I know I’ve mentioned it before, but I never really paid attention to it; the cream really does rise to the top. I know I had a higher fat content in my milk because I get frequent milk blebs. That’s basically where the nipple poor at the tip of the nipple clogs. It can look like a white pimple at the end of the nipple. It is really just congealed milk, like cottage cheese or a milk curd. They are easy to get rid of, but very painful in the moment. I never really realized how high fat my milk was until yesterday. I had several bottles in the fridge that I wanted to combine into one before I left for work. When I went to pour one into the other there was a good 3 or 4 inches of thick cream at the top!  When I held the milk up to the light it was very dense and you could hardly see through it.  Basically I pumped heavy whipping cream!  😂🍦 I pulled out my other bottles to see varying amounts of cream at the top. No wonder there are times when I don’t pump as much. The high cream milk is very fat and calorie dense. So the next time you get discouraged by only pumping 2 ounces, put your milk in the fridge for a few hours and see how much cream rises to the top. Be encouraged that this is a higher fat and higher calorie milk. And A friendly reminder, don’t vigorously shake the milk to combine it with the watery portion, make sure to swirl it. Shaking milk breaks down the fat protein and actually alters the milk at a molecular level.  To make sure you get a more even fat content for your milk throughout the day, you can combine the milky pump in one day into one bottle. That makes a more homogenous mixture of fat and calories that you’re bottle feeding your baby throughout the day. Happy pumping!

• Every day is a new day. I’m really learning to take each day at a time. It’s so easy to compare my story to someone else’s. Especially when it comes to milk volume. I definitely have to work at my supply. Milk tea at night. Oats in the morning. Frequent pumping during the day. Occasionally pumping before bed. And yet my daughter has always had enough. She’s nine months old and eating EVERYTHING in sight. She loves fruits, vegetables, chicken, pork, rice, pasta, yogurt, and cheese. She will eat lemons and pickles and not bat an eye. She’s growing like a weed and constantly needing longer pants. I watch her for how my milk supply is doing and the milk I pump is based on her needs.

I do think it’s important to normalize pumping, though. It is important for women to feel empowered that their body is making good nutrition for their baby. It’s important to know your baby and know if he or she is getting enough milk. In the first two weeks of life, babies should eat 10+ times per day. Babies need to regain their birth weight by 2 weeks of age. This is a really good indication that the baby is getting the calories they need. The average baby gains 1 ounce per day until 3-4 months of life and an average of 1/2 an ounce a day after that. Wet and dirty diapers are also a good indication of milk intake. On day one of life they should make one wet diaper, on day two they should have two wet diapers. On day three they should make three wet diapers. This pattern continues until day 5 when they should start making 6-8 wet diapers a day. 

 *Addendum; I realized I should note, this is not all the milk my daughter gets in a day. She breastfeeds directly from me when she wakes in the morning, when I get home from work, around bed time, and usually still once or twice at night. This pumped milk is what she takes while I’m gone at work. Sometimes she will take more than what I’ve pumped the day before. My husband will take a packet of frozen milk out of the freezer for her. My daughter still prefers milk straight from the tap. AKA me. She nurses much more vigorously when I’m home. This is her personality and how she prefers to eat.

Your baby’s eating and sleeping patterns may be unique to him. You may pump more during the day if your baby eats more at each setting.

In a previous blog I talked about my work pumping room. It has two chair separated by two curtains. I would say about 50% of the time I pump alone. It is a great time to FaceTime with my husband and see the baby to help my milk supply or a nice quiet rest to be able to write a blog. The other 50% of the time when I walk in there is the distinctive whirring of another breast pump.

Every pump and every brand has a very distinctive sound. Nine times out of 10 I know exactly who is behind that curtain based on the sound of their pump. Yesterday was no exception. Usually through the course of time and conversation, I get to know the other moms behind the curtain. I’ve pumped with nurses from every floor and unit, chaplains, administrative assistants, and students. We talk about everything related to our babies: their ages, their developmental milestones, and how much they’re sleeping at night. The biggest topic of discussion, though, always is milk supply.

