For the first six months after birth, baby is supposed to be on an exclusive breast milk diet. At six months and beyond your breast milk goes through a major change. The volume of milk slowly drops because baby is eating and drinking other foods. They may also be sleeping longer at night and are more active during the day. Your milk is super smart and shifts with this drop to have more antibodies and a higher fat content. The breast makes milk based on how it is emptied and what your hormones are doing based on how old baby is. Your hormones are also shifting and you may start your monthly cycle again. Many experience a further dip in supply around the time with their period. If you’re exclusively breastfeeding, you may notice baby pulling or tugging on your nipple or using their hands to beat your chest while feeding. If you’re pumping, you may slowly start to see less milk each pump session. Usually months 5-7 are the hardest from a baby behavior perspective and it settles out again as baby eats more table food and your hormones adjust. If breastfeeding is your goal, just keep offering the breast and pumping often.
Absolutely everything you put on or in your body had a risk/benefit. Some things have more research and information and somethings are newer and were still discovering them. Nitrates, for instance, which are found in processed meats are known to cause colon cancer. Yet many people routinely consume them without a second thought. Starbucks had a sign at every store saying they know some of their products are known to cause cancer and to be aware of the risks. Fenugreek is not supposed to be taken during breastfeeding if you’re on thyroid medications, but many are unaware of the risk because they haven’t researched it and still drink teas and eat products containing it. We’re still researching and learning about marijuana and CBD in the breastfeeding population and haven’t figured out long term recommendations. Still, some chose to weigh the benefits to their unique story and still consume it while breastfeeding
Did you know the American Academy of Pediatrics and the Academy of Breastfeeding Medicine have completely opposite, yet compatible, protocols for safe sleep? AAP discourages bed-sharing while ABM supports it. My role is to educate you on both recommendations and help support whichever decision you make, while also taking your unique situation in mind. If you have a formula and breastfeeding preemie, I’m going to tell you to follow the AAP guidelines as the risk of SIDS is too great in your circumstance. If you have an exclusively breastfed, full term, healthy newborn, you can absolutely bed share when done safely and correctly and I will teach you how to do that.
My role as a lactation consultant is to educate you in what we do know and the most current information and support you in whatever decision you decide to make. The same goes for the COVID-19 vaccine. Yes, there is limited research and information, but from what experts do know, they are considering it safe while breastfeeding but to still make an informed choice for you and your family. Whether you chose to be vaccinated or not is a personal choice between you, your family and your health care team. As with anything you put in your body, it is a risk/benefit decision based on your medical and family history and risk of exposure. I completely understand if in your community you have limited risk and exposure to people potentially infected with COVID and you’re choosing to wait and see. I fully support your decision to seek more information and see evidence and research. I also fully support you if you chose to be vaccinated and continue breastfeeding. When we have more information I will continue to update what I present and how I educate.
It’s common for a toddler, or an even older child, to ask to breastfeed after a new sibling is born. Toddlers who were weaned immediately before or during pregnancy may be especially curious. Many just want to know if you’ll say yes – or they may just want your attention or “babied” themselves. Continuing to breastfeed, or letting them try to breastfeed again after weaning, can ease the transition of gaining a sibling. They are less likely to be jealous of the baby who is always with mommy if they can nurse alongside them. Nursing your older child once the new baby arrives can reduce engorgement when colostrum transitions to mature milk and can protect milk production if your newborn is not feeding effectively. If you say yes to a weaned child, many will just touch, lick or kiss the nipple, some will have forgotten the mechanics of how to breastfeed and won’t have further interest. Others can successfully breastfeed again. If you are happy to nurse your toddler, go for it. If it is overwhelming, it is still your body and you get to decide when and for how long toddler is allowed to breastfeed. You may prefer nursing your baby and your toddler separately or together. Breastfeeding is normal and it is normal for children to be curious and want to breastfeed at 2, 3, or even 4 years old.
When you give birth your body will continue to produce colostrum, with milk becoming plentiful after around 3-5 days. As with your first baby, breastfeed at least 8-12 times per day to establish your milk supply. Some will feed their newborn baby first or encourage the older sibling to nurse less until breastfeeding has been well established to ensure the newborn has full access to breast milk. Look out for feeding cues and give your newborn unrestricted breast access to help ensure they get plenty of milk.
Some times if your toddler is breastfeeding frequently, they may lose interest in solid foods for a while from increased milk intake. They may have looser stools. This is normal and should regulate with time.
It can take a while before your body adapts to the needs of two different feeders. You may feel lopsided if one breast drains more than the other. Eventually things will even out and you’ll find your rhythm. Alternating breasts for each feed helps with development of newborn vision and keeps the size of your breasts balanced. However, some mums find that giving a toddler his ‘own side’ works for them.
