Pumping Log: Clogged Ducts

Clogged milk ducts are no fun. My ducts clogged several times when I started nursing. With immediate action, I was able to clear the duct in a few hours and nursing returned to normal.

These are signs that you might have a clogged duct:

  • a small, hard lump that’s sore to the touch or a very tender spot in your breast.
  • redness.

a hot sensation or swelling that may feel better after nursing.

If this sounds like you, YOU NEED TO UNCLOG THAT DUCT. If left untreated, clogged ducts can turn in to mastitis.

Here are several strategies that worked well for me:
-Hot showers or hot compresses (hot washcloth or heating pad over the lump) before nursing (or plank over a bowl of hot water or hot bath or hot towel etc)
-Nurse on demand starting on the affected side.
-NURSE LIKE A COW. Lean over baby on your knees and forearms and let gravity help.
-After nursing, hand-express that boob! Start at your ribcage and squeeze/massage over that duct toward the nipple like you’re trying to squeeze that last bit of veggie pouch out the tip. It can hurt, If you don’t do it, the doctor or lactation consultant will, and it will still hurt like heck. But you can at least feel where it is and when to stop.
-The clogged milk is SALTY and that’s why babe might start to refuse it. Once you find the salty spot, “milk” yourself that way till the salty stuff empties.

Repeat this process each feeding until the lump goes away or you feel it release and your milk flow return to normal. If it doesn’t go away in a day or two, seek professional help to avoid it turning into an infection.

Pumping Log: Nipple confusion??

Nipple confusion. While many moms who are going back to work trying to get their babies to take their milk from a bottle, many of them are also frustrated when the baby refuses to take one. Their baby turns away, arches her back, pushes the bottle nipple from her mouth, chokes, gags, and becomes extremely fussy. Or the baby was doing struggling at the breast, started taking a bottle well, and now no longer wants anything to do with the breast. These are all symptoms that mothers a tribute to “nipple confusion”. As a speech therapist, this term has always bothered me. In my mind confusion means a mood or emotional mental status. Like, I was confused at the directions. I was confused as to where I was. I was confused as to why he behaved that way. Babies are born, natural feeders, they literally come out of the womb wanting to suck. I would like to rewrite the term nipple confusion instead with flow confusion. Babies are not confused about where their milk is coming from, but how it is coming out. The flow from a breast and a bottle are very different. At the breast when a baby is first placed at the nipple, the baby sucks in a very quick, rhythmical suckling pattern. This stimulates milk flow. After several minutes of this quick, high paced suckling, the mother experiences let down. This is a very fast flowing time in the milk phase. During let down the baby’s sucking rate changes to a slow and rhythmical pattern. After several minutes of this, the baby goes back to that high suckling phase. That is because the mothers milk flow has decreased. The baby then stimulates another let down to occur by changing her rate of sucking. A typical mother can experience anywhere from 2 to 4 let downs during a typical feeding. Bottle nipples, however, do not work on a demand-supply basis. As soon as that bottle nipple is placed in the baby’s mouth, it begins to flow. The baby does not even necessarily need to suck if the hole in the tip of the nipple is large enough. The baby could munch mash on the nipple or even just let it flow into her mouth. It takes much. Less work but much more coordination to drink from a bottle nipple. The baby needs to be able to coordinate her sucking, swallowing, and breathing any typical rhythmical pattern.

Differences in the way a baby sucks on the breast vs. a bottle

  • To latch to the breast, baby must open his mouth widely. A baby does not need to open wide to suck on a bottle.
  • When sucking on the breast, baby’s tongue makes a wave-like motion; it begins at the tip of the tongue and moves toward the back. The tongue compresses the breast against the roof of the mouth. A bottle fed baby uses his tongue differently and may lift the back of his tongue to stop the flow of milk and protect his airway.
  • If a breastfed baby needs a rest, he simply quits sucking and the milk flow slows. Milk may flow from a bottle even when baby is not sucking, forcing baby to continue feeding without a break.
  • To breastfeed, the baby needs to take the nipple far back into the mouth to the soft palate and then uses her tongue to compress out the milk (which can take a minute or so before it starts flowing). With a tilted bottle, a baby has gravity on her side: She can suck with her lips and get all the milk she wants right away.
  • Babies aren’t confused about what nipples are for, but they may prefer getting milk faster without having to work as hard or be unable to control the flow and become overwhelmed and shut down.