Typically there is only ever one other mom in the pump room. However yesterday at least 4 other mothers tried to come in and pump at the same time. It was like the 405 at 8am! The entering mom’s knew it was me pumping from the quiet drone of my spectra pump. In trying to be effective, twice I left the in coming mother behind the curtain with me so I could clean up while she could set up. Both times we talked milk supply.

There’s such a weird pressure to “perform” in our culture. Even with pumping milk. We are told by “them” how much to feed our babies and if you don’t reach certain milk goals during certain months of development your baby is going to starve and fall off the growth curve. That it the whole point of this blog.

I want to normalize breastfeeding. I want to normalize milk supply and help reduce even a fraction of stress pumping mothers feel. Your baby is unique. Your story is unique. The amount and fat content of your milk is unique and specifically tailored to the individual needs of your baby. Remember breastmilk can vary from 13-35 calories per ounce! One mom I talked to yesterday could pump TWENTY OUNCES in one sitting first thing in the morning. I don’t think I’ve ever pumped more than 18 in a day across four pump sessions!! And yet my daughter is growing and healthy and following her 75 percentile growth curve.

We need to stop letting “them” tell us how much and how often our baby needs milk and listen to our individual babies. Let’s support each other and encourage each other in our unique breastfeeding stories. I hope if you get nothing else out of these blog posts it’s encouragement to keep going, stop worrying, and own your personal breastfeeding story. Happy Pumping!!

Clogged milk ducts are no fun. My ducts clogged several times when I started nursing. With immediate action, I was able to clear the duct in a few hours and nursing returned to normal.

These are signs that you might have a clogged duct:

• a small, hard lump that’s sore to the touch or a very tender spot in your breast.
• redness.

a hot sensation or swelling that may feel better after nursing.

If this sounds like you, YOU NEED TO UNCLOG THAT DUCT. If left untreated, clogged ducts can turn in to mastitis.

Here are several strategies that worked well for me:
-Hot showers or hot compresses (hot washcloth or heating pad over the lump) before nursing (or plank over a bowl of hot water or hot bath or hot towel etc)
-Nurse on demand starting on the affected side.
-NURSE LIKE A COW. Lean over baby on your knees and forearms and let gravity help.
-After nursing, hand-express that boob! Start at your ribcage and squeeze/massage over that duct toward the nipple like you’re trying to squeeze that last bit of veggie pouch out the tip. It can hurt, If you don’t do it, the doctor or lactation consultant will, and it will still hurt like heck. But you can at least feel where it is and when to stop.
-The clogged milk is SALTY and that’s why babe might start to refuse it. Once you find the salty spot, “milk” yourself that way till the salty stuff empties.

Repeat this process each feeding until the lump goes away or you feel it release and your milk flow return to normal. If it doesn’t go away in a day or two, seek professional help to avoid it turning into an infection.

Nipple confusion. While many moms who are going back to work trying to get their babies to take their milk from a bottle, many of them are also frustrated when the baby refuses to take one. Their baby turns away, arches her back, pushes the bottle nipple from her mouth, chokes, gags, and becomes extremely fussy. Or the baby was doing struggling at the breast, started taking a bottle well, and now no longer wants anything to do with the breast. These are all symptoms that mothers a tribute to “nipple confusion”. As a speech therapist, this term has always bothered me. In my mind confusion means a mood or emotional mental status. Like, I was confused at the directions. I was confused as to where I was. I was confused as to why he behaved that way. Babies are born, natural feeders, they literally come out of the womb wanting to suck. I would like to rewrite the term nipple confusion instead with flow confusion. Babies are not confused about where their milk is coming from, but how it is coming out. The flow from a breast and a bottle are very different. At the breast when a baby is first placed at the nipple, the baby sucks in a very quick, rhythmical suckling pattern. This stimulates milk flow. After several minutes of this quick, high paced suckling, the mother experiences let down. This is a very fast flowing time in the milk phase. During let down the baby’s sucking rate changes to a slow and rhythmical pattern. After several minutes of this, the baby goes back to that high suckling phase. That is because the mothers milk flow has decreased. The baby then stimulates another let down to occur by changing her rate of sucking. A typical mother can experience anywhere from 2 to 4 let downs during a typical feeding. Bottle nipples, however, do not work on a demand-supply basis. As soon as that bottle nipple is placed in the baby’s mouth, it begins to flow. The baby does not even necessarily need to suck if the hole in the tip of the nipple is large enough. The baby could munch mash on the nipple or even just let it flow into her mouth. It takes much. Less work but much more coordination to drink from a bottle nipple. The baby needs to be able to coordinate her sucking, swallowing, and breathing any typical rhythmical pattern.

