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.

Sudden Breast Milk Supply Drop

- Julie Matheney
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Occasionally I’ll hear of moms who had a well established milk supply and all of a sudden their supply drops. What can cause a late onset decreased milk supply?

🤰🏽Pregnancy. Milk supply drops during pregnancy because of hormone shifts to protect and grow the fetus. Domperidone or other milk making herbs/medications and more pumping or feeding will not work to increase supply

💊Hormonal birth control (pill including progestin only pill, IUD, etc)

🤱🏽Breastfeeding on only one side at a feeding or “block feeding” to correct an oversupply if done too long or with a small storage capacity

💊Some medications can decrease the milk supply (antihistamines, decongestants). Certain herbs in excess or as essential oils can, too (too much peppermint or sage)

🛌 Sleep training. Babies are supposed to wake often at night for the first 3 months and continue to frequently wake through 6 months and occasionally wake there after to feed. Night nursing keeps milk hormones high for making supply and sleep training prior to 3 months can sabotage milk supply

😷Blocked ducts/mastitis as well as any illness with a fever may decrease the milk supply

🍼Giving bottles can very much decrease the milk supply if you’re not pumping to replace those feeds. When at all possible, pump whenever baby is getting a bottle, regardless of if it is formula or breast milk being given

🎡”Overdoing it”. Anything that interrupts feeding baby on demand, including too many visitors, too many errands, or making baby wait to feed by the clock

🚿An “abundant milk supply” associated with a less than “ideal” latch. The milk flows into baby’s mouth with little participation of baby. Baby may often choke while breastfeeding, especially during a strong let down. 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 there were no feeding problems early on. Baby was riding an over abundant supply instead of stimulating milk supply
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#milksupply #milksupplybooster #breastmilkbooster #breastmilksupply #breastmilkmagic

Breastsleeping

- Julie Matheney
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Let’s talk about co-sleeping and bed sharing. The recommendations from the American Academy of Pediatrics and the Safe to Sleep program for a safe sleep environment include:
💡Baby on his/her back
💡Use a firm sleep surface
💡Room-sharing without bed-sharing
💡Avoid soft bedding
💡Avoid overheating.
Additional recommendations from the AAP to reduce SIDS include:
💡Avoid exposure to smoke, alcohol, marijuana, and illicit drugs
💡Breastfeed your baby
💡Immunize
💡Use a pacifier

The Academy of Breastfeeding Medicine had a protocol for safe sleep and co-sleeping/bedsharing which is highly protective of SIDS called “breastsleeping”; baby feeds at the breast during the night. When mom and a full term, healthy baby share a firm mattress (not a couch or water bed) with no blankets or pillows that could possibly cover baby’s head or face and mom’s body forms a “C” shape around baby’s body, this position is safe and protective of baby and allows for optimal breastfeeding over night.

This allows baby to sleep on their back next to mom when not directly breastfeeding. This is for healthy babies. Babies should be unswaddled to avoid overheating and moms with long hair should be tied up. Older siblings or children should not sleep with babies under a year. Any smoking, nicotine or marijuana, is a high risk factor for SIDS.
Ever single aspect needs to be followed or it negates safe sleep.
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#cosleeping #bedsharing #safesleep
#breastsleeping #breastsleep

How can I toughen up my nipples for breastfeeding?

- Julie Matheney
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Were you told nipple pain and damage were normal while breastfeeding and your nipples just needed to “toughen up”? Whoever told you that does not understand basic anatomy. Nipples, are made from elastic, erectile tissue (the same tissue from a cellular level as the penis!) They are designed to erect and evert with stimulation and shrink back down after feeding. They physically CANNOT callous. They can crack and bleed and blister. They can have skin slough off. They can get infected. Some can become desensitized or used to stimulation with time. But they can NEVER “toughen up”. If you have a calloused nipple, I would see a dermatologist or breast specialist ASAP.

Babies mouths have two areas: the hard, bony palate up front (including where the teeth will go), a.k.a. the danger zone, and the soft palate at the back of the mouth just in front of where that little hangy downy thing is, a.k.a. the safe zone. One of the reasons a nipple erects, everts, and stretches is to help to get it in the safe zone.

