NO STASH NEEDED
Did you know up until 2010 most people didn’t even own a breast pump? You either breastfed until you weaned or bottle fed formula. The Affordable Care Act signed in 2010 changed the game by saying insurance had to provide lactating parents a breast pump. Before that, most parents didn’t own a pump as they were quite expensive and there were only a limited amount on the market. You may have had one if your baby was in the NICU. Our mothers and grandmother certainly didn’t own a pump.

If breastfeeding is going well there is no need to have a freezer stash. Having milk in the freezer is a nice security, but if you’re usually with your baby or gone for only a short while occasionally, there is no need to have a stash. Having the right stash for your family means having enough stashed for when you’re away from your baby. If you’re gone for one feeding, you only need one feeding worth of milk. If you’re gone 2-3 feedings, you need 2-3 feedings worth of milk. If your baby is being bottle feeding while you’re away, you would pump while you’re gone to tell your body the milk is needed. That milk then becomes the stash for the next time that you’re gone. If you want to have a big stash, great!!! You can absolutely have that as an option. Just don’t feel pressured from other people’s journeys on social media to have something you may not need or use. I’ve had several moms who spent countless hours pumping and stashing only to have to donate or throw out the milk stash because they never used it and it was going to expire. I’ve also had several moms who thought you had to have a stash and were relieved to know they didn’t! Do what is best for you and your baby and not based off of anyone else. You’ve got this. Trust your body. Trust your baby.
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MAKING MILK
The uterus doesn’t tell the breasts how many babies have come out. So the breast, when things go right, is designed to readily make milk for the first 6-8 weeks to feed however many babies have come out, in the event there are twins or triplets. Milk removals in the first 3-4 days after birth, while your milk is still colostrum, help lay down the hormone receptors needed to make milk. The more the breast is stimulated in the early days, the higher the potential for the breast to make milk. In the few weeks following birth, once milk has transitioned, a high supply ensures baby has plenty of milk while going through multiple growth spurts. Supply then gradually tapers off around 11-14 weeks (“regulates”) to just what is being regularly emptied. Many people, though, don’t see this abundant milk supply in the early days. Why does this happen?

🛑 Really long labor and delivery (24+ hour birth, 4+ hours of pushing)
🛑 Lots of fluids during labor
🛑 Maternal hemorrhage/large blood loss at birth
🛑 Inefficient milk movement in the first few days after birth (inefficient baby, not pumping when baby is supplemented, tongue tie baby)
🛑 Retained placenta
🛑 Uncontrolled diabetes or thyroid disorders
🛑 Feeding by the clock instead of on demand whenever baby is cueing
🛑 Early sleep training
🛑 Supplementing baby with a bottle and not pumping at the same time (You need to feed something, either the baby or a pump to tell your body to make that milk)
🛑 Placenta encapsulation for some (in many, placenta pills boost mood and supply. For some, it can actually decrease supply)

What can you do?
✅Get help as SOON as possible. There is a few week window where supply can be increased after birth. After that window it can be very difficult to get supply up and you’ll have a higher likelihood of needing to supplement in addition to your milk.
✅Work on position and latch to optimize the time baby is at the breast.
✅Get a quality pump and have a flange fitting
✅Have tongue and/or lip ties addressed
✅ Pump when baby is being bottle fed, even in the MOTN
✅Stay hydrated and if there was a blood loss, eating iron rich foods and quality nutrition can help as your blood supply rebounds.

PUMP TIPS
⚖️Pumping is never an accurate measure you your supply
⏰ Pumping is time consuming. It still involves set up and clean up
📏Pump flanges that are sent with the pump are not one size fits all. They are not even one size fits most. The majority of people who pump will need to buy a smaller flange
The soft parts (membranes, tubes, duckbills) wear out with time and need replaced occasionally. The more you pump, the more often these will need to be replaced
🍼If your baby is being fed, you need to feed something: feed the baby or feed the pump. If you want to make the milk your baby needs, you need to be pumping as often or even more often to maintain your supply
🌛Pumping overnight can be crucial for maintaining supply
☄️Test for high lipase early into your pumping journey
🌪Pumping on the highest vacuum is never a good idea. If you have to crank the suction up, either you have the wrong size flange or a bad pump
🤱🏾Pumping while also breastfeeding is never a true indication of milk supply
💣Not all pumps are good pumps. Some are really crappy and it’s the pump that will sabotage your supply, not your body
🚰Some can breastfeed fine and never trigger let downs well to a pump
😵‍💫Pumping shouldn’t be painful
🤲🏼Alternate the stimulation/massage and expression modes often while pumping to trigger more let downs
👐🏾Massaging and shaking your breasts before and using hands on compressions while pumping can help you empty more milk

