Category: Uncategorized

Nipple Damage: Now What?

- Julie Matheney

It’s normal to experience nipple tenderness for the first few days after delivery. Tenderness peaks between the 3-6th days postpartum and then should resolves by the end of the second week. Any damage to the skin of the breast or nipple should be taken care of immediately to avoid further damage or infection.

Painful breastfeeding is not normal.  The first step to decreasing pain while breastfeeding is to identify what’s causing it. Usually the simplest way to reduce nipple pain is to make sure baby is in the right position. Baby’s tummy should be touching mom’s body, with the belly button touching. Baby’s arms hug the breast and their face comes straight to the nipple. Baby’s Head should be straight, with their ear, shoulder and hip making a straight line. Their head should be slightly extended backward to allow the nose to pop up off the breast. Pulling baby in closer through the shoulders usually helps get a deeper latch.  If nursing is still painful, even with careful attention to latch and positioning, there may be other things at play. Usually there is a tongue/lip tie, tension in baby’s body like from a long labor and delivery (greater than 24 hour labor and/or more than 4 hours of pushing), or tension on baby’s body from intrauterine position (sitting really low for a large portion of pregnancy or being breech). Having the tongue tie released and/or doing tummy time and bodywork on baby should resolve the pain. If you’re working on release and baby’s body, consider the temporary use of a nipple shield to protect nipples, until damage is resolved and the underlying cause of the damage is managed.

When your nipples are already damaged:

Step one: Wash and Rinse Damaged nipples are prone to bacterial infection. Washing and rinsing damaged nipples can help prevent this type of infection. When bacteria grows in a wound, they create a bio-film that lengthens healing time. Baby’s saliva also fosters this bio-film. Washing cracked or fissured nipples gently twice a day with a gentle, fragrance free soap (not an antibacterial soap) and rinsing them with water can help remove the bacterial bio-film and allow faster nipple healing. Stop washing with soap once the nipples are healed. After every feed, rinse nipples with either clean water or a saline rinse. You can make your own saline rinse by mixing ¼ rounded teaspoon of sea salt with 8 ounces of warm water. Soak your nipples in this solution for 30-60 seconds. Soaking for longer may actually over hydrate your skin and increase cracking.

Step Two: Moist Wound Healing after washing and rinsing and/or soaking your nipples, dry and apply your antimicrobial ointment of choice. This could be virgin coconut oil, Dr Jack Newman’s All Purpose Nipple Ointment, or medihoney. There are other nipple balms and butters on the market. Make sure the one you’re using is antimicrobial. While you may think airing the nipple out will help scab the nipple over, Keeping cracks covered with some type of ointment promotes moist wound healing which is better for the sensitive nipple tissue which is a different kind of tissue than the rest of your skin. A non-stick wound pad, reusable breast pad, or a cooling breastfeeding gel may be placed over the ointment to keep your nipples from sticking to your bra or clothing. Ointment should be applied like chapstick, in a thin layer. Gently wipe off any leftover ointment before baby feeds. Disposable nursing pads should be avoided as these do not allow for good air flow and the quick wicking material tends to stick to nipples. Wool breast pads are preferable for their antibacterial and air flow properties.

Monitor for Infection Contact your primary caregiver physician and an IBCLC lactation consultant if you have any signs of infection like increasing redness, fever, or pus. If you have a fever of 100 degrees or greater for 24 hours, or bacterial infection which will require oral antibiotics. Research suggests that taking probiotics containing lactobacillus fermentum and lactobacillus salivarius can also help treat bacterial infections of the breast.

My baby mouth breathes: when should I be worried?

- Julie Matheney

Babies are obligatory nose breathers. They should be breathing through their nose all the time. This is how they can have their mouth full with a nipple during breast or bottle feeding and still breathe. Mouth breathing isn’t as efficient as nose breathing — especially when it comes to oxygen absorption in the lungs. And breathing through the nose helps to filter out bacteria and irritants from entering the body. Babies should be breathing through their nose all the time, especially during sleep. And snoring with mouth breathing is NEVER normal.