When a baby is latched correctly, the nipple tip stretches back to where the palate is soft, this 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 the friction causes damage. This also happens when there is a tongue tie. Instead of the middle of the tongue massaging the nipple, the middle of the tongue is anchored to the floor of the mouth and the tongue tip 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 because of their anatomical design Other than temporary tenderness in the first few days, there should be no pain. Except when your baby shark is teething and bites you. But that’s a totally different post. Need to heal your nipples fast?  Watch my YouTube video on the best strategies Need to heal your nipples fast?  Watch my YouTube video on the best strategies 

 

If you’re struggling to latch your baby, consider taking my Latched class  Click here to enroll today! If you’re struggling to latch your baby, consider taking my Latched class  Click here to enroll today! 

#nippledamage #breastfeedingpain #breastfeedingsupport #breastfeedingtips

Tongue tie with no nipple pain

- Julie Matheney
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While maternal nipple pain and damage are classic signs of tongue tie in baby, I have seen many cases where the mother reports absolutely no pain with breast-feeding. These babies tend to have very high palates and some times a weak suck (not always). The actual nipple in most cases is large and long and goes up into the palate where the tongue tends not to be able to pinch it as much. There may be creasing of the nipple, but usually not the classic damage seen with other presentations of tongue tie. These mother‘s bodies often compensate with a fast let down and over supply of milk. These babies trigger let down easily and the mothers body responds with freely flowing milk. Baby drinks from the fountain without learning how to stimulate the breast and empty it on their or or learning how to trigger new let downs. These babies often gain weight well or even faster than expected until around 3-4 months when they unexpectedly drop off the growth curve and mom feels like her supply suddenly drops. Symptoms often include clicking at the breast (caused by that high palate and the fast flow of milk) which in turn increases the risk of reflux, colic and gassiness. Moms also complain that they need to constantly hold or shape the breast or baby loses the latch. These ties often go undiagnosed and many of these babies are switched to bottles and formula as the supply continues to decrease from the baby inefficiently moving milk from the breast which can also coincide with mother going back to work. If she is using a poor quality pump or the wrong size flanges and not moving milk well with the pump, she’ll often blame herself for the low supply.

To learn more about tongue tie and what to do about them, take my parent class Tied & Untied. Click here to enroll Tied & Untied. Click here to enroll 
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#tonguetie #tonguetied #tonguetiebabies #breastfeedingproblems #milksupplyissues #milksupplyproblems #milksupplybooster

Why does my breast pump hurt?

- Julie Matheney

You would think that the stronger is better. But I’m telling you: don’t suck your brains out your nipples. 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 that. The suction level, or vacuum, is different than the cycle speed, which is how fast it pumps. 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.

Each pump has its own max suction strength. “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 many 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.

Think of pumping like drinking from a milkshake with a narrow straw. When you suck too hard, the straw collapses 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. 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 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/mastitis. This also leaves milk behind which eventually can drop your overall milk supply. This can also damage the nipple. Having the right size flange AND using enough suction to move milk but not compress the ducts is essential to a happy pumping journey.

How much breast milk does my baby need?

- Julie Matheney
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Day 1-3

5-15mL per feeding: 8-11 times in 24 hours

Day 4-Week 2

1-2oz per feeding: 8-16 times in 24 hours

Weeks 2-3

1-3oz per feeding: 8-16 times in 24 hours (15-24oz per day based on baby’s weight)

Months 1-6

2-5oz per feeding: 6-12 times in 24 hours (22-32oz per day)

Months 6-11

2-6oz per feeding: 5-11 times in 24 hours (22-32oz per day)

Months 12-24

14-19oz per day: Per family lifestyle

Months 24-36

10-12oz per day: Per individual toddler

*

Individual feeding times and volumes vary by unique individual  www.lalactation.com

Baby’s weight

Breast milk needed per 24 hours in ounces

5 pounds

12.5 oz

6 pounds

15 oz

7 pounds

17.5 oz

8 pounds

20 oz

9 pounds

22.5 oz

10 pounds

25oz

11 pounds

27.5 oz

12 pounds

30 oz

*Calculations are based on 2.5oz of milk per pound of body weight which is the total volume in 24 hours baby needs to grow. Daily milk intake will vary +/- www.lalactation.com

Babies are born at different weightsBabies are born at different weights. The smaller a baby is, the less milk they need each 24 hour period. As they grow, milk supply slowly increases to meet these growing nutritional needs. Pediatricians and lactation consultant calculate milk volume needs at 2.5 ounces per pound a baby weighs. So a 6 pound baby needs about 15oz a day to grow. They will gain about 1/2 a pound a week, so each week they need just about 1oz more of milk. This is why babies cluster feed as they age. Those little clusters of feeding help slowly and gradually increase your milk supply.

