The number one method to sabotage your milk supply when you go back to work is a caregiver who over feeds your baby.
Scenario one: Baby is given a full bottle and takes 5 ounces in five minutes. Baby then spits up half the feeding and caregiver tries to give more to “keep it down”. Caregiver tells mom baby is fussy and has reflux. Baby gets put on Zantac and rice cereal.
Reality: there are several factors going on in that scenario that will sabotage a working mother’s milk supply. First, babies are not supposed to take five ounces in a feeding. Their stomach is the size of their fist and should only be taking 1-3 ounces per feeding through the first year of life. Their stomach can only hold so much and if it’s past capacity, the only place for it to go is up. I can eat a whole cake, but I shouldn’t. As an adult, if I overeat I get uncomfortable, too. I either take peptobismol or put on my stretchy pants to wait for the pain to subside. Then I don’t eat that much again. Babies fuss and spit up for the same reason. We’re over diagnosing babies with reflux that are being fed too much or too fast.
Scenario two: Caregiver gives a baby six ounces every feeding, 3 times while mom is gone, every time the baby cries or wants to suck. Baby appears fussy and wants to suck all the time.
Exclusively breastfed babies should consume 25-35 ounces across each 24 hour day and approximately 20% of their calories should be taken over night. If you do the math, that’s a little over an ounce an hour, or 1-3 ounces every two to three hours. And in accordance to what the baby needs, mom will make that volume. So if caregiver is feeding 6 ounces three times in an 8 hour shift, you’re expecting mom to pump 18+ ounces. In reality, her body will most likely make 6-10 ounces which would be the amount she would make if she were home with her baby. In a few days of over feeding the baby, mom becomes discouraged that she’s not making enough and pretty soon she’ll start supplementing with formula
Babies also want to suck for a variety of reasons: comfort, pain, bonding, nutrition, pleasure, etc. Babies use mom as a pacifier without actually drinking. When babies are away from their mommies is very stressful, so their way to soothe is to suck.
Scenario three: Baby is given 4 ounces and chugs it down in five minutes. Baby is happy to chug down high volume and the caregiver thinks baby is just a piggy and really hungry. Baby occasionally coughs and chokes and milk comes out her mouth.
Reason: Babies have a swallow reflex that is with them at birth. When liquid reaches the back of the throat it triggers the swallow reflex. Babies are obligated to swallow otherwise they will choke or let the milk pool out of their mouths. When you see a baby chugging down milk really fast, it’s not usually because they are starving, but because they are trying to keep up with the flow of the bottle. As I said in an earlier post, there’s really no such thing as nipple confusion, but flow confusion. At the breast, other than during active let down in the first few minutes of active feeding, the baby controls the flow of milk by how they suck. In bottle feeding, the bottle will flow because gravity always wins. Caregivers need to be taught paced bottle feeding. Using a slow flow nipple, feeding baby in side lying, and frequently tilting the fluid away from the nipple to slow the baby from drinking so fast gives the baby more oral control and time to appropriately eat.
There are two kinds of receptors in the stomach: stretch and density. It should take a baby 10-20 minutes to eat from a bottle. This is also how long it takes the stretch receptors to tell the brain that the stomach is full. I can eat a whole pizza really fast, but I shouldn’t. Babies can eat a large volume really quickly, but they shouldn’t. Not only is it not developmentally appropriate, but pretty quickly the high volume needs will sabotage mom’s opinion of her perfectly healthy milk volume. She’ll turn to all kinds of milk makers: cookies, teas, herbs, etc and eventually if she’s discouraged enough she’ll turn to formula, when in reality if the caregiver would slow down feedings and give the rigjt volume, every one would be happy.
Asking for medical advise from social media forums, especially mommy groups, is like asking a mother who’s had a baby to deliver yours. Just because she has experience in the field does not make her qualified to give technical advice in that area. She can give you her opinions or share her experience, but she did never be relied on as a trustworthy source when providing care to YOUR child.
Breastfeeding is especially one of those areas that we need to tread wisely into when asking for help and advice. Or culture has hidden breastfeeding from the norm and made it this mysterious, murky action where myths and misunderstandings abound. So much of the information found in quick Google searches are anecdotal, antiquated, or based off formula feeding data which is completely distinct and sometimes totally opposite of true breastfeeding. We should be seeking community support for breastfeeding, but not when medical advice is being solicited.