The truth is, most babies have no problem switching from breast to bottle and back again. Others, specifically those who take a little longer perfecting the art of suckling at the breast, can have trouble transition from breast to bottle — and then back to breast. These babies often have difficulty coordinating the intricate act of sucking, swallowing and breathing. Since we don’t know which babies will do well and which will struggle, most experts agree that you should wait until your newborn has established good breastfeeding habits, usually around three weeks of age and after the two week growth spurt, before offering the bottle. If you’re still struggling with breastfeeding at three weeks and it’s still your goal, hold off on the bottle a little bit longer.

At the NICU where I work, if we have a mom who plans in breastfeeding, we will always use a slow flow nipple. It most closely resembles the flow at the breast to make the transition back and forth easier. We also use various positioning and pacing techniques to help babies get the hang of coordinating their sucking, swallowing, and breathing. A slow flow nipple is always best to start with if you plan to continue breastfeeding

Pumping Log : Storage

We’ve talked a bit about increasing milk supply and about pumping. So now that we have all this yummy milk, what are we going to do with it? Let’s talk about milk storage.

The U.S. Centers for Disease Control and Prevention (CDC) offers ranges of time that milk can safely be left at for certain temperatures. Use this link to go directly to their website. But there is a simple rule that fits within these ranges and is easy to recall, even when you’ve had less sleep than a college kid in finals week. Just remember 5-5-5.

  • 5 hours at room temperature. If the room is very warm (more than 85 degrees F), 3-4 hours is a safer time range.
  • 5 days in the fridge (the back of the refrigerator is the best place to store your milk since it is the coldest.)
  • 5 months in a regular freezer (the separated compartment in a typical fridge/freezer unit) According to the CDC, milk frozen for longer than the recommended time ranges is safe, but may be lower in quality as some of the fats in the milk break down.

Other time ranges that don’t fit as neatly within the 5-5-5 rule, but are still helpful:

  • Human milk can be stored for 6-12 months in a chest or upright deep freezer.
  • Human milk can be safely stored with ice packs in insulated storage bags for up to 24 hours.

As part of my routine, if I work the next day, I put my milk into separate bottles and stick them in the fridge when I get home from work. That way my husband can feed them to my baby the next day while I’m at work. If the next day is a day off, I put my milk into disposable milk storage bags to stick in the freezer until the next time I work. The bags are labeled with the date they were pumped and always put in order from oldest to newest milk. This method saves going through a bunch of milk bags and saves both time and money. There are several brands of milk storage bags. I’ve found I really like the Dr Dudu bags. They’re larger size and with the double zipper I don’t need to worry about leaks in my lunch bag during the work day.

Milk from different pumping sessions/days may be combined in one container – use the date of the first milk expressed. I frequently pour all of my milk from one day of work into a larger bottle. This helps even out the calorie count and fat content since we know different pumping seasons yields different milk content. Avoid adding warm milk to a container of previously refrigerated or frozen milk – cool the new milk before combining. Breastmilk is not spoiled unless it smells really bad or tastes sour.

Safely Thawing Breast Milk

As time permits, thaw frozen breast milk by transferring it to the refrigerator for thawing or by swirling it in a bowl of warm water. You should avoid using a microwave oven to thaw or heat bottles of breast milk. Microwave ovens do not heat liquids evenly which could easily scald a baby or damage the milk. Bottles may explode if left in the microwave too long. Excess heat can also destroy the nutrients in your milk. It is recommended that you do not re-freeze breast milk once it has been thawed. Although I read on kellymom.com that if the milk had only been partially thawed and there are still ice crystals in it, you can safely refreeze the milk and thaw it on a later date.

When the fat in your milk separates in the fridge or freezer, make sure you swirl the milk to incorporate it back into a smooth, creamy mixture. Breast milk has living components in it which help protect your baby’s gut and promote digestion and immunity. Shaking breast milk actually denatured, or breaks down, the shaped molecules of the protective proteins, leaving them in pieces. Lactoferrin, lysozyme, and other protective components work their protection magic when they are in their original shaped molecular structure.

Other helpful website for breast milk storage Kellymom.com

Pumping Log : Boosting Supply

Every working mother I know it’s concerned about her milk supply. We are terrified that if we don’t make enough milk while at work our babies will starve to death. I’ve had my moments of discouragement where I, too, feel like a failure as a mother because I had a low pumping day. Of course this stress only causes a further decrease in supply which becomes a vicious cycle of stress and poor pumping. While I can’t turn my boobs on line a faucet to pump specific amounts of milk each pump session, there are several things I do to promote the best possible milk supply.