The calculation of ounces per pound doesn’t last for long. Once baby reaches around 10 pounds, usually some where around 6-8 weeks depending on baby’s birth weight, milk volumes steady out and baby will need approximately 24-30oz in 24 hours. How much they take per feeding is dependent on how often they are feeding. They need to take less milk per feeding the more often they feed. These charts are a visual reference for those milk volume needs. Remember individuals volumes vary by individuals. These are guidelines based on decades of research. If your baby is not gaining weight, usually more milk is needed. If you’re struggling to figure out how much to feed baby, schedule a private lactation consultation.

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Understanding the dynamics of breast milk fat composition

- Julie Matheney

Breast milk, often referred to as nature's perfect food, dynamically adapts to meet the nutritional needs of a growing baby. From birth through infancy, the composition of breast milk undergoes significant changes in nutrients, fat content, and volume, catering to the evolving requirements of the baby.

In the initial days after birth, colostrum, the first milk produced by the mammary glands, is rich in antibodies and immune-boosting factors essential for protecting the newborn against infections and illnesses. As baby continues to nurse, the composition of breast milk transitions to meet the increasing nutritional demands.

Breast milk contains a balanced mix of carbohydrates, proteins, fats, vitamins, and minerals. The levels of these nutrients vary over time, ensuring optimal growth and development for baby. From about 10 pounds of weight until a year, baby’s milk volume needs don’t increase. They’ll average 25-30oz in 24 hours. How can they still gain weight when they don’t increase milk volume? You breast milk composition changes to meet their nutritional needs at every age and stage and the amount of weight they gain each week slows.

There are many misconceptions about breast milk, specifically about milk fat, with many people being concerned about foremilk (higher water concentration at the beginning of feeding) vs hindmilk (higher fat concentration at the end of feeding).  The fat content of breast milk plays a supporting role in baby’s brain development and overall growth. Interestingly, the fat content of breast milk changes throughout a single feeding and over the course of the day. While what you eat can increase certain types of fat in your milk (DHA/EPA), the actual fat content dynamically changes for each feeding based on many factors like time of day, frequency and length of feeding, age of the baby, and unique maternal factors. Yes, milk fat increases from the beginning to the end of the feeding, but your body doesn’t produce two kinds of milk. Foremilk/hindmilk really only becomes an issue for some babies where there is a true oversupply and you would normally see symptoms like foamy, green poops and slower weight gain than anticipated.

The volume of breast milk produced by a mother varies based on factors such as baby's age, feeding frequency, and individual differences in milk production. During the early weeks, babies typically have frequent nursing sessions, stimulating the production of breast milk. As the baby grows and the milk supply stabilizes, feeding patterns may change, with longer intervals between feedings.

The frequency of breastfeeding is crucial for maintaining milk supply and ensuring adequate nutrition for the baby. Babies instinctively regulate their feeding patterns, signaling hunger cues to initiate breastfeeding. If a baby isn’t gaining weight on breast milk alone, the issue is often not the fat content but rather the overall total volume of milk baby is getting.

One of the remarkable aspects of breastfeeding is its ability to adapt to the specific needs of the baby. Whether the infant requires extra hydration during hot weather or additional nutrients for growth spurts, breast milk adjusts its composition accordingly, providing tailored nourishment.

In conclusion, breast milk is a dynamic fluid that evolves in composition and volume to meet the changing needs of the growing infant. Understanding the constant changes in breast milk nutrients, fat, and volume based on the age of the baby and feeding frequency empowers parents to support their child's optimal development through breastfeeding.

How much water should I drink while breastfeeding?

- Julie Matheney

Breastfeeding is an incredible bonding experience between a mother and her child, facilitated by various hormones, including oxytocin. Oxytocin, often dubbed the "love hormone," plays a crucial role in lactation and maternal-infant attachment. One intriguing side effect of oxytocin release during breastfeeding is the overwhelming thirst experienced by many nursing mothers.

