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.

.

.

🤱🏻🤱🏼🤱🏽🤱🏾🤱🏿

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

Low breast milk supply

Whether it’s 3, 5, or 10% of the population, there are people that struggle to or never make a full breast milk supply. From 1 month to 1 year, exclusively breastfed babies average 25oz of breast milk per day. True low milk supply means making less than this when the breasts are stimulated every 1-3 hours day and night. Chronic low milk supply is linked to either a greater health concern or something out of your control which you cannot change or fix with cookies, teas or even sometimes medications and pumping.

🗝Low milk supply that can be increased with time and support:

💡Baby not feeding efficiently from lack of oral motor skill or tongue tie

💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)

💡Not feeding or pumping enough, especially over night

💡Scheduled feedings or over use of a pacifier

💡Birth. Many medications designed to help you labor and deliver actually inhibit baby from latching and feeding effectively for hours to days after birth. Hemorrhage or birth trauma can also cause low supply in the beginning

💡Supplementing, especially in the two weeks after birth

🗝Reasons for chronic low milk supply that may increase even with maximal support:

💡Insufficient glandular tissue (IGT). Breasts never developed during puberty and look tubular or widely spaced. Signs of IGT include breasts did not grow in puberty, or increase in size during pregnancy. No engorgement in the week after birth

💡Uncontrolled or undiagnosed thyroid disorder

💡Uncontrolled diabetes

💡Hormone or endocrine disorders, including severe PCOS

💡Hormonal birth control placed/used too soon after delivery

💡Breast or nipple surgery, augmentation, reduction, trauma

💡Nipple piercing that scars shut instead of staying open

There is a mistaken belief that prescription galactagogues, teas, or herbs can cure ANY chronic low milk supply. Before self-prescribing or taking Domperidone, Reglan, fenugreek, or any other lactation supplement, consider having your serum prolactin levels tested and a full evaluation by a skilled lactation consultant. Continue to follow @lalactation for strategies of breastfeeding with chronic low milk supply.

#lowmilksupplyawarenessday #igtandlowmilksupplysupportgroup #igtandlowmilksupply #igt #lowmilksupply #lowsupply #normalizebf #normalizebreastfeeding #worldbreastfeedingweek #wbfw #chestfeeding #sns #atbreastsupplementation #breastfeeding #bf #ibclc #bottlefeeding #donormilk #mixedfed #pacedbottlefeeding #triplefeeding #breastfeedingproblems #breastfeeding #supplementalnursingsystem #postpartum #breastpump #milkbank #lactationcookie #lactation #galactagogues

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 can I make more breast milk?

The best way to lose weight is to be in a calorie deficit. Choosing the right foods, protein, fruits and vegetables with moderation of carbs, sugars and starches is guaranteed for most to lose extra pounds. Sure, exercise helps. It helps burn calories, again contributing to calorie deficit. But exercise alone won’t help you lose weight if you’re still eating a high calorie diet. Sure, going vegetarian or vegan or doing Weight Watchers or Atkins or any other “diet” helps. It helps you monitor intake to be in a calorie deficit. But even on any diet plan, if you’re not following it correctly and still eating high amounts of foods you won’t lose weight. Certain people do better on certain diets or with specific exercise programs because of how their specific body handles and processes food, vitamins, stress, movement, and all of the other factors like environment and genetics. Finding a nutritionist, weight loss coach, or personal trainer helps you look at your specific body and goals and helps you reach them. You can absolutely get there in your own, having someone counsel you through often gets you quicker results from their experience and wisdom. But the principle remains: calorie deficit is the number one way to lose weight.

The best way to make breast milk is to empty breast milk. Whether that’s your baby or a high quality breast pump, moving milk multiple times a day tells the body to make more milk. The more often milk is removed, the faster it is made. Sure, supplements help. They support your thyroid and blood with the extra nutrients and hormones needed to produce milk. But supplements alone is no replacement for moving milk. You can take the best lactation bars and drink all the tea you want, but without emptying the breast every few hours routinely I wouldn’t expect the majority of us to make enough milk to feed baby. Sure, hydration and nutrition are important. It takes calories to make calories and hydration help with that process. But even the research shows women who are malnourished in famine torn countries make plenty of milk for their babies when baby is allowed unrestricted access to the breast. Yes, adding in chia seed, flax seed, oats, nuts and nut butters, and coconut water helps make milk. Certain people do better on certain herbs and foods because of how their specific body handles and processes food, vitamins, stress, hormones, and all of the other factors like anatomy and genetics. Finding a lactation consultant, peer counselor, or trained doula helps you look at your specific body and goals and helps you reach them. You can absolutely get there in your own, having someone counsel you through often gets you quicker results from their experience and wisdom. But the principle remains: emptying milk from the breast is the number one way to make breast milk.

