Category: Uncategorized

Why should I see an IBCLC or lactation consultant

- Julie Matheney

If you broke your foot you wouldn’t go to your local nail salon to have your pedicurist look at it. Yes, they work with feet. I just wouldn’t trust their expert opinion on whether I need a cast or some physical therapy. If my car engine was making smoke and my gauges were outside the appropriate ranges, you wouldn’t go to the car wash to have it looked at. Yes, they work with cars. I just wouldn’t trust their expert opinion on whether my engine block is cracked or not. So why when we’re having lactation problems do we turn to mom groups or even pediatricians? Yes, moms have babies. Yes, pediatricians work with babies. But neither are the experts in lactation (ok, occasionally a pediatrician will seek additional training, but honestly it’s rare). To become a board certified lactation consultant, you need to take advanced college level coursework specifically in human lactation. You need to spend hundreds to thousands of hours being directly mentored by someone who already is board certified. And you have to pass a FOUR HOUR board exam. To be board certified. IBCLCs spend thousands of dollars and years of their lives training to become experts in breasts, babies, and feeding. If you’re struggling, please find the correct help. There’s a lot of bad information out there that may inadvertently sabotage your breastfeeding journey without you even being aware.

Coffee while breastfeeding

- Julie Matheney

An average cup of coffee contains 95mg of caffeine, but some types contain over 500mg. That’s important to be aware of when breastfeeding as it’s generally considered safe to drink up to 300 mg per day— about 2–3 cups of coffee or 3–4 cups of tea.

The caffeine content of coffee depends on many factors, such as:

• Type of coffee beans: different varieties of coffee beans naturally contain different amounts of caffeine.

• Roasting: Lighter roasts have more caffeine than darker roasts.

• Type of coffee: caffeine content can vary significantly between regularly brewed coffee, espresso, instant coffee and decaf coffee.

• Serving size: “One cup of coffee” can range anywhere from 30–700 ml (1–24 oz), greatly affecting the total caffeine content.

• One cup of brewed coffee (8 oz) contains about 70–140 mg of caffeine, or about 95 mg on average

• One shot of espresso is generally about 30–50 ml (1–1.75 oz), and contains about 63 mg of caffeine

• Instant coffee usually contains less caffeine than regular coffee, with one cup containing roughly 30–90 mg

• Decaf has about 0–7 mg per cup, with the average cup containing 3 mg

Want to enjoy a coffee alternative that gives all the feels while still being breastfeeding supportive? My two breastfeeding friendly favorites are @wearerasa and @milkstabrew.

Comparison will steal your peace

- Julie Matheney

Too often we look around to see what everyone else is doing and it makes us feel incomplete, incompetent, like we’re doing something wrong or not doing enough. We see the success of others in parenting, sleep training, their milk supply, pumping, whatever, and it makes us feel like we’ve failed. Comparison is the number one way to have your joy and peace stolen. Stop looking at Becky over there with her oversupply and thinking your normal supply is inadequate for your content and growing baby. Stop looking at Gina over there whose baby has slept through the night since two months and thinking there’s something wrong with your happy child. Stop comparing your tiny but mighty that looks like the rest of your flock to my giant giraffe babies that look like the rest of my herd. You’re not getting a grade. Breastfeeding is not a pass/fail activity. Trust your baby. Trust your body. You’ve got this.

Do I need to wean when baby has teeth?

- Julie Matheney

When a baby is latched correctly, their tongue comes over the gums (and teeth) to cup the nipple and breast. If a baby is latched deeply, they physically cannot bite the breast. They may bite while unlatching or if they slide down the breast because of distraction or behavior. Never fear, you can safely continue to nurse once baby starts teething. I can’t guarantee you won’t get bit, but that’s another post.

Ways to naturally boost milk supply without taking any herbs or supplements:

- Julie Matheney

Ways to naturally boost milk supply without taking any herbs or supplements:

⌛️Empty the breast more often. The more you empty to either baby or pump the more you’ll make!

