Nausea while breastfeeding

The interplay between oxytocin and stress hormones is a fascinating aspect of our neuroendocrine system. Cortisol and oxytocin are both regulated by the hypothalamus, a critical part of the brain that helps maintain hormonal balance. The hypothalamus plays a pivotal role in maintaining the balance between these hormones.

Oxytocin is produced in the paraventricular nucleus inside the hypothalamus, a small but crucial part of the brain that regulates many autonomic functions. From the hypothalamus, oxytocin is transported to and released by the posterior pituitary gland into the bloodstream which then travels to the breast and causes the pulsatile contractions known as the Milk Ejection Reflex (let down).

In response to stress, the hypothalamus releases corticotropin-releasing hormone (CRH). CRH prompts the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to release cortisol and adrenaline into the bloodstream, preparing the body for a 'fight-or-flight' response. The hypothalamus coordinates the release of CRH and oxytocin, attempting to balance the stress response with mechanisms that promote recovery and resilience

These hormones counteract each other: cortisol increases alertness and stress, while oxytocin reduces anxiety and fosters calmness, helping to restore equilibrium in the body's stress response system

What Causes Let-Down Nausea?

The sudden surge of oxytocin, combined with fluctuating levels of other hormones released by the hypothalamus, can activate the parasympathetic nervous system, which can sometimes trigger nausea. This response is similar to the body's reaction to certain stressors or stimuli

Breastfeeding is both physically and emotionally demanding. Anxiety, lack of sleep, and overall stress can exacerbate nausea during let-down

Blood Sugar Levels: Low blood sugar, a common issue for new mothers who might skip meals or eat irregularly, can also cause or worsen nausea as hormones are fluctuating during breastfeeding

Managing breastfeeding nausea

Hydration and Nutrition: Ensure you're staying well-hydrated and eating balanced meals regularly. Small, frequent meals rich in protein and complex carbohydrates can help stabilize blood sugar levels and reduce nausea, especially when eaten a few minutes before moving milk

Relaxation Techniques: Practice deep breathing, meditation, or gentle yoga to reduce overall stress. Creating a calm and comfortable environment during breastfeeding or pumping  can help

Cluster Feeding

Cluster feeding is a normal and common behavior in newborns, where they nurse frequently and irregularly over a period of several hours, often in the evening. This behavior helps stimulate milk supply and can also provide comfort to the baby, who may be going through a growth spurt or developmental leap. Despite its normalcy, cluster feeding can be particularly challenging and frustrating for new parents, especially if they are unprepared for its intensity and duration.

New parents may find cluster feeding overwhelming for several reasons. First, the frequent and seemingly incessant nursing sessions can lead to physical exhaustion and a sense of being constantly tethered to the baby. The lack of predictability in feeding patterns can also make it difficult for parents to find time for their own basic needs, such as eating, sleeping, and showering. This can contribute to feelings of frustration and stress, as the demands of cluster feeding can seem relentless.

Additionally, new parents might worry that their baby is not getting enough milk or that there is something wrong with their breastfeeding technique. This anxiety can be exacerbated if they are not aware that cluster feeding is a typical behavior that helps regulate and increase milk supply. The emotional toll of seeing their baby seemingly insatiable and unsettled can add to their frustration.

Education and support are key in helping new parents navigate cluster feeding. Knowing that cluster feeding is a normal part of newborn development can alleviate some of the stress and help parents manage their expectations. Seeking support from lactation consultants, pediatricians, or breastfeeding support groups can provide reassurance and practical advice. Understanding that this phase is temporary and that it plays an important role in establishing a healthy milk supply can also help parents cope with the challenges of cluster feeding.