Mouth breathing as an infant can indicate several things:

🤢Nasal congestion from an illness or allergies

😛Tongue tie

👀Large tonsils/adenoids

👃🏽Deviated nasal septum

🧠Learned habit

Prolonged mouth breathing can cause:

• Atypical development of the mouth, nasal passages and face

• Poor quality sleep

• ADHD

• Increased risk of asthma

• Swollen tonsils

• Dry cough

• Inflamed tongue

• Teeth issues, like cavities and bad alignment

• Foul-smelling breath

If you notice baby mouth breathing regularly (other than when sick), please make an appointment with a health care provider to help figure out the root cause.

• Stay away from your baby’s known allergens

• Gently push the chin upward to close baby’s mouth when sleeping

• Consult with a doctor as soon as you notice baby breathing through their mouth consistently

• Put a humidifier in their room to prevent their mouth from drying out

• Have tongue tie revised and work on suck training exercises, tongue posture, and body work for proper body posture to correct habits baby made from compensating for the tie

Peppermint and Breast Milk

- Julie Matheney

Good bye pumpkin, hello peppermint. Tis the season for peppermint bark, candy canes, peppermint lattes, and holiday cookies with crushed red and white striped mints. While you may binge on all things peppermint this December, be warned: it may drop your milk supply.

Peppermint is a soothing herb best known for treating stomach and digestive problems. Popular products like toothpaste, chewing gum and tea are often flavored with peppermint. The calming and numbing effect of peppermint treats headaches, menstrual cramps, diarrhea, anxiety, nausea, and skin irritation. Peppermint oil has even been used to treat cracked nipples!! It is also used as an active ingredient in vaporizers and chest rubs. Menthol and methyl salicylate, the active ingredient of peppermint, possess antibacterial, antifungal, and antiviral properties.

It’s been commonly reported that peppermint and spearmint decrease milk supply, especially when taken in large amounts such as during the holidays. Drinking an occasional peppermint latte shouldn’t be a problem. But if you start to notice your supply taking a dip this holiday season, check your peppermint intake.

Dropping breast milk supply

- Julie Matheney

Feel like your breast milk supply is dropping? It may be normal. The uterus doesn’t tell the breasts how many babies came out. Immediately after birth, hormones cause the breast to go into overdrive to try to figure out how many babies were born…to feed them ALL.

The breast makes milk by being emptied and learns your babies habits and how much milk it needs to make with time and experience. In the early weeks your breasts have extra blood and fluid support to help your breast tissue make milk. This is what makes you aware of the filling and emptying of milk. This extra fluid support goes away around 6-8 weeks and you’ll no longer feel that full/soft feeling. By 10-14 weeks your breasts become more EFFICIENT and only want to make what is routinely emptied. Your breasts will go back to prepregnancy size. You may stop leaking (if you leaked) and not be able to pump as much. That’s NORMAL.

Your body doesn’t want to make milk that isn’t needed. You biological body doesn’t know what a freezer is or that you’re trying to collect that leaking milk for later. Your body wants to be as efficient as possible and make only what is being routinely removed from the breast. It costs your body energy to make milk: about 20 calories per ounce of milk made. Your body doesn’t want to burn calories to make milk that’s not being regularly emptied so it can use those calories for things like your brain function. Because mom brain is real.

So before you reach for formula thinking you don’t have enough milk. Realize that when everything is going normal your milk supply is supposed to regulate and your breast aren’t supposed to stay engorged and full forever. Your body is efficient. As long as baby continues to make good wet and dirty diapers, has a pain free latch where you’re hearing baby swallow, feeding baby in demand and not to the clock, and baby gains weight over time, you body is just doing what it’s supposed to do. You can always increase supply by feeding or pumping more often and decrease supply by feeding or pumping less.