When mothers give out advice on social media platforms, they are not taking into consideration the whole breastfeeding picture and may inadvertently give advice that could care harm or actually negatively impact breastfeeding. For instance, when a mother of a two month old asks for advice on increasing her breastmilk supply and mother start giving advice on herbs, lactation cookies, or teas, they may not be considering WHY she is needing to increase her supply. Is her baby in the NICU? Is she going back to work and stressed with the pumping process? Does she have. History of sexual abuse that she actually needs to work through? Did her pediatrician have her supplement which impacted her supply? Is she trying to sleep train and sabotaging her own supply? Is she ALLERGIC to the herbs in those teas and supplements? How often is she feeding? Does she have a metabolic or hormonal disorder impacting her supply? Does she have enough glandular breast tissue to even produce sufficient milk supply? Does her baby have a tongue tie? Does the baby simply have a poor latch? These are the questions that are crucial in giving appropriate breastfeeding advice to protect the breastfeeding relationship. The best advice a mother can give on the social media platform is to have the questioning mother contact a lactation consultant.
The gold standard for breastfeeding advice is the International Board Certified Lactation Consultant (IBCLC). There are other forms of lactation consultants that teach and serve out of a variety of backgrounds. The IBCLC is the top most coveted professional because of the extensive education and rigorous testing they need to go through in order to be able to assist lactating mothers. In order to sit for the FOUR HOUR board exam, candidates must have extensive education in specific health science subjects, like nutrition, psychology, and childhood development; 90 college level credit hours of education in human lactation and breastfeeding, and hundreds to thousands of clinical practice in providing care to breastfeeding families. They must also maintain a high level of continuing education courses and continue to sit for the board exam every 10 years.
So when you see moms with questions related to breastfeeding in social media forums that are beyond opinions or personal experience, the best advice is professional advice.
Lactose is the number one carb/sugar in human milk. We wouldn’t survive as a species if babies were lactose intolerant. Human milk actually has 50% more lactose than cow’s milk! Our bodies produce a protein called lactose that breaks down lactose in the gut. Lactase is supposed to disappear after baby is weaned- usually by seven years of age. Yes, babies are supposed to be breastfeed until between 2.5 to 7 years of age. Human babies are supposed to drink only human milk and our bodies are designed to digest it efficiently and effectively. When this protein disappears, the body has a hard time digesting lactose. In reality up to 70% of adults are lactose intolerant as adults because this protein is supposed to disappear. We’re not meant to drink milk after childhood. But this shouldn’t happen until after baby is weaned- as a toddler or preschooler. The reason babies can have indigestion and upset from milk is from bovine protein either that mom is eating (those excessive cheese lovers know what I’m talking about) or from introducing artificial baby milk (aka formula that is cow’s milk based).
Taken from viva.org.uk
The proteins in milk can be divided into two categories: caseins and whey proteins (remember Little Miss Moffett on her tuffet eating her curds and whey? Curds are like the globs in cottage cheese and the whey is the watery substance). Human milk contains these in a ratio of 40:60 casein to whey; while in cow’s milk the ratio is 80:20 respectively. The amount of total protein in cow’s milk is more than double that of human milk to help baby cows double in size very quickly after baby. Cow’s milk contains considerably more casein than human milk to achieve that growth. Casein can be difficult to digest, in fact it is used as the primary ingredient of some glues! Artificial baby milks have to be formulated or altered to contain more whey than casein, to try to replicate the ratio of whey to casein to be as similar to that of human milk as it can to be better digested. But it is still a forgoing protein that the body wasn’t designed to digest.
Now there are truly some babies who have difficulties with digestion, however congenital lactose intolerance is very, very rare. It would be seen immediately after birth with very severe symptoms and should be diagnosed by a pediatrician as soon as possible. A small percentage of breastfeeding mothers notice an obvious difference in their baby’s behavior and/or health when mom eats certain foods. As previously stated, cow’s milk products are the most common problem foods and the only foods conclusively linked by research to fussiness/gassiness in babies because of the protein found in cows milk. Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think.
There are some really well written articles if you feel your baby has a protein intolerance. For more information, check out the following resources:
The Comparative Composition of Human Milk and of Cow’s Milk. http://www.jbc.org/content/16/2/147.full.pdf
A Comparison Between Human Milk and Cow’s Milk. https://www.viva.org.uk/white-lies/comparison-between-human-milk-and-cows-milk
I was recently contacted via Facebook about my opinions on supplementing at birth when mother’s milk “doesn’t come in right away”. I thought you might be interested in my response. The first several paragraphs are the background anatomy and physiology of early breastfeeding. Below are the questions I was sent as well as my responses. Enjoy!
