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.

Breast vs Bottle Feeding

- Julie Matheney

Did you know that babies use completely different muscles to feed from the breast than from a bottle? They use more of their tongue and jaw at the breast and more lips and cheeks on a bottle. Breastfeeding is also a more complex feeding process where a vacuum is made in baby’s mouth from the tongue forming a seal against the roof of their mouth. Babies don’t need to create as strong a vacuum in the mouth to still bottle feee, as they can compress the nipple and milk still flows.

Bottle feeding is not a developmental skill. There is no age when a baby needs to take a bottle if breastfeeding is going well. Historically, babies went from breast to cup. Bottles are a relatively new invention with the formation of rubber nipples. It is developmentally appropriate to start open cup drinking by 6 months. That means if you’ve been exclusively breastfeeding and need to go back to work or your baby is starting table foods, you can skip the bottle and go straight for a cup. Starting with a small cup, like a medicine cup, shot glass, or @ezpzfun Tiny Cup are great ways to start. Your baby has been watching you drink from a cup for months and understands how it works. Straw cups are also great at this age and many babies will get the hang of it in a few tries. Using a straw cup like the Honey Bear has the advantage of you being able to squeeze the milk up to baby to teach baby how to get the milk by sucking.

When did you start cup feeding? Want to learn more? I have many videos of cup and straw feeding on my YouTube channel. Link in bio!

Want to learn more? Consider taking my parent class, LATCHED

 

#cupfeeding #cupfeedingbaby #honeybear #honeybearstrawcup #6monthsold #6monthsbaby #6monthsoldbaby #breastfeeding

Weaning from a nipple shield

- Julie Matheney

Nipple shields are a commonly used tool in the lactation world. They may help a premature baby latch to give the baby time to mature and learn how to suck, prevent nipple damage from a tied baby, or be used when a nipple is flat/inverted (either from normal anatomical variations or because the breast is fluid overloaded from interventions during birth).  While there are many benefits to using a shield, are also risks, like the potential for decreased milk supply. Hopefully if you were given a shield, you were also given an exit strategy for weaning off of it. With any tool, make sure the reason you were given one has been addressed (giving a premature baby time to grow, doing oral motor exercises and a tie release, education that fluids during labor and delivery can temporarily make breast tissue swell and make nipples look shorter or flatter than they naturally are, etc). When you are ready to wean from one there are multiple strategies to help:

💡Start with the shield on and take it off after the first let down once baby is not as hungry/use it on the first side and not on the second side

💡Try without the shield once a day during daylight hours when baby is happy and not too hungry. Catching early hunger cues is imperative. If they’re crying, try a different time

💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible

💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch

💡Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible

💡Hand express to get milk flowing to keep baby interested

💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby

💡Try a different shield like the Lovi or Dr Brown’s which are thinner and give you more stimulation

Breastfeeding Rage

- Julie Matheney

Navigating the realm of breastfeeding grief is a poignant journey that many mothers undergo, a journey often unspoken. Whether faced with unexpected hurdles, feelings of inadequacy, or the necessity of early weaning, the emotional weight can be profound. The image of the envisioned breastfeeding experience might clash with reality, evoking a sense of loss. In these moments, seeking support becomes paramount. Opening up to friends, family, or professionals allows for a healing dialogue. It's crucial to validate these emotions, understanding that not every breastfeeding journey follows the expected path. Every mother's experience is unique, and the love and dedication as a parent remain the constant, irrespective of the breastfeeding narrative. Let's cultivate a compassionate space for sharing these experiences and supporting one another through the intricacies of breastfeeding grief. 💙🌸

Social media is filled with pictures of overflowing bottles and serene mothers cradling their content newborns to their breast. For many, though, the breastfeeding journey may not be what was planned for or expected, leading to intense emotions that go beyond frustration. Postpartum mood disorders, including postpartum rage, are on the rise. Postpartum rage, characterized by intense, often unexplained anger, can be heightened when breastfeeding expectations are unmet. It's crucial to recognize that this anger may, in fact, be a form of grieving as well. Whether hindered by physical challenges, birth trauma, societal pressures, or other unforeseen medical complications, the gap between expectations and reality can be a source of profound sorrow. Acknowledging breastfeeding rage as a potential facet of grief allows for a deeper understanding of these complex emotions. Seeking support, both emotionally and professionally, becomes paramount in navigating through these feelings.