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#normalizebreastfeeding #normalizenormalbodies #postpartumbody #milksupply #milksupplyissues #makingmilk

Low breast milk supply

- Julie Matheney

Whether it’s 3, 5, or 10% of the population, there are people that struggle to or never make a full breast milk supply. From 1 month to 1 year, exclusively breastfed babies average 25oz of breast milk per day. True low milk supply means making less than this when the breasts are stimulated every 1-3 hours day and night. Chronic low milk supply is linked to either a greater health concern or something out of your control which you cannot change or fix with cookies, teas or even sometimes medications and pumping.

🗝Low milk supply that can be increased with time and support:

💡Baby not feeding efficiently from lack of oral motor skill or tongue tie

💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)

💡Not feeding or pumping enough, especially over night

💡Scheduled feedings or over use of a pacifier

💡Birth. Many medications designed to help you labor and deliver actually inhibit baby from latching and feeding effectively for hours to days after birth. Hemorrhage or birth trauma can also cause low supply in the beginning

💡Supplementing, especially in the two weeks after birth

🗝Reasons for chronic low milk supply that may increase even with maximal support:

💡Insufficient glandular tissue (IGT). Breasts never developed during puberty and look tubular or widely spaced. Signs of IGT include breasts did not grow in puberty, or increase in size during pregnancy. No engorgement in the week after birth

💡Uncontrolled or undiagnosed thyroid disorder

💡Uncontrolled diabetes

💡Hormone or endocrine disorders, including severe PCOS

💡Hormonal birth control placed/used too soon after delivery

💡Breast or nipple surgery, augmentation, reduction, trauma

💡Nipple piercing that scars shut instead of staying open

There is a mistaken belief that prescription galactagogues, teas, or herbs can cure ANY chronic low milk supply. Before self-prescribing or taking Domperidone, Reglan, fenugreek, or any other lactation supplement, consider having your serum prolactin levels tested and a full evaluation by a skilled lactation consultant. Continue to follow @lalactation for strategies of breastfeeding with chronic low milk supply.

#lowmilksupplyawarenessday #igtandlowmilksupplysupportgroup #igtandlowmilksupply #igt #lowmilksupply #lowsupply #normalizebf #normalizebreastfeeding #worldbreastfeedingweek #wbfw #chestfeeding #sns #atbreastsupplementation #breastfeeding #bf #ibclc #bottlefeeding #donormilk #mixedfed #pacedbottlefeeding #triplefeeding #breastfeedingproblems #breastfeeding #supplementalnursingsystem #postpartum #breastpump #milkbank #lactationcookie #lactation #galactagogues

Why I will answer some lactation questions and not others

- Julie Matheney

Why I’ll answer some lactation questions and not others via social media.
Breastfeeding is well studied and the field of lactation has developed standards of care. There is best practice in lactation, and then there is personalization. Example: Most breastfed babies take a full feeding in 20-30 minutes (10-15 minutes on each side). Some need only 5 minutes. Others take 60. There is the majority of what is considered “average” or “typical”, but in reality there is still a wide range of “normal". There are topics in lactation that are universal for all people: offer one breast first. If baby is still hungry, offer the second breast. Breastfeeding should not be painful. Positioning is key for a deep latch. These are the kinds of answers I will freely dole out on social media all day long. They apply to every breastfeeding journey.

Some answers need to be individualized and often more information is needed before I can give you the correct answer. In order to give the in-depth answer, I need a signed medical consent, just like at your doctor’s office. This protects the privacy of your information and lets me reach out to other health care providers, like your pediatrician, should the need arise. I need a full medical and birth history as these can change my recommendation. For instance, the biggest questions I get are about low milk supply. The blanket answer I can give over social media is best practice: empty the breasts frequently at least every 2-3 hours day and night with either your baby or a high quality pump. Why can’t I give advice beyond that? If you have an allergy, a thyroid condition, a hormonal issue, recommending herbs or supplements could decrease your supply, cause an allergic reaction, or have an unwanted interaction with your medications. You could be taking a medication or using a birth control method that is causing the low milk supply and nothing I suggest would fix the supply issue until the medication or birth control is stopped. Your baby could have a tongue tie, you could be pumping with the wrong sized flange, your baby could have an immature suck, you could just be positioning your baby wrong, that nipple shield could be interfering with your sensitivity to baby’s suck, or SO MANY OTHER REASONS. I can’t give you the correct plan of care without having specific questions answered. And I can’t do that without spending some quality time with you.