Pumping while away from baby helps maintain your supply

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

Pumping for a toddler

The number one complaint I get my mothers going back to work is a drop in supply when they start to pump. They go from seeing tons of milk to very little. Pumping at work is a PITA. You have to be very committed to it and depending on your job it can be stressful or difficult to get away to pump. What most women don’t seem to understand about Breastfeeding is that the more milk you remove the more milk you will make. You can’t just will your body to make the same amount of milk whether you pump once or six times. The science doesn’t work that way.

Through the first year of life, I recommend mothers pump three times on an 8 hour shift and four times on a 12 hour shift. Remember, I recommend leaving the same number of ounces as number of hours you will be gone. If you’re gone 8 hours, you only need to leave 8 ounces. Make sure your caregivers are doing paced bottle feedings and not accidentally sabotaging your milk supply. Mothers can add in additional pump sessions by pumping in the car with the battery operated pump. Once your baby turns a year, and his or her milk needs decrease; as long as they are taking a healthy amount of solid foods mom can drop down to pumping twice or three times a shift.

As your Toddler continues to grow, you can make the decision to add in another milk/milk substitute, continue to pump, or just breastfeed when you are home and have caregivers give water depending on how much you are gone from your older toddler.

My last pump session at work. cheers.

Breastfeeding will working is a large commitment. I know this full well. These are the guidelines I followed with my own daughter. Up until she was 12 months, I pumped 3 times on my 8 hour shift. I had decided at 17 months to stop pumping while at work and just feed my daughter when I was home. However she had other plans 🙂 she constantly asks for May May, which is her word for my milk, while I am gone. So I was back to pumping just once a day and mixing my small amount of breastmilk with flax milk. She eats off of me like a barracuda when I walk in the door. (I think she just wants the snuggles). At 18 months I am now no longer pumping at work. She will nurse when she wakes up, when I come home, around bed time at 6:30, and every once in a while she’ll still wake up around 4am for an early morning snack. This is what my tiny human does. You have to figure out what works best for your tiny human, your family, and your health. Happy pumping!

Sabotaging your milk supply: working mothers who pump

The number one method to sabotage your milk supply when you go back to work is a caregiver who over feeds your baby. 

Scenario one: Baby is given a full bottle and takes 5 ounces in five minutes. Baby then spits up half the feeding and caregiver tries to give more to “keep it down”. Caregiver tells mom baby is fussy and has reflux. Baby gets put on Zantac and rice cereal.

Reality: there are several factors going on in that scenario that will sabotage a working mother’s milk supply. First, babies are not supposed to take five ounces in a feeding. Their stomach is the size of their fist and should only be taking 1-3 ounces per feeding through the first year of life. Their stomach can only hold so much and if it’s past capacity, the only place for it to go is up. I can eat a whole cake, but I shouldn’t. As an adult, if I overeat I get uncomfortable, too. I either take peptobismol or put on my stretchy pants to wait for the pain to subside. Then I don’t eat that much again.  Babies fuss and spit up for the same reason. We’re over diagnosing babies with reflux that are being fed too much or too fast.

Scenario two: Caregiver gives a baby six ounces every feeding, 3 times while mom is gone, every time the baby cries or wants to suck. Baby appears fussy and wants to suck all the time.

Exclusively breastfed babies should consume 25-35 ounces across each 24 hour day and approximately 20% of their calories should be taken over night. If you do the math, that’s a little over an ounce an hour, or 1-3 ounces every two to three hours. And in accordance to what the baby needs, mom will make that volume. So if caregiver is feeding 6 ounces three times in an 8 hour shift, you’re expecting mom to pump 18+ ounces. In reality, her body will most likely make 6-10 ounces which would be the amount she would make if she were home with her baby. In a few days of over feeding the baby, mom becomes discouraged that she’s not making enough and pretty soon she’ll start supplementing with formula

Babies also want to suck for a variety of reasons: comfort, pain, bonding, nutrition, pleasure, etc. Babies use mom as a pacifier without actually drinking. When babies are away from their mommies is very stressful, so their way to soothe is to suck.

