Breasts are made of a network of ducts, covered by a layer of fatty tissue. During pregnancy, estrogen and progesterone enlarge the milk ducts and multiply the glandular tissue that produces milk. After birth, estrogen and progesterone drop and prolactin and oxytocin rise. Prolactin makes milk production and oxytocin releases it into the ducts. Extra blood and fluid fill the breast just after birth to supoort your body adding hormone receptors in the breast to make milk. The blood and fluid surrounds the ducts and this extra pressure is what makes your breasts feel full between feeding. This blood and fluid reabsorb around 6-8 weeks once supply is established and you won’t feel that full/soft feeling except when you go a really long time between feeding or pumping. Breasts go back to prepregnancy size when supply regulates around 11-14 weeks but continue to make milk. When you wean from breastfeeding, it can take several months for prolactin levels to return to baseline (which is why you may still see milk for months after weaning). Once you stop breastfeeding, the milk making structures actually self-destruct – a process that involves massive cellular suicide, and the removal of the debris. Around 6 months after weaning, the milk-producing tissue is replaced with fatty tissue. If you return to your pre-pregnancy weight, your breasts most likely will return to the same size. They may not be as “perky” because the skin is a bit more stretched and the connective and fatty tissues in the breasts often shifts during pregnancy and breastfeeding. While they may look smaller after weaning most of us can expect that our breasts will return to a similar size as they were pre-pregnancy. They’re just a little more lived in and well loved.
15 minutes per side is a recipe for baking, not breastfeeding. Not every baby needs 15 minutes per side. Some babies take a full feeding in only a few minutes minutes, and from just one breast per feeding. Other babies may feed for a few minutes off each side. Older, more distractible babies are efficient eaters with more important things to do than state at your chest. They may graze at the boob a few minutes at a time or want to go back and forth from side to side.
Other babies may be boob barnacles and need much longer at the breast. Or they may want to be at the breast for more than just nutrition: teething, growth spurts, you going back to work, developmental leaps, sickness. Being on your body brings healing, comfort and stability while they’re going through all kinds of rapid changes and growth. Being on you for an hour or more is the best medicine to what ails them.
The only time we should be limiting time at the breast is in NICU with premature babies where fatigue is a factor or under the direction of a lactation consultant because of true low supply, tongue tie or other oral motor disfunction while on a triple feeding plan. This would be a temporary plan because of a true lactation issue.
In general, you know baby is getting enough breast milk when you have a pain free latch where the nipple goes in and out of baby’s mouth the same shape. You can hear baby swallow and don’t need to keep them awake at the breast for them to continue feeding. Baby should be making lots of heavy wet diapers and pooping daily or every other day. They also gain weight to their own curve and are a similar size of your unique family genetics.
If your baby typically latches for you, and feeds well, and refuses to latch, they most likely are done. Follow your baby’s lead and get to know their feeding habits. Trust your baby and trust your body. If you’re concerned about how your baby is feeding, schedule and appointment with a breastfeeding expert: an IBCLC lactation consultant.
We have 7 senses, not 5, but not all of them are fully developed at birth:
Vision. Babies have very poor vision with no depth perception. They can see about 8-10” away, the distance from the breast to your face. They also don’t have very good color perception and prefer high contrast, like your areola compared to your breast. Over the first few months, babies may have uncoordinated eye movements and may even appear cross-eyed.
Hearing. At birth, fluid in the ear canal and middle ear may affect your baby’s hearing. This fluid usually clears in a few days, and after that your newborn can hear fairly well. Babies actually do have fully developed hearing, but they are still learning to process and interpret what they hear. They know your voice and prefer it above all others. They also know your language and can distinguish it from other forgiven languages. A song or book they heard while in utero will also be preferred to a new one they’ve never heard before.
Smell. Babies have a fully developed sense of smell. Your amniotic fluid changes smell based on what you ate and your hormones. Those little bumps that developed around your areola secrete and oil that smells like your amniotic fluid, helping baby locate dinner. Your body odor also changes and become more pungent to help baby know it’s you and bond to you as caregiver. Avoid washing in strong soaps or using a lot of deodorants and perfumes. You’re supposed to be stinky.