Breastfeeding is a natural process that has become misunderstood by the general public as it became hidden from the community. I believe when mothers actually understand the process of breastfeeding, it can help then understand what is going on in their newborn. Prenatal breastfeeding classes are essential for this. At 10-14 weeks of gestation, every mothers breast begins to fill with colostrum, a high protein milk which acts as a laxative. It’d why their breast change size during pregnancy. Mothers already have the first milk in the breast that their babies need for birth. It is in a small volume because babies are born constipated and fluid overloaded from the womb. In a natural, uncomplicated delivery, a newborn has a high need to suck because of this constipation. Sucking causes peristalsis (a wave like movement) to travel through the esophagus through the stomach to the intestines to push out the poop. It takes approximately three days for all the meconium to be pooped out (which is exactly how long it takes for colostrum to change over to mature milk!!) Nature designed the breast to feed the need of the baby in perfect balance to allow baby to become unconstipated so the gut would be ready for nature milk at the right time. Breast milk actually doesn’t “come in”. It’s already there in the form of colostrum. The first few days are controlled by the autonomic system. You’re pregnant so you will produce colotrum and your body will think you’re feeding a baby. You need your baby to suck at birth to lay down hormone receptors in the breast for prolactin, the milk making hormone. The more your baby simulates your breast in the first few days after birth, the more hormone receptors are activated to make milk for your baby. After the first few days, you switch from the autonomic system to the demand a supply model that continues for the duration of breastfeeding. The more the baby demands, the more mama makes.
Unfortunately in the modern world of medicine, we have tampered with the natural process of birth and thereby impacting breastfeeding. With IV fluids, the epidural, and other medications used in birth, we’re changing how newborns interact with the world and how hormones in mom are being produced. The epidural rate in hospitals in LA County is over 80%, with many hospitals over 90%! It actually causes sleepy babies that do not do as well at the breast (Richard and Alade, 1990, https://youtu.be/4eQdQ1Ww9-k) Cesarean births also significantly delay the Natural switch from colostrum to mature milk for obvious reasons based on the above information. Babies really need to be skin to skin and at the breast with no interruption for the first few days of life or until mature milk had come in. Skin to skin contact promotes physiologic stability in the baby (including regulation temperature ebooks sugar) while promoting free access to the breast to facilitate the process described above. If hospitals encouraged mothers in Birthing a more natural and unmedicated way, we would actually see a significant drop in the need for supplementation and in breastfeeding issues.
The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding. Formula fed babies have a 50% higher risk of dying of SIDS at all ages of infancy with even higher rates in other developing nations due to unsafe water and lack of finances for parents to afford formula. Baby friendly hospitals in the US understand the importance of breastfeeding but aren’t the best at communicating why. Breastfeeding is better for babies for a laundry list of reasons.
One of my newest clients.
What should expectant parents look for when searching for a lactation consultant? They need to find someone who is skilled and trained. An IBCLC is always the gold standard because of the extensive training we go through. Facebook forums are horrible for information because there is a lot of poor information floating around. Yelp is great for reviews of local consultants. If they suspect a tongue tie, they need to find a lactation consultant specifically trained in it. Not every one is.
How are lactation consultants accredited and are their different professional organizations? http://blog.mothersboutique.com/whats-the-difference-between-lc-ibclc-cle-etc/
http://www.lalecheleague.org/faq/lc.html
What is generally the maximum amount of time a mother should wait for milk to come in before offering formula? For instance, after a c-section when it can take longer. This is a loaded question because every story is different. In the hospital it’s always based on bilirubin numbers and the risk for jaundice. In my practice, if a baby has not has the recommended number of wet diapers by day three we’re supplementing at the breast using an SNS at the very least.
What are the guidelines when it comes to (temporarily) supplementing with formula for newborns? Unfortunately there are no guidelines and every practitioner comes from their own experience and setting. There are no rules and it’s a case by case basis which should be based on parents breastfeeding goals, but unfortunately is not always an option.
