Why should I see an IBCLC or lactation consultant

If you broke your foot you wouldn’t go to your local nail salon to have your pedicurist look at it. Yes, they work with feet. I just wouldn’t trust their expert opinion on whether I need a cast or some physical therapy. If my car engine was making smoke and my gauges were outside the appropriate ranges, you wouldn’t go to the car wash to have it looked at. Yes, they work with cars. I just wouldn’t trust their expert opinion on whether my engine block is cracked or not. So why when we’re having lactation problems do we turn to mom groups or even pediatricians? Yes, moms have babies. Yes, pediatricians work with babies. But neither are the experts in lactation (ok, occasionally a pediatrician will seek additional training, but honestly it’s rare). To become a board certified lactation consultant, you need to take advanced college level coursework specifically in human lactation. You need to spend hundreds to thousands of hours being directly mentored by someone who already is board certified. And you have to pass a FOUR HOUR board exam. To be board certified. IBCLCs spend thousands of dollars and years of their lives training to become experts in breasts, babies, and feeding. If you’re struggling, please find the correct help. There’s a lot of bad information out there that may inadvertently sabotage your breastfeeding journey without you even being aware.

Where did my milk go?

What can cause a late onset decreased milk supply?

1.The mother is pregnant again. Milk supply decreases during pregnancy. Domperidone will not work when the mother is pregnant.

2.The mother is taking some hormonal birth control method (pill including progestin only pill, IUD, etc)

3.The mother is breastfeeding on only one side at a feeding or “block feeding” (several feedings in a row on the same breast, used to treat “overabundant milk ejection, “overabundant milk supply”). I have posted on “block feeding” previously.

4.Some medications other than hormones can decrease the milk supply (antihistamines for example).

5.Can an emotional shock decrease the milk supply? Possible but unusual in our experience.

6.Blocked ducts/mastitis as well as any febrile illness may decrease the milk supply.

7.The use of bottles more than occasionally can very much decrease the milk supply.

8.”Overdoing it”. It’s time that others do most of the usual chores that fall on women’s shoulders.

9.An “abundant milk supply” associated with a less than “ideal” latch. In this situation, the milk flows into the baby’s mouth with little participation of the baby. The baby may often choke while breastfeeding, especially when the mother has a milk ejection reflex. A tongue tie is a common cause of a baby having a less than “ideal” latch and can be a significant cause of late onset decreased milk supply even if neither the mother or the baby had problems early on.

This problem of late onset decreased milk supply and accompanying symptoms is typically the problem of the mother who once had an abundant milk supply and milk supply may still be quite good, but less than it once was.

How Much Breast Milk Does Baby Need?

HOW MUCH BREAST MILK DOES MY BABY NEED IN A DAY?

How many ounces of breast milk should my exclusively breastfed baby be eating at a feeding? This is usually on the top five questions from families. 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 of breast milk 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 of breast milk 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.
  • A helpful question to always be asking is: how many times a day is baby feeding? 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, just like us as adults, some days we want to eat more than other days depending on the activities of the day, growth spurts, cravings, and even babies emotionally eat sometimes. Trust your baby to know their stomach better than you do. 
  • Babies get hungry frequently: 8-12 or more times a day. They drink so much breast milk because they grow so rapidly. They will double their birth weight by six months and triple their weight by a year. Imagine how much you would need to eat to double your weight in six months! You may feel like you feed your baby all the time, and you are. Every 1-3 hours in the first few months is normal!! Every feeding is different and breast milk volumes taken vary throughout the day. Sometimes you want a snack and sometimes you want a buffet. 
  • How is pumping going for you and can you keep up with his volume needs? Pumping is never an indication of your breast milk supply, it just indicates what your pump can empty from you. So many people have their breast milk supply sabotaged by baby being overfed from a quick flowing bottle, not enough time spent during the feeding, or interpreting baby’s cues wrong.
  • If your milk supply is keeping up with their demand there’s no problem. If you’re concerned about your baby’s feeding habits, definitely schedule a consultation with me.

Foremilk/Hindmilk and Making Fattier Milk

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How can I make fattier milk? I get this question a lot. Fat in breast milk changes constantly both throughout the day and as baby ages. It is predominantly influenced by how full/empty the breast is which tells your body how old your baby is. Newborns nurse around the clock and have a higher milk fat content than toddlers who may only nurse a handful of times a day and are getting their fats from table foods. Your diet does not usually have an effect on the quantity of fat present in breast milk but it can change the type- saturated, trans, monounsaturated, polyunsaturated.