1. Hydration. The best hydration is to drink to thirst. Since times in the busyness of my day, though, I forget to stay well watered. I keep a water bottle in my pumping bag and try to drink while pumping. I also work feeding patients. So each time I go into the kitchen at work I try to grab a cup of water.

2. Nutrition. Eating the right kinds of foods also help with adequate milk supplies. Fresh fruits, vegetables and plenty of protein help keep my body working at its best. Oatmeal is also a staple in my diet. Oatmeal contains a protein that may increase prolactin, the hormone that facilitates milk production in mammals. Other whole grains such as quinoa and sesame also contain this same protein.

3. Supplements. Fenugreek, mothers milk tea, and fennel are all known galactogogues, a fancy word for milk makers. I try to drink a cup of tea every night. I’ll admit I’m not the best at taking the fenugreek, but I definitely notice a boost in my supply when I do. Another supplement known to help breast milk production is brewers yeast. Brewer’s yeast comes from a single-celled fungus and is a byproduct of beer making, though it can also be grown as a nutritional supplement. A good source of iron, chromium and selenium, brewer’s yeast also contains several B vitamins, though not B-12. Brewer’s yeast has a history of use as a galactagogue, which is a food, herb or medication that increases milk supply in nursing mothers. Some mothers find drinking a single beer can immediately increase milk supply (although drinking beer is best left to evenings or weekends). You can also buy a powdered brewers yeast from the store or Amazon. It can be added to smoothies, cookies, or other recipes. Here’s one of my favorites!!

 

Pumping Log: periods and breast milk

While we may affectionately call them jugs, breasts do not work like standardized cartons of milk. As I already discussed in specious post, the volume of breast milk pumped during the day varies by many factors. If stress and eating and hydration and life aren’t enough to alter your milk supply, Mother Nature throws in another curve ball. Once your period returns, hormones also impact your breast milk production. A few days before our periods start, our blood calcium levels drop. This drop in blood calcium can cause two things to happen

  • It can cause a drop in milk supply. Not every women experienced this, by side notice that starting a few days before their periods, their milk supply drops a bit. This lasts until a few days after the period has started.
  • It can slightly change the flavor of your milk. Again, this isn’t true for everyone. But Aunt Flo can slightly alter the flavor of your milk, making it less palatable for your baby. This alteration starts a few days before your period, and lasts until a few days after your period has begun.

The result? If your pumped milk is looking a little lean, you may just be about to ride the crimson tide. Make sure you’re eating a week balanced diet with foods rich in calcium when you start PMS’ing. Chocolate is high in calcium, right? Happy pumping.

PS this picture is from my morning pump. My baby started on the right side this morning and didn’t really want anything to do with the left side. See the difference?

Pumping Log #3

Every pumping session is a new session. Calories in breast milk range from 13-35 calories per ounce. The average amount of calories in typical breast milk around 20-22 calories. This fluctuation is due to changing fat content. The amount of fat in human milk changes depending on the degree of emptyness of the breast (empty breast = high fat, full breast = low fat). The longer a mom goes between pump sessions, the more water is in the milk and the lower the fat content. This is because the mom’s body thinks the baby is getting dehydrated and the water content is to rehydrate the baby. A breastfeed baby can take in the same amount of calories from different volumes of milk. For example, 4 ounces of 15 calorie pumped milk early in the morning has the same calories as 3 ounces of 20 calorie breastmilk pumped only a few hours later. This is unlike formula. Standardized formula has 20 calories per ounce.

For more info on the nutrition facts in breastmilk, check out these websites!!

Children’s Hospital of Philadelphia 

Kellymom.com

Happy Pumping!!

Pumping Log #2

What’s in my pumping bag. A well stocked pumping bag is the most essential item you will need when you go back to work. Packing the bag efficiently and with necessities can help eliminate stress and worry while pumping at work. Here are a few of the things in my pumping bag. Obviously the pump is the most important piece. Make sure to check that you have all the pieces and parts in the morning before you leave for work. I had forgotten one or two pieces several times. I actually now keep a spare pump in my car that is always ready to go in the event that I forget something. I always keep instant oatmeal, mothers milk tea, and honey sticks ready for a quick snack on the go. When I know I am going to work the next day, I bring empty bottles to put my milk in. That way I can keep it in the fridge and handy for the next days feedings. If I know I am going to be home the next day, I use disposable milk storage bags. I’ve tried several brands and really like the Dr. DuDu. They’re sturdy and have a double zipper. Plus they come in a handy 8oz size for streamlining in the freezer. I can put my pumped milk in the freezer and it will be ready to go the next time I’m at work. I always keep extra nursing bra pads. I wear washable ones made of bamboo fiber. But you never know when you might need to change them. I keep it small stash of disposable ones in my bag at all times. Another necessity is my stash of essential oil’s. I use fennel to help keep my supply up. Serenity, lavender, balance, and citrus bliss help elevate my mood when I’m feeling down at work. What’s in your bag?

