Instant coffee usually contains less caffeine than regular coffee, with one cup containing roughly 30–90 mg

• Decaf has about 0–7 mg per cup, with the average cup containing 3 mg

Want to enjoy a coffee alternative that gives all the feels while still being breastfeeding supportive? My two breastfeeding friendly favorites are @wearerasa and @milkstabrew.

Nipple Damage

- Julie Matheney

Nipples and penises have a lot in common. From an anatomical, cellular level, they are both made of the same elastic, erectile tissue. They erect and evert with stimulation. They can crack, bleed, and blister, but they can never toughen up or callous. And neither one should ever crack or bleed.

Babies mouths have two areas: the hard, bony palate up front and the soft palate at the back, just in front of where that little hangy downy uvula is. One of the reasons a nipple erects, everts, and stretches is to help to get it in the safe zone where the palate is soft.

When a baby is latched correctly, the nipple tip stretches back to where the palate is soft, then the tongue massages the nipple to express milk. If baby has a shallow latch, the tongue pinches the nipple tip against the hard roof of the mouth and causes damage. This also happens when there is a tongue tie where the tongue is restricted in its movement. Instead of the middle of the tongue massaging the nipple, the the tongue is anchored to the floor of the mouth and it flicks the nipple, or the middle of the tongue where the restriction is pinches the nipple against the bony palate.

Nipples are perfectly designed to withstand breastfeeding. Other than temporary tenderness in the first few days, there should be no pain or damage. If you do get damage, they should heal quickly (within 24-48 hours) if you can get a consistent deep latch.

Moist wound healing is most effective to heal a nipple. Tips to heal a damaged nipple:

💡Keep breast milk on the nipple. Using a washable breast pad can help keep milk on the nipple

💡Nipple balms/butters, coconut oil and lanolin can help keep the nipple from sticking to clothing and feel soothing

💡Breast gels

💡A 20 second saline rinse once or twice a day

💡Soak the nipple in an Epsom salt bath, either in a bowl or Haakaa filled with warm water

💡A prescription for Dr Jack Newman’s All Purpose Nipple Ointment for severely damaged nipples

💡Silverette cups for persistent damage

💡Temporarily use a nipple

💡Schedule a lactation consultation time get to the root of the damage

Silverette Cups to heal moderate to severe nipple damage

Where did my milk go?

- Julie Matheney

What can cause a late onset decreased milk supply?

1.The mother is pregnant again. Milk supply decreases during pregnancy. Domperidone will not work when the mother is pregnant.

2.The mother is taking some hormonal birth control method (pill including progestin only pill, IUD, etc)

3.The mother is breastfeeding on only one side at a feeding or “block feeding” (several feedings in a row on the same breast, used to treat “overabundant milk ejection, “overabundant milk supply”). I have posted on “block feeding” previously.

4.Some medications other than hormones can decrease the milk supply (antihistamines for example).

5.Can an emotional shock decrease the milk supply? Possible but unusual in our experience.

6.Blocked ducts/mastitis as well as any febrile illness may decrease the milk supply.

7.The use of bottles more than occasionally can very much decrease the milk supply.

8.”Overdoing it”. It’s time that others do most of the usual chores that fall on women’s shoulders.

9.An “abundant milk supply” associated with a less than “ideal” latch. In this situation, the milk flows into the baby’s mouth with little participation of the baby. The baby may often choke while breastfeeding, especially when the mother has a milk ejection reflex. A tongue tie is a common cause of a baby having a less than “ideal” latch and can be a significant cause of late onset decreased milk supply even if neither the mother or the baby had problems early on.

This problem of late onset decreased milk supply and accompanying symptoms is typically the problem of the mother who once had an abundant milk supply and milk supply may still be quite good, but less than it once was.

Breastfeeding and lactose, dairy, food intolerances and allergies

- Julie Matheney

Lactose is the number one sugar in breastmilk. It is the protein in cow’s milk that is difficult to digest for some babies. Human milk has human protein. It is easily digested by the stomach and absorbed in the intestines. The protein of cow’s milk is shaped different and not easily absorbed by the stomach and intestines as it’s designed to be absorbed by calves. It can sometimes make babies gassy or have poops that have bloody or mucous in them. Cow’s milk sensitivity or allergy can cause colic-like symptoms, eczema, wheezing, vomiting, diarrhea (including bloody diarrhea), constipation, hives, and/or a stuffy, itchy nose. Which can also be signs of other things. You could always try decreasing your dairy intake. Baby’s symptoms will usually begin to improve within 5-7 days of eliminating a problem food. Baby may not improve immediately, however, especially if the reaction is to a food that has been a regular part of your diet. Sometimes symptoms get worse before they begin to improve. It usually takes 2-3 weeks to see an improvement.