I often get questions about foremilk/hindmilk as related to making a fattier milk. But what is fore milk/hindmilk? Is that even a thing? The breast only makes one type of milk, however, because of the way milk is released during a feeding, the fat content can change. Fats make up about 3-5% of the nutrients of breast milk and each ounce of contains about 1.2 grams of fat. Milk is made in the alveoli, which are grape-like clusters of cells at the back of the breast. Once the milk is made, it is squeezed out through the alveoli into the milk ducts, which resemble highways and carry the milk through the breast to the nipple. As milk is produced, fat globules in the milk stick to each other and to the walls of the milk ducts. As time passes, milk gradually moves toward the nipple as the breasts fill, pushing the thin watery milk forward while leaving the denser and fattier hindmilk behind (because the fat is sticking to the walls of the ducts). Shorter time between feedings or pumping a help keep the hind milk at the front of the breast. Think of it like turning on a faucet in the sink. 

At first, the water comes out cold and then gradually gets warmer until it is hot. If you come back a minute later and turn the faucet on again, it will still be relatively warm. However, if wait an hour, the water will be cold. You’ll have to wait for it to warm up again. Breast milk fat is similar.

When the baby first latches on, the higher-water content foremilk is released. Little by little the milk becomes fattier as fat globules are pulled down from the ducts. Frequent feedings or pumping mean the milk doesn’t have time to “get cold.” There is no switch that gets flipped – the change from foremilk to hindmilk is gradual. There is less foremilk for your baby to go through before they get to the fattier milk. Basically, the less time in between feedings, the higher the fat content at the beginning of that particular feeding.

Here are the best strategies to help increase the fat in your milk:

📌Nurse or pump more frequently. The fullness of the breast makes the most difference with the amount of fat in your milk. The fuller the breast, the more water content is in your milk because your body thinks baby is dehydrated from going a long time without feeding or that you have an older baby that is getting fats from table foods. The shorter amount of time you go between feeding or pumping, the higher the fat content in your milk. You will see a smaller volume, but a higher fat content.

📌Drain the breast. Let your baby completely finish on one side before switching to the other side. Emptier breast’s have higher milk fat content. 

📌Use your hands. Compressing and massaging the breast from the chest wall down toward the nipple while feeding and/or pumping helps push fat (made at the back of the breast in the ducts) down toward the nipple faster. 

📌Eat more healthy, unsaturated fats, such as nuts, wild caught salmon, avocados, seeds, eggs, and olive oil. 

📌 Increase your protein intake. This helps increase overall milk supply, which = more  fat for your baby. Lean meats, chicken, fish, eggs, dairy, nuts, and seeds are the best dietary sources of protein. Vegetarians if you do not get enough protein from your food alone, consider adding a protein supplement in your routine.

📌Sunflower lethicin. Often used to relieve frequently blocked ducts, this supplement works by decreasing the stickiness of breast milk by mixing the fatty parts of breast milk with the watery parts to make it “slide out” easier. Some people believe that this helps increase the fatty acids in milk at the beginnings of feedings, too. 

Switching baby too quickly from breast to breast while they are still actively sucking means that they aren’t getting enough time to let the fattier hindmilk unstick from the milk ducts.

 

TAKE AWAY:

Depending on your nursing pattern, it’s possible for fat content to be higher at the beginning of a particular feeding than it is at the end of other feedings. The longer the time between feedings, the lower the fat content at the beginning of the next feeding. If feedings are closer together, you’re starting off with a higher fat content. 

Because every baby varies in the amount of time it takes him to receive his fill of the higher-fat milk at the end of the feeding, it’s important not to switch breasts while baby is actively nursing.

 

Pumping Log #2

What’s in my pumping bag. A well stocked pumping bag is the most essential item you will need when you go back to work. Packing the bag efficiently and with necessities can help eliminate stress and worry while pumping at work. Here are a few of the things in my pumping bag. Obviously the pump is the most important piece. Make sure to check that you have all the pieces and parts in the morning before you leave for work. I had forgotten one or two pieces several times. I actually now keep a spare pump in my car that is always ready to go in the event that I forget something. I always keep instant oatmeal, mothers milk tea, and honey sticks ready for a quick snack on the go. When I know I am going to work the next day, I bring empty bottles to put my milk in. That way I can keep it in the fridge and handy for the next days feedings. If I know I am going to be home the next day, I use disposable milk storage bags. I’ve tried several brands and really like the Dr. DuDu. They’re sturdy and have a double zipper. Plus they come in a handy 8oz size for streamlining in the freezer. I can put my pumped milk in the freezer and it will be ready to go the next time I’m at work. I always keep extra nursing bra pads. I wear washable ones made of bamboo fiber. But you never know when you might need to change them. I keep it small stash of disposable ones in my bag at all times. Another necessity is my stash of essential oil’s. I use fennel to help keep my supply up. Serenity, lavender, balance, and citrus bliss help elevate my mood when I’m feeling down at work. What’s in your bag?