Drinking and Breastfeeding

Milk is made from your blood, so what you drink can impact your milk supply. 

💦 How much water should you be drinking? There are some ridiculous answers out there. If your breast milk production has decreased, helpful people may suggest that you chug tons of water. Your lack of water intake may contribute to but is not completely responsible for your supply drop. Drinking too much water can inadvertently harm your milk supply

💦 When you drink too much water, your body tries to restore the electrolyte balance in your body by dumping the excess water into your urine. This results in water being diverted away from your breasts, which in turn decreases your milk supply. Water dense foods can also be just as hydrating as plain water from the tap. 

💦 You will lose up to 30oz of water through your breast milk to your baby; so do try to drink 8-12 glasses of water a day

☕️ Coffee is safe to drink: 300-500mg of caffeine per day max

☕️ Younger babies (< 6 months), preterm and medically fragile babies process caffeine slower and they may be sensitive to it. 

☕️ If you consistently drank coffee during pregnancy you baby is already used to caffeine

☕️ It takes 15-20 minutes for coffee to hit your bloodstream and is usually completely gone by 4-7 hours. So if you’re concerned or having it for the first time after birth, either breastfeed baby first and then have your coffee or have it while breastfeeding

🍷 According to the CDC, moderate alcohol (up to 1 standard drink per day) is not known to be harmful to baby

🥂 Less than 2% of alcohol reaches breastmilk and typically peaks within 1/2-1 hour after consumption *however* factors such as food, weight & body fat need to be considered

🥂 Alcohol does not accumulate but leaves breastmilk as it leaves the bloodstream. There is no need to pump and dump when consuming limited amounts of alcohol

🥂 If you are feeling like you NEED to consume large amounts of alcohol regularly, speaking to a qualified professional is admirable and a very good option

ALCOHOL AND BREASTFEEDING

Is it ok to have alcohol and breastfeed? The short answer is yes, in moderation. No, you don’t need to pump and dump for 1 standard drink. Yes, those alcohol testing milk strips are kinda dumb. 

Alcohol passes freely into breast milk and peaks around 30-60 minutes after consumption (60-90 minutes if you drink with food) so what you would breathalyze you would “breastalyze”. This does not mean your milk has an much alcohol as you consumed or as a straight up alcoholic beverage. It means you milk has the same amount of alcohol as your blood. For instance, if your Blood Alcohol Content (BAC) is 0.10 (or 0.10%, 1/10 of 1 percent) from drinking, you breast milk has 0.10% alcohol in it. In comparison, a typical beer has 4.5% alcohol, a glass of wine has 15% alcohol, and a shot of vodka has 40% alcohol. 

Let’s interpret that: if you breastfeed while you’re having your first drink, your baby will most likely be finished feeding before the alcohol hits your system. There’s no need to pump and dump your milk. Only time clears the alcohol from your system. If you’re breastfeeding a newborn, premature or medically compromised infant, you’ll want to be more cautious of the alcohol you consume and may want to consider waiting longer to breastfeed than an older baby. Such a small portion of alcohol gets into your milk, if you have an older baby and have only had one drink there’s really no need to wait to pump or feed. 

If you want to have an occasional drink, I will never judge you!!! Go for it!! If you need alcohol, large quantities or alcohol or are struggling with alcohol, please find a qualified counselor to work with ❤️ 🍻

