Tummy time and breastfeeding

Tummy Time is one of baby’s first exercises! It is a crucial exercise for baby’s motor, visual, and sensory development. We’re encouraging baby to use their core strength and rotate their head from side to side. It also helps with digestion and frequent tummy time helps baby poop. It is not only an important way to prevent flat spots on baby’s head, it is also an important part of baby’s normal growth and development. The womb is an incredibly tight place, especially if baby made it to term or you have a short torso and there wasn’t much space for stretching. Long vaginal labors with extended pushing phases can leave baby with lots of tension in the head, neck and shoulders. Getting baby into different positions really should start from birth to help relieve this tension. Too much tension can impact breastfeeding, which often looks like baby arching at the breast or having a side preference because it’s uncomfortable to feed in certain positions from tension on the neck. Laying baby flat on their back too often will impact the shape of their head, which in turn influences brain growth. Baby can begin tummy time as a newborn and increase time as they age and develop.

Tummy time doesn’t mean you need to plunk your baby down on a mat and engage them with black and white drawings with a timer set. It can look like wearing your baby in a ring sling or structured carrier, napping with your baby laying on your chest, or even like this, with baby across your lap. This is a great position for you if you’re needing to pump but baby wants to be on your body. You can still sway or move and give baby some gentle pats to help calm them or transition them to sleep. This is a safe place and position for them to nap if you stay awake, as you can monitor the baby for the duration of their sleep. 

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For more information on tummy time, check out @tummytimemethod

Pumping is not an indication of milk supply

Hey you!!! Yes, you, the one pumping milk at 2am. Just a reminder pumping volumes are not a true indicator of your milk supply and don’t determine your work as a parent. There are many factors that go in to how much you can pump. Pump quality, the flanges you’re using, how you’re setting up the pump session, how long it was since your last session, time of day, medications, and where you’re at on your period all play a role in how much milk you will see in the bottles. 

Pumps were designed after babies and not the other way around. And they’re not usually as efficient as an efficiently feeding baby. A baby with no tongue or lip tie and a strong suck can remove more milk and trigger more milk to be made better than commercially purchased pumps. 

I expect you to be able to pump 1/4-1oz combined from both breasts when pumping after directly breastfeeding and 2-4oz every 2-3 hours when pumping in place of breastfeeding. Your worth is not measured in ounces. Nor is it measured by what that other lady on social media can pump. You’ve got this. Trust your baby and trust your body. 

If you’re struggling with pumping or how to understand the process better, consider taking my Pumped class. Or a personal flange fitting both in person and virtual.

Breast milk is made from your blood

The food you eat and the water you drink do not magically go directly to your breast milk. What you eat and drink goes first to your stomach to be broken down and then into your intestines to be absorbed and processed. Your digestive system breaks nutrients into parts small enough for your body to absorb and use for energy, growth, and cell repair. The muscles of the small intestine mix food with digestive juices from the pancreas, liver, and intestine. Special cells in the walls of the small intestine absorb water and the digested nutrients into your bloodstream. Your blood carries molecule-sized components such as simple sugars (carbohydrates), amino acids, white blood cells, enzymes, water, fat, and proteins throughout your body. As blood passes by the breasts, milk glands pull out these nutrients for milk production and pass some of them to your baby. Not all molecules are small enough to pass through into milk. (That’s why some medications are safe to take while breastfeeding and some are not. Molecules that are too big can’t get into the milk while really small molecules can.) 

Nuts, seeds, beans, and grains all have plant based proteins. Meat and dairy are animal based proteins. Both plant and animal proteins carried in your blood can make it into your milk. Sometimes these proteins can affect baby’s digestive system, causing symptoms like reflux, gas, colic, and blood or mucus in the poops from iritations to baby’s intestinal lining. Diary proteins are the most common cause of upset in the stomach, however research suggests that the proportion of exclusively breastfed infants who are actually allergic to something in their mother’s milk is very small. Fussiness and gas alone are not  enough to diagnose a cow milk protein allergy. 

In general, there are NO foods that need to be avoided because you’re breastfeeding. Every baby is different in the foods they are sensitive to. IF your baby always seems to have a reaction when you eat a certain food or a large amount of a certain type of food, cutting back on it or cutting it out temporarily may be helpful. 

Mastitis treatment

Mastitis is a common complication of lactation that at it’s most basic definition is inflammation or swelling in the breast. This inflammation often starts with an unresolved plugged duct where milk has either not be moved soon enough (like from baby sleeping longer at night or not pumping enough at work) or from the wrong size pump flange that does not allow milk to empty efficiency. Mastitis may happen with increased maternal stress or a change in the family  routine. This may be when guests are visiting, during the holidays, or when returning to work. It is not always easy to tell the difference between a breast infection and a plugged duct. They have similar symptoms, and both can get better within a day or two.