Differences in the way a baby sucks on the breast vs. a bottle

• To latch to the breast, baby must open his mouth widely. A baby does not need to open wide to suck on a bottle.
• When sucking on the breast, baby’s tongue makes a wave-like motion; it begins at the tip of the tongue and moves toward the back. The tongue compresses the breast against the roof of the mouth. A bottle fed baby uses his tongue differently and may lift the back of his tongue to stop the flow of milk and protect his airway.
• If a breastfed baby needs a rest, he simply quits sucking and the milk flow slows. Milk may flow from a bottle even when baby is not sucking, forcing baby to continue feeding without a break.
• To breastfeed, the baby needs to take the nipple far back into the mouth to the soft palate and then uses her tongue to compress out the milk (which can take a minute or so before it starts flowing). With a tilted bottle, a baby has gravity on her side: She can suck with her lips and get all the milk she wants right away.
• Babies aren’t confused about what nipples are for, but they may prefer getting milk faster without having to work as hard or be unable to control the flow and become overwhelmed and shut down.

The truth is, most babies have no problem switching from breast to bottle and back again. Others, specifically those who take a little longer perfecting the art of suckling at the breast, can have trouble transition from breast to bottle — and then back to breast. These babies often have difficulty coordinating the intricate act of sucking, swallowing and breathing. Since we don’t know which babies will do well and which will struggle, most experts agree that you should wait until your newborn has established good breastfeeding habits, usually around three weeks of age and after the two week growth spurt, before offering the bottle. If you’re still struggling with breastfeeding at three weeks and it’s still your goal, hold off on the bottle a little bit longer.

At the NICU where I work, if we have a mom who plans in breastfeeding, we will always use a slow flow nipple. It most closely resembles the flow at the breast to make the transition back and forth easier. We also use various positioning and pacing techniques to help babies get the hang of coordinating their sucking, swallowing, and breathing. A slow flow nipple is always best to start with if you plan to continue breastfeeding

Not only am I a lactation consultant, I am also a full time working mom with an 8-month-old at home. I’m gone around 40-50 hours a week for work and am pumping on the go. At the hospital where I work there is an employee lactation room. Half the time I’m in here by myself and the other half there is another mother behind a curtain pumping with me. It is amazing to see how universal our concerns are with breast-feeding.The number one complaint I hear about from the other side of the curtain is that the mom is not pumping enough. I have never been a super pumper and have always had to really work on my supply. It is amazing to me how from day today, pumping to pumping, I can get varying amounts of milk. It’s depends on my stress level, what I’ve eaten, how much water I’ve been able to get in, and how often I can get away to pump during my shift. Pumping is also very psychological. It’s honestly hard to “feed a machine” instead of my baby, but the more I look at pictures and videos of her or FaceTime with her while pumping, the more I tend to make. Here are the top tips I give to the other moms pumping at work:

1. Shake the girls. Give your breasts a good shake before each pumping session. This wakes up the breast and helps release hind milk from the back of the breast.
2. Use the stimulation and let down modes on your pump more often. Use the stimulation mode for 2 minutes followed by the let down mode for 4 minutes. Go back to the stimulation mode for another 2 minutes followed by the let down mode for another 4. Do this up to 4 times in your pumping session to see an increase in your milk. Massaging your breast from top to bottom in a clock wise motion will also help empty the breast. End your pumping session with a few minutes of hand expression.
3. Keep well hydrated. Water water water!!!
4. If you feel like you did not pump enough during the day at work, add in an extra pumping at night before you go to bed. Keep this extra pumping going even if your home with your baby for the weekend. You can stock up this milk in your freezer for those occasional days where you don’t pump enough on your shift.

For more tips and tricks, feel free to give me a call, attend one of my working mother classes, or schedule a personalized consultation!