Taste. While breast milk constantly changes in flavor based on what you eat, and has a similar flavor profile to what you ate during pregnancy and flavored your amniotic fluid, baby’s sense of taste isn’t fully developed at birth. Flavors are much stronger for them and they prefer sweet (which is most like the sweetness of breast milk) to bitter or sour.
Touch. This is one of the strongest sense at birth. Touch is very powerful and can elicit reflexes in the baby to help them survive. Touching baby’s mouth gets them to root for a good latch. Touching the roof of their mouth triggers a sucking reflex which helps them feed. Being held in skin to skin contact regulates their heart rate, respiratory rate, blood sugar and temperature. They know they’re on an adult who will protect, defend and care for them. Do not underestimate the power of infant touch.
Proprioception. The body awareness sense which tells us where our body parts in relationship to each other. It also gives us information about how much force to use, allowing us to grab the object we want without crushing it. This sense is developed by experience and babies need to use all of their other senses to mature these skills over their first year of life and beyond. Reflexive movements in response to movement and sensory input help lay the foundation for posture and motor planning later on.
Vestibular. This sense is all about balance and movement, which tells us where our body is in space. It is the first sense to be fully developed by 6 months gestation. It is the unifying system in our brain that modifies and coordinates information received from other systems. Some babies, especially if premature, can be very sensitive to our handling and have difficulties going from one position to another. They can get easily unsettled with diaper changes and switching breasts. When a baby has an overactive vestibular system, they can displays gravitational insecurity and an intolerance to movement. Working with physical and occupational therapy can work through vestibule disorders.
My baby had their tongue tie released, what should I expect? First, having a tongue tie released isn’t always a magix fix to breastfeeding issues. While 80% of mothers do report a significant decrease in reported nipple pain after the procedure, there is still a recovery and healing proceess that needs to take place. That tongue has been like that since 8 weeks gestation and depending on how baby has learned to use their tongue, some relearning is necessary.
Do I need to do stretches on my baby’s tongue after a release? There are conflicting answers, and it seems like every provider has a different one, which gets really confusing. The biggest concern is reattachment, which defeats the purpose of the release and for some, reattachment means re-release.
Every baby is unique, as is their healing post release. When you have a tongue that is strong and coordinated but range of motion is limited because of the frenulum, the stretches, exercises and wound care management are different than a tongue that is super weak and disorganized. I have found in my practice that tongues that are super strong pre-release do much better post release and tend to need much less wound care management to keep the tongue from reattaching. They also need fewer oral motor exercises to get baby back to breast. The tongue was already functioning as it should, it was just anchored by the frenulum. When you have a weak tongue where range of motion was poor to begin with, they tend to need much more suck training/exercises, and without stretching, the tongue will reattach because of how the tongue rests on the floor of the mouth instead of up on the palate during healing. Body work is essential for these babes as the tension and weakness is usually though the whole system. Bodywork, suck training and lactation support are still crucial for the few days to weeks after the release is done.
But what should you expect as a parent.
Day 1-3 your baby will feel sore and tender. They may be fussier than usual. A white patch will form where the surgery was done. Baby may have difficulty latching to bottle or breast, so have an alternative feeding plan ready such as cup or finger feeding.
For the first week, baby is relearning how to use their tongue. Your provider should talk to you about stretches to do several times a day to help prevent the tongue from reattching. Our body likes to heal together so this is very important. Some minor bleeding may occur, but if you see lots of blood notify your provier right away. Pain management is often needed for the first few days, but many babies can taper off of this.
From week 2-4, the white patch will shrink and may turn yellow as it heals. Some babies will see a small to drastic reduction in their symptoms at this point. Many babies will still need bodywork or lactation suppot.
Natural remedies can include frozen breast milk chips that you can use to numb the area. This is especially helpful for very small babies when you don’t want to use an OTC rememfdy.
Coconut oil is often recommended to lubricate the wound and for use during the stretches. A little goes a long way.
There are natural remedies that some parents find helpful such as arnica or camellia. And infant’s children tylenol can also be helpful. Mae sure to talk to your provider and your pediatrician for the correct dosage which is done by age and weight.