🕰Feed on demand and not by the clock.

🤱🏽Keep baby in skin to skin contact with you, even as an older baby. This contact has a hormone reaction to naturally increase supply at any age.

💦Drink more water (at least 10-12 glasses per day)

🥗Eat between 2100-2500 calories per day of high quality protein, low in sugar and processed foods

🍷Drink alcohol and caffeine in moderation, and make sure to drink extra water if you do a both dehydrate and can decrease milk supply

🍆Have sex! The same hormone released during orgasm causes milk to be released for let down. Having sex naturally raises the level of this hormone in your body for 24 hours, making it easier to let down milk the next day!

🏝Relax and have a calm routine during pumping. Stress and distraction can inhibit milk let down for some even when there’s plenty of milk in the breast.

🎧Listen to music and place heat on your breasts while pumping. Several research studies have found by doing these things moms can pump up to 30% more milk!

📏Make sure you’re pumping with the correct flange size.

🛌When possible, avoid sleep training. Letting baby wake at night helps keep your milk supply naturally high as milk making hormones are highest at night.

💊Be careful you’re not taking any medications that drop supply like hormonal birth control, antihistamines and antibiotics.

What do my Labor and Delivery have to do with breastfeeding?

- Julie Matheney

All babies are born with innate instincts and reflex to get them to the breast soon after birth. Every baby, when placed skin to skin on their mother immediately after birth, will do the breast crawl and have a first latch within approximately 60 minutes of delivery, even medicated or c-section births. In the first 24 hours, babies are often sleepy. Waking for brief periods to feed and go back to sleep. The second day (and usually the second night) is when babies make up for the first day after delivery, ravenously cluster feeding for hours, much to the dismay of now extremely fatigued parents. But your labor has more of an impact on breastfeeding than you may realize.



We learning and understanding how our bodies prepare for breastfeeding during pregnancy, how what happens during labor and birth sets the stage for breastfeeding, and how the first minutes and hours after birth can have a lasting impact on the entire breastfeeding journey. The way baby is born  powerfully influences the first hours and days of breastfeeding. Unmedicated, vaginal birth sets the stage for problem-free breastfeeding, where biology, instinct and reflex can take center stage. In contrast, a complicated, intervention-intensive labor and birth increases the risk of problems.

How long you labor is really out of your control. The length of your labor may actually increase breastfeeding difficulty. For really long labors (over 24 hours), pushing for 4 hours or more, or very intense short labors, both you and baby may be so exhausted that rest and recovery take precedence over breastfeeding. Baby may be too tired to breastfeed often in the first few days, which increases your risk of not stimulating the breast well which in turn delays colostrum transitioning to mature milk and can decrease the overall volume your breast may be able to make in the future. Long, medically intervened labors also usually mean increased bags of IV fluids, which can cause excess fluid in your body which in turn delays the transition of colostrum to mature milk up to 10-12 days. It can also cause your hand, feet, and breasts to swell with extra fluid, called third spacing, which can make latching baby a challenge. (See my videos on Instagram about reverse pressure softening for help with this).

Events surrounding birth can inadvertently sabotage breastfeeding, as birth is supposed to be a well orchestrated series of events and hormone releases, setting you up for successful breastfeeding. Many of the birthing practices that are considered almost routine (induction, epidurals, separation of the mother and her baby for cleaning, weighing and foot printing) interfere with this hormonal dance resulting in poorer breastfeeding outcomes.

The routine progression of hormonal changes during  labor and birth perfectly prepares the body to breastfeed immediately after birth. During labor, oxytocin surges are responsible for increasingly stronger and more effective contractions. As oxytocin goes up, and the pain that accompanies the strong contractions increases, endorphins are released. High levels of endorphins help you cope with painful contractions and contribute to their becoming more instinctive. As the baby moves down the birth canal, almost ready to be born, catecholamines are released. The surge in catecholamines creates an energy boost and allows the baby is born with high levels of catecholamines as well (; ). This results in a vigorous, alert baby and an energized mother ready to breastfeed for the first time.