Breastfeeding nipple facts

Most (not all!!) mammals have nipples as they feed their live young milk from their bodies made in mammary tissue. Marsupials and eutherian mammals typically have an even number of nipples arranged in pairs on both sides of their bodies, from as few as two to as many as 19 pairs. Some 5,600-6,000 species of mammals feed their young milk, and thus have mammary glands, but not all mammals have breasts (or nipples!!). In humans, the areola surrounds the nipple in a round shape and comes in varying sizes, on average 3 to 6 centimeters. The little bumps around the areola (called Montgomery glands) secrete an oil that smells like amniotic fluid to help baby use smell to find the nipple to latch on. In the center of the areola is the nipple, again in a wide variety of sizes shapes and lengths, and can be 10 to 27 millimeters (mm) wide by 1 to 10 mm in height. Its skin is similar to the areola, but has no oil glands. It has 4 to 20 pores where milk can come out. The skin of the nipple rests on a thin layer of smooth muscle, called areolar muscle fibers which are distributed in two directions: radial and circular. The muscle of Sappey responsible for circular fibers and the muscle of Meyerholz, formed by the radial fibers. Contraction of these muscles is responsible for the erecting of the nipples during stimulation and breastfeeding as well as the ejection of milk from the breast. How tight or loose these nipple muscles are may contribute to why some of us leak more than others and some don’t leak at all, but there is no way to exercise these nipple muscles!

Deep breathing and breastfeeding

Put your oxygen mask on first. When there is an emergency on a plane, we are instructed to put our mask on first before helping others. This is also critical when caring for our babies. You’ve just gone through one of the most traumatic experiences your body could physical do: give birth to another human being. You’re healing a dinner plate sized wound on your uterus while sweating like a pig and not sleeping for more than a few hours at a time. There are so many physical, social, and emotional changes happening to you all at once it can be easy to just ignore all of them to focus your energy into your new tiny human.

Deep breathing is one of the easiest, most convenient tools to reduce stress, anxiety, and pain. And who doesn’t have all of those after the trauma of giving birth and dealing with all of the physical, social and emotional changes of bringing a tiny human into their life? Laying on your back, feet up against the wall and focusing on intentional breaths is one of the simplest ways to reset and promote balance in your body again 

Deep breathing:

❤️ Decreases stress, increases calm. Stress and anxiety makes your brain release cortisol, the “stress hormone”, which decreases oxytocin, your milk let down hormone. Deep breathing slows your heart rate, allowing more oxygen to enter the blood stream which relaxes your brain and lowers cortisol. This results in higher oxytocin and thus more milk

🧨Relieves pain through endorphin release which can help while you’re healing your lady bits (or those cracked nips)

💎Detoxifies the body by stimulating the lymphatic system. Carbon monoxide is released by breathing. 70% of the toxins in your body are cleared just by breathing

🚗Increases energy. More oxygen= better body functions and that improves stamina. Who doesn’t need that for 2am feedings?

🩺Lowers blood pressure. Relaxed muscles allows blood vessels to dialate, which improves circulation and lowers blood pressure

💊Fully oxygenated blood carries and absorbs nutrients and vitamins more efficiently, improving your immune system against viruses and bacteria. This also helps improve digestion! 

🤸‍♀️Supports good posture. When you breathe in, your lungs expand which pulls your diaphragm down and straightens your spine. You definitely need to lengthen your spine and release that neck tension from being hunched over while latching your baby

The risks of not addressing maternal mental health include:

✏️Poor infant growth, language and cognitive development 

✏️Poor gross and fine motor development

✏️Less efficient breastfeeding or weaning from breastfeeding earlier than desired

✏️Poor infant sleep and increased maternal stress. 

When considering antidepressant use during lactation, while most medications are considered safe for mom and baby, there is no “zero risk” option. However, the benefits of using a medication to help decrease depression and anxiety usually outweigh the risks acostares with taking a medication. If a mother has been on a certain med prior to breastfeeding and it worked well for her, it would be reasonable to resume that medication while breastfeeding. Sertraline (Zoloft) is a first-line drug for breastfeeding, due to documented low levels of exposure in breastfeeding babies and the very low number of adverse events described in case reports. Prozac is generally considered safe to take while breastfeeding; however, research shows that the average amount of the drug in breastmilk is higher than with other SSRIs. 

