I have a gassy baby. How can I help?

 

Babies are gassy, fussy creatures. Did you know the majority of babies pass gas 13-21 times a day? Did you know most adults fart 5-15 times per day? Come on, admit it. You’ve passed a few SBDs in your day. Our digestive tracts are sensitive and impacted by what and how we eat. Before you reach for the baby gas drops and probiotics or trying major elimination diets, though, try these things first:

⭐️ TUMMY TIME. This puts baby on their belly which helps stimulate healthy movement through the digestive tract. 

⭐️ BABY WEARING. Having baby in an upright position with legs in a froggy position also helps with stimulation of good digestive movement 

⭐️ SMALL FEEDS. Smaller, more frequent meals can be easier for some babies to digest than larger, less frequent meals

⭐️ DEEP LATCH. Make sure to get a deep latch every time. Shallow latches where you can hear clicking or breaking of the suction during swallowing increases air in the gut. If you see a dimple in baby’s cheek that’s an indication of a shallow latch

⭐️ TONGUE TIE REVISION. When a baby can’t move their tongue correctly or fully they swallow more air. Tongue ties are one of the major culprits of gas, reflux and colic. Having the tongue released in many cases reduces babies reflux and gas 

⭐️ BURP BABY. Some times just being patient to burp the baby well can eliminate wind. After all, farts can just be butt burps

⭐️ MASSAGE. Giving baby a nice belly massage can also help soothe and relieve gas. 

How many times a day does your baby fart?

 

For my full YouTube video showing how to help your baby CLICK HERE



F6CE62A1-AA1E-4D3E-A728-6B40ECA9E7A2

ADHD and Breastfeeding

For me, being a parent with ADHD means being easily over stimulated by all the noise and energy. I get easily touched out where I want littles off my body. I’m easily distracted and will start one task only to find myself immersed in a less important task and never finished the first task. 

 

I have always been able to hyperfocus on tasks. It made me a work horse in my hospital job with the ability to tune out beeping monitors and nurses and patients talking around me. It is exceptionally helpful when writing social media posts and blogs. As a parent, this tendency gets in the way because there are more important things that need to be done but I get stuck in the loop. During hyperfixation I easily lose track of time and sometimes the ability to prioritize other tasks. Snapping out of hyperfixation is difficult and then everything that needed done gets rushed or put off until later. Always later. And some times when I’m hyper-focusing on a task, I won’t hear my kids until they escalate or crying or whining.  

 

Those with ADHD have an additional work load while breastfeeding. Often undiagnosed and misunderstood in women, those who are breastfeeding will experience additional challenges such as:

🤯Sensory overload: being easily touched out during feeding. Finding the noises and energy of the baby to be very draining and tiring. 

⛓Feeling restricted or trapped by feedings

⏱Time blindness: easily losing track of time during and between feedings

🙀Distracted by tasks, difficulty completing tasks, starting one task only to find yourself sucked into a less important task. You go to wash pump parts only to find yourself rearranging the glass cupboard. 

😵‍💫Overwhelming thought, swirling thoughts, easily anxious. This can have many impacts including inhibiting let down when feeding and reducing the ability to sleep when woken during the night for night feedings. 

 

🤱🏽 Breastfeeding was the easiest part of parenting. It was an excuse to sit in one place and have baby quiet for a long period of time. It meant an excuse for ignoring other tasks because I was feeding the baby. 

🥳Starting something and getting distracted, leaving half done tasks. Folding laundry and fixating on rearranging the sock drawer. Going to put the dishes in the dishwasher, setting them by the sink, cleaning the counter instead because there’s crumbs. 

🤫Listening is hard. I want to listen to my husband and kids, but I often find myself thinking about a million other things. Some times to the point of completely blocking out what they’re telling me.

🧐Hyperfocus. I have always been able to hyperfocus on tasks. It made me a work horse in my hospital job with the ability to tune out beeping monitors and nurses and patients talking around me. It is exceptionally helpful when building social media with posts and blogs. As a parent, this tendency gets in the way because there are more important things that need to be done but I get stuck in the loop. During hyperfixation I easily lose track of time and sometimes the ability to prioritize other tasks. Snapping out of hyperfixation is difficult and then everything that needed done gets rushed or put off until later. Always later. And some times when I’m hyper-focusing on a task, I won’t hear my kids until they escalate or crying or whining.  

🤯Overstimulated. Before kids, I didn’t think I was sensitive to noise and energy. I was the extrovert who loved being around people. But kids are a different kind of energy, especially while also working full time. There’s no downtime or escape from the energy and it’s very draining to the point of meltdown. Getting overstimulated and feeling sensory overload is a very common feeling for those with ADHD.

 

When considering ADHD medication 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 anxiety and increase focus usually outweigh the risks. If you have been on a certain med prior to breastfeeding and it worked well for you, it would be reasonable to resume that medication while breastfeeding.