When waiting for milk to come in, what amount of weight loss would be a red flag? 10% is normal weight loss for all infants. Birth weight needs to be regained by 2 weeks. And we need to know WHY. Is there a tongue tie? Does the mother have a hormone issue? Does the baby have birth trauma or tortícolis? Is there a metabolic issue or heart defect? Is it simply a poor latch or improper position? Did the baby have poor oral skills? These all can relate to weight loss. At what point would you advise a breastfeeding mother to offer formula? If baby gets adequate skin to skin time and constant access to the breast, most of these issues resolve on their own. If a baby is lethargic, sleeping more than 4 hours multiple times in a row, or not making enough wet and dirty diapers by 48-72 hours, I’m all about supplementing. But that’s me coming from a hospital background. I don’t mess around with the risk of jaundice. I also always prefer supplementing at the breast with an SNS and with donor breast milk when possible. Stimulate the breast for increased production while getting the baby fed and used to the breast at the same time.
Do you feel the threat of “nipple confusion,” supply issues, or a mother “giving up” breastfeeding are valid reasons for avoiding formula when milk hasn’t come in? Are there other reasons to avoid temporary supplementing? This is another misconception. There really isn’t “nipple confusion”. It’s actually flow confusion. At the breast, babies need to stimulate milk flow at the beginning of a feeding with active suckling. It can take one to two minutes of suckling for let down to happen. Breasts can flow at different rates and even flow different during a single feeding. Bottles, however, are instant and constant. It’s much easier to feed from a bottle, so some babies “prefer” this from having to work at getting their milk. A lactation consultant can help with any issue of flow at the breast to help with this. Opinions vary in the introduction of a bottle. Some say no sooner than 2-3 weeks or when breastfeeding is well established. Die hard lactation consultants say no sooner than 6 weeks. In NICU where I work, we use bottles from day one and babies easily transition back and forth between breast and bottle. We use and teach paced bottle feedings and use of a slow flow nipple to try to replicate breast flow from a bottle.
What do you think is the biggest benefit to enlisting lactation consultants’ help in breastfeeding? The earlier you get help, statistics show, the longer mothers will breastfeed. If breastfeeding is your goal, get help in the first 72-96 hours. Enlisting help give mothers the confidence in knowing subtle changes in positioning and latch that can make a world of difference. An LC can also identify if there is something wrong, like a tongue tie, inverted nipple, swelling of the breast from fluids at birth, etc that is impacting feeding.
Do you feel pediatricians are being pulled in different directions when it comes to supplementing? For instance, they are promoting breastfeeding because of the proven health benefits, but also want to be able to offer formula because sometimes it’s needed? Pediatricians get a 45 minute lecture on breastfeeding on medium school if there lucky. It depends on their training and setting. They are mostly concerned about weight and usually have no problems supplementing outside the hospital setting. In the hospital, if it is baby friendly, there are guidelines for when formula can be introduced.
What are your thoughts on the “fed is best” campaign? I strongly disagree with it. But I’m in the profession of breastfeeding. The risks of not breastfeeding far outweigh the benefits of formula feeding. There are obviously cases when supplementation is absolutely necessary and mothers should never be shamed of needing to supplement. They should also be encouraged to get professional help as soon as possible to facilitate breastfeeding from the beginning. So many issues can be prevented before they’re a problem.
Do you feel that there is too much pressure to breastfeed currently? Whether from society, lactation consultants, media, doctors, etc. I believe we don’t have enough proper education on breastfeeding. With good quality education of the risks of not breastfeeding and the benefits to the mother, baby, partnrr and community, as well as having adequate postnatal support, I believe more families would actually choose breastfeeding.
In your opinion, is there anything that can be done to prevent instances where babies or starving or losing too much weight while waiting for milk to come in? The best practice after a normal delivery is keeping babies skin to skin on mom and with free access to nurse on demand. Babies should not be swaddled in isolettes away from their mothers. They should be allowed to sleep with skin to skin contact for the first few days of life. If a baby is not making enough wet and dirty diapers by 48 hours, they need to be evaluated for a tongue tie or other oral motor issues by a therapist in the hospital or a skilled/trained lactation consultant who is trained in oral motor which may be impacting the ability to drain the breast this causing the cycle of not enough milk taken in by baby and the breast not being stimulated by baby to produce more milk.
If not, do you think more breastfeeding mothers should be informed of this scenario before labor? I believe every mother needs to attend a high quality breastfeeding class before birth and breastfeeding support groups after birth. So many mothers don’t get education because they think it’s going to be natural and easy. But we’ve lost the communal/tribal living where we breastfeed with other women and learn about breastfeeding from childhood. There is so much misinformation on social media it perpetuates problems. But I also believe we should be educating mothers about the real impact of epidurals, medications, and induction on breastfeeding so mothers can understand how it will impact breastfeeding.