Milk supply at night

Infant sleep patterns, especially during the early months, are characterized by frequent waking, often every 2-3 hours, which is largely driven by their need for regular feeding. Night feedings play a crucial role in maintaining and boosting breast milk supply due to the hormonal mechanisms involved. Prolactin, a hormone essential for milk production, tends to be at its highest levels during nighttime. When an infant breastfeeds at night, the mother's body receives signals to produce more milk, ensuring an adequate supply for the baby's needs. Frequent night feedings help to maintain high prolactin levels and stimulate continuous milk production. Consequently, consistent night feeding is vital for establishing and sustaining a robust breast milk supply, particularly during the early weeks postpartum when the milk supply is being established. Skipping night feedings can lead to decreased milk production as the demand decreases, sending signals to the body to reduce milk output. Therefore, understanding and supporting infant sleep patterns that include night feedings are essential for successful breastfeeding.

Research indicates that newborns typically wake every 2-3 hours during the night for feeding. This frequent waking is due to their small stomach capacity and high metabolic rate, requiring regular intake of nutrients. Studies show that by the age of three months, many infants may start to sleep for longer stretches, though it is common for them to still wake at least once or twice during the night for feeding. On average, these night wakings can last anywhere from 20 minutes to an hour, depending on how quickly the baby feeds and settles back to sleep.

A study published in *Sleep Medicine Reviews* highlighted that infants between the ages of 0-6 months wake up approximately 2-3 times per night. Another research in the *Journal of Clinical Sleep Medicine* found that these night wakings typically decrease in frequency as the infant grows older, but individual patterns can vary widely. Some infants may continue to wake frequently throughout the first year, especially if they are breastfed, as breast milk is more quickly digested than formula, necessitating more frequent feedings.

Night feedings are crucial for maintaining breast milk supply due to the elevated levels of prolactin during nighttime. Consistent night feeding supports ongoing milk production by keeping prolactin levels high and ensuring that the body continues to respond to the infant's nutritional demands. Thus, understanding typical infant sleep patterns and their need for night feedings is essential for breastfeeding success and ensuring adequate milk supply.

Painful white spot on nipple: Milk blebs

Managing a milk bleb (also known as a milk blister) can be uncomfortable, but there are effective ways to address it. Here are steps to help manage and treat a milk bleb:

🤱🏽Frequent Nursing: Continue breastfeeding frequently to keep milk flowing and prevent further blockages. Start nursing on the affected side first to ensure thorough drainage.

🤱🏼Proper Latch: Ensure your baby has a proper latch to prevent friction and irritation that can contribute to milk blebs. Change your feeding position to have baby’s mouth come from a different angle to the bleb

❤️‍🔥Warm Compresses: Apply a warm, moist compress to the affected nipple before nursing or pumping. This can help soften the bleb and promote milk flow.

👐🏼Gentle Massage: Gently massage the area around the bleb while breastfeeding or pumping to help clear the blockage. Be careful not to cause additional irritation.

🌦️Soak in Warm Water: Soak your nipple in warm water mixed with a little Epsom salt. This can help reduce inflammation and soften the skin.

🫒Olive or Coconut Oil: Apply a small amount of oil to the nipple to soften the skin and make it easier to remove the bleb.

⚔️Avoid popping it with a needle as this can increase your risk of infection.

🩹Antibiotic Ointment: For persistent or painful blebs, contact your healthcare provider and ask for a prescription of triamcinolone cream .

🥑Stay Hydrated and Healthy**: Maintain good hydration and a balanced diet to support overall health and effective milk production.

🤱🏽Consult a Lactation Consultant: If milk blebs are recurrent or particularly painful, consult a lactation consultant for personalized advice and support.

Always ensure good hygiene, wash your hands before touching your breasts, and keep your nipples clean and dry. If you experience persistent pain, signs of infection, or recurring blebs, seek medical advice promptly.