Scenario three: Baby is given 4 ounces and chugs it down in five minutes. Baby is happy to chug down high volume and the caregiver thinks baby is just a piggy and really hungry. Baby occasionally coughs and chokes and milk comes out her mouth.

Reason: Babies have a swallow reflex that is with them at birth. When liquid reaches the back of the throat it triggers the swallow reflex. Babies are obligated to swallow otherwise they will choke or let the milk pool out of their mouths. When you see a baby chugging down milk really fast, it’s not usually because they are starving, but because they are trying to keep up with the flow of the bottle. As I said in an earlier post, there’s really no such thing as nipple confusion, but flow confusion. At the breast, other than during active let down in the first few minutes of active feeding, the baby controls the flow of milk by how they suck. In bottle feeding, the bottle will flow because gravity always wins. Caregivers need to be taught paced bottle feeding. Using a slow flow nipple, feeding baby in side lying, and frequently tilting the fluid away from the nipple to slow the baby from drinking so fast gives the baby more oral control and time to appropriately eat.

There are two kinds of receptors in the stomach: stretch and density. It should take a baby 10-20 minutes to eat from a bottle. This is also how long it takes the stretch receptors to tell the brain that the stomach is full. I can eat a whole pizza really fast, but I shouldn’t. Babies can eat a large volume really quickly, but they shouldn’t. Not only is it not developmentally appropriate, but pretty quickly the high volume needs will sabotage mom’s opinion of her perfectly healthy milk volume. She’ll turn to all kinds of milk makers: cookies, teas, herbs, etc and eventually if she’s discouraged enough she’ll turn to formula, when in reality if the caregiver would slow down feedings and give the rigjt volume, every one would be happy.

Happy pumping!!

 

Breastfeeding advice from social media: Buyer beware

Asking for medical advise from social media forums, especially mommy groups, is like asking a mother who’s had a baby to deliver yours. Just because she has experience in the field does not make her qualified to give technical advice in that area. She can give you her opinions or share her experience, but she did never be relied on as a trustworthy source when providing care to YOUR child.

 

Breastfeeding is especially one of those areas that we need to tread wisely into when asking for help and advice. Or culture has hidden breastfeeding from the norm and made it this mysterious, murky action where myths and misunderstandings abound. So much of the information found in quick Google searches are anecdotal, antiquated, or based off formula feeding data which is completely distinct and sometimes totally opposite of true breastfeeding. We should be seeking community support for breastfeeding, but not when medical advice is being solicited.

When mothers give out advice on social media platforms, they are not taking into consideration the whole breastfeeding picture and may inadvertently give advice that could care harm or actually negatively impact breastfeeding. For instance, when a mother of a two month old asks for advice on increasing her breastmilk supply and mother start giving advice on herbs, lactation cookies, or teas, they may not be considering WHY she is needing to increase her supply. Is her baby in the NICU? Is she going back to work and stressed with the pumping process? Does she have. History of sexual abuse that she actually needs to work through? Did her pediatrician have her supplement which impacted her supply? Is she trying to sleep train and sabotaging her own supply? Is she ALLERGIC to the herbs in those teas and supplements? How often is she feeding? Does she have a metabolic or hormonal disorder impacting her supply? Does she have enough glandular breast tissue to even produce sufficient milk supply? Does her baby have a tongue tie? Does the baby simply have a poor latch? These are the questions that are crucial in giving appropriate breastfeeding advice to protect the breastfeeding relationship. The best advice a mother can give on the social media platform is to have the questioning mother contact a lactation consultant.

The gold standard for breastfeeding advice is the International Board Certified Lactation Consultant (IBCLC). There are other forms of lactation consultants that teach and serve out of a variety of backgrounds. The IBCLC is the top most coveted professional because of the extensive education and rigorous testing they need to go through in order to be able to assist lactating mothers. In order to sit for the FOUR HOUR board exam, candidates must have extensive education in specific health science subjects, like nutrition, psychology, and childhood development; 90 college level credit hours of education in human lactation and breastfeeding, and hundreds to thousands of clinical practice in providing care to breastfeeding families. They must also maintain a high level of continuing education courses and continue to sit for the board exam every 10 years.

So when you see moms with questions related to breastfeeding in social media forums that are beyond opinions or personal experience, the best advice is professional advice.

“I don’t make enough milk, now what do I do?”

I was recently contacted via Facebook about my opinions on supplementing at birth when mother’s milk “doesn’t come in right away”.  I thought you might be interested in my response. The first several paragraphs are the background anatomy and physiology of early breastfeeding. Below are the questions I was sent as well as my responses. Enjoy!