According to the CDC’s new guidelines, here is how best to care for your pump parts:
Wash your hands before using your pump, and use disinfectant wipes to clean the outside of your pump.
After every use, take apart the pump parts and rinse them under running water. Don’t put them directly in the sink!
Clean your pump parts as soon as possible with hot, soapy water in a wash basin and brush used only for cleaning pump parts, or in the dishwasher.
Rinse in fresh water (don’t put them back in the same basin).
Air dry on a clean dish towel, but don’t rub the parts with the towel as this could spread germs.
Rinse your basin and brush, and leave them to air dry. Clean them as well at least every few days.
If you’re using the dishwasher, place on a hot water and heated drying cycle, or a sanitize cycle. Wash your hands before taking out the parts, and allow them to air dry.
Store items in a clean, protected area only after they’re completely dry.
Ugh. Remember my last post about my horrible eye allergy? The doctor put me on steroid eye drops for a week. I looked up the medication the Hale’s book of medications and breastfeeding. Little had been studied in the drug and lactation, but the risk of it passing into my milk was in the safe zone. I never take a risk with eyes, so I diligently took the drops the prescribed 3x per day. But oooooooooh how it impacted my milk supply!!! If you’ve followed my blog, I was doing great Pumping. And average of 12-19 ounces during an 8 hour shift. With these eye drops on board, my supply dropped to barely 1-3 ounces per pump session for a total of 8 ounces of less per day. I was freaking out to say the least.
Two pump sessions worth in the middle of my eye drop treatment. 😑 Only four ounces total.
I added in two extra pump sessions, one before work and one before bed, to give us a little extra umph and getting us to around 12 ounces for while I was gone at work. Herbs, teas, and cookies were not going to do much if anything because this was being caused by a medication messing at a hormonal level. Pumping was my only hope to get through that week. Fortunately my daughter is on solids and is a champion eater. We just made sure to give her extra foods at meal times and she was waking at night more frequently to nurse. Normally I try not to nurse her at night, but this was an important exception. I was also fortunate to have a four day weekend and I just let her nurse on demand.
This is an entire days worth of pumping. Less than eight ounces for the day.
Two days after the drops were done, my supply came back. The take away is this: if you’re on medications that are altering your supply or if you suddenly notice a change in milk supply and are trying to figure out what changed while trying to breastfeed, don’t give up. Keep pumping and add extra pumps if you need to. If your baby is under six months or not on solid foods, you may need to supplement or nurse more frequently during the night until your supply increases or returns to normal.
First pump of the day today and pumping is back to my normal volume!!!
Fenugreek is one of the most commonly used galactogogues (supplements taken that are known to increase milk production). Fenugreek seeds (per 100 g) are rich sources of protein (46% of DV), dietary fibre (98% DV), B vitamins, iron (186% DV) and several other dietary minerals. The flavorful herb may be found in many Indian, Persian, Turkish, and Egyptian dishes. It is often the key ingredient in mother’s milk teas and lactation bars. Most mothers typically notice an increase in production 24-72 hours after starting the herb, but it can take two weeks for others to see a change. Some mothers do not see a change in milk production when taking fenugreek. Dosages of less than 3500 mg per DAY have been reported to produce no effect in many women. Interestingly enough, it’s been said if you want to know if you’re taking the correct dosage, you’re supposed to slowly increase the amount of fenugreek until your sweat and urine begin to smell like maple syrup. Got pancakes?
However, like any herb or supplement, be aware of what you are injesting. Some people are allergic to fenugreek, specifically people who have peanut allergy and chickpea allergy may have a reaction to fenugreek. Fenugreek seeds can cause diarrhea, dyspepsia, abdominal distention, flatulence, perspiration, and a maple-like smell to urine or breast milk. There is a risk of hypoglycemia particularly in people with diabetes; it may also interfere with the activity of anti-diabetic drugs. It may interfere with the activity and dosing of anticoagulants and antiplatelet drugs. You should not take it if you are pregnant as it may affect uterine contractions and may be unsafe for women with hormone-sensitive cancers. In summary, those with thyroid, blood sugar issues (such as diabetes), peanut allergies and those taking certain blood clotting medications should avoid fenugreek.