 

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

🥛 Changes in milk supply

🛌 Sedation/sleepiness or agitation/hyperactivity in baby

⚖️Poor feeding or weight gain in baby

 

Stimulants and non-stimulants for ADHD can work well to help you feel balanced again. Work closely with an IBCLC and your primary care physician when resuming or starting a medication to help continue and feel supported in your breastfeeding journey 



Ardo Calypso Breast Pump Review

672B7366-D31A-49C3-874C-8987729BE346

The Ardo Calypso breastpump is a piston-driven, closed system breast pump. Weighing less than 1 pound, it is a lightweight and one of the quietest breast pumps I’ve used. Vacuum Seal technology ensures no milk can get in the tubing or pump. The piston technology allows the suction to maintain its negative pressure, therefore never releasing the breast and allowing the ability to replicate a baby’s natural nursing action. It does have 64 individual settings, meaning there are multiple cycle and suction options that can be changed into different combinations for individuality. That said, the maximum suction strength and cycle speed are still relatively low compared to other pumps like the Spectra or Limerick, meaning if you need a faster or stronger cycle or suction, this pump won’t get there.  If you have sensitive nipples and trigger let downs easily, this pump is a good option. If you need to feel the stimulation of the pump to trigger your let downs, this is not the pump for you. The Calypso breastpump can operate on 6 AA batteries (rechargeable or standard), a wall power plug, or a car adapter. Another disadvantage is their flanges. They come as a one piece unit in 26 and 31mm sizes. So unless you have extremely large nipples or can use a flange insert, this pump isn’t a good option for getting the right flange fit. You’d need to use the tubing with another flange system if you needed different flanges like LacTeck, PumpinPals or smaller traditional, plastic flanges instead of the inserts.

View their warranty here

  • Closed System
  • Single or Double Pump capability
  • Piston driven suction measuring 250 mmHg
  • Weighs less than 1lb
  • Battery operable or wall plug operable
  • 64 customizable settings on a digital display
  • (1) Year or 400 operational hour Warranty. This is voided if you use other  products, like flanges with it. 

Included:

  • Two Ardo 26mm Breast shells (flanges)
  • Two Ardo 31mm Breast shells (flanges) with 26mm soft silicone inserts
  • Two Ardo Tubing
  • Two Ardo Lip Valves
  • Two Ardo Membrane Pots, and one replacement spare  
  • Multiple Ardo 5 Fl oz Milk Collection Bottles  
  • One Ardo Wall Power Adapter
  • Handle to convert the pump into a hand pump
  • Cooler bag with ice block
  • Carrying bag (which honestly is very nice and sturdy)

Birth control and breastfeeding

There are two forms of birth control. Non-hormonal and hormonal methods. Non-hormonal birth control is any option that does not have a hormone in it. Options include the copper IUD and barrier methods like the condom, cervical cap, diaphragm, sponge and sterilization. Rhythm or calendar methods where you’re tracking cycles and assessing cervicales fluids need to be tracked vigilantly and many will choose to still use an additional method if cycles are unpredictable.

Breastfeeding itself has also historically been considered its own form of birth control. Lactation amenorrhea is nature’s natural family planning to help space out babies. If you are exclusively breastfeeding, no bottles no pacifiers no pumping, and baby is still nursing frequently day and night, often sleeping close to or co-sleeping with breastfeeding parent, where there is no vaginal spotting or a period hasn’t returned yet and baby is under 6 months of age, this form is considered >95% effective to keep you from getting pregnant again. While this is the general rule of thumb, every single criteria needs to be met in order for it to be effective. And even if this is being followed to the letter, some may still cycle again and can become pregnant before a period returns. I’m of the anecdotal opinion that there are many modern influences on why this method doesn’t always work. Prior history of HBC, maternal age, modern diet and lifestyle, may not allow everybody to be able to experience this form of birth control. On the other hand, there is also a small population that never gets a period the entire time they breastfeed and may actually need to wean in order to get pregnant again. This method of bc is not one size fits all and needs to be counseled as such. It is possible to have several light periods without ovulating, giving you a heads up that another form of bc is needed to prevent pregnancy, but it is also possible to ovulate and get pregnant before you have a first postpartum period.

In terms of hormone based birth control, in a nut shell:

  • Hormonal Birth Control (HBC) comes in 6 different delivery systems. 
  • Any HBC runs the risk of decreasing your milk supply. So you’ll want to be careful with the method you’re choosing.
  • The hormone level of each brand in each type of HBC will have its own amount of hormone and they are not equal. So do your research when selecting any HBC, even if you’ve used a particular method prior to your breastfeeding days.

All types of HBC prevent pregnancy effectively but the best method for you will be the one that suits your lifestyle and needs. The most effective HBC will also support any goals you personally have related to breastfeeding.

Hormonal methods of birth control contain either progestin or a combination of both progestin and estrogen. Hormonal birth control options include the pull, the intrauterine device (IUD), the shot, the implant, the ring and the patch. These methods of birth control have high rates of efficacy, but if you choose a method that is difficult for you to use correctly, it could lead to unintended pregnancy. Certain methods also carry a higher risk of decreasing milk supply  

All HBC works to prevent pregnancy by preventing ovulation or thickening cervical mucus to prevent implantation of an already fertilized egg. Many do both. 

The best birth controL is one that works for for each individual’s lifestyle, that can be used correctly and consistently. Knowing what’s available and the risks and benefits of each method can help guide the best choice for your family. In the event you see an impact on your breast milk and need to switch forms to reach your goals, there are also many options. Please also note that hormone based contraceptives are not considered safe for ALL to take and you will want to discuss your unique medical history with your healthcare provider when making any decision about what you are putting in your body.