Breastfeeding is a natural process that has become misunderstood by the general public as it became hidden from the community. I believe when mothers actually understand the process of breastfeeding, it can help then understand what is going on in their newborn. Prenatal breastfeeding classes are essential for this. At 10-14 weeks of gestation, every mothers breast begins to fill with colostrum, a high protein milk which acts as a laxative. It’d why their breast change size during pregnancy. Mothers already have the first milk in the breast that their babies need for birth. It is in a small volume because babies are born constipated and fluid overloaded from the womb. In a natural, uncomplicated delivery, a newborn has a high need to suck because of this constipation. Sucking causes peristalsis (a wave like movement) to travel through the esophagus through the stomach to the intestines to push out the poop. It takes approximately three days for all the meconium to be pooped out (which is exactly how long it takes for colostrum to change over to mature milk!!) Nature designed the breast to feed the need of the baby in perfect balance to allow baby to become unconstipated so the gut would be ready for nature milk at the right time. Breast milk actually doesn’t “come in”. It’s already there in the form of colostrum. The first few days are controlled by the autonomic system. You’re pregnant so you will produce colotrum and your body will think you’re feeding a baby. You need your baby to suck at birth to lay down hormone receptors in the breast for prolactin, the milk making hormone. The more your baby simulates your breast in the first few days after birth, the more hormone receptors are activated to make milk for your baby. After the first few days, you switch from the autonomic system to the demand a supply model that continues for the duration of breastfeeding. The more the baby demands, the more mama makes.

Unfortunately in the modern world of medicine, we have tampered with the natural process of birth and thereby impacting breastfeeding. With IV fluids, the epidural, and other medications used in birth, we’re changing how newborns interact with the world and how hormones in mom are being produced. The epidural rate in hospitals in LA County is over 80%, with many hospitals over 90%! It actually causes sleepy babies that do not do as well at the breast (Richard and Alade, 1990, https://youtu.be/4eQdQ1Ww9-k) Cesarean births also significantly delay the Natural switch from colostrum to mature milk for obvious reasons based on the above information. Babies really need to be skin to skin and at the breast with no interruption for the first few days of life or until mature milk had come in. Skin to skin contact promotes physiologic stability in the baby (including regulation temperature ebooks sugar) while promoting free access to the breast to facilitate the process described above. If hospitals encouraged mothers in Birthing a more natural and unmedicated way, we would actually see a significant drop in the need for supplementation and in breastfeeding issues.

The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding. Formula fed babies have a 50% higher risk of dying of SIDS at all ages of infancy with even higher rates in other developing nations due to unsafe water and lack of finances for parents to afford formula. Baby friendly hospitals in the US understand the importance of breastfeeding but aren’t the best at communicating why. Breastfeeding is better for babies for a laundry list of reasons.

One of my newest clients.

What should expectant parents look for when searching for a lactation consultant? They need to find someone who is skilled and trained. An IBCLC is always the gold standard because of the extensive training we go through. Facebook forums are horrible for information because there is a lot of poor information floating around. Yelp is great for reviews of local consultants. If they suspect a tongue tie, they need to find a lactation consultant specifically trained in it. Not every one is.

How are lactation consultants accredited and are their different professional organizations? http://blog.mothersboutique.com/whats-the-difference-between-lc-ibclc-cle-etc/

http://www.lalecheleague.org/faq/lc.html

What is generally the maximum amount of time a mother should wait for milk to come in before offering formula? For instance, after a c-section when it can take longer. This is a loaded question because every story is different. In the hospital it’s always based on bilirubin numbers and the risk for jaundice. In my practice, if a baby has not has the recommended number of wet diapers by day three we’re supplementing at the breast using an SNS at the very least.

What are the guidelines when it comes to (temporarily) supplementing with formula for newborns? Unfortunately there are no guidelines and every practitioner comes from their own experience and setting. There are no rules and it’s a case by case basis which should be based on parents breastfeeding goals, but unfortunately is not always an option.