While breastfeeding is optimal, there are times when supplementing with formula may be given by choice or necessity. Formula feeding your breast fed baby is a GOOD choice when needed and you should feel supported in how you are feeding your baby, especially if breastfeeding is still the end goal. If you are offering your baby formula, safe preparation, handling, and storage are important to know about.

• Wash first: Use hot, soapy water to clean all bottle parts (and your hands!!!) before mixing formula
• Follow the directions: Formula makers have different mixing guidelines, so check the instructions if and when you change formulas. Most manufacturers use the same recipe: 1 level scoop of powder for every 2 fluid oz of water. ALWAYS add the water first to the bottle. If you add the powder first and then try to fill with water to the ounce line, you’ll be using less water than directed as the powder displaces that space.
• Measure accurately: Too much powder might cause an upset tummy for baby. DO NOT ADD EXTRA SCOOPS to increase calorie count. You’ll also be increasing every nutrient in the formula which can cause baby to get too much protein or other nutrients. It also decreases the amount of water baby is getting which can lead to hydration. Calorie fortifying should only be done under the direction of a pediatrician or pediatric nutritionist. Adding more water than directed can make baby sick
• Check for clumps: Look at the formula after mixing to make sure there are no clumps. They can get stuck in the bottle nipple. Use a fork to separate clumps and shake again
• Time it: Mixed formula stays good for 2 hours at room temperature. You can mix up one bottle at a time, or mix a full day’s worth in a pitcher and refrigerate it for up to 24 hours, pouring individual bottles to feed from one large batch
• The right temperature is anywhere from cool to lukewarm. If your water is safe, it’s OK to mix powder with room temperature water right from your tap. NEVER put a bottle of formula or breast milk in the microwave. This can create hot spots that would burn baby’s mouth

To warm formula:
🥵Use boiled or hot water while mixing the formula, no additional heating needed
🚿 Run the bottle under very warm or hot water for a few minutes
🔥Fill a pan with hot water. Remove it from the heat. Place the bottle in the pan for a few minutes
🍼Use a bottle warmer
💧After warming the bottle, shake it vigorously to make sure there are no hot spots in the formula. Test it by squirting a drop on the inside of your wrist. If it’s hotter than lukewarm, let it cool down before feeding it

BREAST CHANGES
When you’re pregnant, breast tissue for making milk increases, accounting for the size increase you experience during that time. On day 3-4 after birth when your milk transitions from colostrum to mature milk, your breasts engorge. This means extra blood (hello veins) and fluid fill the breast to support making milk. This additional blood and fluid are what help make you aware of that full breast feeling before each feeding. Your uterus doesn’t tell your breasts how many babies were born, so the body is prepared to make milk for 1, 2, or even 3 babies and often initially makes more milk than is needed.
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Around 6-8 weeks, your hormones shift and the extra blood and fluid in your breasts go away (not your milk supply decreasing). You may no longer feel that full/empty sensation between feeds, but still be able to see lots of milk, because your body knows baby is on a full milk diet and going through multiple back to back growth spurts. You may occasionally engorge if you go too long between feedings or if you skip a pump session.
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Between 11-14 weeks, your body has finally figured out how many babies it is feeding based on how often the breast is emptied. Your breasts will go back to their prepregnancy size while still making just enough milk for baby. Congratulations on your mom boobs. They no longer feel full/empty, making them feel like pancakes and leaking often slows or stops. You have not lost your milk supply, your body is more efficient at making milk and will consistently make what is routinely emptied. You are still maintaining a full supply as long as you’re continuing to feed on demand or (routinely pump).
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Don’t be alarmed when these changes happen. This is the normal process that every body will go through

TONGUE TIE
“It’s only a minor tie, they’ll grow out of it”, “They’re gaining weight fine, try a nipple cream or shield”, “At least they’re still getting your milk from a bottle”, “Breastfeeding just isn’t for everyone” “Baby is gaining weight just fine, you can deal with the pain”.