When taking any medication, you want to monitor for side effects both in you and the baby. Most common side effects when taking antidepressants are:

🥛 Changes in milk supply

🛌 Sedation/sleepiness in baby

Poor feeding or weight gain in baby

Antidepressants can work well to help you feel balanced again. Work closely with an IBCLC while starting antidepressants to help continue and feel supported in your breastfeeding journey

Nipple vasospasm: That tingling isn’t thrush

Has your nipple looked waxy or dull white after feeding or pumping? That’s because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area. The arteries go into spasm and stop letting blood through. There is a disorder called Reynauds that make peoples experience this in their fingers and toes on a more routine basis. When it happens in the nipple it really HURTS. Some say it feels like fire or ice. Others describe it as a pinchy, slicing feeling, or pins and needles. The nipple often turns pale and become painful right after the baby unlatches. It often gets misdiagnosed as thrush but will not respond to medications. So if you’ve been on multiple rounds of medications for thrush and it’s not working, you may actually be having vasospasm.

It can simply be caused by a bad latch, but can have several other culprits. For people prone to vasospasm, the repetitive action of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger the spasm.

The two main ways to help: massage and heat.

🤲🏼Gently massaging, rubbing, or pinching the nipple helps. Immediately cover your nipples with your shirt/bra/nursing pad, then gently rub or massage them through the fabric.

🌞Heat is important because of science: evaporation is a cooling process. When liquid turns to gas, it uses heat energy from its surroundings to transition. When milk and saliva evaporate off your nipple, the skin and surface tissue cool rapidly, causing the vasospasm.

🌞To slow evaporation, place heat on your nipple as soon as baby unlatches. Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands (like you use in snowy climates for skiing), or a heating pad can help. Leave heat on for a few minutes until the pain subsides.
🌚Avoid anything wet on the nipple as this promotes evaporation.
🌝Wear wool nursing pads between feedings

VASOSPASM TREATMENT.
Unfortunately, there isn’t a lot of good quality research about treating breastfeeding nipple vasospasm no. Much of what we know is taken from other vasospasm research, or applied from anecdotal evidence. You should always consult your primary health care provider before making any changes to your health, such as adding a supplement, taking medications, or making big lifestyle changes. At a basic level:
🌻Watch for a deep latch every time
🌻Have baby assessed for tongue tie
🌻Check your flange size. If you’re maxing our the suction on the pump, your flange is too big. When too much areola is drawn into the tunnel, the areola swells shut around the nipple and causes the spasm. Using too small a flange does the same: cuts off blood flow to the nipple tip.

Other tips to reducing vasospasm:
🌸Avoid nicotine and medications that cause vasoconstriction (such as pseudoephedrine, beta blockers).
🌸Limit or avoid caffeine
🌸Some research indicates hormonal birth control pills increase the risk of vasospasm.
🌸The main supplement that seems to help with vasospasm is vitamin B6. Dr Jack Newman suggests 100 mg of B6 twice day, as part of a B vitamin complex. If your B vitamin contains 50 mg of B6, you’d take two of them, twice a day. If it contains 25 mg of B6, you’d take four of them twice a day.
🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Supplementing with cal/mag often helps with vasospasm.
🌸Being active helps prevent their vasospasm. An active lifestyle can keeps blood circulating through your body.
🌸The internet is full of conflicting opinions on if ibuprofen is a vasoconstrictor or vasodilator. Regardless, it sometimes turns up to treat/prevent vasospasm. If you have regular vasospasm, the risks of longterm ibuprofen use most likely outweigh the potential decrease in vasospasm. It may be OK for occasional vasospasm. Discuss regular ibuprofen use with a healthcare provider.
🌸For chronic, painful vasospasm that does not respond to breast-feeding help, some doctors may prescribe a short course of a blood medication called Nifedipine.

Complementary Foods

Breast milk or formula should be the primary source of nutrition for babies under 1 year old. The first foods we introduce to our babies are often called “complementary foods” because the idea is to introduce foods that complement breast milk/formula, not to simply replace milk.