References:
Kellymom.com
[Bingel 1991] Bingel AS, Farnsworth NR. Higher plants as potential sources of galactagogues, in Wagner H, Farnsworth NR, eds. Economic and Medicinal Plant Research, Volume 6, Academic Press Ltd, New York, 1994: 1-54. [Brinker 1998] Brinker F. Herb Contradictions and Drug Interactions. Sandy, OR: Eclectic Medical Publications, 1998, 70–1. [Dugue 1993] Dugue P, Bel J, Figueredo M. Fenugreek causing a new type of occupational asthma. Presse Med 1993 May 29;22(19):922. [Hale 2002] Hale T. Medications and Mothers’ Milk, 10th Edition. Pharmasoft Medical Publishing, 2002, p.277-279. [Heller] Heller L. Fenugreek: A Noteworthy Hypoglycemic [Huggins] Huggins KE. Fenugreek: One Remedy for Low Milk Production. [Korman 2001] Korman SH, Cohen E, Preminger A. Pseudo-maple syrup urine disease due to maternal prenatal ingestion of fenugreek. J Paediatr Child Health 2001 Aug;37(4):403-4. [McGuffin 1997] McGuffin M., Hobbs C, Upton R, Goldberg A. American Herbal Product Association’s Botanical Safety Handbook. Boca Raton: CRC Press, 1997. [Ody 1999] Ody P. Herbs to Avoid During Pregnancy from Herbs for a Healthy Pregnancy. Los Angeles, Calif: Keats; 1999. [Ohnuma 1998] Ohnuma N, Yamaguchi E, Kawakami Y. Anaphylaxis to curry powder. Allergy 1998 Apr;53(4):452-4. [Patil 1997] Patil SP, Niphadkar PV, Bapat MM. Allergy to fenugreek (Trigonella foenum graecum). Ann Allergy Asthma Immunol 1997 Mar;78(3):297-300. [Reeder 2011] Reeder C, Legrand A, O’Conner-Von S. The Effect of Fenugreek on Milk Production and Prolactin Levels in Mothers of Premature Infants. J Human Lactation 2011;27(1):74. Abstract only. [Rice] Rice LA. Fenugreek, in Herbal Supplements in Pregnancy [Swafford 2000] Swafford S, Berens B. Effect of fenugreek on breast milk production. ABM News and Views 2000;6(3): Annual meeting abstracts Sept 11-13, 2000
These crocheted boobs were made by my coworker for my community breastfeeding classes!!!
Let’s talk honestly about nipples for a minute. Most basic breast-feeding classes talk about anatomy of the breast. They may touch briefly on anatomy of the nipple, but I don’t feel like it’s enough for us to fully understand the amazingness that is our nipples. In the anatomy of women, a nipple, mammary papilla or teat is a small projection of skin containing the outlets for 4-18 lactiferous ducts. The average woman has 9 of these ducts. They come in all shapes and sizes, but the average projection and size of human female nipples is slightly more than 3/8 of an inch (10mm) or the equivalent of about 5 stacked American quarters. Pregnancy and nursing tend to increase nipple size, sometimes permanently. Nipples are made of erection tissue.
They are actually made of the same erection tissue as the penis. It is why when these are stimulated by either a sexual partner or a baby, they perked up or erect. When nipples are stimulated, they send messages to the brain to release oxytocin, the cuddle hormone. This hormone is what makes you to feel all tingly, warm, secure, and in love with your spouse. But oxytocin released during breastfeeding is actually what causes your letdown reflex to happen. It’s basically what causes your milk to flow. As your newborn is stimulating your nipple, it sends a message to the brain “hey there’s a baby here! Send milk!” The brain then releases oxytocin which causes your letdown reflex to happen. It’s while your let down happens usually 1 to 2 minutes after your baby starts suckling at the breast. Erection tissue is never meant to bleed, crack, or scab.
Could you ever picture your husband letting you touch his penis if there was cracking, bleeding, or scabbing? And yet when new moms breast-feed, there is the stereotype that this is just a normal part of the breast-feeding process. Cracked, bleeding, and scabs nipples are caused by an incorrect latch of the baby or some other anatomical or physiological difference, such as a tongue or lip tie or an immature sucking pattern. Nipples were never designed to endure what so many women tolerate as “normal”. If you are experiencing any pain, cracking, or bleeding of your nipples during breast-feeding, please see me or another lactation consultant in your area as soon as possible. Let us help you correct the latch or look for a tongue tie that would be causing those problems. You deserve a pain-free, happy nipple breast-feeding story! Please also help stop the stereotype that it is OK for women to endure this. It is totally OK to experience initial discomfort when breast-feeding. Your nipples are not used to that kind of sensation at that frequency. But pinching or stabbing pain is never normal at any stage of breastfeeding.