A small amount of the synthetic hormones in contraceptives will enter your milk and be passed to your baby. There is no evidence in the research that this is harmful to your baby. Some babies younger than 6 weeks may have difficulty metabolizing the hormones and for this reason it is not recommended to start using HBC until your baby is older than at least 6 weeks. Some report after they start taking HBC they notice an increase in fussiness in their babies and many of these same parents report an improvement in the fussiness when they change their method of birth control.

Also keep in mind that no form of hormonal contraception offers protection from sexually transmitted infections (STIs)—but using a condom with a hormonal birth control even further reduces your risk for pregnancy while also protecting from STIs.

Let’s take a look at different forms of hormonal birth control, how they are delivered and how effective they are. 

The Pill

Oral contraceptives are also called “the pill.” Birth control pills have been in use since the 1960s are the most common form of hormonal contraception in the United States. There are three types of pills with different combinations of hormones. The first is the cyclic combination oral contraceptive (COC). People who use this pill as prescribed have monthly bleeding that mimics a monthly period. The second type is the extended use COC pill. When taken as directed, a person experiences less menstrual-like bleeding. This method tricks your body into thinking it’s already pregnant so it doesn’t release an egg to be fertilized. There’s also the progestin-only pill (POP), which is estrogen-free and is often referred to as “the mini pill”. 

The benefits of the pill include it’s rapid reversibility (cycles return within a few months), regulation of menstrual bleeding, decreased menstrual blood loss, decreased menstrual pain, decrease in frequency of menstrual migraine and decreased endometriosis symptoms. Because the hormones in the pill suppress ovulation, its use is also associated with decreased premenstrual syndrome (PMS), decreased ovarian cysts, decreased risk of ovarian cancer and decreased risk of fibrocystic breast changes and cysts.

Birth control pills must be taken daily to achieve the highest level of efficacy. They also have increased potency when taken at the same time every day to maintain hormone levels consistent across time. Research shows that more than half of people using the pill forget to take one or more each month. Both the COC and extended COC pills have estrogen, the hormone that raises during pregnancy and is in opposition to prolactin and oxytocin, the hormones responsible for making and releasing milk. Taking either of these options will drastically drop your milk supply and are not preferred when breastfeeding is the goal. Progestin only pills, called the mini pill, is considered safe while breastfeeding and has the least risk of dropping milk supply. This is the preferred method of contraception while breastfeeding. While the limited research that is out there shows it holds a minimal risk of dropping supply, every body responds differently to hormones, and I have seen some people drastically drop their supply even on the mini pill. The perk of this methods is If you notice a drop in supply you can stop taking the pill and your supply should rebound in the same time frame it took to see it drop. So if you were on the pill for one cycle it will usually only take one cycle to rebound. Many people see no difference in their supply when taking the mini pill but this is why we call it risk assessment.

The Patch

The patch is similar to the pill in that it contains estrogen and progesterone. Instead of taking a pill every day, however, the patch is made of thin plastic that is placed on the skin of the arm, abdomen, buttocks or upper torso and delivers hormones through the skin. The patch should be placed on clean, dry skin and needs to be replaced weekly. Typically, the patch is used for three consecutive weeks, followed by one week during which no patch is worn in order for menstruation to happen. Benefits of the patch include the convenience of once-a-week dosing and a rapid return to fertility for those who stop the method to become pregnant. Some reported side effects of the patch include skin reactions, breast discomfort, headache and nausea. Because of the high levels of estrogen and progesterone, this method is also not preferred while breastfeeding as it runs a high risk of significantly decreasing breast milk supply.

The Ring

The ring delivers estrogen and progesterone through a circular piece of plastic that’s vaginally placed. The  ring is inserted and often left inside the vagina for three weeks, followed by one week during which no ring is used to facilitate menstruation. Some advantages of the ring include rapid return to fertility when pregnancy is desired, convenience of weekly insertion, and the ability to remove it for a brief amount of time (3 hours) without compromising efficacy. Some ring users report vaginal discomfort, and others experience nausea, breast tenderness, or changes in libido. As with some other hormonal contraceptives there may be a risk of blood clots with the ring, but more research is needed. Because of the high levels of estrogen and progesterone, this method is not preferred while breastfeeding as it runs a high risk of significantly decreasing your supply.

The Shot 
The shot is also called the injectable contraceptive. A commonly used version of this contraceptive  contains only  progestin , no estrogen. and is administered every three months. The shot is reversible, but a return to fertility may be delayed until the effect of the last injection wears off. Because the effects of the shot can last up to 3 months, if you are one of the people that does experience a drop in milk supply with any progestin based HBC, you do run the risk of losing the supply and not being able to bring it back up until the effects of the shot wears off. Which means you may need to supplement until the shot wears off and you run the risk of not being able to bring back supply as that is a signficinat amount of time to have a lowered overall supply.

Some people like the shot because it is available without estrogen and is only taken every one to three months depending on the brand. Some other benefits include absent or light bleeding, decreased cramps and PMS symptoms, reduced endometriosis pain and decreased risk for pelvic inflammatory disease (PID) and endometrial and ovarian cancer.