So, why does oxytocin make breastfeeding mothers thirsty?

Oxytocin stimulates the let-down reflex, which is the process by which milk is released from the mammary glands. As oxytocin surges during breastfeeding, it causes the muscles around the milk ducts to contract, pushing milk towards the nipple for the baby to feed. This physiological response not only assists in milk ejection but also triggers a sensation of thirst in many mothers.

The mechanism behind oxytocin-induced thirst is multifaceted. One theory suggests that oxytocin may stimulate the hypothalamus, the region of the brain responsible for regulating thirst and fluid balance. Additionally, the act of breastfeeding itself can be physically demanding, leading to increased fluid loss through sweat and respiration, further contributing to feelings of thirst.

Now, how much water should breastfeeding mothers drink?

The general recommendation for breastfeeding mothers is to stay well-hydrated to support milk production and overall health. While individual water needs vary based on factors like climate, activity level, and body size, lactating women should aim to drink enough fluids to satisfy thirst and maintain hydration.

Aim to drink water whenever you feel thirsty, and consider these tips to ensure adequate hydration:

  1. Drink to thirst: Listen to your body's cues for water. Thirst is a natural indicator that your body needs fluids, so keep water within easy reach during breastfeeding sessions.
  2. Stay hydrated throughout the day: Make a habit of drinking water regularly, not just during breastfeeding sessions. Keep a water bottle handy and sip frequently.
  3. Monitor urine color: A pale yellow color indicates adequate hydration, while dark urine may signal dehydration. Aim for urine that is light in color as a simple indicator of hydration status.
  4. Consider fluid-rich foods: Incorporate hydrating foods like fruits and vegetables into your diet, which contribute to overall fluid intake.
  5. Avoid excessive caffeine and alcohol: Both caffeine and alcohol can have diuretic effects, potentially increasing fluid loss and impacting milk production. Moderation is key.

In conclusion, oxytocin-induced thirst is a natural response during breastfeeding, driven by hormonal changes and the physiological demands of lactation. By staying attuned to their bodies' signals and prioritizing hydration, breastfeeding mothers can support their own well-being while nurturing their little ones. Remember, a well-hydrated mother is better equipped to provide the nourishment and care that her baby needs.

The Importance of Night Breastfeeding: Impact on Milk Supply and Infant Weight Gain

- Julie Matheney

Nighttime breastfeeding serves as a crucial component of infant nourishment and maternal lactation. While the idea of cutting out nighttime feedings may seem tempting for exhausted parents seeking uninterrupted sleep, it's essential to understand the potential consequences this decision may have on both milk supply and infant weight gain.

Here's why maintaining nighttime breastfeeding is crucial:

  1. Stimulation of Milk Production: Nighttime breastfeeding sessions play a significant role in stimulating milk production and maintaining a robust milk supply. Prolactin, the hormone responsible for milk production, is typically higher during nighttime hours. By nursing during the night, mothers help to sustain adequate milk production levels to meet their baby's growing needs.
  2. Infant Nutritional Requirements: Infants have high nutritional demands for growth and development, especially during the early months of life. Nighttime feedings provide essential nutrients and calories necessary for optimal infant growth, particularly during growth spurts. Cutting out nighttime feedings prematurely may deprive babies of the necessary nutrition they require for healthy weight gain and development.
  3. Satiety and Comfort: Breastfeeding offers more than just nutrition; it provides comfort, security, and emotional bonding for both mother and baby. Nighttime feedings help soothe infants, promote relaxation, and foster a sense of security, contributing to better sleep patterns and emotional well-being for both mother and child.
  4. Maintaining Milk Supply: Breastfeeding works on a supply-and-demand basis. The more frequently a baby nurses, especially during the night when prolactin levels are highest, the more signals the body receives to produce milk. Cutting out nighttime feedings prematurely can disrupt this delicate balance and potentially lead to a decrease in milk supply over time.
  5. Weight Gain and Growth: Research indicates that babies who receive nighttime feedings tend to gain weight more steadily and exhibit optimal growth patterns. Adequate nighttime feedings contribute to improved weight gain, ensuring that infants meet their developmental milestones and thrive.