Exclusively pumping is like having unexpected twins

The Double Duty of Exclusive Pumping:

🧑🏽‍🍼Time and Effort: Exclusively pumping requires significant time and dedication. You're not just feeding one baby directly; you're also spending extra hours feeding your pump. Not to mention all the set up and clean up that involves

🎛️Logistics:Managing the logistics of pumping and feeding your baby involves intricate planning and organization—keeping track of pumping schedules, milk storage, sterilization, and bottle preparation

🎢Physical and Emotional Demands: Exclusive pumping can be physically and emotionally demanding. It requires resilience and perseverance to maintain a steady milk supply while

Remember, You Are Incredible:

- Your dedication is extraordinary. Unlesss they’ve done it before, people don’t understand that exclusive pumping (or triple feeding) is like having twins. It’s not **just pumping**, it’s feeding two babies, one is just electronic

- It's okay to feel overwhelmed or exhausted at times. Stay hydrated. Make sure you have plenty of snacks. Naming your pump can help some feel more connected to the process. Find support to make sure you have a quality pump and the right size flanges as well as help with pump schedules to make sure you reach your goals

- Celebrate your achievements. Every ounce of milk pumped is a testament to your determination to reach your feeding goals

This message is a reminder of the incredible dedication and love that goes into exclusive pumping. It's important to acknowledge the challenges while also celebrating the immense strength and resilience of parents who undertake this journey

What medicine can I take while being sick and still breastfeeding?

There is nothing worse than being sick. It’s even harder when you still need to breastfeed when all you want to do is sleep and there’s nothing that sounds good to eat or drink. So what can you take get help feel better fast? There are still safe medications and herbs/supplements. Thomas Hale wrote the textbook on medications and breast milk and categorized medications as follows:
L1 Safest
L2 Safer
L3 Probably safe
L4 Possibly hazardous
L5 Hazardous

🤒Pain and fever
👍🏼Ibuprofen (Motrin/advil), acetaminophen (Tylenol), and paracetamol (L1) are safe to take while breastfeeding.
👎🏻Aspirin (L2) can pass into human milk and cause a serious condition called Reye’s syndrome in baby. Reye’s syndrome is associated with brain and liver damage.
👎🏻Use of codeine is not recommended while breastfeeding. If essential, and only where there is no alternative, it should be at the lowest effective dose, for the shortest possible duration and you should stop taking it and seek medical advice, if you notices side effects in baby such as:

  • Breathing Problems
  • Lethargy
  • Poor Feeding
  • Drowsiness
  • Bradycardia (slow heart beat)

🤧Sinus congestion
👍🏼Saline rinse L1
👍🏼Afrin and Nasacort L3 Because these medicines are not absorbed well from the nasal passages, they don’t have the same effect on milk supply that decongestants taken by mouth can have.
👎🏻Pseudoephedrine L3
Medications containing pseudoephedrine (Sudafed, Zyrtec D) — use with caution because they can decrease milk supply

😮‍💨Cough/chest congestion
👍🏼Guaifenesin (Robitussin/Mucinex) L2
👍🏼Dextromethorphan (Robitussin DM/Delsym) L3 The amounts of dextromethorphan and its active metabolite in breastmilk are very low and are not expected to affect the nursing infant. It is best to avoid the use of products with a high alcohol content while nursing.

Not sure if the medications you want to take is safe? Call Infant Risk at 806-352-2519 also is a phenomenal resource for safe things you can take and do while sick and breastfeeding

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. 


For more information on tummy time, check out @tummytimemethod

Drinking and Breastfeeding

Milk is made from your blood, so what you drink can impact your milk supply. 

💦 How much water should you be drinking? There are some ridiculous answers out there. If your breast milk production has decreased, helpful people may suggest that you chug tons of water. Your lack of water intake may contribute to but is not completely responsible for your supply drop. Drinking too much water can inadvertently harm your milk supply

💦 When you drink too much water, your body tries to restore the electrolyte balance in your body by dumping the excess water into your urine. This results in water being diverted away from your breasts, which in turn decreases your milk supply. Water dense foods can also be just as hydrating as plain water from the tap. 

