Perspectives on breastfeeding

PERSPECTIVE

“My hospital nurse told me to feed baby every 2 hours with 15mL and my pediatrician told me to feed baby every 3 hours with 30mL.”

“My IBCLC told me there is a tongue tie but the ENT said there wasn’t one.”

“One consultant told me to use a nipple shield as lo as needed. The other said get off as quick as possible”

“They said don’t let baby feed more than 10 minutes per side, but my baby won’t stay latched that long.”

I hear this all the time in my practice and it can be confusing for families. Why did I get different advice from different people? Perspective. Doulas, midwives, pediatricians, even lactation consultants all come from their own training, education, clinical practice and personal experience. When in doubt, the best person to get lactation advice from is an IBCLC. They have had to go through extensive training and mentoring to become certified in the study of human lactation. But remember: even lactation consultants come from different perspectives.

A hospital based IBCLC typically only works with babies in the first 2-4 days after birth and may see dozens of babies in a week, getting only a short amount of time with each family. A private practice IBCLC may have more time to spend with you but experience and expertise may vary. An IBCLC who is also a nurse will approach breastfeeding differently than one who is also a feeding therapist or who started out as a mother who struggled to breastfeed and became passionate to help others going through what she went through. My best advice is find some one who listens to you, educates on why they want you to do something, and supports you in your journey. Because you have a unique perspective, too.

Lauren Archer, Love of a Little One doula, takes a picture of my midwife and newborn
This is the same image from Lauren’s perspective

My baby mouth breathes: when should I be worried?

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

Mouth breathing as an infant can indicate several things:

🤢Nasal congestion from an illness or allergies

😛Tongue tie

👀Large tonsils/adenoids

👃🏽Deviated nasal septum

🧠Learned habit

Prolonged mouth breathing can cause:

Atypical development of the mouth, nasal passages and face

• Poor quality sleep

ADHD

• Increased risk of asthma

• Swollen tonsils

• Dry cough

• Inflamed tongue

• Teeth issues, like cavities and bad alignment

• Foul-smelling breath

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

• Stay away from your baby’s known allergens

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

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

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

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

Paced bottle feeding

Paced bottle feeding (meaning you’re setting the pace for how fast/slow baby drinks) helps prevent over feeding baby: it takes 20 minutes for the stomach to tell the brain that it’s full. If a baby takes a bottle too quickly, the mouth can still be “hungry” and wanting to suck when the stomach is actually full. Like going to an all you can eat buffet and eating a lot of food quickly and then realizing half hour later you ate way too much. A baby that happily sucks down too much milk from a bottle can make you think you don’t have enough breast milk even if you make a normal amount. It can also make baby frustrated by the flow of milk from the breast and inadvertently sabotage breastfeeding

These pictures are the same baby in two different positions for paced feeding: semi upright and side lying. Side lying is my favorite position to use as it puts baby in the same position as breastfeeding. Many parents feel baby is more supported in this position. Baby is supported by your leg or breastfeeding pillow.

Tips:

🍼Never feed baby on their back

🍼Keep the bottle parallel with the floor with about half the nipple filled with milk

🍼Use the slowest flow nipple baby will tolerate

🍼Rub the nipple gently on baby’s lips, allow baby to latch at their own pace, don’t force it into their mouth

🍼It should take 15-20 minutes to finish the bottle

🍼Watch the baby and not the bottle, stop when they show signs of being full

🍼Resist the urge to finish the bottle, even if there is only a little left, when baby is showing signs their tummy is full

🍼Take short breaks to burp and give the tummy time to fill naturally

🍼If baby is gulping or chugging, slow down

🍼If baby has taken a good volume of milk (2-4oz) in a short amount of time and is still acting hungry, offer a pacifier for a few minutes to help them digest and give the tummy to to tell the brain it’s full. If they’re still hungry, slowly offer more in 1/2oz increments

Dropping breast milk supply

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

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

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

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

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🤱🏻🤱🏼🤱🏽🤱🏾🤱🏿

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

How much milk should I leave my breastfed baby?

How many ounces should I leave if I’m exclusively breastfeeding but need to leave my baby a bottle?

The answer is: that depends. Some babies are grazers. They like smaller, more frequent feedings to keep their tummy from being too full or uncomfortable. Their feedings can range from 1-3 ounces and they may feed 10 or more times a day. Other babies are bingers. They like a big, full tummy and may take 3-5 or even occasionally 6 ounces but not as often. They may feed only 6-8 times a day and have longer sleep stretches. Their tummy doesn’t mind being stretched fuller and their bodies tell them it’s ok to go longer between feedings.