Parents tell me they hear lines like this from their health care providers. That just isn’t right and it makes me so upset. We have to remember that breast/chestfeeding is the biological norm and if a baby is struggling to latch there is always a reason. The number one reason I see for nipple pain and damage is tongue tie (after we’ve worked on position and latch).

While nipple tenderness is normal for the first week after birth, nipple pain and damage should NEVER be considered “normal” or part of routine feeding. Weight gain is only a piece of the breast feeding puzzle, and while it’s an important one, it only focuses on half of the breast/chestfeeding dyad. Offering your milk is important, but for some families the container it comes in can be VERY important. Unfortunately nipple pain and damage have been normalized by society and even by some health care providers. If a health care provider tells you there is no tongue tie and not to worry about nipple pain and damage because baby is gaining weight well, they should also be referring you out to a lactation specialist (IBCLC) to get to the root of why you’re having that pain and damage. Keep looking for your answers.

We are not symmetrical beings. Even though on the outside we have two eyes, two ears, and two hands, if we were to measure both, one would be slightly larger, rounder, flatter, etc than the other. Breasts are not symmetrical. For some breast differences are hardly noticeable; in others it can be drastic. They usually won’t cause issues with breastfeeding

Milk supply is often higher on one side versus the other. Possible reasons:

• One breast will physically have more alveoli and ducts than the other. Let downs can trigger differently and each side can have different flow rates and milk volumes. Milk can also taste different from one side even in the same feeding. Our bodies are incredible and mysterious
• Breast surgery (implants or reductions), scars from nipple piercings, or traumas can alter milk production
• Nipples can be completely different sizes, shapes, or lengths (inverted/flat) which make it easier for baby to latch to on one side. When it’s easier to latch on one side, we subconsciously start on that side more, increasing supply on that side
• Some babies have tension in their body from intrauterine positioning or from birth trauma. Baby may feel more comfortable being held on one side or in a certain position so we put them on that side more often. (Tummy time and manual therapy like chiropractic or CST can help)
• You may have a conscious or unconscious side preference. Handedness can play a role. One side often just feels more comfortable to hold baby on for extended periods of time, often leading us to feed more often on that side which increases supply.

How to balance your boobs:

• Start feeding on the slacker side more often since baby usually removes more milk from the first breast offered which naturally boosts supply
• End feedings on the slacker side
• Pump the slacker side more often. Either for a few minutes after some feedings or occasionally add pumps on just one side between feedings
• Do nothing!! Celebrate your anatomy and use it to your advantage

I often get asked how I became an IBCLC. Here’s my journey:

When I was 10 years old I told my mom I wanted to feed babies for a living. In high school I looked into becoming a nurse, but realized nurses in the NICU do more than just feed babies. Much of their job is shots, IVs, and other intensive medical procedures which I really didn’t want to do. I was on a competitive speech team in high school and my coach was a speech pathologist. She told me you could feed babies as an SLP. I shadowed some therapists in the NICU and was hooked. I became a speech pathologist because the same things you speak with, you eat with. I’ve been a speech pathologist in a hospital for over a decade with a specialty in feeding and swallowing disorders. In working in the NICU setting, I realized I wanted a more intimate approach to working alongside families as they worked to feed their babies. I became a board certified lactation consultant and have really fallen in love with what I do. There’s nothing better than empowering families to reach their feeding goals, wherever they are in their journey. Speech pathology has given me a unique lens for approaching breastfeeding and I’m grateful or my unique journey into working with breastfeeding families.