Regardless of why it started, The diagnosis of mastitis is generally made by your symptoms. It is characterized by one sided breast tenderness and redness (often with a noticeable lump in a certain area), accompanied by a fever of 101°F (38.5°C) or greater. You may feel fatigued and symptoms of the flu like, chills, nausea or vomiting, body aches, and headache. The breast will also often have a wedge shape, redness in an area accompanied by breast fullness and tenderness in the same spot. 

For treatment strategies, check out the latest video in my IG subscription or on my LA Lactation YouTube channel!

Birth control and dropping milk supply

Any birth control with a hormone in it can drop your milk supply. Hormones in birth control pills prevent pregnancy by:

  • Stopping or reducing ovulation (the release of an egg from an ovary).
  • Thickening cervical mucus to keep sperm from entering the uterus.
  • Thinning the lining of the uterus so that a fertilized egg is less likely to attach. 

The Pill (estrogen and progestin) tricks your body to think is pregnant so it won’t ovulate. Estrogen based pills will drastically drop milk supply, just like pregnancy does, and should be avoided while breastfeeding unless your weaning. Hormonal IUDs (Mirena, etc), arm implants (Nexplanon, etc), and the mini pill (progestin only) are often recommended as the best form of BC while breastfeeding because most research says that they don’t impact milk supply. Many who use these methods don’t experience any supply drop. For some, though, any hormone based BC will drop milk supply, some times drastically. Every body is sensitive to different levels of hormones. If you have an IUD or arm implant placed and notice a drop in supply, the only way to increase supply again is to remove them. Increased pumping or herbal supplements will usually not be enough to increase supply again because you’re working against hormones. If you’re considering a hormonal based IUD and aren’t sure if your supply will drop, consider taking a few rounds of the mini pill (progestin only) which is the same hormone in the IUD and implant. If your supply drops, you only have to stop taking the pill and your supply will rebound much quicker. 

Benefits of skin to skin contact for newborns

SKIN TO SKIN 

Babies are needy. The need to be on your body and all of their instincts and reflexes are designed to get them there. Their neurological system is immature at birth and still needs to develop.  Being on your body:

 🧠 Accelerates Brain Development:

Holding baby on your body increases the development of essential neural pathways, which accelerates brain maturation

🌞Calms, Soothes & Reduces Stress:

Having your baby on your body soothes baby so much that babies’ cortisol levels (stress hormone) are measurably lowered after only 20 minutes of being held skin to skin. And, remarkably, their pain is reduced when held skin to skin

😴 Improves Quality of Sleep:

Development of mature brain function in infants depends on the quality of their sleep cycling. During skin to skin, most infants fall asleep easily, and achieve what is called “Quiet Sleep”, a natural deep sleep for 60 minutes or more

💉Enhances Immune System:

Baby’s immune system is stimulated when placed skin to skin. Your mature immune system passes antibodies through your skin to baby. Being on your skin also increases baby’s skin hydration, which provides a protective barrier from harmful bacteria entering baby’s skin

⚖️Stimulates Digestion & Weight Gain:

Skin to skin contact reduces cortisol and somatostatin in babies, allowing for better absorption and digestion of nutrients, while decreasing gastrointestinal problems. With a reduction of these hormones, baby’s bodies preserve brown fat (the healthy fat babies are born with), helping to maintain birth weight and keep a warm body temperature. As a result, baby’s body does not have to burn its own fat stores to stay warm, resulting in better weight gain. After just one hour of skin to skin, the infant’s digestive system is restored to the right balance for optimal GI function

When I’m your body, baby’s body learns to self-regulate, resulting in a regular and stable heartbeat and breathing pattern

❤️ Synchronizes Heart Rate + Breathing:

Weaning blues: why do I feel so emotional from weaning baby from the breast?

If postpartum depression weren’t enough, it’s also possible to be depressed and have mood shifts from weaning from breastfeeding. During breastfeeding, oxytocin, the cuddle hormone, is released every time milk lets down. This feel good hormone helps reduce the risk of postpartum depression. Prolactin, the hormone that actually makes the milk, also brings a feeling of well-being and relaxation. There is very little research on the subject, but it’s hypothesized that when you wean, the decrease in prolactin and oxytocin can make some feel moody, sad or even angry. The faster the weaning process the more abrupt the shift in hormone levels, and the more likely to experience feelings such as being tearful, sad or mildly depressed. Some also experience irritability, anxiety, or mood swings. These feelings are usually short-term and often go away once hormones stabilize. Some will also feel relieved and happy once it’s over and they can move on into the next stage of parenting. And that’s OK, too!!

If you are weaning and experiencing mood swings, you’re not alone! Remember, it takes at LEAST a full 40 days for those with an established milk supply to no longer see milk when they hand express or stimulate the breast. Your milk making cells are going through a cellular death called involution where they literally change from milk making cells back into breast fat cells. Some find it takes 1-3 period cycles after weaning for their hormones to reset and feel “back to baseline” which coincides with when this process is complete. It will get better!!