The question is: how many feedings do they get in 24 hours? From one month to one year, babies take between 19-32 ounces of breast milk a day. The average is 25 ounces in 24 hours. There’s a range because babies eat more or less depending on the activities of the day, growth spurts, teething, and even babies emotionally eat sometimes. In general, take 25 and divide it by the number of feedings they average in any given day. Also take into account that growth slows between 6-12 months and baby should be eating table foods, so you don’t need to increase the ounces in the bottle during that time. If your baby took 4 Oz bottles at 4 months, 4 Oz bottles are still appropriate at 9 months because they’re also begging for the food right off your plate in addition to what you’re putting on their tray.

How to build a breast milk stash

You don’t need to have a stash. If you want to exclusively breastfeed and are never away from your baby, you don’t need any milk in your freezer. You don’t need a huge stash if you’re going to be gone from baby. It’s nice to have stored up milk, but that milk is extra milk. Feed the baby, not the freezer. You only need enough milk for when you’re away from baby. If you’re only going to be gone for 2-3 hours, you may not need any milk at all. Feed your baby immediately before you leave. If baby becomes fussy before you get home, have your caregiver take baby on a walk, distract with toys or use a pacifier and feed them as soon as you walk in the door. If you’re going to be gone more than 3 hours, you only need to have enough milk for the time you’re gone. Optimally if baby is being fed by bottle, to maintain your milk supply, you should be pumping, thus replacing the milk from your stash that was used.

There are several ways to build your stash

🍼Passively collect with a milk catcher like a Lacticup or Milkies Milk Saver. No extra work needed, this works great in the early weeks if you leak

🍼Use manual silicone breast pump like the Haakaa. While these look passive, the vacuum created does stimulate the breast and can increase leaking and milk supply

🍼If you have a large to very large storage capacity and only feed from one breast at a time, pump the other breast during or after feeding baby

🍼Pump with a double electric pump, after breastfeeding, for 10-15 minutes. Only expect to get 1/4-1 ounce as this is “left over” milk that your baby doesn’t need.

🍼Pump with a double electric pump in between breastfeedings when you think baby may take a longer nap. Aim to pump half way between when you think baby will want to feed again. If you think baby will go 2 hours, pump after an hour, etc. try not to pump too close to the next feed as baby may get fussy at the slower flow of milk.

Remember:

🥛Decide how often and how much you want to pump/collect. Know that the more you empty, the more you will make as you’re telling your body baby needs that milk.

🥛Too much pumping or frequently changing your pump routine does increase your risk of plugged ducts and mastitis

🥛You can combine 24 hours of milk into one batch

🥛Breastfed babies usually only need 2-4 ounces every 2-4 hours. Aim to leave 1-1.5 ounces for every hour you’re gone

Make it a double

They say you can’t over feed a breast fed baby. They’re usually pretty good about taking what they need and stopping when they’re full. This is because of stomach and breast anatomy. Remember how sucking and milk flow rate at the breast are different than the bottle? This directly links to stomach anatomy.

There are two kinds of receptors in the stomach: density and stretch. Density receptors tell you how calorically dense or fat-rich your food is. It’s why at the Cheesecake Factory your belly starts to feel really full after about ten bites of Godiva chocolate Cheesecake but you can eat 3 bags of popcorn at the theater. Chocolate is much richer and calorically denser than popcorn. Stretch receptors tell you how full your stomach is from a volume perspective. Your stomach at rest is on average the size of your fist. That’s true throughout your entire life. But the stomach can stretch. Just like my stretchy pants at Thanksgiving. It can still only fill to a certain capacity. The only problem is, it takes approximately 20 minutes for your stretch receptors to tell your brain that the stomach had stretched to capacity. This is what I call the twenty minute phenomenon. You know, when a group of college boys order a pizza, they each eat a whole pizza in ten minutes and then twenty minutes later feel over full and sick. They as much as they could as fast as they could but paid for it in the twenty minute window. Exclusively breast fed babies don’t typically over eat because again, breast milk flow varies over a feeding. It starts slow, mommy goes into let down, then milk shows, mommy changes the baby to the other side, milk starts slow, mommy goes into let down, 15-20 minutes later the baby’s stomach tells the brain it’s full and the baby stops eating. Anatomy and physiology in perfect harmony.

Unfortunately bottle fed can be over fed. Bottles have these lovely ounce markers on them that tell us how much the baby needs to eat to be full. At every feeding my baby NEEDS to get a full 5 ounces of she will be hungry. She NEEDS to eat 24 ounces in a day or she will starve to death. And when baby stops eating at 3.5 ounces, I just jiggle the bottle or wait a few minutes and jiggle the bottle until baby takes that full feeding. Jiggle, wiggle, look at that she took the full feeding. Instead of listen to baby’s cuts that she’s full, we let the bottle dictate how much baby needs. And we wonder why formula feed babies have a significantly higher rate of obesity. Here’s the thing. Bottles are not the enemy. My daughter takes breast milk from a bottle five days a week while I’m at work. They are lovely devices that do an essential job. But we need to be mindful to not over feed our bottle fed babies.