#BreastfeedingRage #GrievingProcess #MotherhoodRealities #BreastfeedingGrief #MotherhoodJourney #SupportEachOther

Can you overfeed a breastfed baby?

- Julie Matheney
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Can you overfeed a baby? The answer is absolutely yes. You have a tiny human with a tiny human stomach. All of our stomachs can stretch to hold more capacity than what we actually need to take. The question is, is over eating a problem? We’ll take a look at this and strategies to understanding if whether your baby is over feeding and if it’s a problem or not.

Now we all know that it is very easy to overfeed from a bottle. Bottles have a hole in them that are instant and constant and absolutely yes, many bottle fed babies are over fed. Many times parents are watching the volume in the bottle instead of watching the baby for baby’s cues that they are ready stop. It also takes 20 minutes for the stomach to tell the brain that it’s full, so it is very easy for babies to take the large volume in a short amount of time and eat more than their stomach needs to, before the brain knows that it’s full. The mouth can still be hungry while the stomach is full so babies may show cues that they are still wanting to suck which parents interpret as cues that Baby wants to continue to feed, and because the stomach can stretch and hold more than it needs to, parents often overfeed from a bottle.

The big question is, can babies overfeed at the breast? The breast works different than a bottle. The breast needs to be stimulated to release milk and milk is released in multiple waves that take time to be triggered. Most young babies will take 15 to 30 minutes at the breast, which allows their tummy time to tell the brain that it’s full. As they age and become more efficient; they learn to listen to their stomach to help guide when to stop feeding.

It is still possible to overfeed at the breast. We usually see this for two reasons: either from the mother side or from the baby side.

On the mother side, the most common reason for overfeeding is the mother has an over supply of milk. There are several reasons for having an oversupply. First, it may be caused by using a Haakaa or a breast pump and overstimulating the breast to make more milk than it needs. This also drives up the letdown response, which makes milk flow faster than if the baby were just feeding at the breast without the over supply. In this case, baby takes too much milk too fast. Mother may also have an oversupply being driven by certain medications. The most common medication I see driving over supply is Zoloft. There are also different medical conditions that can be the reason for an oversupply such as a prolactinoma, which is a pituitary gland tumor, or uncontrolled thyroid disorders.  This would be diagnosed by a physician after bloodwork and other medical imaging. Lastly, some new parents who don’t have as much experience with babies may also interpret every cue as a hunger cue. Some babies are totally willing to keep eating even if they are full. If you offer me a cheesecake, I will totally eat the cheesecake even if I don’t need it. Some babies are also like this, they will always latch when offered the breast. Every time baby is put down to sleep in the crib, they cry. Or they sleep for 10 minutes and cry to be picked up. But these cues get misinterpreted as the baby is still hungry and the baby is put back to breast. Some babies are very willing to go back to breast and keep feeding.

Overfeeding  could also be on the baby side. Certain tongue ties will stimulate the breast into an over supply. These babies often use a quick suckle pattern which initiates the let down reflex from how the nipple is stimulated. These cases are complicated in that the tongue may be restricted in a way that the mother doesn’t have much nipple pain or damage, but her body is compensating for the baby not having full range of motion of the tongue. Babies with reflux may also over feed at the breast. They often want to nurse more to keep swallowing, which helps keep milk in the stomach. Breastmilk is a pain reliever and many babies with reflux learn that they would rather be swallowing milk down than bringing it back up as reflux. So frequently feeding helps them swallow more often, but it becomes a vicious cycle.

When does overfeeding actually become a problem? If baby is having a lot of negative symptoms related to feeding, and over feeding is determined to be part of the root, addressing the reason WHY there is overfeeding would be appropriate.

If the baby has digestive discomfort, and has a lot of reflux/excessive spit up/projectile vomiting with pain, severe gas or digestive pain, we would want to address over supply or other issues, causing this discomfort. If the baby is having green, frothy/foamy or watery poops, this is also a sign of too much milk too fast. These kinds of watery or green poops may be a sign of lactose overload, where baby is accessible too much foremilk due to an oversupply.