The shot has some potential disadvantages. Bleeding can become unpredictable for some while others may find they don’t bleed at all. There is also a higher correlation of people who get the shot and see and increase in weight, although the research isn’t sure why. More research is needed to determine whether and how the shot impacts mood (people interested in this method but worried about the role of hormonal contraception in depressive symptoms could mention this to their healthcare provider). This is especially compounded in the postpartum period when there is a higher risk of PPD/PPA. People who use the shot long-term can experience a loss in bone density, but it’s generally reversible. The biggest challenge with the shot and breastfeeding is once you’ve been given the shot you can take it back. The hormones are in your system. If you see a drop in your supply you won’t be able to do much about it until the shot wears off. There would be a few, extreme interventions such as herbs, medications, and additional feeding and pumping that may help, but supply is not guaranteed to rebound from this type of drop.

The Implant

The hormonal implant is the most effective form of hormonal birth control. The implant is a thin rod that is inserted under the skin in the upper arm. It lasts for three years, at which point you can return to  your health care provider to have a new rod implanted. The implant is progesterone-only and contains no estrogen. There are several advantages to this type of method: you never need to generate to do anything, its discreet, decreased menstrual pain and rapid reversibility. Because it’s effective for three years, the implant is also cost effective. In research studies, fewer than 20 percent of people have the implant removed early because of side effects.

Insertion of the implant is an in-office procedure that causes a small percentage with this type of HBC to experience some swelling, bruising, and pain. Removal of the implant is also an in-office procedure and usually takes just a few minutes. Some disadvantages of the implant include the possibility of unpredictable bleeding, headache, weight gain, acne and breast pain. Studies are in conflict for whether it lowers libido or improves sexual function. Because it is progestin only, it does have less of a chance of decreasing your milk supply. BUT if you are one that does see a drop in supply with any HBC and you see a drop in supply from this method, only removal of the implant will help increase supply again. Because of this, you might want to trail the effects of progestin only pills before trying this semi permeant method of contraception.

IUD

The IUD is a small T-shaped implant placed inside the uterus. There are two types of IUDS: copper, which doesn’t  have hormones, and hormonal. It must be placed by a healthcare provider in an in-office procedure. Some OBs may push for placement of an IUD at your 6 week postpartum appointment. This is because the cervix often hasn’t fully closed since delivery so it is easier for your practitioner to place. The IUD is highly effective. It doesn’t contain estrogen, is a one time placement that you can forget and not need to have placed multiple times, discreet, rapidly reversible, long lasting and has high rates of satisfaction among those who have one placed. Hormonal IUDs come with differing doses of hormones and the length of their use varies from three to seven years based on each brand. This is important to consider. The higher the level of hormone in the IUD, the higher the risk it will cause a drop in your supply. The Mirena and Liletta have 52mg and the highest amount of hormone. The Kyleena has 19.5mg and Skla has 13.5mg. The paraguard, which is made of copper has 0 hormones and will not impact milk supply but carries the same other risks of IUDs.  If you see a supply drop, there is not much you can do to regain that milk as this is reproductive hormones impacting breast milk hormones.

Some potential disadvantages include unpredictable changes in period cycles, cramping at the time of insertion, and some concerns about weight gain. In rare cases, pelvic infection can happen after insertion.  Occasionally they have also “fallen out,” or people have pulled them out accidentally. There is also a rare but possible chance that it will perforate (poke through) the wall of the uterus. If the IUD is the culprit for decreasing your milk supply, depending on your breastfeeding goals and how significant the drop is, some will consider removing the IUD.

There is no way to predict how your individual body will respond to a HBC, even if you used it prior. Depending on the importance of the breastfeeding goal vs risk of pregnancy,  I always counsel my patients to consider trying a round or two of the mini pill prior to IUD insertion. If they do notice a drop in supply, stopping the pill and using a different method of non hormonal contraceptives may help them reach their goal for breastfeeding. Other families will assess the risk of pregnancy vs breastfeeding vs formula and if there is a supply drop, supplement with formula to whatever level is needed. This decision is one that only you and your partner can make and the options need to be weighed based on your unique lifestyle, family planning and breastfeeding goals.

ABM Clinical Protocol #13: Contraception During Breastfeeding. Breastfeeding Medicine. 2015 https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/13-contraception-and-breastfeeding-protocol-english.pdf

Daniels K, Abma J. Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017 [Internet]. Available from: https://www.cdc.gov/nchs/data/databriefs/db327-h.pdf

Hatcher RA, Trussell J, Nelson A, Cates W, Kowal D, Policar M. Contraceptive technology. 20th ed. Ardent Media; 2012.

Goulding Alison N., Wouk Kathryn, and Stuebe Alison M., Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed. Breastfeeding Medicine. January 2018, 13(1): 75-80.

Birth Control

U.S. Selected Practice Recommendations for Contraceptive Use, 2016, K. Curtis et al, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

 

Picking a breast pump: vacuum considerations

What do I need to know about picking a breast pump? Suction/Vaccum

71CDABD0-6549-4807-BF81-79BF1F17BDD1

You would think that a stronger breast pump is better. But before you put that breast pump on the highest setting, make sure you know the benefits (and risks) of using the highest strength setting. Breast Pump power of suction is usually documented as mmHG which is millimeters of mercury, the standard unit of measuring vacuum pressure. Studies were done on babies sucking at the breast and breasts pump suction levels are based off what we know of how babies remove milk from the breast. The suction level, or vacuum, is DIFFERENT than the cycle speed, which is how fast it pumps. This is why breast pumps should have two settings that should be changeable: cycle (speed) and vacuum (strength). Most pumps will cycle 40-70 cycles per minute. This is based off of the average number of sucks a baby does at the breast in that same amount of time.