Tips to not over feed a bottle fed baby (regardless of what’s in the bottle)

1. Always use a show flow nipple until 1 year of age. Slow flow most closely mimicks the flow at the breast. It also shows a baby down so the brain can keep up with the stomach (aka be mindful of those stretch receptors).

2. Watch your baby’s cues. Does he push the bottle away? Did he become sleepy? Do his hands and body relax? Does he release his iron grip on the nipple? These are signs he’s done. Over fed babies tend to spit up or vomit more because their tummies are at capacity. Don’t try to force in that last half an ounce. Respect your baby and stop feeding. Your baby will let you know if he’s still hungry.

3. In reality, babies only ever need 3-5 ounces of milk per feeding. In the first four to six months when your baby isn’t eating any solids, here’s a simple rule of thumb: Offer 2.5 ounces of formula per pound of body weight each day. For example, if your baby weighs 6 pounds, you’ll give her about 15 ounces of formula in a 24-hour period. Once a baby is six months of age and starting solid foods, offer the breast or bottle first (3-5 ounces), then offer well balanced, nutritious, solids. The solids will provide them the additional nutrition they need. (**Disclaimer : if your baby is not ready for solids at six months, that’s FINE. Your baby is ready to start solids when they can sit unsupported for a good amount of time, uses a pintcher grasp, and has the hand eye coordination of hand to mouth. If your baby is over six months and not taking solids, your baby may need additional milk per feeding.)

4. It is OK for volumes of feedings to be didn’t throughout the day. We take for granted that babies can know their bodies. They can tell us when they’re hungry and when they’re full. Sometimes I’m really hungry in the morning and I eat a Grand Slam breakfast. Other times I only want a piece of toast. It’s OK to have your baby eat a ton one meal and very little the next. Remember, there are no ounce markers on the breast. Exclusively breast fed babies do this all the time. And there’s no amount of nipple jigging that will get them to take more in a feeding.

Here’s the big take away: it’s OK to take the pressure off feeding, especially if your a working mom trying to keep up with pumping. As long as your baby is following their growth curve, making enough wet and dirty diapers, and happy, keep doing what you’re doing. If your baby is not getting enough nutrition, not gaining weight, or unhappy, please have your pediatrician write a referral to a pediatric clinic ASAP or give me a call and we can dialogue through a plan of action.

Happy feeding!!

Myths and Old Wive’s Tales

We all have questions about what “normal” and “typical” feeding looks like for our babies. We also have lots of questions about when things go different than we anticipated or we run into problems with breastfeeding. So often we turn to other mom’s experiences that we find on social media or internet blogs. We think we’re doing something wrong or we inadvertently pick up the bad habits of others. Some of us learn fact from fiction by trial and error. Others turn to family and friends for help, but they each may have a very different answer and it can be extremely confusing. How do you make the right decision? By getting your information from the right, trusted source, you can save yourself from experimenting with things that may work in the moment but will set you up for feeding failure in the future. Here are common breastfeeding myths.

Myth #1: Breastfeeding is supposed to be the most natural thing in the world, so it should come naturally to me and my baby, right?

There are many reasons why you or your baby could experience difficulties breastfeeding, from anatomical differences to coordination issues. Babies are just as brand new to feeding as you are and it can take some time to learn the skills needed to effectively eat. Many moms see happily breastfeeding infants with their smiling mothers and just assume it will be easy. Due to poor education and lack of support, they can become easily frustrated or discouraged when challenges arise.

Take time before your baby comes to learn how to breastfeed and all that accompanies. Don’t wait to ask for help. As soon as you notice any problems with feeding, call for help. There is no stupid question. Even if you took a class before birth, you aren’t expected to know everything. We are here to help!
Myth #2: My body knows how much milk to make

Actually, you have to tell you body how much milk to make, which is why it is so important to stimulate milk production in the first 24 hours. The more you breastfeed, the more milk your body produces. The less you feed, the faster your milk decreases. Frequent breast stimulation tells your body that milk needs to be produced.

If baby is having difficulty latching and nursing early on, your baby has difficulties staying awake during feedings, or your baby sleeps for a long time, pumping or hand expressing will continue to facilitate milk production until your baby gets the hang of feeding and gets into a more regulated sleep/wake cycle.

As I always tell moms with babies in the NICU, if you’re away from your baby and your goal is to breastfeed, you still need to feed something or you will see a decrease in milk supply. If you can’t feed your baby because you are at work or your baby is in the NICU, feed your pump until you can feed your baby.