You will not run out of milk, your body will make more to accommodate however many nurslings there are.
It is normal for let-down not to feel as strong as baby gets older. Some of us never feel let-down, and some stop feeling the let-down sensation as time goes by. This does not necessarily indicate that let-down is not taking place. Remember, just because you don’t feel it or it feels different over time, or any mean it’s not happening.
Signs of let-down include:
• Uterine cramping during letdown in the first week postpartum
• Baby’s sucking pattern changes from a quick suck-suck to a rhythmic suck-swallow pattern as milk begins to flow
• Feeling of calm, relaxation, sleepiness or drowsiness.
• Sudden thirst
• Leaking from the other breast
• Tingling, pins and needles sensation, itching, nausea, headaches, or negative emotions
Things that can be the cause of a slow or inhibited let-down:
• History of breast surgery where nerve damage that can interfere with let-down.
• In extreme situations of stress or crisis, the release of extra adrenaline in can reduce or block the hormones which affect let-down from a fight or flight response
• Sometimes a cycle is created, where baby fusses and pulls off because the let-down is slow, which makes mom tense up, which makes the let-down even slower, etc.
• It’s normal to have a harder time letting down for the pump than baby.
Later into your breastfeeding journey, you may notice it takes longer to trigger a let-down. This is common and what works early on may change over time.
Check for possible causes:
• Worn pump parts that need replaced. Replace the valves and membranes often. Check for worn tubing.
• Make sure you’re pumping with the correct flange size. Nipples may become more elastic over time and a different size may be used.
• Starting your period or are you possibly pregnant? Both can decrease milk production and impact let-downs.
• New hormonal birth control or medication? These may impact supply.
• Check your body. Tension, pain, cold, fatigued or anxiety may block the neurochemical pathways required for milk let-downs.
Tips to trigger let down:
• Try a different pump or flange size
• Use heat, breast massage/compressions, or vibrations to prompt milk flow
• Orgasm. The same hormone released during orgasm also causes let down. Studies show having an orgasm can help let down
• Relax. Use slow, deep breaths and meditation
• Singing or humming can also speed let-down
• Gently massage your breasts. Stroke your breast towards the nipple with the flat of your hand or edge of a finger. Gently roll your nipple between your fingers
• Watch videos of your baby. Smell their clothing. Remember the feeling of let down
• Use all of your senses to facilitate let-down. Concentrate on the sight, sound, smell and feel of your baby.
• Take a warm shower or bath prior to nursing
• If you are in any pain, consider taking a pain reliever about 30 minutes before you feeding. Pain can cause stress and inhibit let-down.
• Choose a calm, less distracting setting
• Turn on music or a tv show that you enjoy
• Skin to skin contact with your baby: Undress baby to their diaper and yourself from the waist up. Stay like this for 1-2 hours prior to a feeding
• Eat a favorite snack and drink a comforting beverage like warm tea
• Get comfortable. Sit in a comfy chair or lay in bed. You should be in a comfortable position
• Switch nurse: move baby back and forth frequently between breasts until let-down occurs
• Visualization. Take several deep breaths and close your eyes as you begin. Try to visualize and “feel” what the let-down response feels like for you (if you normally feel anything). Imagine milk flowing or use images of waterfalls. An excellent book on visualization techniques is Mind Over Labor by Carl Jones.
• Distraction: watch TV, read, talk to a friend, don’t watch the pump bottles.
• One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study. (Reference: Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.)
The vernix caseosa is a greasy, cheese-like coating that covers baby’s skin in the womb to protect their skin from getting pickled by amniotic fluid prior to birth. According to present knowledge, vernix production is unique to humans. At birth, vernix may cover the entire skin surface or only be found in body folds. Its color may actually help indicate intra-uterine problems or disease.
😳In utero: When swallowed by baby in utero, vernix helps:
• Develop the gut
• Prevents loss of electrolytes and fluids
• Seals the skin to prevent the amniotic fluid from turning baby into a raisin
• Acts as a microbial barrier from pathogens
• Protects skin growing underneath it
😳In birth: The oily texture may naturally lubricate the birth canal to reduce friction as baby makes their exit. It can also help with mother’s perineal healing!
😳 In postpartum:
• Vernix protects baby’s skin from drying out
• Reduced risk of bacterial infections
• Help baby retain heat
😳 In breastfeeding: The scent of vernix might be involved in triggering neural connections in babies’ brain needed for breastfeeding. The immune proteins found in vernix and amniotic fluid are similar to those found in breastmilk. Swallowing vernix and amniotic fluid in utero help coat baby’s lungs and digestive tract, preparing the digestive tract for the similar peptides found in breastmilk. The smell may also help baby find the breast!