 

Skin to skin contact immediately after birth helps these same hormones continue to work in preparation of the first breastfeeding moment. Baby’s body weight on mom’s uterus, baby hand and head movements on her body, and then baby sucking at the breast stimulate even more oxytocin release (). Oxytocin helps the placenta separate and contracts the uterus further, preventing excessive bleeding. After birth, high levels of catecholamine in the baby insure alertness for the breast crawl and first latch. The endorphins present in mom pass on to baby through her breast milk, helping the baby stay calm and relaxed. After the first feeding, these hormones peak and allow both mother and baby 

Prolactin and oxytocin, the. milk making hormones, are released by baby’s sucking at the breast. Prolactin makes milk and oxytocin causes your letdown or release of milk. Prolactin, AKA “the love hormone”, is responsible for nurturing behaviors. Oxytocin makes you feel relaxed, sleepy, or calm feelings during milk letdown. 

All Labor pain-relief drugs have been shown to delay the onset of milk production and increase the risk of breastfeeding difficulties. This was well documented in a 2014 study by Lind et al. Pitocin, unlike naturally occurring oxytocin, does not cross the blood/brain barrier. As a result, the pituitary is not stimulated to release endorphins. Without the pain-relieving help of abundant endorphins, people who are induced with pitocin are more likely to require epidurals. In a vicious cycle, whenever an epidural is given and all pain is removed, naturally occurring oxytocin levels drop, requiring increased amounts of pitocin to continue contractions (Lieberman & O’Donoghue, 2002). Without the high levels of oxytocin and endorphins that would normally be released, a surge in catecholamines does not occur immediately before birth. This hormonal disruption during labor results in women giving birth with relatively low levels of naturally occurring oxytocin, endorphins, and catecholamines. Consequently, the outcome of low hormonal levels is a less responsive mother and baby which in turn impacts vigor at the breast ().

The medication used in the epidural does, in fact, “get to the baby.” Epidural narcotics or anesthetic drugs cross the placenta and can be found in cord blood. More research is needed, but we are starting to learn the neurobehavioral effects of medicated deliveries. Babies exposed to epidurals have a higher risk of have difficulty with latching on and an uncoordinated suck/swallow response for hours or days after birth (; ). Epidurals are also documented to lengthen the second stage of Labor and increase the likelihood of needing a C-section. The trauma of c-section birth, versus the natural positioning of coming through the birth canal, can make it painful for baby to assume the natural, instinctive positioning for breastfeeding and can make it difficult to latch. 

Elective induction of labor is also a risk to breastfeeding because of the potential of added intervention and the increased likelihood of the baby being born prematurely. The more premature a baby is, even at 37-38 weeks, the more immature and uncoordinated sucking and swallowing can be. Babies practice the coordination of sucking and swallowing in utero without expiation to feed, so the longer they are able to practice in utero, the more coordinated and ready they are to feed at birth.

So now what? You’ve had the baby and had a long, medicated delivery. Knowledge is power. You cannot change your birth story, but you can influence your breastfeeding journey.