Introducing solid/table/first foods should start when babys mouth and gut are ready to tolerate digesting them. Baby’s tongue thrust reflex should have disappeared, baby should be able to sit unsupported for at least the length of a meal, and baby should be using a pincher grasp to be able to bring their own food to their own mouth. This usually happens around 6 months, although for some it’s a little younger and others a little older. Food choices should be about exposing baby to a full palate of flavors and a wide variety of textures that add to baby’s feeding experience without taking away the nutrients and energy found in milk. The goal of complementary feeding is NOT to try to fill baby up with as much food as possible to cut back on giving breast milk or formula. It’s about baby gradually increasing the amount of foods eaten from your family’s unique diet across multiple months.

Cooked sweet potatoes, mashed avocado or banana, purée canned pears or peaches, and cooked carrots are wonderful first foods and simple to make. Next offer foods from your family table first (in the appropriate purée or cooked and cut form). Your baby has already been exposed to what you eat on a daily basis through your milk and they’ll have a higher likelihood of preferring those foods. Many foods marketed for babies, like rice cereal or oats, don’t actually add any nutritional value to baby’s diet. Read jarred food labels carefully for preservatives and sugar. There’s also a risk of filling your baby up with low calorie jarred foods which then decreases the amount of nutrient dense milk they will want to drink.

Remember: just as every family eats different foods and has their own unique way of doing meals, so does every tiny human. If you’re concerned about your littles eating habits, request feeding therapy with an occupational therapist at your next pediatrician appointment.

Remember:
⭐️ The World Health Organization recommends breastfeeding until 2 years of age
⭐️ Breast milk never loses its nutritional value and is good for children at any age
⭐️ From 7-9 months babies need about 250 calories from food a day
⭐️ From 10-12 months babies need around 450 calories from food a day

Sleep Like A Baby

BREASTFEEDING FACT: No one sleeps all night
The reality is, no one, including adults, sleeps all night all the time. Older infants and toddlers are no exception. They often wake multiple times a night, but as they mature, they learn to put themselves back to sleep. We all go through multiple sleep cycles in a night, and toddlers actually go through more of these sleep cycles than we do. Which means they have more opportunity to get woken up from a light sleep.

Generally, there are 2 sleep stages in newborn babies and 4 sleep stages in babies over 3 months old. Newborn sleep stages are rapid eye movement (REM) and non-rapid eye movement (NREM). Newborns spend close to equal amounts of time in REM and NREM while they sleep.

REM is an active sleep state and NREM is a quiet sleep state. During REM, a baby can be seen making small movements. The baby’s eyes move around (while closed), their arms, legs and fingers might twitch or jerk, their breathing might speed up, and they may move their mouths. During NREM, the baby is still and doesn’t move. Around 3 months, babies begin experiencing the same sleep stages as adults.

Adults go through 4 sleep stages. These sleep stages include three stages of NREM sleep (which happen first at night) and one of REM (which happens last). The first two are lighter stages of sleep, during which a person can be easily awakened. The third stage of sleep is the deepest stage, and it is very difficult to wake someone in this stage. The fourth is REM, where dreams happen. Although babies begin experiencing 4 stages of sleep around 3 months, it is not until closer to 5-years-old that children’s sleep actually begins to mirror that of adults. As babies, they experience a short REM stage almost immediately after falling asleep instead of last in the cycle. In contrast, adults do not experience REM until they have been asleep for around 90 minutes. As a baby’s sleep schedule changes, so do their sleep cycles. Baby REM sleep is one part of the sleep cycle that changes over time. However, there is no simple chart outlining sleep cycle length or REM by age. Know that it is normal for your baby and toddler to wake frequently at night, and as they age, they will get better and better at putting themselves back to sleep.

.

sleeplikeababy #sleeplike #babysleeping #babysleep #babysleeptips #breastsleeping #nightnursing #nightbreastfeeding

Antidepressants and breastfeeding

Put your oxygen mask on first. When there is an emergency on a plane, we are instructed to put our mask on first before helping others. This is also critical when caring for our children. Stress, depression, and anxiety can play major roles in how we care for our babies and for ourselves. Antidepressants are OK to take while breastfeeding. When maternal mental illness is not addressed, research shows this not only has a negative impact on the mother’s overall health, but can impact the baby as well.