While it's understandable that parents may seek uninterrupted sleep, it's essential to approach nighttime breastfeeding with patience and understanding. Here are some strategies to support nighttime breastfeeding while promoting parental rest:

  • Co-sleeping: Safe co-sleeping arrangements can facilitate nighttime breastfeeding while allowing parents and infants to rest close together.
  • Cluster Feeding: Encourage cluster feeding in the evening, where babies feed more frequently in a condensed period, potentially leading to longer stretches of sleep afterward.
  • Supportive Partners: Partners can assist by taking on other caregiving responsibilities, allowing breastfeeding mothers to rest during the day to offset nighttime awakenings.

In conclusion, the decision to cut out nighttime breastfeeding should be approached thoughtfully, considering both the short-term sleep needs of parents and the long-term health and well-being of both mother and baby. Nighttime breastfeeding plays a vital role in maintaining milk supply, supporting infant weight gain, and nurturing the emotional bond between parent and child. By understanding the importance of nighttime feedings and implementing strategies to support breastfeeding, parents can navigate this phase with confidence and care.

Common breastfeeding questions

- Julie Matheney

Breast Milk didn't freeze in the freezer

You’re pumping and throw that bag of liquid gold in the freezer, but when you come back the next day the bag is still liquid. Puzzled, you hit up google only to find no actual answers for why this happened.

HELP! My breast milk won't freeze!!

There is only one research study done in Spanish that has attempted to research this phenomenon. Here’s what we know:

🍷It’s not because you’ve had too much alcohol. Yes, alcohol has a lower freezing temperature, but the amount of alcohol you’d have to consume to get that level in your milk would land you in the hospital

🧊Check to make sure your freezer is at the correct temperature.

🥶The quick fix is to take the bag out of the freezer, shake it vigorously and put it back in the freezer in a single layer without it touching other bags

🍦 There are a few theories about this. One PhD chemist says it has to do with the high osmolarity of that particular milk. Basically it has extra nutrients than other milk, extra vitamins and most likely a higher fat content  it’s why it doesn’t happen all the time

🔬Dr. João Aprigio Guerra de Almeida is Coordinator of the Network of Milk Banks of Brazil and states:

“The fact that human milk does not freeze is associated with a phenomenon called gelation, which is autocatalytic, begins even inside the mammillary ducts, continues after extraction, and is accentuated by temperature fluctuations (heating to thaw, pasteurization and cooling) and does not disqualify the milk for consumption.” Basically, pressure from the ducts changes the protein structure of the milk which prevents the milk from freezing. Even if the milk is kept at -18ºC in the freezer, it does not freeze, because the proteins form a network that ignites the water molecules, preventing them from coming together to form ice crystals.

Have you ever experienced this with your milk?

The discussion by Dr. João Aprigio Guerra de Almeida is translated from Spanish from an original blog post written on December 14, 2018  by Gema Cárcamo González-IBCLC.

SOS, mi leche materna no se congela.

How long is breast milk good for?

I often get asked about the safe handling storage of breast milk as well as formula. So let’s break it down:

Breast milk is a living substance with digestive enzymes that help break down milk in baby;’s digestive tract. It’s also full of live immune properties to help baby fight infections, bacteria and viruses. Formula is FOOD. I know that seems obvious, but it’s really important to remember. Since it is food, we have to follow food safety rules when preparing, using and storing formula. Breast milk is also a food, but like all foods, they have unique storage properties based off of what the food is and the risk of contamination and spoiling. So the rules for formula and breast milk are similar, but different. The rules for formula help prevent bacterial contamination which can make your baby sick. Keep in mind that these are guidelines. You know your home situation best, which includes your water source, what else is living in your refrigerator, the climate you live at, and your own cleanliness in the kitchen. 

Let’s talk about formula first. Prepared formula, meaning mixed powdered formula that you made with water following the manufacturer’s instructions but that has not come into contact with your baby’s mouth, can be stored in the fridge for 24 hours at an ideal temperature of 37 degrees Fahrenheit. CLICK HERE TO LEARN MORE Ready to feed formula that hasn[‘t been offered can actually be stored inthe feridge for up to 48 hours, ideally in an air-tight storage container. This is stored in the back of the fridge where it is coldest and least likely to be impacted by temperature fluctuation that happen near the door of the fridge. This does mean that if you are offering more than one bottle of formula per day you can mix your entire day’s worth of formula in the mourning, store it in a pitcher,and pour out of the pitcher into your bottle volumes to heat and feed. This can save you time when your baby is really hungry. You also want to make sure all of your containers for storage are air tight to prevent that formula from absorbing odors from other foods in the fridge. 