Breast pump effectiveness is evaluated by measuring the vacuum (also called suction) of the pump with a pressure gauge, an instrument that measures negative pressure. The gauge needle points to a number from 0 to 450 mmHg (the abbreviation for millimeters of mercury – Hg is the chemical symbol for mercury).  The gauge measures the vacuum, not the speed, of the pump. When there are questions about a pump’s performance, the concern is usually about the vacuum, but not always. Each breast pump has been manufactured to have specific pressures based off that unique pump. When assessing different pumps, the reading on the gauge is then compared to a standard range for that individual breast pump that is being tested, to determine whether the pump is performing per manufacturer’s guidelines or not. When you purchase a breast pump, the mmHg the pump has a capacity to reach may be in the product listing or manual. This number is important to pay attention to. Based on known research for the vacuum babies can generate a that the breast to remove milk, the pressure leves should be in the range of 220 to 350. The number is the maximum suction level that specific pump can achieve. “Hospital grade” pumps generally have maximum suction levels in the 300 range while personal grade pumps are generally in the 200 range. This doesn’t necessarily make a pump better or worse. Hospital grade pumps typically have bigger, stronger motors as they are physically bigger pumps. They are also multi-user pumps that need to have a longer shelf life for use.

Did you know that atmospheric pressure impacts vacuum capacity? Interestingly enough, vacuum levels can vary based on weather patterns and the elevation of where you are pumping. Maximum pump vacuum values are set at sea level. The higher you are in elevation, the lower the maximum suction strength your vacuum with achieve! This means when there is a low pressure storm front such as rain or snow moving through or are you at are at a higher elevation, the performance of the vacuum in your pump is affected. The vacuum isn’t as strong as at sea level or on a sunny day. If you live in a high altitude location or are subject to frequent storms, you’ll want to make sure you have a quality pump that has a high maximum vacuum capacity. You may find you need to have the suction one or two levels higher than usual during a storm. This does NOT mean you need to be pumping at the maximum suction level in your pump. But it is good to be aware of if you travel to higher elevations and question why your milk output isn’t as high as usual. 

Breast pump suction is supposed to mimic baby’s natural sucking through several phases:

  • Let Down – mimics when baby is vigorously sucking at the very beginning of the feeding and in order to try to stimulate additional let downs during the feeding. Babies can trigger any where from 2-9 let downs in a feeding. This phase stimulates the nerves in your nipples, which signals the release oxytocin, the hormone responsible for letting down your milk. The release of oxytocin contracts the small muscles that surround your milk-producing tissue, which squeezes milk into your ducts and down to the nipple which is then removed by the baby. Many babies will stay in this vigorous sucking phase for up to 1-2 minutes or until they trigger your let down.
  • Expression – this phase is when baby’s sucking slows down, and he/she is swallowing the remove all the milk that was let down from the breast. Many babies stay in this phase for 4-8 minutes, the time it takes to “reset” your hormones to trigger another hormone release of oxytocin.

Vacuum suction patterns have been programmed into certain pumps that copy the movements of an infant’s tongue with the goal of to reproducing the pattern of how older infants suck. After the first few weeks, babies will typically alternate between a light and fast “flutter sucking” to a deep and rhythmic sucking pattern, and occasionally when flow changes suck with both intensity and speed. By alternating back and forth between similar patterns on the pump, more let downs can be triggered which allows more milk to be expressed.  Pumping with higher strength and efficiency is what is needed to make sure that the body receives adequate signals to increase breast milk volume and to transition from colostrum to mature milk when establishing supply in the immediate days postpartum. This is especially imperative in situations where the pump is replacing direct breastfeeding. This happens when there is a separation from mother and baby in the first week after birth, baby is unable to latch and suck adequately, there is a tongue tie and the family is waiting to have that released, or any other reason why a parent would choose to exclusively pump.

It’s not true that higher pump suction level equals more milk output. The highest suction level on a breast pump are actually above the comfort zone of the majority of pumping mothers. So even if the breast pump has a maximum suction level of 350 mmHg, most will still feel more comfortable expressing in lower ranges of suction level regardless of whether the pump can reach 250 or 350 mmHg at its maximum setting. Pumping at too high of a suction level can actually hinder milk flow and even be the root cause of plugged ducts, mastitis, and breast/nipple damage! Think of it like drinking from a juice box straw. With hard sucking, the juice box starts to collapse on itself and not as much juice can move out because of the vacuum effect. You get more juice by gentle, consistent sucking. Milk ducts are small, compressible tubes inside the breast that move milk from milk-making glands at the back called alveoli down to every smaller diameter ducts that empty to nipple pores at the front. Too much breast pump suction compresses the areolar tissues which squeezes the ducts and actually decreases the flow of milk out the ducts. With time this can cause milk to back up in the breast, increasing the risk of plugged ducts. This can also foster inflammation and risk damage.