Pumping Log #1

  • Not only am I a lactation consultant, I am also a full time working mom with an 8-month-old at home. I’m gone around 40-50 hours a week for work and am pumping on the go. At the hospital where I work there is an employee lactation room. Half the time I’m in here by myself and the other half there is another mother behind a curtain pumping with me. It is amazing to see how universal our concerns are with breast-feeding.The number one complaint I hear about from the other side of the curtain is that the mom is “not pumping enough” or “can’t keep up with the baby”. I have never been a super pumper and have always had to really work on my supply. It is amazing to me how from day today, pumping to pumping, I can get varying amounts of milk. It’s depends on my stress level, what I’ve eaten, how much water I’ve been able to get in, and how often I can get away to pump during my shift. Pumping is also very psychological. It’s honestly hard to “feed a machine” instead of my baby, but the more I look at pictures and videos of her or FaceTime with her while pumping, the more I tend to make. Here are the top tips I give to the other moms pumping at work:

1. Shake the girls. Give your breasts a good shake before each pumping session. This wakes up the breast and helps release hind milk from the back of the breast.
2. Use the stimulation and let down modes on your pump more often. Use the stimulation mode for 2 minutes followed by the let down mode for 4 minutes. Go back to the stimulation mode for another 2 minutes followed by the let down mode for another 4. Do this up to 4 times in your pumping session to see an increase in your milk. Massaging your breast from top to bottom in a clock wise motion will also help empty the breast. End your pumping session with a few minutes of hand expression.
3. Keep well hydrated. Water water water!!!
4. If you feel like you did not pump enough during the day at work, add in an extra pumping at night before you go to bed. Keep this extra pumping going even if your home with your baby for the weekend. You can stock up this milk in your freezer for those occasional days where you don’t pump enough on your shift.

 

For more tips and tricks, feel free to give me a call, attend one of my working mother classes, or schedule a personalized consultation!

Tongue Tie and Breastfeeding

Tongue tie, technically known as ankyloglossia, is a condition present at birth that affects an estimated 2-5% of all babies born. It is characterized by a short, thickened, or abnormally tight lingual frenulum, which is the tissue that connects the tongue to the floor of the mouth. Depending on the severity of the tongue tie, range of motion of the tongue can be restricted. In very severe cases, the tip of the tongue can appear to be heart shaped. Because of this anatomical difference, sometimes tongue tied babies can’t maintain a latch for long enough to take in a full feeding. Others may appear to breastfeed for long periods of time without actually be effectively transferring milk. Some tongue tied babies will successfully breastfeed only during “let-down”, when the milk flows on its own from the breast into the babies’ mouths, but won’t be able to actively express milk out of the breast on their own. Many babies with tongue tie also have a lip tie, an abnormally tight membrane attaching their upper lip to their upper gums. This can be seen by rolling the upper lip upward. Babies with lip tie often have difficulty flanging their lips properly to feed which impacts their ability to latch well. This can cause them to take in excess air during breastfeeding which often makes these babies gassy and fussy.

While many pediatricians do not see tongue tie as an issue, current research and literature suggests that it can have a significant impact on breastfeeding. However, the American Academy of Pediatrics, among others, have documented the negative effects of tongue tie on breastfeeding. The most common complaint of mothers with tongue tied babies is sore nipples, which is due to poor latch and inefficient sucking. Other breastfeeding problems for the mother can include recurrent plugged ducts, mastitis or thrush, vasospasm, and supply difficulties. Babies with tongue ties typically have difficulty latching, make click sounds while nursing, may be gassy and fussy during feedings, and have slow weight gain despite having mothers who use correct positioning and nurse frequently.