Lots of snuggles, skin to skin time, and baby wearing can be helpful. Keep time at the breast pleasant and if you’re having trouble feeding, make sure to reach out as soon as possible for help.
Some times even the best lactation consultants and feeding therapists can miss a posterior tongue tie in the immediate days or weeks after birth. Having a frenulum under the tongue doesn’t automatically mean it’s tied. A long, stretchy frenulum that allows full movement of the tongue is normal and not something that needs released. However, sometimes a frenulum can allow the front of the tongue to do what it needs to, but still be tied at the back. These are what I can tricky posterior ties. Mom may have lots of milk and baby transfers well from the breast in the early days or weeks post delivery. Mom may have no nipple pain or damage whatsoever. Only they come back a month later with new symptoms like slow weight gain or feeling like there breast isn’t emptying. Why is that?
Mom’s body often compensates well during the early weeks post delivery. The uterus doesn’t tell the breasts how many babies came out. So her body goes into overdrive to make more milk than needed from the start. As time moves on, the body figures out how much milk to make and drops supply to just what is being emptied. A baby that rode on mom’s robust post delivery flow may all of a sudden start to struggle at the breast as supply regulates. Based on how the anatomy is, there may never have been nipple pain or damage. If the baby has a high palate where the front of the tongue can still move well and mom has a large nipple that fills baby’s mouth well, the nipple may come out creased or pinched, but without pain. The anatomy on one or both sides masked the tie while baby was small.
If breastfeeding was going well in the beginning, but symptoms start to pop up later, working with a qualified lactation consultant can help figure out what’s going on. And some times that means finding a posterior tie that was originally missed where a release is necessary to get feeding back on track.
Did you know mastitis may be related to your posture?
Fluid dynamics is the science of how fluids move in our bodies. All of put bodily fluids are supposed to be free-flowing and unobstructed for optimal health. Milk is a fluid that flows through ever narrowing ducts and pores. Lymph is a fluid throughout your body (and breasts) that helps transport waste from cells and tissues in your body to help flush it from your system. It also helps reabsorb milk that doesn’t get emptied to baby/pump. Anything that increases resistance of the movement of these fluids increases the likelihood of plugged ducts or mastitis. Causes for increased resistance: ⭐️ Breast implants or reduction causing scar tissue in the breast ⭐️ Sleeping in the same posture especially on your side where you put pressure on the breast for extended periods of time ⭐️ Tight fitting clothing/bras that constrict movement of milk and lymph between feedings ⭐️ Shoulder injuries where there is inflammation or scar tissue ⭐️ Neck injuries or issues with neck mobility ⭐️ Tension in your body from stress or poor posture for extended periods of time during breastfeeding (bringing yourself to the baby) ⭐️ Not moving the body enough/sitting for prolonged periods of time in the same position ⭐️ Increased overall inflammation in the body such as from infection or excessive fluids from IVs used during labor and delivery or from immune disorders ⭐️ Having very large, heavy breasts which act more like an appendage where milk and fluid can fill the lower quadrant of the breast and have difficulties moving out again
What can you do? ❤️ Shake your breasts!! Get that fluid moving manually with your hands ❤️ Lean over and dangle your breasts to reduce pressure on them and help them free flow ❤️ Practicing yoga works well, especially with poses like downward dog where you’re changing the orientation of the fluid in your breast related to gravity. ❤️ Avoid restrictive clothing and bras ❤️ Get a massage!! Having hands on the body helps get the fluid inside moving in the right direction ❤️ See my video for lymphatic drainage massage
Cracked. Painful. Damaged. Nipples. Ouch!!! Did you know the nipple shield you were given at the hospital may be the culprit for your persistent nipple pain? Most hospitals will give out a 24mm cone shaped shield (Medela brand). While this may work for some, for many it will be too big or the wrong shape, causing baby to still bite your nipple through the shield. Those with elastic nipples may have their nipple sucked too far and poke out the holes. Ouch!!! Nipple shield now come in many shapes, sizes, lengths and materials to individualize the shield to get an optimal latch. Not happy with your current shield? Schedule an appointment to find out what other options may work better for you.