2 hours. That’s how long you have for formula to sit at room temperature once it’s been mixed, as long as it hasn’t touched your baby’s lips. That means you can mix up a bottle before you leave the house and leave it in your diaper bag to be fed within two hours of leaving the house. 

Once that bottle of formula has touched your baby’s lips, you have to use it within 1 hour or you need to toss it. This is because bacteria from your baby;’s mouth is introduced back into the bottle (thanks baby back wash) and the bacteria can multiply and grow to unsafe levels. Health care providers will always recommend safest practice to help keep your little one healthy. 

 

Worried about wasting formula? Here are a few tips: Mixing formula in a pitcher means you can pour out just enough for the feeding. If baby is still hungry, you can pour small amounts for top ups to prevent mixing too much and wasting formula. If your baby has a little formula remaining in the bottle and you know they will want a top off later, consider offering the bottle again at the 50-minute mark before the bottle expires. 

So what about freshly pumped breast milk? There are other rules that apply:

  • Use breast milk storage bags or clean, food-grade containers to store expressed breast milk. Make sure the containers are made of glass or plastic and have tight fitting lids.
    • Avoid bottles with the recycle symbol number 7, which indicates that the container may be made of a BPA-containing plastic.
  • Never store breast milk in disposable bottle liners or plastic/ziplock bags that are not intended for storing breast milk.
  • Freshly expressed or pumped milk can be stored:
    • At room temperature (77°F or colder) for up to 4 hours.
    • In the back of the refrigerator away from the door for up to 4 days.
    • In the freezer for about 6 months is best; up to 12 months is acceptable. Although freezing keeps food safe almost indefinitely, recommended storage times are important to follow for best quality. Freeze your milk flat to save space and make sure to store int he back of the freezer where it’s coldest, away from the door where temperature can fluctuate.
  • If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk. The longer breast milk sits out, the more the live digestive enzymes in it will break down the nutrients in your milk. 
  • When freezing breast milk:
    • Store small amounts to avoid wasting milk that might not be finished. Store in 2 to 4 ounces or the amount offered at one feeding.
    • Leave about one inch of space at the top of the container because breast milk expands as it freezes.
    • Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling. At your destination, use the milk right away, store it in the refrigerator, or freeze it.
  • Make sure to test for lipase before storing large batches of breast milk in the freezer. Lipase is the enzyme that breaks down the fat in breast milk. For some people with high lipase, their milk can taste soapy or metallic when stored. Some babies are fine to drink this milk and others may refuse it. See my other posts and videos on high lipase and what to do about it. 
  • Always thaw the oldest breast milk first. Remember first in, first out. Over time, the nutrients in breast milk start to break down. When at all possible, feed fresh milk. 
  • Breast milk can be defrosted in the fridge, normally in around 12 hours. Alternatively, hold the bottle or bag of frozen milk under warm running water (a maximum of 37 °C or 99 °F). Don’t leave frozen breast milk to defrost at room temperature. If you forget it on the counter for too long, past safe feeding guidelines, you may lose that batch of milk. And we cry over spilt and lost breast milk. 
  • Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn baby’s mouth.
  • If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer. If there are still ice crystals felt in the milk, it is still considered frozen.
  • Once breast milk is brought to room temperature or warmed, use it within 2 hours.
  • Never refreeze breast milk after it has thawed.
  • Breast milk does not need to be warmed. It can be served room temperature or cold.
  • If you decide to warm the breast milk, here are some tips:
    • Keep the container sealed.
    • Place the sealed container into a bowl of warm water or hold it under hot, running water for a few minutes.
    • Test the milk’s temperature before feeding it to your baby by putting a few drops on your wrist.
  • Swirl or shake the breast milk to mix the fat, which may have separated. Fat separation is normal for breast milk. There used to be an old wives’ take that shaking the milk could some how damage the milk. We’ve debunked that for years. If you’re concerned about the bubbles that form from shaking giving your baby gas, you can swirl or stir it as well.  
  • If your baby did not finish the bottle, use the leftover milk within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded. Yes, you get a longer amount of time to offer breast milk in a bottle than formula.