Some babies with very short or thick lingual frenulums are able to compensate well and breastfeed without difficulty. Tongue tie needs to be diagnosed by function and not just appearance, so what the baby’s tongue looks like is not as important than what it can do. According to one study, simple inspection of a tongue-tie is not enough to determine which infants will need medical intervention. However skilled professionals will complete a clinical assessment which includes observation and measurement of the effectiveness of feeding to help determine appropriate action to improve breastfeeding skills. This is not a comprehensive list for tongue function, but it may give you an idea for why your baby is having breastfeeding difficulties:

  • Does the tongue elevate? When the baby cries the front edge of the tongue should come up at least as high as the corners of the baby’s mouth.
  • Does the tongue extend? The baby’s tongue should be able to protrude or stick out at least past the lower gum  if not to the border of the lower lip
  • Does the tongue lateralize, or move side to side? Tracing the baby’s bottom gums triggers a reflex for the tongue to follow the finger..
  • The baby’s tongue should be able to lift towards the roof of the mouth and touch behind where the upper teeth will come in. Is there a membrane there that prevents the tongue from lifting? When very tight from tension, the membrane may appear white.

If it is determined that the tongue tie is indeed the culprit for breastfeeding difficulties, some pediatricians, ENTs and dentists can perform a frenotomy or frenectomy. This is a quick procedure to cut the frenulum which returns the full range of motion of the tongue and upper lip. Specialized scissors may be use to simply cut the tongue or lip tie. Some prefer to use lasers, which have the benefit of minimizing the amount of bleeding during and after the procedure and decrease the chance that the frenulum will grow back. Many practitioners use a local topical anesthetic to numb the area before the procedure and some use an injection of anesthetic as well. Babies can breastfeed as soon as the procedure is done. Post-procedure care should be done to minimize the frenulum from growing back. Current research shows this is a safe, easy procedure with minimal risk to the baby. The majority of mothers notice an immediate difference in breastfeeding effectiveness and a significant reduction in nipple pain.

When should the frenotomy be done? Current research shown between 2-6 days after birth to establish proper breastfeeding patterns. This same study showed that waiting more than four weeks for frenotomy drastically increased the likelihood that mothers would abandon breastfeeding all together.

If you suspect your baby has a tongue or lip tie, set up a consultation for a full assessment of your baby’s oral motor skills.

For more resources and articles, see Breastfeeding a Baby with Tongue-Tie or Lip-Tie at kellymom.com

  1. Lalakea, M. Lauren; Messner, Anna H. (2002). “Frenotomy and frenuloplasty: If, when, and how”. Operative Techniques in Otolaryngology-Head and Neck Surgery. 13: 93. doi:10.1053/otot.2002.32157. 
  2. Wallace, Helen; Clarke, Susan (2006). “Tongue tie division in infants with breast feeding difficulties”. International journal of pediatric otorhinolaryngology. 70 (7): 1257–61. doi:10.1016/j.ijporl.2006.01.004. PMID 16527363.
  3.  Emond A1, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A. “Randomized controlled trial of early frenotomy in breastfed infants with mild to moderate tongue-tie.” Arch Dis Child Fetal Neonatal Ed. 2014 May;99(3):F189-95.
  4. Jack Donati-Bourne, Zainab Batool, Charles Hendrickse, Douglas Bowley “Tongue-Tie Assessment and Division: A Time-Critical Intervention to Optimise Breastfeeding/” Journal of Neonatal Surgery 2015; 4(1):3
  5.  Jain E. Tongue-tie: its impact on breastfeeding. AARN News Lett.1995;51 :18
  6. Huggins K. Ankyloglossia: one lactation consultant’s personal experience. J Hum Lact.1990;6 :123– 124
  7. Messner, Anna H.; Lalakea, M. Lauren; Aby, Janelle; Macmahon, James; Bair, Ellen (2000). “Ankyloglossia: Incidence and associated feeding difficulties”. Archives of otolaryngology—head & neck surgery. 126 (1): 36–9. doi:10.1001/archotol.126.1.36. PMID 10628708. 
  8. Tongue Tie – What Do Parents Need To Know? Submitted by jessicabarton on
  9.  Rosegger H, Rollett HR, Arrunategui M. [Routine examination of the mature newborn infant. Incidence of frequent “minor findings”]. Wien Klin Wochenschr.1990;102 :294– 299

Nursing Bras

Many moms need to breast pump for a variety of reasons, from going back to work, to increasing milk supply, to feeding a preemie in the NICU. I think it’s pretty safe to say these models have never seen a breast pump in their life. And if they have, I think they may need to see a plastic surgeon to help with their nipple placement! For help with fitting your breast pump, nipple shield, or nursing bra, feel free to set up an appointment with me!