So why do you feel like you need to turn the pump suction all the way up to move your milk? The number one reason I see for this is because you’re actually using the wrong size pump flange (the horn shaped part of the pump that actually touches your breast during pumping). The majority of people cannot pump with the flange that comes in the box. The 24mm flange was standardized many years ago and hasn’t changed much with time.  In my experience, the majority of the people I work with need to size DOWN, and often significantly. When the flange is too big there is too much air space in the tunnel and a higher vacuum level is needed to generate enough change in the negative pressure in the flange to move the breast tissue. By finding the correct flange fit, less vacuum is needed to effectively move milk and the entire pumping experience is more comfortable. For more information on flange fit, read my other blog post or enroll in my course Pumped

It’s impossible to know ahead of time which cycle and suction settings will work best for your when you start using a breast pump. Everyone’s anatomy is unique and their sensitivity to the pump is individual. What works for one person may not necessarily work for the next. Those with nipple sensitivity may need a softer, gentler pump that cycles slower and with less vacuum. Other many have larger breasts with longer nerve pathways from the nipple that need higher suction and speed to stimulate let down.  When considering a breast pump, the most important thing is having a pump that gives you the most flexibility to adjust cycle and vacuum settings to find what works to trigger your milk.

If you’re buying a hospital grade breast pump because you know you’re going to be frequently pumping at work or exclusively pumping, look for a maximum vacuum strength above 300 mmHg. Most hospital grade breast pumps on the market will top out at 320 – 350 mmHg. If a breast pump is marketed as hospital grade and the maximum suction level is listed at below 300 mmHg, you should look more closely at the technical specifications and compare them to other hospital grade breast pumps on the market before buying it. If you’re buying a personal grade breast pump, look for a maximum breast pump suction level of 250 – 300 mmHg. The majority of personal grade electric breast pumps on the market fall within this range. If the vacuum strength tops out at below 250 mmHg, it usually means a weaker motor. This may still stimulate a small percentage of pumpers, especially in the early days postpartum when it is easiest to trigger let downs, but may not be strong enough for long term pumping. You should look more closely at the technical specifications before buying a breast pump like this, because a weaker motor means the motor has to work harder to perform at the same level as other personal grade breast pumps. These pumps also wear out faster and the motors don’t work as well for as long.

Scissor release of newborn tongue tie: why does my baby still not breastfeed well?

Did you baby have a tongue tie snipped with scissors in the hospital after birth but you’re still experiencing symptoms after discharge? Newborns are tiny and all their muscles are very tight from being scrunched up in utero and then being squeezed out of the birth canal. Often times immediately after birth, a provider with scissors will release an anterior tie, but not always do a full release of the tongue, leaving a posterior tie behind. If there wasn’t a diamond shaped wound under the tongue that needed stretched several times a day to prevent reattachment, it was not necessarily a complete release. Many symptoms can be resolved, but some can still linger.

The genioglossus muscle on the floor of the mouth is responsible for sticking the tongue out and keeping it out. This allows the tongue to cup the breast while feeding and not snap back to gum or bite the breast. If the posterior portion remains, the tongue may still be tied, resulting in fatiguing, snapping back, or still not efficient in pumping out milk. The lips may also come in and compensate, which looks like lip blisters, two tone lips, or red creasing in the fold between the nose, cheeks and lips.

If your baby had a scissor release after birth, but you’re still having symptoms, some times a second release or the posterior tie with a laser by a skilled pediatric dentist or ENT can fully release the tongue and improve baby’s feeding skills.

ADHD and breastfeeding: why are my symptoms worse now that I have kids?

For me, being a parent with ADHD means being easily over stimulated by all the noise and energy. I get easily touched out where I want littles off my body. I’m easily distracted and will start one task only to find myself immersed in a less important task and never finished the first task.

I have always been able to hyperfocus on tasks. It made me a work horse in my hospital job with the ability to tune out beeping monitors and nurses and patients talking around me. It is exceptionally helpful when writing social media posts and blogs. As a parent, this tendency gets in the way because there are more important things that need to be done but I get stuck in the loop. During hyperfixation I easily lose track of time and sometimes the ability to prioritize other tasks. Snapping out of hyperfixation is difficult and then everything that needed done gets rushed or put off until later. Always later. And some times when I’m hyper-focusing on a task, I won’t hear my kids until they escalate or crying or whining.

Those with ADHD have an additional work load while breastfeeding. Often undiagnosed and misunderstood in women, those who are breastfeeding will experience additional challenges such as:

🤯Sensory overload: being easily touched out during feeding. Finding the noises and energy of the baby to be very draining and tiring.

Feeling restricted or trapped by feedings

Time blindness: easily losing track of time during and between feedings

🙀Distracted by tasks, difficulty completing tasks, starting one task only to find yourself sucked into a less important task. You go to wash pump parts only to find yourself rearranging the glass cupboard.

😵‍💫Overwhelming thought, swirling thoughts, easily anxious. This can have many impacts including inhibiting let down when feeding and reducing the ability to sleep when woken during the night for night feedings.

🤱🏽 Breastfeeding was the easiest part of parenting. It was an excuse to sit in one place and have baby quiet for a long period of time. It meant an excuse for ignoring other tasks because I was feeding the baby.

🥳Starting something and getting distracted, leaving half done tasks. Folding laundry and fixating on rearranging the sock drawer. Going to put the dishes in the dishwasher, setting them by the sink, cleaning the counter instead because there’s crumbs.

🤫Listening is hard. I want to listen to my husband and kids, but I often find myself thinking about a million other things. Some times to the point of completely blocking out what they’re telling me.