Another symptom to watch for that would lead us to believe overfeeding is a problem would be baby coughing, choking, or leaking milk during the feeding. If the baby just physically cannot keep up and is constantly struggling during the feeding, there would be a reason why we would want to reduce milk supply to help baby feel more comfortable at the breast. Although this may also be a symptom pointing back to a tongue tie driving the over supply, so just bringing supply down would not necessarily be the best answer in this case. We would want to determine if the oversupply is causing the coughing and choking or if an inefficient tongue is contributing to baby not being able to swallow efficiently.

Babies gaining weight too quickly or faster than expected can also be a symptom that baby is being overfed, however, this is my symptom of least concerned. If the baby is gaining happily with no digestive discomfort, poops are a normal color and consistency, and is not leaking, coughing, or choking during feedings, fast weight gain alone would not be a concern. Many typically feeding babies with mothers with a normal supply can gain weight quicker than anticipated and then level off in weight once they become more active or distracted.

Yes, it is occasionally possible for breastfed babies to overfeed. If there there are symptoms happening (recurrent plugged ducts and mastitis for mother from an over supply, nipple pain and damage, coughing/choking baby, digestive discomfort or concerns with poop), working with an IBCLC lactation consultant can help determine what the root is (excessive pumping, medications, tongue tie, reflux, etc) to help balance the dyad for happier feeding.

How much breast milk does a newborn need?

- Julie Matheney

For the first few months after delivery, when hormones are balanced and the breast is well stimulated, the breast makes lots of milk. Research shows at any given feeding, breastfed babies take 65-80% of the available milk in the breast. When feeding is well established, most babies eat until they are full, not until the breast is “emptied”. In fact, the breast is constantly making milk and can never truly be emptied. Your body knows a young baby is growing quickly and frequently cluster feeding, so your body has milk available all the time. This is why people can create a stash. They are pumping the extra milk that baby leaves behind.

Efficient and frequent milk removals helps to produce more milk quickly. The extent to which the breast is drained during a feed is what research has shown to drive milk production. The more often a breast has milk moved from it, the faster milk is made to replace that milk. The longer you go between feedings, the slower milk is eventually is made. Breastmilk fat/calorie content is also driven by a similar mechanism. The fuller the breast, the lower the fat content of the milk; the body thinks baby is dehydrated and focuses on hydration. The more often milk is moved, the higher the fat content of the milk; your body knows baby is in a growth spurt or needs higher fat to help sleep. If you go multiple days with fuller breasts where less milk is being moved, supply will drop to protect the breast from sitting milk which has a higher risk of inflammation that causes plugs and mastitis.

As baby ages, this extra milk goes away and your body makes what baby is routinely taking. Because your body AND your baby become more efficient. If you think baby isn’t moving milk well, and supply is suffering for it, it is important to address it as early as possible.

Research: https://publications.aap.org/pediatrics/article-abstract/117/3/e387/68590/Volume-and-Frequency-of-Breastfeedings-and-Fat?redirectedFrom=PDF

#breastfeeding #breastfeedingsupport  #lactationconsultant #lactation #milkproduction #pregnancy #postpartum

Why does my breast pump hurt? Can my breast pump cause plugged ducts and mastitis?

- Julie Matheney

You would think that the stronger a breast pump can suction, the better. But before you crank that pump to the highest setting, make sure you know the benefits (and risks) of doing that. Breast pump suction power is measured in mmHG (millimeters of mercury), the standard unit of measuring vacuum pressure. Studies were done on babies sucking at the breast and breasts pump suction levels are based off what we know of how babies remove milk from the breast. The suction level, or vacuum, is different than the cycle speed, which is how fast it pumps. This is why breast pumps should have two settings: cycle (speed) and vacuum (strength). Most pumps will cycle at 40-70 cycles per minute. This is based off of the average number of sucks a baby does at the breast in that same amount of time. Every baby sucks are their own pace and with their own vacuum strength.

Every pump has its own max suction strength that it can reach. “Hospital grade” pumps generally have maximum suction levels in the 300+ mmHg range while personal grade pumps are generally in the 200+ mmHg range. This doesn’t necessarily make a pump better or worse. The highest suction level on most pumps are actually above the comfort zone of the majority of pumpers. Most people feel comfortable expressing in the range of 150 – 200 mmHg regardless of whether the pump can reach 250 or 350 mmHg at its max. Using the suction too high, especially in combination of the wrong size flanges, can hinder milk flow and be the root cause of plugged ductsmastitis, dropping milk supply and breast/nipple damage!