If you have cracked, bleeding nipples there is always a reason. Reasons for cracked nipples: 🗡Shallow latch 🗡Very short or flat nipples where baby is not yet proficient at taking a big mouthful of breast 🗡Baby is tongue tied 🗡Breast infection 🗡Pumping with the suction too hard 🗡Wrong size pumping flanges causing friction on the nipple 🗡Wrong size nipple shield 🗡Baby was in an odd position in utero and has tension in the head/neck/shoulders 🗡Baby has torticolis (they prefer to turn their head toward one shoulder and they pull the head in this direction while nursing, twisting the nipple)
To treat cracked nipples: 🧸Get a deep latch every time 🧸Breast milk on the nipple after every feeding 🧸Coconut oil, EVOO, nipple balms, butters or creams 🧸Breast gels 🧸Breast shells or Lacticups keep the nipple from touching clothing when damage is severe but should be limited in use 🧸Silverettes 🧸Dr Jack Newman’s All Purpose Nipple Ointment
Did you use a nipple shield to help your baby latch? Want to transition baby off the shield? First, weaning from the shield is your choice. If you like it and it’s comfortable for you, don’t feel pressured to get rid of it before you and your baby are ready. There are risks associated with shield use, like the potential for decreased milk supply. But if that’s the only way your baby will latch right now, give yourselves time and grace to keep trying as baby gets older and more proficient at the breast. As always, if you’re really struggling to get off the shield, find a knowledgeable lactation consultant to help you with the process to make sure something else isn’t going on with baby’s latch. 💡You can always start with the shield on and take it off after your first let down once baby is not as hungry or use it on the first side and offer the second side without it 💡Start by trying without the shield once a day during daylight hours when baby is happy and not too hungry. Catching baby with early hunger cues is imperative. If they’re crying and really hungry, try a different time 💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible 💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch 💡Help baby latch with laid back nursing, supporting the breast in a “U” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible. A baby that can’t feel the breast can’t latch to the breast. 💡Hand express to get your milk flowing so baby gets instant satisfaction and reduce the work 💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby 💡If baby becomes frantic or upset during trials, using the shield is not a sign of defeat but continued practice. 💡If at first you don’t succeed, try, try again.
Most parents are very aware of the AAP guidelines for safe sleep for babies, which includes having babies sleep in the same room as their parents for the first 6-12 months. Did you know having baby sleep in the same room as you also applies to naps during the day? Research shows babies who sleep in a separate room from their parents are at a greater risk of SIDS for both daytime and night sleeps. While 83% of SIDS deaths occur at night, the risk during the day is still there. The safest option is to keep your baby near you while they sleep for the first few months of life.
Here’s three ways to have baby sleep close to you: 👼🏼 Baby Wear: This ancient practice has baby riding on your body like a baby monkey. They may be worn on your chest facing you, on your chest facing out, on your hip or back. Ring slings, soft wraps, structured carriers or baby back packs all work. The movement of your body helps baby be swayed to sleep and the rhythm of your heart and body heat help them stay comfortable and calm. You can still move around and get chores like vacuuming and washing dishes done
🛌 Co-nap: Every new parent I know is sleep deprived to some extent. As they say: eat when baby eats, sleep when baby sleeps, and vacuum when baby vacuums (which means it’s ok to stall a bit on those chores to enjoy those baby snuggles). If you are breastfeeding and bed-sharing, learning side lying breastfeeding can be a game changer. Never co-sleep with baby on a couch or chair. If you plan to sleep at the same time as baby, or fear you might accidentally fall asleep, always lay down on a firm, flat mattress and make sure there are no blankets or pillows around that could cover baby. Those who are not breastfeeding, smokers and others who fall outside the guidelines for safe bed-sharing can put baby to sleep in a bassinet or crib, then lay down in their own bed in the same room.
😴Contact Nap: It’s a term coined by Sarah Ockwell-Smith, author of The Gentle Sleep Book. It means having all or part of one body in contact with another body while one or both sleeps. Skin to skin contact releases oxytocin, the cuddle hormone, to help you bond. And when you’re breastfeeding, this contact also helps naturally boost your milk supply. Its OK to contact nap as long as you mutually want and it WON’T create a dependency to sleep on you in the future.