The risks of not addressing maternal mental health include:
✏️Poor infant growth, language and cognitive development
✏️Poor gross and fine motor development
✏️Less efficient breastfeeding or weaning from breastfeeding earlier than desired
✏️Poor infant sleep and increased maternal stress.

When considering antidepressant use during lactation, while most medications are considered safe for mom and baby, there is no “zero risk” option. However, the benefits of using a medication to help decrease depression and anxiety usually outweigh the risks acostares with taking a medication. If a mother has been on a certain med prior to breastfeeding and it worked well for her, it would be reasonable to resume that medication while breastfeeding. Sertraline (Zoloft) is a first-line drug for breastfeeding, due to documented low levels of exposure in breastfeeding babies and the very low number of adverse events described in case reports. Prozac is generally considered safe to take while breastfeeding; however, research shows that the average amount of the drug in breastmilk is higher than with other SSRIs.

When taking any medication, you want to monitor for side effects both in you and the baby. Most common side effects when taking antidepressants are:
🥛 Changes in milk supply
🛌 Sedation/sleepiness in baby
Poor feeding or weight gain in baby

Antidepressants can work well to help you feel balanced again. Work closely with an IBCLC while starting antidepressants to help continue and feel supported in your breastfeeding journey

Human milk fat


The fat in your milk accounts for 50% of the calories your baby takes in each feeding. While protein and lactose remain relatively stable throughout the day, milk fat concentration can vary by 47% in a 24 hour period!

Factors that influence milk fat in breast milk:
🤱🏽 In the lactation parent (some of these you can change and control and some of these you can’t):
Lifestyle
Diet
Body size
Health or disease/inflammation
Number of children
Type of birth
Overall milk volume produced daily

👶🏼 In the baby (the lactating parents body responds to make specific milk to accommodate the baby):
Gender
Gestational age
Birth weight

🍫 Other factors that influence fat in human milk:
⏰ Time of day (highest fat is in the afternoon/evening)
👶🏼 👧🏽 Stage of lactation (colostrum has the lowest amount of fat. Extended milk for toddlers 12+ months has the highest amount of fat!)
🗓 Time postpartum (milk fat increases with time!) mm
Ways to help increase milk fat:
🤱🏽 Feed more frequently. An emptier breast has higher fat and lower water concentrations. Pump
⭐️ Shake your breasts prior to feeding. This gets the fat at the back of the breast to be activated more quickly to flow sooner in the feeding
🐠 Add in healthy fats to your diet: salmon, herring, sardines, flax and chia seeds, and walnuts are high in healthy fats that can boost your milk fat.
🍦 Manage diabetes/blood sugars
🏋🏽‍♀️ Make sure you’re not anemic or iron deficient
♨️Reduce inflammation in the body (can often be done with diet and lifestyle changes and/or with the help of a naturopathic practitioner)

COLORS OF MILK

Your milk can be a variety of colors which can be caused by a variety of things.

💛Diets high in yellow-orange vegetables (yams, squash, carrots, etc) can lead to high levels of carotene in your milk, which can turn it yellow or orange.

💛Frozen milk may look more yellowish when thawed.

🧡Food dyes used in carbonated sodas, fruit drinks, and gelatin desserts have been associated with milk that is pink or pinkish orange.

💙Blueish milk is often just a higher water content in the milk. It could also be caused by food dyes.

💚Greenish milk has been linked to consuming green sports beverages, seaweed, certain herbs, or large amounts of green vegetables (such as kale or spinach). I had mine turn green from a plant based multivitamin!!

💗Pink milk, some times called “strawberry milk” be a sign of blood in your milk. This can occur with or without cracked nipples. Seeing blood in your milk may be alarming at first, but it is not harmful to babies. If you have any concerns or other symptoms associated, such as pain or mastitis, set up a lactation consultation right away.