Think of it like drinking from a milkshake with a narrow straw. When you suck too hard, the straw starts to collapse on itself and the shake is really hard to drink. Milkshakes move better with gentle, consistent sucking that doesn’t collapse the straw. Milk ducts are like compressible straws inside the breast that move milk from the milk-making glands called alveoli to your nipple pores in your nipple to your baby. Not only does everyone have a different number of these ducts, but the diameter of the ducts also varies from person to person. Too much breast pump suction compresses the areolar tissues which pinches off the ducts and actually decreases the flow of milk to the pump. With time this can cause milk to back up in the breast, increasing the risk of plugged ducts. This can also foster inflammation and risk damage. This also leaves milk behind which eventually can drop your overall milk supply. Having the right size flange AND using enough suction to move milk but not compress the ducts is essential to a happy pumping journey.

Need to treat mastitis fast? CLICK HERE FOR MY VIDEO ON MANAGING MASTITIS

 

Click the picture for the new mastitis protocol from the ABM

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Why is my baby a lazy feeder?

- Julie Matheney

We are a survivalist species. Our babies are born with instincts to survive. They cry when they are put down because they know they are vulnerable to temperature and can’t feed themselves. They use their senses to find their food source and are familiar with their parents over strangers by sound and smell. They have reflexes to help them learn critical motor patterns for development.

When a baby isn’t feeding well, it isn’t because they are lazy. Lazy is a character trait for someone who volitionally doesn’t want to do something. If a baby didn’t feed well, historically that baby may not survive. We need to find the reason why they aren’t feeding well and address that.

Reasons a baby may not feed well at birth may include:
⏱️Prematurity. When a baby is born before 36 weeks, there is often a lot of support and expectation set that baby may need time to learn to feed. But 37 and 38 weekers are the great pretenders. They look like full term babies but often don’t feed like them. They may need 4-6 additional weeks to figure out how to feed because they really needed those extra few weeks to practice sucking and swallowing in utero without the expectation to coordinate swallowing as well
💊Medications. Medications cross the placenta to baby, and while most are safe, babies can have withdrawal symptoms from certain meds after birth, making them sleepy. These could be medications given during labor and delivery or even medications mother was taking during pregnancy. As these medications clear from baby’s system, they will perk up. Other medications, like SSRIs, can continue to make babies sleepy
👅Tongue and lip tie. The tongue needs to move in and out, side to side, and up and down. Babies need to protrude the tongue over the gums and keep it out while pumping the tongue up and down to effectively move milk from the breast. Ties can restrict this movement and make it challenging to feed.

If your baby isn’t feeding well and you’re being told they’re lazy, ask why. That isn’t a valid reason. If you’re struggling to feed your baby, work with a baby feeding expert: the IBCLC lactation consultant. #newmom #newborncaretips #prematurityawareness #prematurity

ORAL MOTOR EXERCISES FOR THE TONGUE TIE BABY

Want to learn more? Take my Tied and Untied parent course CLICK HERE

Will peppermint drop my milk supply?

- Julie Matheney
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Peppermint is a popular flavor during the festive Christmas season, and it's often found in candies, teas, and other treats. While peppermint is generally considered safe for consumption, there is a traditional belief that it may have an impact on milk supply.

Some people claim that peppermint, particularly in the form of peppermint tea, might potentially decrease milk supply. However, scientific evidence is limited and has yet to support this as true. A 2020 study found that Menthol did suppress milk production in mice. Menthol is a chemical naturally found in peppermint and other mint plants, but it can also be made in a lab. It's essential to note that individual responses can vary, and not every breastfeeder will experience a noticeable effect on milk supply when consuming peppermint.

If you're breastfeeding, enjoy your peppermint mocha during the holiday season. Pay attention to your body's response, and if you have concerns about your milk supply, consult with an IBCLC lactation consultant for personalized advice.

I believe the REAL reason why we see supply drop at the holidays isn’t the peppermint consumption, but being off normal schedules and routines, traveling, and having the baby be passed from grandma to aunt to friend where hunger cues are being missed and feedings delayed. In general, maintaining a well-balanced diet, staying hydrated, and responding to your baby's feeding cues are crucial factors in supporting a healthy breast milk supply. Enjoying holiday treats in moderation, including those with peppermint.