You deserve the best possible answer and the correct information. If you’re struggling with breastfeeding and need some help, there is help available!!! If you have a general question, hit me up all day any day! If you need more than a generic answer, put yourself first and book an appointment with me for some specific attention and TLC.

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Why does my baby grab, pull, and pinch my breast?

- Julie Matheney

A newborn’s hands are a tool that the baby uses to find and latch on to the nipple, rather than something to be restrained and held out of the way. In utero, babies often bring their hands to their face in preparation to swallow amniotic fluid, which helps them practice swallowing for after birth. Young babies use their hands to push and pull the breast to shape the breast and provide easier access to the nipple. Their hands on your breast releases oxytocin and also helps the nipple erect and evert. Newborns and young infants also use their hands to push the breast away, possibly to get a better visual sense of the location of the nipple as it is a darker color than the breast. They may feel the nipple with their hand, and use the hand as a guide to bring their mouth to the nipple.

Kneading, squeezing, patting, twiddling, pinching, biting, touching your face and pulling hair and so many more behaviors. Older babies, especially around 5-6 months, do this for two reasons: to help stimulate a let down/increase the flow of milk AND because they’re exploring the world around them. Much like the early days, touching the breast and even twiddling the other nipple help release oxytocin to send more milk or increase the flow of milk. You may notice baby does this more often when you’re on your period or in the late afternoon and evening when supply naturally dips. Many breastfeeding behaviors are a phase, older babies or toddlers like to experiment with what they can do while breastfeeding. If a specific behavior is only mildly annoying, then one option is to wait and see if the novelty wears off on its own. If you don’t like the behavior, give baby a toy or something else to hold while at the breast or cover the other breast with a blanket or your shirt. Wear a necklace or scarf they can play with. Sing a song or read them a book to distract them. Don’t be too quick to hide baby’s hands. They do serve a purpose.

How can I make more breast milk?

- Julie Matheney

The best way to lose weight is to be in a calorie deficit. Choosing the right foods, protein, fruits and vegetables with moderation of carbs, sugars and starches is guaranteed for most to lose extra pounds. Sure, exercise helps. It helps burn calories, again contributing to calorie deficit. But exercise alone won’t help you lose weight if you’re still eating a high calorie diet. Sure, going vegetarian or vegan or doing Weight Watchers or Atkins or any other “diet” helps. It helps you monitor intake to be in a calorie deficit. But even on any diet plan, if you’re not following it correctly and still eating high amounts of foods you won’t lose weight. Certain people do better on certain diets or with specific exercise programs because of how their specific body handles and processes food, vitamins, stress, movement, and all of the other factors like environment and genetics. Finding a nutritionist, weight loss coach, or personal trainer helps you look at your specific body and goals and helps you reach them. You can absolutely get there in your own, having someone counsel you through often gets you quicker results from their experience and wisdom. But the principle remains: calorie deficit is the number one way to lose weight.