🧐Hyperfocus. I have always been able to hyperfocus on tasks. It made me a work horse in my hospital job with the ability to tune out beeping monitors and nurses and patients talking around me. It is exceptionally helpful when building social media with posts and blogs. As a parent, this tendency gets in the way because there are more important things that need to be done but I get stuck in the loop. During hyperfixation I easily lose track of time and sometimes the ability to prioritize other tasks. Snapping out of hyperfixation is difficult and then everything that needed done gets rushed or put off until later. Always later. And some times when I’m hyper-focusing on a task, I won’t hear my kids until they escalate or crying or whining.

🤯Overstimulated. Before kids, I didn’t think I was sensitive to noise and energy. I was the extrovert who loved being around people. But kids are a different kind of energy, especially while also working full time. There’s no downtime or escape from the energy and it’s very draining to the point of meltdown. Getting overstimulated and feeling sensory overload is a very common feeling for those with ADHD.

When considering ADHD medication 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 anxiety and increase focus usually outweigh the risks. If you have been on a certain med prior to breastfeeding and it worked well for you, it would be reasonable to resume that medication while breastfeeding.

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

🥛 Changes in milk supply

🛌 Sedation/sleepiness or agitation/hyperactivity in baby

⚖️Poor feeding or weight gain in baby

Stimulants and non-stimulants for ADHD can work well to help you feel balanced again. Work closely with an IBCLC and your primary care physician when resuming or starting a medication to help continue and feel supported in your breastfeeding journey

Fore milk and hind milk

Is fore milk and hind milk really a thing? Many parents read or heard some where that “foremilk-hindmilk imbalance” is a thing they need to be concerned about. This confusion has led to so much unnecessary anxiety. Do I make 2 kinds of milk?  Does baby need to breastfeed for a specific number of minutes to make sure to get to the hindmilk?  How long do I need to feed before the hind milk starts flowing?

This term was coined related to human milk in a 1988 journal article that reported the experiences of a few mothers who breastfed by the clock, switching breasts after 10 minutes even though baby hadn’t finished on that side. The results have never been duplicated, and newer findings call into question this article’s conclusions.

This concept is also well known in the dairy industry related to cows.  A normal calf will nurse its mother 8-12 times per day in the first seven days of life and as calves get bigger, they will nurse larger volumes per meal and less frequently. By one month in age, calves will nurse approximately 4 times per day. Cows are follow mammals and the way a cow nurses and the fat content in her milk is different than in humans. Cows in the dairy industry, though, are only milked twice a day, every 12 hours, so the creamier, higher calorie milk, has had time to separate, and this fatty, thicker, "hind-milk" comes at the end of the milking session. The majority of the cream is in the hind milk, which is the last milk in the udder.

Cows make milk and store it in the udder for baby. This is the foremilk that is most often milked by dairy farmers and it is higher in lactose and lower in butterfat. When the calf is not satisfied by the available milk and continues to nurse, a more nutrient dense, higher butterfat hindmilk (cream) is made to meet baby's additional calorie needs. Cream is not made until stored milk is exhausted. If a cows let down is incomplete she will not give this higher butterfat milk that we call cream. When a cow has a calf to feed she often does not let her milk down completely for her human milker and when there is no more calf is more likely to let down completely including the hind milk. When being milked, a cow can refuse to let down milk entirely, let down just a bit, hold back the last milk, let down only from 1 or 2 quarters, etc. Their control is pretty amazing.  A cow with a calf on her will sometimes not let down all of her milk to a milking machine or human milker, wanting to save it for her own calf. Some cows are willing to let down completely for a milker even if they have a calf they are nursing. It really depends on the cow. This on demand feature allows calves to survive and flourish when the mother cow is also being milked for human consumption. A cow can not willfully withhold any component of her milk but rather the natural process allows us to have milk and the calf to still do well with only what the cow can produce on demand later.

With humans, when a mother nurses her baby frequently, every 1-3 hours, the milk actually stays mixed up.  In fact sometimes with frequent nursings the feeding can start with the creamy 'hind milk".  Dr. Hartman taught that mothers that nurse more often have higher calorie milk ALL THE TIME.  With humans it is usually when there is a longer stretch between breastfeeds, like at night,  that gives the fat time to separate and cling to the walls of the alveoli, that the difference between the fore and hind milk can be observed.  This is why many IBCLC lactation consultants are against sleep training where we are trying to get young babies to sleep longer than they naturally would in their own. this reduces time they would naturally spend at the breast which can drop supply.

There is a lot of misunderstanding of foremilk and hindmilk and I've had many mothers overly concerned because they have been told their babies doesn't nurse the prescribed amount of time to get to the hind milk or their baby isn’t gaining weight well and are told their milk isn’t fatty enough. If the baby is gaining properly and healthy, baby IS getting plenty of the calories needed. When in doubt, feed the baby more often at the breast  

Another concern of many parents is for having a foremilk/hindmilk imbalance. In reality this is usually lactose overload and not a fat imbalance.  Lactose is the primary sugar (carbohydrate) in human (and all mammals’) milk. It is a large molecule and the body has to break it down to be able to absorb it. It is broken down in the body by an enzyme called lactase. Your baby’s body naturally produces lactase until around 2-5 years old (the natural age of weaning from the breast). This enzyme is supposed to disappear and is also why many adults can become lactose intolerant later in life: they no longer have the enzyme to break down lactose effectively

