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Picking a breast pump: vacuum considerations

- Julie Matheney

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

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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.

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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.

Interestingly enough, vacuum levels can vary based on weather (so do not test pumps during stormy conditions) and elevation. 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!

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 the range of 150 – 200 mmHg 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 side flange/breast shield. 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.

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?

- Julie Matheney

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?

- Julie Matheney

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

- Julie Matheney

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

- Julie Matheney

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

- Julie Matheney

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.

Foods that increase breast milk supply

- Julie Matheney

Prolactin is hormone responsible for making breast milk. We know that when you’re breastfeeding, you need about 300-500 extra calories to supoort making nutrition for your baby. You’re still eating for two!! There are foods with phytoestrogens which help boost and support your natural prolactin levels.

There are several main classes of phytoestrogens. Lignans are part of plant cell walls and found in fiber-rich foods like berries, seeds (flaxseeds), grains, nuts, and fruits. Two other phytoestrogen classes are isoflavones and coumestans. Isoflavones are present in berries, grains, and nuts, but are most abundant in soybeans and other legumes. Coumestans are found in legumes like split peas, lima and pinto beans. Eating these will naturally increase prolactin which in turn helps support making milk

  • We all know oats are the go-to for increasing supply. They are rich in plant estrogens and beta-glucan. But other grains like brown rice, barley, and quinoa work as well!
  • Garlic! It will definitely flavor you milk, but research shows babies love the flavor and often suck more in response.
  • Fennel: Raw or cooked, fennel seeds can be added to a recipe, or drunk as a tea. There are also many lactation specific supplements that include fennel in pill form for a more concentrated dose
  • Dark Leafy greens like spinach, kale, collard greens, and broccoli. And yes, you can eat broccoli while breastfeeding.
  • Seeds: Sesame seeds, flax seeds, and chia seeds are all super boosters of making milk and can be added to baked goods and smoothies very easily
  • Berries: Get a phytoestrogen boost with fruits like strawberries, cranberries, and raspberries.
  • Nuts: Almonds are high in linoleic acid and known to be the most lactogenic nut. Packed with healthy fats and antioxidants, Vitamin E and omega-3, walnuts, cashews, and pistachios are all good choices. Snack on raw or roasted nuts, add them to cookies, smoothies, and salads.

Breast milk facts

- Julie Matheney

The main components of breast milk are water, fat, proteins, lactose (milk sugar) and minerals (salts). Milk also contains trace amounts of other substances such as pigments, enzymes, vitamins, growth hormones, and antibodies. It is normal for breast milk to separate (the fatty part of the milk rises to the top).

Other facts about human milk:

  • Fat content during a feed is determined by the fullness of the breast, not what you eat. The emptier the breast, the higher the fat content in the milk
  • The longer time between feeding or pumping, the lower the initial fat content at the start of the next feed. The fat level at the start of one feed may not be the same as the fat content at the start of the next.  The longer the gap between feeds, the higher the water content and lower the fat content.
  • Length of feed is irrelevant – some babies take a full feed in 5 minutes while others need 40 minutes to get the same amount. You can’t tell anything about fat content from the length of the feed.
  • There are millions of live cells in milk, including immune-boosting white blood cells and stem cells, which may help organs develop and heal.
  • Over a 1,000 proteins help baby grow and develop, activate the their immune system, and develop and protect brain neurons
  • More than 200 complex sugars act as prebiotics in your milk, feeding ‘good bacteria’ in baby’s gut
  • Enzymes are catalysts that speed up chemical reactions in the body. 40 different ones in your milk have jobs like helping baby’s digestion and immune system
  • Growth factors that support healthy development. These affect many parts of your baby’s body, including her intestines, blood vessels, nervous system, and her glands, which secrete hormones.
  • Hormones send messages between tissues and organs for them to work right. They help regulate baby’s appetite and sleep patterns
  • There are 5 basic forms of antibodies in your milk, protecting baby against illnesses and infections by neutralising bacteria and viruses.

Hormone swings with breastfeeding

- Julie Matheney

When the placenta is delivered, estrogen levels drop. While breastfeeding, periods may not return for several months because the hormone that causes you to make milk, prolactin, also stops you from ovulating and having your period. Breastfeeding, though, can cause hormonal fluctuations that can some times catalyze additional hormonal imbalance symptoms. Breastfeeding mimics menopause due to the production of the milk-producing hormone, prolactin, temporarily blocking estrogen production, which keeps your estrogen levels low and prevents your period from occurring. Around 2-3 months postpartum, hormones begin to reset to pre-pregnancy levels.

However, the stress hormone cortisol can increase, and in combination with lack of sleep, melatonin decreases (and, as a result, serotonin) and these hormone changes can negatively impact mood. For most, prolactin levels drop around 6 months postpartum as baby takes more solids and sleeps longer and periods may start again. These hormone shifts can have crazy symptoms. And if you've suffered from a hormone imbalance prior to pregnancy, there's a good chance it'll come back once this shift happens.

Some times just understanding the hormone shift can help you cope. Some times you’ll need to be seen by a health care provider to figure out your exact imbalance to work on strategies, therapies, nutrition or medications to bring you back to balance.

I think my baby has a breastfeeding aversion

- Julie Matheney

Aversion to feeding means screaming or crying when offered the breast or bottle, refusing to eat, or needing to be fed while moving or while drowsy/asleep. This is not a temporary nursing strike where baby refuses the breast/bottle for a few days because of periods returning, mom going back to work, teething, or illness, etc. The behaviors seen in baby are much more extreme for a true aversion. Most common causes:

👅Tongue tie: One of my biggest red flags for tongue tie is reflux and shutting down during breastfeeding (sleepy on the breast, popping on and off, refusing the breast and preferring the bottle but then shutting down on the bottle). Some babies with tongue or lip tie do fine for the first few months by compensating on a full milk supply. The aversion comes around 3-4 months when supply regulates. Address the ties and do oral motor exercises to strengthen the system and the refusal can go away.

🥛Intolerances/Allergy: This looks similar to reflux, but often with bowel issues as well (constipation, diarrhea, or mucousy/foamy poops). Babies who’s digestive tracts are uncomfortable don’t want to eat. They learn quickly to associate feeding with pain, so they shut down on feeding.

🤮Reflux: Easiest culprit to blame and mask with medication. The medication may mask the pain but won’t actually take the reflux away. Reflux is usually caused by food allergy/intolerance, gut issues, or tongue tie. Address the issue, resolve the reflux.

🥵Silent aspiration: Milk going into the lungs instead of to the stomach.

🤯Behavioral: The number one concern of parents is feeding the baby. When feeding isn’t going well, it causes extreme stress, which can causes parents to do extreme things to try to fix the problem. It’s easy to spiral out when you’ve tried everything and it’s not working out of stress and desperation. Occasionally the reason for the refusal is no longer there, but it was so stressful in the moment, the panic that it could happen again sets in and perpetuates the problem. Some times the root issue is still there, but you’ve compensated and it’s causing a behavioral manifestation in both you and the baby.