The best way to make breast milk is to empty breast milk. Whether that’s your baby or a high quality breast pump, moving milk multiple times a day tells the body to make more milk. The more often milk is removed, the faster it is made. Sure, supplements help. They support your thyroid and blood with the extra nutrients and hormones needed to produce milk. But supplements alone is no replacement for moving milk. You can take the best lactation bars and drink all the tea you want, but without emptying the breast every few hours routinely I wouldn’t expect the majority of us to make enough milk to feed baby. Sure, hydration and nutrition are important. It takes calories to make calories and hydration help with that process. But even the research shows women who are malnourished in famine torn countries make plenty of milk for their babies when baby is allowed unrestricted access to the breast. Yes, adding in chia seed, flax seed, oats, nuts and nut butters, and coconut water helps make milk. Certain people do better on certain herbs and foods because of how their specific body handles and processes food, vitamins, stress, hormones, and all of the other factors like anatomy and genetics. Finding a lactation consultant, peer counselor, or trained doula helps you look at your specific body and goals and helps you reach them. You can absolutely get there in your own, having someone counsel you through often gets you quicker results from their experience and wisdom. But the principle remains: emptying milk from the breast is the number one way to make breast milk.

Pumping while away from baby helps maintain your supply

Where are you getting your feeding advice from?

- Julie Matheney

Feeding “advice” we would never tell an adult:

⌚️It hasn’t been 3 hours yet. You can’t possibly be hungry again

⏱It hasn’t been 3 hours yet. You can’t possibly be thirsty again.

🧊You need to drink all 64oz of your daily water intake in 4 equally portioned cups. If you can’t drink 16 ounces in one sitting, something is wrong with you.

🍽Clean plate club. Finish everything on your plate regardless of how full your stomach feels.

🍏Eat food purely for their nutritional value. 🍦Never have food simply for the comfort or enjoyment of it.

🔦Eat alone in a dark room and never with anyone else

💡How could you get so distracted while eating? Focus and pay attention.

🪑Eat until you’re done then leave the table immediately. Don’t hang out at the table for longer than needed.

🛌Never eat a bed time snack

🛏Wake up in the middle of the night thirsty? Too bad. Go back to bed you can have some water in the morning

⏰You have 15 minutes to eat. Tic toc. When the clock hits 15 you need to stop whether you’re done or not

🍴3 meals, 2 snacks. That’s it. 7, 9, 12, 3 and 5. Hungry or thirsty at a different time? Here’s a pen cap to chew on

🍔There’s only one way to eat and if you don’t eat like me and my family you’re doing it wrong

Do you get where I’m going here? Too often we analyze the science of breastfeeding instead of considering the art of feeding and eating. We try to make a literal formula for how our baby should eat when some times we have to appreciate feeding for what it is: an enjoyable and pleasurable sensory experience that is social and includes more than just calorie intake.

Cluster feeding

- Julie Matheney

CLUSTER FEEDING. Two words when paired together that drive fear and trembling to parents. Cluster feeding is NORMAL for ALL breastfed babies. It has nothing to do with your supply. It has nothing to do with the clock. It has nothing to do with what you’re eating or drinking or those supplements you just took. It may not even have anything to even do with being hungry. Babies typically cluster feed in the afternoon/evening. When your milk supply naturally and appropriately dips. When your milk is a smaller water concentration with a higher fat content. As long as baby is happy to feed the rest of the day, is making plenty of wet and dirty diapers, is content and sleeping routinely between feedings, and gaining weight over time, DON’T BLAME THE BOOB!! Even if baby seems like they want to feed constantly. Cluster feeding is normal. It typically happens MORE when baby is going through a growth spurt (body growing), developmental leap (mind/skills growing), or teething/illness. Why does baby want the breast more?

• Preparing for a longer sleep: Some babies just prefer to fill up on milk for a few hours before a longer sleep.

• Milk flow is slower at night: Some babies nurse longer to fill up due to the slower flow.

• A growth spurt: they usually occur around 3, 6, and 8weeks of age.

• They need of comfort. Breast milk has hormones to develop baby’s circadian rhythm. At nighttime baby may just seek comfort to help them sleep.

• Developmental leap: Mental and emotional growth spurts when they acquire new skills.

• Baby is sick, thirsty, or teething: breast feeding is a pain reliever, medicine and hydration all in one

Know that it’s normal. Be patient through the process. Be prepared with snacks and water for yourself, a comfy spot, a good pillow for support and the remote and your phone charger close by to get you through. You’re not alone and it doesn’t last forever!!