I started with the 90 credit hour program through Lactation Education Resources to become a CLC. I worked part time as an SLP in acute (with adult patients) and NICU (with babies). I then took the 45 credit hour course to be CLEC through UC San Diego. They brought Virginia Baker to my hospital in Los Angeles to teach the course live which was awesome. I was then hired by my same hospital to work per diem (on call) as a lactation consultant to help me get my hours with the expectation to be able to sit for the IBCLE exam to become board certified. I was able to sit under pathway 1 since breastfeeding was a large part of my role as SLP in NICU and in postpartum as a CLC. It took me the full five years to get all my hours and coursework done.

A few years ago my husband encouraged me to start my own lactation consultant practice. He could see my passion for working with families and my frustration at the hospital system. I launched my private practice in 2017. In teaching prenatal breastfeeding classes at several local natural birth centers, I was able to Network with midwives and doulas to help local families meet their feeding goals. I started taking more courses and conferences on evaluating and managing tongue and lip ties, meeting local dentists and helping families address ties in their babies.

I’m thrilled that after 14 years in the hospital setting I’ve finally reached my career dream. This past Friday (July 2, 2021) was my last day working in the hospital and I’m now full time in my private practice helping families feed their babies.

When you are nursing, you need to consume extra water in order to stay well-hydrated.– The IOM points out, “Given the extreme variability in water needs that are not solely based on differences in metabolism, but also in environmental conditions and activity, there is not a single level of water intake that would ensure adequate hydration and optimal health for half of all apparently healthy persons in all environmental conditions…” in general, lactating people need ~13 cups of water/day, but your body can use water from many sources, including veggies, fruit, soup, water, fruit/veggie juices, milk, tea and other beverages. The foods you eat accounts for about 1/5 of total fluid intake.

How much water should you be drinking while breastfeeding? There are some ridiculous answers out there. If your milk supply has dropped, helpful people may suggest chugging tons of water. Your lack of water intake is most likely not responsible for your decrease in breast milk and drinking too much water can inadvertently harm your milk supply.

When you drink too much water, your body tries to restore the electrolyte balance by dumping the excess water into your urine. This results in water being diverted away from your breasts, which in turn decreases milk supply.
🍉Water dense foods can be just as hydrating as plain water from the tap. The general rule is: drink to thirst, eat to hunger.
💧Keep a full water bottle by your favorite nursing spot 🛋. There is nothing more frustrating than desert mouth when you are stuck in a chair in the middle of let down with your babe.
💦Strategically place water bottles where you will see them as a reminder to drink: in your diaper bag, in your 🚗 car, by your desk at work and next to your 🔑 keys.
⏰If you really have mom brain, set an alarm for every hour and try to sip a few ounces each time the alarm goes off.
🍑Eat foods that have a high water content, such as melons🍈 🍉 , cucumbers 🥒, salad 🥗 and 🥣 soup
🧉Spice it up by adding fruit, a small amount of juice or a squeeze of lemon or lime to your water
☕️Coffee, tea and soda will dehydrate you, so try to limit caffeinated beverages

Breastmilk is 88% water. Babies do not need additional water, even in hot weather. Too much water, especially in the first 9 months, can be dangerous.

Under 6 months, water can be dangerous:

• In the first days after birth, water may increase bilirubin levels (jaundice) and cause excess weight loss
• Fills baby up without adding calories, resulting in weight loss
• Makes baby less interested in nursing, which may delay milk coming in or prevent establishing an optimum milk supply
• Increases the risk of diarrhea and malnutrition

Older babies

• Too much fills baby up, sabotaging milk supply from not nursing enough
• Breast milk has the nutrition and calories babies need to grow – water does not.
• Breastmilk has all the water your baby needs, even in very hot weather.
• At 6 months, baby can learn to use a cup at the same time as starting solid foods. Giving a few sips of water a couple of times a day (no more than 2-3 ounces per 24 hours) is fine and can prevent constipation
• Breastmilk supplies plenty of fluids and older babies (9+ months) who breastfeed without restriction can get the fluids they need through breastfeeding. Some may need a little water with solids to prevent constipation (4-6oz/day).

If you feel you must give baby (6-12 months) water, offer limited amounts in a cup (not bottle) and only after baby has satisfied hunger with breastfeeding.