  • Keep baby in skin to skin contact as long dn often as possible to help restore your oxytocin levels. Every 60 minutes 1-2x/day has been found to exponentially increase milk supply
  • Offer the breast frequent and often. Work on getting baby into a good position to ensure a deep latch
  • If you are separated from your baby or baby is super sleepy, hand express and/or start pumping. You will want to hand express or pump every 2-3 hours during the day and every 3-4 hours at night. You will get more colostrum from hand expression than pumping int he first three days, but pumping will help stimulate the nipples. Don’t be discouraged if you see little milk from a pump. The stimulation is needed until baby is able to latch
  • Stay hydrated and eat good foods full of protein
  • Use a paced bottle feeding technique and try not to over feed baby if you need to supplement. Always supplement with your own milk first, followed by formula. Babies need very little milk in the first 3 days.
  • Find lactation help as soon as possible to help create a plan to get breastfeeding back on track
  • Anderson G, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). 2003. In The Cochrane Library, 3. Oxford: John Wiley. [PubMed]
  • Baumgarder D. J, Muehl P, Fischer M, Pribbenow B. Effect of labor epidural anesthesia on breastfeeding on healthy full-term newborns delivered vaginally. Journal of the American Board of Family Practitioners. 2003;16(1):7–13. [PubMed] [Google Scholar]
  • Declercq E. R, Sakala C, Corry M. P, Applebaum S, Risher P. 2002. Listening to mothers: The first national U.S. survey of women’s childbearing experiences. New York: Maternity Center Association. Also, retrieved December 13, 2004, from  www.maternitywise.org/listeningtomothers. [Google Scholar]
  • Kroeger M, Smith L. J. 2004. Impact of birthing practices on breastfeeding: Protecting the mother and baby continuum. Sudbury, MA: Jones and Bartlett Publishers. [Google Scholar]
  • Lamaze International. 2003. Promoting, protecting, and supporting normal birth: Six care practices. Washington, DC: Author. Also, retrieved December 13, 2004, from www.lamaze.org/about/policy.asp and  http://normalbirth.lamaze.org/institute/default.asp. [Google Scholar]
  • Lamaze International. Six care practices that promote, protect, and support normal birth [entire issue]. Journal of Perinatal Education. 2004;13(2) [Google Scholar]
  • Lieberman E, O’Donoghue C. Unintended effects of epidural analgesia during labor: A systematic review. American Journal of Obstetrics and Gynecology. 2003;186(5):s31–68. [PubMed] [Google Scholar]
  • Matthiesen A. S, Ransjo-Arvidson A. B, Nissen E, Uvnas-Moberg K. Postpartum maternal oxytocin release by newborns: Effects of infant hand massage and sucking. Birth. 2001;28(1):13–19.[PubMed] [Google Scholar]
  • Newton N. The fetus ejection reflex revisited. Birth. 1987;14(2):106–108. [PubMed] [Google Scholar]
  • Odent M. 2003. Birth and breastfeeding: Rediscovering the needs of women during pregnancy and childbirth. East Sussex, England: Clairview Books. [Google Scholar]
  • Ransjo-Arvidson A. B, Matthiesen S, Lilja G, Nissen E, Widstrom A. M, Uvnas-Moberg K. Maternal analgesia during labor disturbs newborn behavior. Effects on breastfeeding, temperature, and crying. Birth. 2001;28(1):5–12. [PubMed] [Google Scholar]
  • Righard L, Alade M. Effect of delivery room routines on success of first breastfeed. Lancet. 1990;336:1105–1107. [PubMed] [Google Scholar]
  • U.S. Department of Health and Human Services & The Advertising Council. Breastfeeding awareness. 2003. Retrieved December 13, 2004, from http://www.adcouncil.org/campaigns/breastfeeding/
  • Uvnas-Mobert K. 2003. The oxytocin factor: Tapping the hormone of calm, love and healing. Cambridge, MA: Da Capa Press. [Google Scholar]

Pumping Log: The cream rises to the top

- Julie Matheney

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!

The whole top 2 ounces is all heavy fat/cream

You can clearly see the fat/cream band at the top.

 

This is almost solid cream.

This one is also thick cream.

Both of these show clear separation of cream and water.

Pumping Log: Every day is a new day

- Julie Matheney
  • 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.

Happy Mother’s Day

- Julie Matheney

To all you moms out there reading my blog, I hope you have a blessed Mother’s Day. May you find joy in every moment you have with your babies, especially in those quiet moments when you have your sweet little one nestled to your breast. They grow too fast. 

Pumping Log: pay no attention to the pump behind the curtain

- Julie Matheney

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!!

My entire day of pumping. Three 20 minute sessions during an 8 hour shift. A little over 9 ounces.