Finally: If you’re mixing breast milk and formula together in the same bottle: Formula rules apply, meaning once that bottle has touched baby’s lips, you only have one hour to feed it to the baby. 

 

Headache while breastfeeding

I have a headache but am also breastfeeding. What can I safely take for me and my baby? Well, first, if you have a headache, start by drinking water. I see many new mothers who are breastfeeding who are not getting adequate nutrition and specifically hydration because of focusing on their little one. If you have a new onset headache, before reaching for the medicine cabinet, start by hydrating. Water, coconut water, soups or births, and High water fruits and vegetables like melon , pineapple, oranges or citrus fruits and cucumber, lettuce, and celery. If that doesn’t do the trick , there are safe medications to take. Dr Thomas Hale wrote the textbook on medication and breastmilk and categorizes them into 5 categories:

L1 safest

L2 safer

L3 probably safe

L4 possibly hazardous

And L5 hazardous.

If you have pain, such as a headache, body aches, pain post delivery or a fever, there are safe medications.CLICK HERE FOR VIDEO

Ibuprofen, Advil, and Motrin are all nonsterioial anti-inflammatory analgesics (NSAIDs), and considered L1 or preferred medications. Panadol, acetaminophen or Tylenol are pain relievers that are considered L1 and safe while breastfeeding. Aspirin, ASA, is considered an L2 medication. While L2 medications are typically considered safe while breastfeeding, Aspirin use  can lead to a condition in babies and children called Reye Syndrome which has been associated with brain and liver damage. Aleve (also known as Naproxen) is considered an L3 and while the AAP-approved it for nursing mothers, Dr Hale states it should be used with caution due to its long half-life and its potential effect on baby’s cardiovascular system, kidneys and GI tract. Use of  Aleve should be short-term, infrequent or occasional use which would still be considered compatible with breastfeeding. 

Ibuprofen or acetaminophen are better choices over aspirin and naproxen for pain relief in lactating women and you would want to discuss the risks and benefits of aspirin If your physician has prescribed this for you based on your unique medical history. 

Codeine is an L3 medication and not generally recommended while breastfeeding. If it is essential, and only where there is no alternative, it should be at the lowest effective dose for the shorted possible duration and you should stop taking it and seek medical attention if you notice side effects in your baby such as breathing problems, lethargy, poor feeding, drowsiness or slow heart beat. 

If you have another medication that you take for fever or pain, you can ask the IBCLC lactation consultant you’re working with to check out it’s safety in the Hale’s Medications and Mother’s Milk textbook, on you can search the LactMed database on the internet. You can also call Infant Risk which is a help center for questions about breastfeeding, infants and medications. If you are in the USA, The phone number for the call center is 1(806) 352-2519 and is open from 8 AM to 5PM Central Standard Time to answer your questions.

I have a sore throat or cough: In general, treat only the symptoms you have, so try to avoid combination medications when one that is for a single symptom could work. Short acting medications that are for less than 4 hours are preferred over longer lasting medications. How you take a medication does matter. Nasal sprays or topical rubs have less of a chance of passing to your breast milk than things you take orally.  

Throat lozenges and sprays are generally considered safe, but avid eating excessive cough drops contains menthol as some have found this can decrease their milk supply. 

Drinking lemon and honey or chamomile tea can be helpful to soother a sore throat and reduce coughing.  Fenugreek tea has also been reported to have a similar effect, although do not drink fenugreek tea if you have a thyroid condition or are on thyroid medications or tend to be hypoglycemic and be aware that it may cause increase gassiness and bloating for you and baby. 

Zinc gluconate or slippery elm bark herbal lozenges may be soothing, but avoid taking large amounts of zinc for more than a week, because it can interfere with other minerals in the body.

Salt water or apple cider vinegar mouth gargles, where you gargle and spit can also bring relief and would not be anticipated to impact milk supply or your baby.

Many forms of robitussin, delsum and benylin are considered compatible with breastfeeding, but always check the active ingredients as there are many versions available on the market. 

Always check with your prescribing physician before starting any herbal supplement or medication based on your unique medical history.