High Lipase: My breast milk tastes soapy

- Julie Matheney

Have you heard of high lipase in breast milk? Lipase is an enzyme that helps break down fat in breast milk. The breakdown of the fat in breastmilk by lipase is normal but not noticeable when the baby is feeding directly at the breast. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or soapy after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it.

 

How do you know if you have high lipase?

  • Test prior to freezing – Before freezing large amounts of breast milk, you can test it for odor and taste changes due to lipase. Collect and freeze 1-2 bags or small containers of breast milk for at least 5 days and then evaluate the odor to see if your baby will drink it.

What can you do if you have high lipase?

  • Freeze milk as soon as you pump it whenever possible
  • Reduce intake of polyunsaturated fatty acids
  • Scald you’re milk prior to freezing 
  • To scald fresh milk: Heat it in a pot until tiny bubbles form around the edges of the pan (approximately 180° F) but don’t boil it. Remove the milk from the stove and allow it to cool before freezing.

Scalding fresh milk will stop the enzymes from breaking down the fat, preventing that soapy smell and taste. Scalding milk does reduce some of the beneficial components in breast milk, however, so give your infant fresh breast milk whenever possible.

To scald milk:

  • Heat milk to about 180 F (82 C), or until you see little bubbles around the edge of the pan (not to a full, rolling boil with bubbles in the middle of the milk).
  • Quickly cool and store the milk.

Scalding the milk will destroy some of the immune properties of the milk and may lower some nutrient levels, but this is not likely to be an issue unless all of the milk that baby is receiving has been heat-treated.

Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 156-158, 203-205, 771, 781.

Lawrence RA. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr Suppl. 1999 Aug;88(430):14-8.

Have a ton of freezer milk with high lipase? Some babies don’t mind the flavor and will drink it anyway. If you’re won’t, Before pitching it, consider trying the following:

  • Mix frozen milk with fresh milk to make it more appetizing to baby
  • Some moms find adding a few drops of alcohol free vanilla extract can mask the lipase flavor. 
  • Use it for a milk bath which can help with dry skin

Milk taste rancid or metallic? That's not lipase, the cause may be chemical oxidation (Mohrbacher, p. 461). Reducing intake of polyunsaturated fats may help. Certain minerals or metals in drinking water may also be to blame like copper or iron ions. When this happens, Mohrbacher has a few suggestions to try:

  • Avoid your usual drinking water (either drinking it or having milk come into contact with it) by using bottled or reverse osmosis filtered water instead
  • Avoid fish-oil and flaxseed supplements, and foods like anchovies that contain rancid fats
  • Increase antioxidant intake (including beta carotene and vitamin E like berries, spinach, beets, and beans).

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010: 460-461.

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Do I need to pump overnight to maintain milk supply?

- Julie Matheney
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There is a science in how breast milk is made and maintained. The MOTN is when hormones are highest for making milk. Milk removals overnight drives a fuller supply all day long. Strong sucking at the breast overnight also plays a role in delaying periods from returning. Periods have their own cyclical impact on milk supply. The biological body is expecting to directly feed the baby. It doesn’t know we live in a modern era with pumps and freezers. When milk is not being moved, your body correctly assumes the baby is being fed by some other source and drops milk supply to protect the breast from plugs and infection. 

Tiny babies have tiny bellies that need to be fed day and night. As baby grows, so does the size of their stomach. There is no magic weight or age when a baby should stop feeding overnight. There is no scientific evidence to back that up. What we do know is the majority of breastfed babies are nursing at least once a night, if not 2-4 times, until after the first birthday. 

Producing breast milk is about demand and supply. What you move is what you’ll make. If you stop moving milk, your body thinks that milk is no longer needed, and decreases milk production. If your supply is constantly being moved, your body keeps producing more milk. While there is a science behind making milk, your body is art and your anatomy is unique to you. Some breasts have a large storage capacity and can hold more milk before seeing a drop in supply while others hold need milk moved more often to maintain supply. There are some people who can go 6-8  or even 10 hours and still maintain a full supply while others will see a drop when going more than 3-4 hours between feeding and pumping.

Feeding (or pumping) over night and milk supply are linked. If you’re making adequate milk during the day while sleeping long stretches at night, AWESOME!! If you’re going long stretches at night and day supply is dipping, that may be contributing. 

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