Myth # 3: Breastfeeding will be painful

Many new mamas try to muscle through nipple pain, cracks, blisters, and bleeding because they think it’s all part of the process. This is one of the biggest and worst myths out there!  While this is the experience of many women, it doesn’t have to be yours! Pain is not normal!

In my classes and consultations, I will teach you how to differentiate between the pressure and sensation of a proper latch and the pain associated with an improper one. What you should feel is something moms describe as a “tugging and pulling”. What you should not feel is pinching or sharp pain. Pain is always a good indication that something isn’t right! This is most likely a signal of a poor latch and you need to break the latch (you can slide your pinky finger in the corner of the baby’s lip between his lip and your areola to break the latch) and start over, repositioning the baby to improve the latch.

Myth #4 I can just get all the information I need at the hospital

Giving birth is one of the most emotionally and physically exhausting experiences you can have as a woman. If you give birth in a hospital, there is actually little time to rest. Nurses will come in every two to three hours to check on you and your baby. Then they will go over a whole laundry list of information, from umbilical cord care and monitoring poops, to symptoms you and your lady bits might experience and what to do about it. They will talk about car seat safety, birth certificate information, diaper care and follow up appointments with your physician. Do you really want to try to squeeze in even more information about the essential task of feeding your baby? Being prepared ahead of time will lighten the load your brain will have to process and let you focus more on just enjoying your new baby.

Myth #5: I don’t want to bother anyone with my problems, I’ll just figure it out

No mama is an island. We all need support, and this especially true for breastfeeding. Research shows that the opinions about breastfeeding of those close to you (including the baby’s father and your mother) affect the duration of breastfeeding overall. It is so important to have support when it comes to breastfeeding. Without it, many mothers wean within a week of giving birth!

Successful breast feeders typically have at least two people they know they can turn to for breastfeeding support, be it a friend, aunt, or cousin. Bring your spouse with you to a breastfeeding class. Talk to those around you about your breastfeeding goals. Join a Facebook breastfeeding support group. Hearing about other moms’ obstacles and how they overcame them can be so encouraging. Find another mom whose baby is a few months older than yours that you can talk to about each stage you’re in and what’s to come. Let me help connect you to other moms in your area.

Myth #6: I’ll just use formula since it’s just as nutritious and so much easier

This one’s a big myth that many people believe! While formula companies would like you to believe they are as nutritious and convenient as breast milk, the truth is actually quite the opposite! The American Academy of Pediatrics, the American Medical Association, the American Dietetic Association and the World Health Organization call recommend that breastfeeding is best for babies up through one year of age, as it helps defend against infections, prevent allergies, and protect against a number of chronic conditions. Breast milk contains antibodies that can lower the occurrence of ear infections, diarrhea, respiratory infections and meningitis. It contains the correct proportions of lactose, protein and fat, which are easily digested by a newborn baby. Babies that are formula fed are more likely to suffer from digestive problems, have a higher risk of childhood obesity and more likely to develop allergies and illnesses. They also do not receive antibodies from their mothers, which means they are less protected against infection and illness.

Not to mention formula is expensive. Feeding a baby exclusively formula can cost up to $3000 for the first year. There’s also the cost of time. Time to wash bottles, time to prepare bottles (especially at 2am this becomes a tedious task), time to buy formula ahead of time so you don’t run out (running out at 2am is the WORST!). And if you want to leave the house you have to consider carrying, storing, and preparing formula away from a full kitchen.

Myth #7: My baby has nipple confusion

The scenario is all too common. Mom has to go back to work or wants a night out so she offers the baby a bottle for the first time. The baby gets fussy, starts pulling off the bottle nipple and screams, spits our milk and gags or vomits. Mom tries fifteen different bottle systems and none of them seem to work. Both mom and baby are super frustrated. Let’s start with the truth. There is no such thing as nipple confusion. Your baby is not confused about what a nipple is. But she is confused about the rate that the liquid is flowing at from the nipple. The rate at which milk flows from the breast, in most moms, is significantly slower than a bottle nipple. Breastmilk flow is stimulated by the baby sucking, and goes through various rates depending on if the baby is just starting a feeding versus in the let down phase of feeding. Bottle nipples, however, are on demand and constant. As soon as that baby starts sucking there is milk available. And it’s always available as long as the baby is sucking. When babies are just born and/or exclusively breastfed, they can easily get overwhelmed by the high flow rate of the standard nipple that comes on most bottles. Signs of being overwhelmed by flow rate include pulling off the nipple, crying, arching the back, turning the head away, refusing to latch, hiccupping, coughing, gagging or choking, Starting with a slower flow bottle nipple, using positioning and pacing can all help the transition from breast to bottle. You can also learn other tips and tricks of the trade in my special breast to bottle feeding consultation.