This picture kinda reminds me of “the girls”… if you know what I mean…
“I’d like a skinny vanilla latté, extra foam extra whip cream!!” One of the first questions I get from a lot of nursing moms is, “when can I drink coffee again?!?” Some doctors don’t have a problem if moms drink one a ounce cup of coffee throughout the entirety of the pregnancy. Other moms because of risk factors are told not to have any until after the babies born. Whether you have coffee or not during your pregnancy, there are a few things to know before introducing it after your baby is born. The first is that it affects infants differently than adults. The following chart was taken from Kelly mom.com. It shows the half-life of caffeine in the bloodstream. I was surprised that Caffeine will stay in the bloodstream of the brand newborn for an average of up to five days!
Their sensitivity to caffeine decreases as they age. Signs of sensitivity are hyperactivity, difficulty sleeping or sleeping for long periods of time, jitteriness, irritability, and fussiness. If you drink coffee during your pregnancy, you might not see as much of an impact on activity levels in your baby if you continue to drink after birth. However if you have stained from college and your pregnancy, you may notice changes in your baby. Per Medications and Mother’s Milk (Hale 2017, p. 139-140) caffeine is in Lactation Risk Category L2 (safer); milk levels are quite low (0.06-1.5% of maternal dose) and usually peak 1-2 hours after ingestion. The American Academy of Pediatrics has classified caffeine as a “Maternal Medication Usually Compatible with Breastfeeding.” If you’re iron deficient or iron deficiency rubs in your family, be extra careful. One study indicated that chronic coffee drinking might decrease iron content of breastmilk (Nehlig & Debry, 1994). We actually routinely give caffeine directly to premature babies in our neonatal unit for lung stimulation!
Remember caffeine isn’t just in coffee! Tea, soft drinks, sports/energy drinks (including the “sports water” products), some over-the-counter and prescription medications, and foods containing coffee or chocolate can also have caffeine!! I can’t have Haagen Daz coffee ice cream late at night because it keeps me up!!! Herbal products containing guarana/paullinea cupana, kola nut/cola nitida, yerba maté, or green tea also contain caffeine. Each food and liquid has varying amounts of caffeine. Different roasts of coffee and the way that the coffee is made also impacts caffeine level. Make sure to check the caffeine level you’re ingesting by serving size to see how much you’re getting!! According to Breastfeeding Answers Made Simple (Hale Publishing 2010, p. 521), excessive caffeine consumption by the mother (more than 750 mg per day) can result in a baby who shows signs of caffeine stimulation.
I typically recommend no more than one 8-ounce cup of coffee a day for nursing mothers (but as a note!! An 8-ounce Starbucks coffee has 250mg of caffeine while a non-gourmet brewed 8-ounce cup of coffee only has 120-160mg of caffeine!!!!!!) The important thing is to know your body and know your baby. Be informed of what you are putting into your body and what is going into your baby. Watch for how your baby reacts to that 1st cup of coffee and if you need to, cut out coffee for a little while longer or switch to decaf.
I personally have my one cup of Costa Rican drip coffee with almond milk every morning. If I’m really lucky, my husband will make me an Italian latte before I leave for work. I can only have one cup. The few times I’ve had a 2nd cup early afternoon, I am up all night. So far my daughter has never had a reaction to coffee. Although, I drink a cup of coffee through most of my pregnancy with the blessing of my midwife. As with anything you consume, if you have any concerns talk to your primary care physician or your pediatrician. You may still want to avoid the Unicorn Frap…
It finally came!! My Mrs. Patel’s mothers milk tea!!! I’ve used the grocery store brand but it didn’t really seem to have a big impact on my supply. In researching teas, I came across this brand. They’re Milk Water tea comes in two tasty flavors : herbal and Chai. The Chai has an amazing sweet taste and when I drink a cup consistently at night I do see an increase in milk the next morning. I just got the herbal blend and am so excited to try it!!! Check out the website here. Take note, the shipping is expensive, so if you have a friend or two who are also nursing it will help distribute the shipping costs.