This stage in parenting is short and babies will eventually stop napping. Make the most of it by keeping it safe (and snuggly).
Most lip blisters in newborns are caused by all the sucking they’re doing to get their milk. They’re often caused by friction on their sensitive lips. The skin of the lip had 3-5 cellular layers, very thin compared to typical face skin, which has up to 16 layers. The lip skin is doesn’t have sweat glands, so it lacks the protective layer of sweat and body oils which keep the skin smooth and moist. This makes the lips dry out faster and become easily chapped.
Lip blisters, AKA:
Friction blisters
Suck blisters
Suck callouses
The sucking reflex starts around week 32 in the womb and is fully developed around 36 weeks. Occasionally a baby may be born with these blisters if they were super active at sucking in the womb.
Babies should latch by cupping their tongue around the breast and creating a vacuum seal in their mouth. The tongue then pumps up to compress the breast to squeeze out milk and then pumps down to generate negative pressure in the mouth to draw milk in like a syringe. The tongue is the dominant organ in effective breastfeeding. The lips actually play a passive role in feeding and should stay soft without the muscles engaged. They are only meant to prevent milk from leaking out of the mouth. Babies get suck blisters/two tone lips from overusing their lip muscles, specifically the one that rounds and closes the lips, called the orbicularis oris.
Think of it like this: try drinking from a straw. You usually put the straw in about 1-2 inches so your tongue and teeth help support it. This gives the straw stability so you can direct the flow of liquid in your mouth. If the straw is only touching the border of your lips, you need to use more of your lip muscles to keep the straw in place and from falling out of your mouth. Your tongue, cheeks, and teeth/gums provide needed support to keep the straw in without over working your lips. Same with the breast or a bottle nipple. The baby’s tongue is supposed to be the dominant muscle in maintaining the latch, with the cheeks and lips playing a passive, supportive role.
Very small blisters that go away in a few days are normal for newborns as they’re learning to latch and suck. Blisters that don’t disappear in the first week or two or that are extensive across the lips are a sign something is going on.
Reasons for lip blisters:
👄 Baby’s in a shallow latch (to breast or bottle) use their lips to hold on to prevent losing the latch. This is the simplest to fix. Fix the latch, the blisters go away. Usually baby is in a shallow latch because of how they’re positioned. Make sure baby is completely touching your body, tummy time tummy with their belly button touching you and not on their back. Baby’s face should be coming straight to your breast instead of turned toward one shoulder.
👄 Lip blisters are a classic sign of tongue/lip tie where the lips are compensating for the lack of range of motion/strength/coordination of the tongue because it’s being tethered to the floor of the mouth.
👄 Premature babies may also get lip blisters as they should still be practicing swallowing in the womb with no expectations. Babies born 34.0-38.6 weeks gestation may look like fully formed babies, but have a lot of maturing and growth to do outside the womb. Their brains would rather be sleeping than eating, and they can fatigue quickly at the breast. They also use those later weeks in utero to practice sucking and swallowing while being fed through the umbilical cord. Premies Also have under developer fat pads in their cheeks. The last weeks of pregnancy help fattening these up. The fat pads support the tongue to make sucking more efficient while decreasing the amount of space in the mouth, this means less suction is needed to draw milk into their mouth. Without the fat pads, babies use alternative muscles to maintain a latch, hence the lip blisters as they’re using their lips more than needed.
👄 When babies are born, there is a lot of pressure on their head and neck. Babies are also supposed to move their head and body around in the womb and again during delivery to help themselves be born. Sometimes they get stuck in a certain position and this can put extra pressure on the baby’s body. If they sat low in pregnancy, we’re always positioned in a certain way, or have little room to move around, we can some times see cranial nerve dysfunction. This can also happen when a baby is pulled out (cesarean, vacuum, forceps). Proper nerve function allows correct muscle movement. If a nerve involved in sucking is temporarily squished, pinched, or strained, certain muscles (tongue, cheeks) can’t function properly which can lead to compensations. See the videos on my YouTube channel for stretches to help baby move their muscles better. If you think baby may have a stretched nerve, chiropractic care, craniosacral therapy, physical or occupational therapy can definitely help.