When waiting for milk to come in, what amount of weight loss would be a red flag? 10% is normal weight loss for all infants. Birth weight needs to be regained by 2 weeks. And we need to know WHY. Is there a tongue tie? Does the mother have a hormone issue? Does the baby have birth trauma or tortícolis? Is there a metabolic issue or heart defect? Is it simply a poor latch or improper position? Did the baby have poor oral skills? These all can relate to weight loss. At what point would you advise a breastfeeding mother to offer formula? If baby gets adequate skin to skin time and constant access to the breast, most of these issues resolve on their own. If a baby is lethargic, sleeping more than 4 hours multiple times in a row, or not making enough wet and dirty diapers by 48-72 hours, I’m all about supplementing. But that’s me coming from a hospital background. I don’t mess around with the risk of jaundice. I also always prefer supplementing at the breast with an SNS and with donor breast milk when possible. Stimulate the breast for increased production while getting the baby fed and used to the breast at the same time.

Do you feel the threat of “nipple confusion,” supply issues, or a mother “giving up” breastfeeding are valid reasons for avoiding formula when milk hasn’t come in? Are there other reasons to avoid temporary supplementing? This is another misconception. There really isn’t “nipple confusion”. It’s actually flow confusion. At the breast, babies need to stimulate milk flow at the beginning of a feeding with active suckling. It can take one to two minutes of suckling for let down to happen. Breasts can flow at different rates and even flow different during a single feeding. Bottles, however, are instant and constant. It’s much easier to feed from a bottle, so some babies “prefer” this from having to work at getting their milk. A lactation consultant can help with any issue of flow at the breast to help with this. Opinions vary in the introduction of a bottle. Some say no sooner than 2-3 weeks or when breastfeeding is well established. Die hard lactation consultants say no sooner than 6 weeks. In NICU where I work, we use bottles from day one and babies easily transition back and forth between breast and bottle. We use and teach paced bottle feedings and use of a slow flow nipple to try to replicate breast flow from a bottle.

What do you think is the biggest benefit to enlisting lactation consultants’ help in breastfeeding? The earlier you get help, statistics show, the longer mothers will breastfeed. If breastfeeding is your goal, get help in the first 72-96 hours. Enlisting help give mothers the confidence in knowing subtle changes in positioning and latch that can make a world of difference. An LC can also identify if there is something wrong, like a tongue tie, inverted nipple, swelling of the breast from fluids at birth, etc that is impacting feeding.

Do you feel pediatricians are being pulled in different directions when it comes to supplementing? For instance, they are promoting breastfeeding because of the proven health benefits, but also want to be able to offer formula because sometimes it’s needed? Pediatricians get a 45 minute lecture on breastfeeding on medium school if there lucky. It depends on their training and setting. They are mostly concerned about weight and usually have no problems supplementing outside the hospital setting. In the hospital, if it is baby friendly, there are guidelines for when formula can be introduced.

What are your thoughts on the “fed is best” campaign? I strongly disagree with it. But I’m in the profession of breastfeeding. The risks of not breastfeeding far outweigh the benefits of formula feeding. There are obviously cases when supplementation is absolutely necessary and mothers should never be shamed of needing to supplement. They should also be encouraged to get professional help as soon as possible to facilitate breastfeeding from the beginning. So many issues can be prevented before they’re a problem.

Do you feel that there is too much pressure to breastfeed currently? Whether from society, lactation consultants, media, doctors, etc. I believe we don’t have enough proper education on breastfeeding. With good quality education of the risks of not breastfeeding and the benefits to the mother, baby, partnrr and community, as well as having adequate postnatal support, I believe more families would actually choose breastfeeding.

In your opinion, is there anything that can be done to prevent instances where babies or starving or losing too much weight while waiting for milk to come in? The best practice after a normal delivery is keeping babies skin to skin on mom and with free access to nurse on demand. Babies should not be swaddled in isolettes away from their mothers. They should be allowed to sleep with skin to skin contact for the first few days of life. If a baby is not making enough wet and dirty diapers by 48 hours, they need to be evaluated for a tongue tie or other oral motor issues by a therapist in the hospital or a skilled/trained lactation consultant who is trained in oral motor which may be impacting the ability to drain the breast this causing the cycle of not enough milk taken in by baby and the breast not being stimulated by baby to produce more milk.

If not, do you think more breastfeeding mothers should be informed of this scenario before labor? I believe every mother needs to attend a high quality breastfeeding class before birth and breastfeeding support groups after birth. So many mothers don’t get education because they think it’s going to be natural and easy. But we’ve lost the communal/tribal living where we breastfeed with other women and learn about breastfeeding from childhood. There is so much misinformation on social media it perpetuates problems. But I also believe we should be educating mothers about the real impact of epidurals, medications, and induction on breastfeeding so mothers can understand how it will impact breastfeeding.