If baby is sensitive to dairy, it will not help to switch to lactose-free dairy products or put your baby in formula, which is cow protein based.

While culture may dictate what you can and cannot eat while breastfeeding, science does not. Most babies have no problems with anything that you eat. It’s generally recommended that you eat whatever you like, whenever you like, in the amounts that you like and continue to do this unless you notice an obvious reaction in your baby.

There is no list of “foods that every nursing person should avoid” because most of us can eat anything we want, and because the babies who are sensitive to certain foods are each unique – what bothers one may not bother another.

Babies’ guts are also constantly developing. So what bothers them as a newborn may not bother them the closer they get to a year.

Unless there are known food allergies in your family history or your baby is having severe reactions to what you think you may be eating, there’s no need to restrict what you eat. Remember: fussiness and gas is normal for a young baby, and is not usually related to foods you eat. If your baby is sensitive to something you are eating, you will most likely notice other symptoms in addition to fussiness, such as EXCESSIVE spitting up or vomiting, colic, rash or persistent congestion, crying inconsolably for long periods, or sleep little and wake suddenly with obvious discomfort. Other signs of a true food allergy may include: rash, hives, eczema, sore bottom, dry skin; wheezing or asthma; congestion or cold-like symptoms; red, itchy eyes; ear infections; irritability, fussiness, colic; intestinal upsets, vomiting, constipation and/or diarrhea, or green stools with mucus or blood. Fussiness that is not accompanied by these other symptoms and calms with more frequent nursing is probably not food-related.

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
  • Anderson G, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). 2003. In The Cochrane Library, 3. Oxford: John Wiley. [PubMed]
  • Baumgarder D. J, Muehl P, Fischer M, Pribbenow B. Effect of labor epidural anesthesia on breastfeeding on healthy full-term newborns delivered vaginally. Journal of the American Board of Family Practitioners. 2003;16(1):7–13. [PubMed] [Google Scholar]
  • Declercq E. R, Sakala C, Corry M. P, Applebaum S, Risher P. 2002. Listening to mothers: The first national U.S. survey of women’s childbearing experiences. New York: Maternity Center Association. Also, retrieved December 13, 2004, from  www.maternitywise.org/listeningtomothers. [Google Scholar]
  • Kroeger M, Smith L. J. 2004. Impact of birthing practices on breastfeeding: Protecting the mother and baby continuum. Sudbury, MA: Jones and Bartlett Publishers. [Google Scholar]
  • Lamaze International. 2003. Promoting, protecting, and supporting normal birth: Six care practices. Washington, DC: Author. Also, retrieved December 13, 2004, from www.lamaze.org/about/policy.asp and  http://normalbirth.lamaze.org/institute/default.asp. [Google Scholar]
  • Lamaze International. Six care practices that promote, protect, and support normal birth [entire issue]. Journal of Perinatal Education. 2004;13(2) [Google Scholar]
  • Lieberman E, O’Donoghue C. Unintended effects of epidural analgesia during labor: A systematic review. American Journal of Obstetrics and Gynecology. 2003;186(5):s31–68. [PubMed] [Google Scholar]
  • Matthiesen A. S, Ransjo-Arvidson A. B, Nissen E, Uvnas-Moberg K. Postpartum maternal oxytocin release by newborns: Effects of infant hand massage and sucking. Birth. 2001;28(1):13–19.[PubMed] [Google Scholar]
  • Newton N. The fetus ejection reflex revisited. Birth. 1987;14(2):106–108. [PubMed] [Google Scholar]
  • Odent M. 2003. Birth and breastfeeding: Rediscovering the needs of women during pregnancy and childbirth. East Sussex, England: Clairview Books. [Google Scholar]
  • Ransjo-Arvidson A. B, Matthiesen S, Lilja G, Nissen E, Widstrom A. M, Uvnas-Moberg K. Maternal analgesia during labor disturbs newborn behavior. Effects on breastfeeding, temperature, and crying. Birth. 2001;28(1):5–12. [PubMed] [Google Scholar]
  • Righard L, Alade M. Effect of delivery room routines on success of first breastfeed. Lancet. 1990;336:1105–1107. [PubMed] [Google Scholar]
  • U.S. Department of Health and Human Services & The Advertising Council. Breastfeeding awareness. 2003. Retrieved December 13, 2004, from http://www.adcouncil.org/campaigns/breastfeeding/
  • Uvnas-Mobert K. 2003. The oxytocin factor: Tapping the hormone of calm, love and healing. Cambridge, MA: Da Capa Press. [Google Scholar]