Most healthy babies can break down lactose in normal volumes of breast milk. Fat slows down milk as it passes through your baby’s gut, giving the gut time to process and digest milk. If baby has a lot of breast milk that is relatively low in fat and higher in water concentration, it can rush through their digestive system more quickly than the lactose can be digested. This happens when baby drinks a very large amount of breastmilk – often when baby has gone a very long time between feedings, or because there is an oversupply of milk. The oversupply can be from many reasons: excessive pumping, using a Haakaa frequently during feeding, certain medications, baby with a tongue tie, etc  

Babies with lactose overload are often described as being really gassy with lots of pain while trying to relieve the gas. Parents also note green, foamy, frothy, or explosive poops. These are often regular, daily poops that happen multiple times a day as the milk they drink flushes rapidly through their system.  This is not the same as a cows milk protein allergy (CMPA) which typically presents as mucous or blood in the poop. But you can have both issues at the same time (CMPA AND lactose overload). Damage to a baby’s intestines, including inflammation caused by cow’s milk allergy and infection, can stop the production of sufficient amounts of lactase. This means milk isn’t digested as it moves through the intestine and instead ferments in the lower bowel causing pain, gas and green stools.

NOTE: green poops can be caused by other things other than just lactose overload or CMPA; sickness, certain medications, not drinking enough milk by volume and food allergies or intolerance can also change the color and consistency of baby’s poop. Healthy babies who are feeding well may occasionally have green poops. If baby only has occasional green poops, most likely everything is fine  

If your baby seems to be suffering with lactose overload try the following tips:

  • Check baby’s latch: a deeper latch can help baby manage the milk flow better. Usually the best way to get a deeper latch is to watch baby’s position at the breast. They should be completely touching your body, belly button touching you. Their chin contacts the breast first with their cheeks touching equally.  Address any known tongue or lip ties which prevent a deep latch. 
  • Try different positions: side lying and laid-back position, help baby manage faster milk flow by using gravity to slow the flow. Avoid additional pumping or Haakaa use to regulate supply down to what the baby needs. Feed the baby and not the freezer. 
  • Feed the baby until they are finished. There is no time limit for how long they may want to be on the breast. Finish the first side first before offering the second side. Some find block feeding helpful but this should be done under the direct care of an IBCLC lactation consultant. 
  • More frequent feeds: the best model of breastfeeding when there is suspected over supply or lactose overload is eat, play, eat, sleep. This helps reduce the volume baby gets at each feeding and increases the fat content of each of those feedings. 

Despite common advice, it is usually not necessary nor helpful to reduce the amount of dairy you consume in your diet to reduce the lactose content in your milk. The amount of lactose in your milk has nothing to do with your diet. Lactose is the number one sugar found in breast milk and your body makes it specifically for your baby. If you eliminate dairy from your diet and you see a reduction of symptoms in your baby, your baby was probably reacting to the proteins found in cow’s milk that can appear in your milk and not the lactose in your milk.

As always, if you’re concerned about your baby’s poops, your milk supply, or your diet, please consult the appropriate health care provider: pediatrician, specially trained IBCLC lactation consultant, maternal health dietician or allergist.

Breastfeeding as birth control

Breastfeeding has historically been used as a method of birth control, called the lactational amenorrhea method (LAM). But 3 conditions must be met to make sure that it works:

  • Baby must younger than 6 months old. After your baby is 6 months old, your period is more likely to come back which means you can become pregnant again.
  • You must be exclusively breastfeeding your baby. This means no pumping, pacifiers, formula or other supplements. And you have to breastfeed for both day and night feeding, typically not going more than 4 hours between feedings during the day and no more than 6 hours between feedings at night.
  • You must not have a period (amenorrhea). When your periods start, use some other birth control method.

When these conditions are met, LAM has been shown to be about 98% effective. For many who exclusively breastfeed, they will have a light period before ovulating, but it is possible to ovulate and get pregnant before having your first postpartum period.

Pre and post breastfeeding weight check

There are many factors that influence how many ounces a baby takes at the breast in a single; baby’s age and weight, how often they’re feeding, when the baby last fed and time of day, and the breast storage capacity of the mom. Many lactation consultants will do a pre and post feeding weight to see how much milk baby transfers at the breast in one feeding. This number is a snap shot in time that is a piece of the puzzle of how baby is feeding.

Feeding is a cumulative action. Some babies are snackers. They take smaller, more frequent feedings and may feed often over night. Some babies are bingers. They take larger, less frequent feedings and may sleep in longer stretches. And most fall some where in the middle. This is feeding. Sometimes baby wants a snack. Some times they want a drink. Some times they want a boob buffet. They move through waves of feeding like hummingbirds to feeding like baby sharks.

 

One single weighted feeding is just that. A single feeding. It’s helpful information that once we gather lots of data points can help us determine if what your baby is doing at the breast is normal for your baby or if it is something we should support. How your baby eats will be individual to your baby.

 

In general, if you have a pain free latch where your nipple goes in and out of baby’s mouth the same shape, where you hear baby swallowing, baby is making lots of wet and routine poops and gaining weight across time, keep going. If you’re concerned about how your baby is feeding, working with an IBCLC lactation consultant can be very reassuring.