💦 You will lose up to 30oz of water through your breast milk to your baby; so do try to drink 8-12 glasses of water a day

☕️ Coffee is safe to drink: 300-500mg of caffeine per day max

☕️ Younger babies (< 6 months), preterm and medically fragile babies process caffeine slower and they may be sensitive to it. 

☕️ If you consistently drank coffee during pregnancy you baby is already used to caffeine

☕️ It takes 15-20 minutes for coffee to hit your bloodstream and is usually completely gone by 4-7 hours. So if you’re concerned or having it for the first time after birth, either breastfeed baby first and then have your coffee or have it while breastfeeding

🍷 According to the CDC, moderate alcohol (up to 1 standard drink per day) is not known to be harmful to baby

🥂 Less than 2% of alcohol reaches breastmilk and typically peaks within 1/2-1 hour after consumption *however* factors such as food, weight & body fat need to be considered

🥂 Alcohol does not accumulate but leaves breastmilk as it leaves the bloodstream. There is no need to pump and dump when consuming limited amounts of alcohol

🥂 If you are feeling like you NEED to consume large amounts of alcohol regularly, speaking to a qualified professional is admirable and a very good option


Is it ok to have alcohol and breastfeed? The short answer is yes, in moderation. No, you don’t need to pump and dump for 1 standard drink. Yes, those alcohol testing milk strips are kinda dumb. 

Alcohol passes freely into breast milk and peaks around 30-60 minutes after consumption (60-90 minutes if you drink with food) so what you would breathalyze you would “breastalyze”. This does not mean your milk has an much alcohol as you consumed or as a straight up alcoholic beverage. It means you milk has the same amount of alcohol as your blood. For instance, if your Blood Alcohol Content (BAC) is 0.10 (or 0.10%, 1/10 of 1 percent) from drinking, you breast milk has 0.10% alcohol in it. In comparison, a typical beer has 4.5% alcohol, a glass of wine has 15% alcohol, and a shot of vodka has 40% alcohol. 

Let’s interpret that: if you breastfeed while you’re having your first drink, your baby will most likely be finished feeding before the alcohol hits your system. There’s no need to pump and dump your milk. Only time clears the alcohol from your system. If you’re breastfeeding a newborn, premature or medically compromised infant, you’ll want to be more cautious of the alcohol you consume and may want to consider waiting longer to breastfeed than an older baby. Such a small portion of alcohol gets into your milk, if you have an older baby and have only had one drink there’s really no need to wait to pump or feed. 

If you want to have an occasional drink, I will never judge you!!! Go for it!! If you need alcohol, large quantities or alcohol or are struggling with alcohol, please find a qualified counselor to work with ❤️ 🍻

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. 

Slacker boob

Did you know? Around 70% of women produce more milk in the right breast. Which means 30% make more in the left. It is VERY common for one side to produce more than the other. Some times double on one side. We don’t know why. This is not a reason to neglect one side. You want to make sure you rotate which breast you offer first. Babies may prefer one side over the other for various reasons:

👶🏽They like to lay with their head in a certain direction or their body is uncomfortable in the opposite position

👶🏿They prefer the flow (one side may flow faster or slower than the other)

👶🏼They may prefer the flavor (YES!! Milk can taste different form each breast during the same feeding!!)

If you want to help balance out a slacker boob:

🔆Offer the slacker first more often. 

🔆End on the slacker can also help, especially if baby just wants to use you like a pacifier. 

🔆Pump the slacker side during or after feedings can also help stimulate more milk production

🔆Make sure you have the correct sized pump flange on the slacker side. Our nipples can often be different sizes and using the wrong sized flange can drop supply on that side

🔆Hand expression on that side at random times of the day even for a few minutes will jump start increased production. 

🔆If it’s positional from your baby (they only want to lay cross cradle to the right and not the left, experiment with other positions like football or side lying to help baby compensate for their body. If your baby prefers one side of the other from a positional perspective, consider taking your baby for some infant bodywork like chiropractic or craniosacral therapy.