💔Occasionally blood in breastmilk is caused by things other than nipple or breast trauma. Papillomas are small growths in the milk ducts which are not harmful but can cause blood to enter your milk. In the vast majority of cases, blood in human milk is not a concern. However, some forms of breast cancer can cause blood to leak from the nipples. Breast milk can also turn pink if a bacteria called Serratia marcescens is present, although rare this bacteria can be extremely harmful to young babies. If you’re experiencing pink milk without noticeable nipple damage, please reach out to a health care provider immediately.

🤎Brown milk may be caused by what is known as rusty pipe syndrome. During pregnancy and in the first few days after birth the ducts and milk making cells in your breasts grow and stretch. As blood flows to your breasts it can sometimes leak into your milk ducts, making your milk look brown or rust-colored. It usually clears within a few days as more milk flows through your breasts. Continue feeding your baby your milk.

Vasospasm: pins and needles in the nipple

Has your nipple looked waxy or dull white after feeding or pumping? That’s because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area. The arteries go into spasm and stop letting blood through. There is a disorder called Reynauds that make peoples experience this in their fingers and toes on a more routine basis. When it happens in the nipple it really HURTS. Some say it feels like fire or ice. Others describe it as a pinchy, slicing feeling, or pins and needles. The nipple often turns pale and become painful right after the baby unlatches. It often gets misdiagnosed as thrush but will not respond to medications. So if you’ve been on multiple rounds of medications for thrush and it’s not working, you may actually be having vasospasm.

It can simply be caused by a bad latch, but can have several other culprits. For people prone to vasospasm, the repetitive action of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger the spasm.

The two main ways to help: massage and heat.

🤲🏼Gently massaging, rubbing, or pinching the nipple helps. Immediately cover your nipples with your shirt/bra/nursing pad, then gently rub or massage them through the fabric.

🌞Heat is important because of science: evaporation is a cooling process. When liquid turns to gas, it uses heat energy from its surroundings to transition. When milk and saliva evaporate off your nipple, the skin and surface tissue cool rapidly, causing the vasospasm.

🌞To slow evaporation, place heat on your nipple as soon as baby unlatches. Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands (like you use in snowy climates for skiing), or a heating pad can help. Leave heat on for a few minutes until the pain subsides.
🌚Avoid anything wet on the nipple as this promotes evaporation.
🌝Wear wool nursing pads between feedings

Unfortunately, there isn’t a lot of good quality research about treating breastfeeding nipple vasospasm no. Much of what we know is taken from other vasospasm research, or applied from anecdotal evidence. You should always consult your primary health care provider before making any changes to your health, such as adding a supplement, taking medications, or making big lifestyle changes. At a basic level:
🌻Watch for a deep latch every time
🌻Have baby assessed for tongue tie
🌻Check your flange size. If you’re maxing our the suction on the pump, your flange is too big. When too much areola is drawn into the tunnel, the areola swells shut around the nipple and causes the spasm. Using too small a flange does the same: cuts off blood flow to the nipple tip.

Other tips to reducing vasospasm:
🌸Avoid nicotine and medications that cause vasoconstriction (such as pseudoephedrine, beta blockers).
🌸Limit or avoid caffeine
🌸Some research indicates hormonal birth control pills increase the risk of vasospasm.
🌸The main supplement that seems to help with vasospasm is vitamin B6. Dr Jack Newman suggests 100 mg of B6 twice day, as part of a B vitamin complex. If your B vitamin contains 50 mg of B6, you’d take two of them, twice a day. If it contains 25 mg of B6, you’d take four of them twice a day.
🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Supplementing with cal/mag often helps with vasospasm.
🌸Being active helps prevent their vasospasm. An active lifestyle can keeps blood circulating through your body.
🌸The internet is full of conflicting opinions on if ibuprofen is a vasoconstrictor or vasodilator. Regardless, it sometimes turns up to treat/prevent vasospasm. If you have regular vasospasm, the risks of longterm ibuprofen use most likely outweigh the potential decrease in vasospasm. It may be OK for occasional vasospasm. Discuss regular ibuprofen use with a healthcare provider.
🌸For chronic, painful vasospasm that does not respond to breast-feeding help, some doctors may prescribe a short course of a blood medication called Nifedipine.