Some times being aware that this is a hormone shift and not something in your head is enough to bring peace in the process. Find your coping mechanisms. Reflect on your journey. There are herbs and supplements that can help in the process (set up a consultation to discuss which ones are right for you as they are NOT one size fits all). And if needed, seek professional counseling. 

Pregnancy and breastfeeding

If you’re still breastfeeding and become pregnant, your mature breastmilk will transition back to colostrum around the end of the first trimester in preparation for whenever the new baby is born. By 4 months gestation, the placenta is large enough to suppress most milk production. Your body will prioritize your fetus over your nursling in terms of milk and produce the appropriate milk for the more vulnerable child. Colostrum is a high protein, laxative milk to help newborns poop out meconium. It is saltier in taste and thicker in consistency. Many older babies don’t care if it tastes different, but some will and may wean themselves. The supply is not likely to be able to support an infant 10 months old and younger. But if the older infant (11+ months) or toddler is eating solids and drinking other liquids, those babies may not care if they are getting milk or “dry nursing” until the next baby comes. Some choose to supplement younger babies with donor milk or may transition to formula until the new baby arrives and then continue to tandem feed with their own breastmilk again. 

Pregnancy hormones can make breasts and nipples more sensitive and uncomfortable. And these sensations often will make one want to wean or experience a nursing aversion. Toddlers may still aggressively want to nurse and it’s ok to put boundaries on your nursing. 

The typical things recommended to increase supply (additional feeding/pumping, herbs and supplements, etc.) are not appropriate and are ineffective since the placenta will continue to increase in size. Hormones supported by the placenta are what impact milk production and there’s not much you can do to combat the hormone shift as it’s needed to support the pregnancy. 

Hunger cues for baby

How do I know my baby is hunger and not just fussy, has a wet diaper, or is lonely and wants to be picked up? Babies have a limited communication repertoire when they are first born. Every cue can look the same. It does get better with time as you learn your baby and your baby grows and matures. In general, young babies go through stereotypical phases of hunger cues. Some times we can miss these cues when the baby is swaddled or in a crib or bassinet away from where we are. 

Early

  • Licking or smacking their lips
  • Opening and closing their mouth
  • Sucking on their lips, tongue, hands, fingers, or anything within reach
  • Time to get your breastfeeding pillow and grab a snack and some water!

Active

  • Rooting around and attempting to latch on anything nearby their mouth
  • Hitting you on the arm or chest repeatedly and/or grabbing at your clothing
  • Trying to get into a nursing position 
  • Fidgeting/squirming
  • Becoming fussy
  • Breathing fast: get ready for them to start crying!
  • This is the best time to latch!

Late

  • Crying
  • Moving their head frantically from side to side
  • You’ll need to calm the baby before attempting to latch!

Many newborns are very sleepy after birth and may actually need to eat more often than they exhibit hunger cues. Newborns should be offered the breast anytime they cue hunger, which can be between 1-3 hours since the beginning of the last feeding. Watch the baby and not the clock. Don’t make the baby “wait” until some mythical hour to be fed. Feed the baby when the baby is hungry. 

Hand sucking is not as reliable an indicator of hunger as baby ages. Starting at around 6-8 weeks, baby will begin to gain more control over their hands and will begin to explore their mouth and everything else in their environment with their hands. Babies also suck on their hands during teething. Symptoms of teething can sometimes occur weeks and even months before the first tooth erupts.

My baby is waking at night: Is this normal?

There are many reasons why your baby would wake more often to feed at night. Regardless of what you find online or from well meaning family and friends, there is no specific, developmental weight or age when a child no longer needs to feed overnight. There is no scientific or medical standard or recommendations for when a baby no longer needs nutrition at night. Society also says babies shouldn’t need tended to at night time and that we should teach them, often from a ridiculously early age, not to need us at night. In reality, we are not in control and neither are our babies. We’re in a mutual relationship where we are learning what our babies need and when they need it. Reasons why babies wake to feed over night:

💡Growth spurts

💡Developmental leap

💡You were gone at work and they missed you or want breast milk straight from the breast

💡Teething

💡They were distracted during the day because the world is an amazing place to learn in and they’re making up for calories over night 

💡Sickness

💡They had a bad dream or are scared without you

💡Because they’re human

Per current research, 78% of babies wake up at least once a night and 60% of waking to feed until 1 year (Brown, 2015). That’s NORMAL. Between 12-18 months your toddler may still occasionally wake to feed. Or they may just need an adult to help them transition back to sleep. It’s not until 24 months that the human baby has matured enough to not consistently need an adult to help them transition back to sleep over night and should be getting all of their calories during day time hours.