The majority of the vernix is absorbed within the first day, so so it’s recommended to wait until after the first 24 hours to bathe baby. Vernix doesn’t fully absorb until day 5 or 6, so it’s best to wait until then.
Breastfeeding fact: breastfeeding helps you burn calories because it takes calories to make calories. We need on average an extra 300-500 calories per day in our diet because our bodies need approximately 20 calories to make an ounce of breast milk. Not everyone will lose weight while breastfeeding. It depends on and how many calories they take in and how their body uses those calories related to their individual milk production. Food choices, hydration, activity levels, and genetics also all play a role on weight loss while breastfeeding
Breastfeeding fact: breastfeeding helps you burn calories because it takes calories to make calories. We need on average an extra 300-500 calories per day in our diet because our bodies need approximately 20 calories to make an ounce of breast milk. Not everyone will lose weight while breastfeeding. It depends on and how many calories they take in and how their body uses those calories related to their individual milk production. Food choices, hydration, activity levels, and genetics also all play a role on weight loss while breastfeeding
“My hospital nurse told me to feed baby every 2 hours with 15mL and my pediatrician told me to feed baby every 3 hours with 30mL.”
“My IBCLC told me there is a tongue tie but the ENT said there wasn’t one.”
“One consultant told me to use a nipple shield as lo as needed. The other said get off as quick as possible”
“They said don’t let baby feed more than 10 minutes per side, but my baby won’t stay latched that long.”
I hear this all the time in my practice and it can be confusing for families. Why did I get different advice from different people? Perspective. Doulas, midwives, pediatricians, even lactation consultants all come from their own training, education, clinical practice and personal experience. When in doubt, the best person to get lactation advice from is an IBCLC. They have had to go through extensive training and mentoring to become certified in the study of human lactation. But remember: even lactation consultants come from different perspectives.
A hospital based IBCLC typically only works with babies in the first 2-4 days after birth and may see dozens of babies in a week, getting only a short amount of time with each family. A private practice IBCLC may have more time to spend with you but experience and expertise may vary. An IBCLC who is also a nurse will approach breastfeeding differently than one who is also a feeding therapist or who started out as a mother who struggled to breastfeed and became passionate to help others going through what she went through. My best advice is find some one who listens to you, educates on why they want you to do something, and supports you in your journey. Because you have a unique perspective, too.
Lauren Archer, Love of a Little One doula, takes a picture of my midwife and newbornThis is the same image from Lauren’s perspective
Humans by design are predisposed to be lactose intolerant. The only reasons Westerners (mostly) lost this intolerance was due to centuries of eating cheese and having their bodies evolve to adapt to consuming it. Lactose is the number one sugar in breast milk. It’s broken down by an enzyme called lactase which is supposed to disappear in early childhood, right around the time we would naturally wean. Asian cultures are predominantly lactose intolerant because their cultures have had cuisine sans cheese and cow’s milk for millennia (think traditional Japanese, Chinese, and Korean dishes. No cheese. No cow’s milk.) Yet in Western cultures it’s occasionally encouraged to drink milk to make milk. There is no scientific evidence to back this up. You do not need to drink cow’s milk or eat dairy in large quantities to make breast milk. You do need to stay hydrated, eat quality foods, and routinely empty the breast.
Do you feel hot, sticky, sweaty, sopping wet and a little stinky? Welcome to motherhood. It does get better. There is an actual biological point to leaking from every pore and that weird stench that accompanies it.
Not all of our senses are developed at birth. It would overwhelm our littles too much to go from a dark, wet environment to such a bright, crazy world to actually have every sense developed like ours. Their vision isn’t great and they have no depth perception. But they have a fully developed sense of smell. They have been getting to know your odors since their womb days. Your amniotic fluid was constantly changing in its scent based on what you ate and drank and your unique hormone combination. All that leaking you’re doing postpartum has a similar scent which serves to orient your baby back to you. Your body odors are familiar to your baby and it makes them feel safe and secure that they are with their birth person and not someone else. Your leaking smells also stimulate their hunger, which is why baby may constantly root when on your body even if they aren’t hungry. Did you know that the breast secretes an oil from those little bumps on your areolas that smells just like amniotic fluid? This helps baby locate dinner when they are ready to eat. Showering is normal, but avoiding the use of scented products can actually be very helpful and calming for your baby. While you may find your body odor unbecoming, know that to your baby it makes you feel like home.
