Tag: increasing milk supply

Where did my milk go?

- Julie Matheney

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.

The sexual and nutritive breast: hormones and breastfeeding

- Julie Matheney

We have done a very good job in America of separating the functions of the breast. Too often we see them as sexual OR as a tool of nutrition for our young. Even breastfeeding supporters who are pro-feeding tend to swing too far the other direction by not seeing the feeding breast as a sexual breast. We need to learn to appreciate the breast as both sexual and nutritive and in doing so actually increase the pleasure and function of both acts.

Many parts of the body have dual features. Yet we would never try to inhibit one of them or consider it odd or out of place. The mouth, for instance, has three purposes. With it we also feed the body. It is the first step in digestion where chewing and swallowing take place. Yet it is also communicative. With it we share it thoughts and express our wants and needs. But let us not forget it is also sexual. With it we kiss and perform all nature of sexual acts. Our hands perform tasks beyond number: communicative through the written word, nutritive in bringing food to the mouth, and sexual with the nuances of caressing, holding, and fondling. Society has no problem with these utilitarian organs.

Breasts are sexual organs. Their stimulation aids in the release of Oxytocin. According to Psychology Today, “Oxytocin is a powerful hormone that acts as a neurotransmitter in the brain. It regulates social interaction and sexual reproduction, playing a role in behaviors from maternal-infant bonding and milk release to empathy, generosity, and orgasm.” This “love hormone”, as it is often called, is released through touching, hugging, kissing, and yes, nipple stimulation. Oxytocin is the hormone that underlies trust. It is also an antidote to depressive feelings, which is why breastfeeding mothers have a largely reduced risk of post partum depression.

When the nipple is stimulated during sex, it plays a part in the release of Oxytocin for orgasm. When the nipple is stimulated during breastfeeding, it plays a part in the release of Oxytocin for milk ejection. This is why when parents become intimate after having a baby, a mother will often leak during orgasm. But a sexually blocked or traumatized mother, who had difficulty with the sexual nature of her breasts, may also find difficulty with the nutritive side of breasts and may have difficulty with the let down of milk.

When we can appreciate breasts as multifunctional, we can appreciate the complex nature of breast feeding. And also understand how to increase milk supply. Breastfeeding is hormone and simulation driven. The more you stimulate, the more hormones are released to make and release milk. Just like with sex, if a mother is stressed, distracted, or uncomfortable, the body’s natural reactions and functions can be impacted (example a distracted woman may not orgasm during sex and a stressed mother may have decreased let down and milk flow). On the other side, we can also use this information to our advantage. We can set the stage to increase milk flow, especially when pumping. By romancing the breasts when pumping (massaging or caressing them, giving gentle nipple rolls, listening to favorite soothing music, having a cup of tea, smelling baby’s clothes or blanket, watching videos of baby) we facilitate the hormone release to make and release milk. When we woo our breasts, speak softly to them and take a time out while feeding our baby or when pumping, we honor the dual nature of our magnificent body and in turn our body will respond positively.

  • Take a moment to reflect on how amazing breasts really are.
  • Think about how you can change the mood around feeding and pumping to help facilitate the hormonal influence on milk production.
  • If you have ideas, feel free to share them!!

Sabotaging your milk supply: working mothers who pump

- Julie Matheney

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

- Julie Matheney

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.

Pumping Log: Medications and Breast Milk Supply

- Julie Matheney

Ugh. Remember my last post about my horrible eye allergy? The doctor put me on steroid eye drops for a week. I looked up the medication the Hale’s book of medications and breastfeeding. Little had been studied in the drug and lactation, but the risk of it passing into my milk was in the safe zone. I never take a risk with eyes, so I diligently took the drops the prescribed 3x per day. But oooooooooh how it impacted my milk supply!!! If you’ve followed my blog, I was doing great Pumping. And average of 12-19 ounces during an 8 hour shift. With these eye drops on board, my supply dropped to barely 1-3 ounces per pump session for a total of 8 ounces of less per day. I was freaking out to say the least.

Two pump sessions worth in the middle of my eye drop treatment. 😑 Only four ounces total.

I added in two extra pump sessions, one before work and one before bed, to give us a little extra umph and getting us to around 12 ounces for while I was gone at work. Herbs, teas, and cookies were not going to do much if anything because this was being caused by a medication messing at a hormonal level. Pumping was my only hope to get through that week. Fortunately my daughter is on solids and is a champion eater. We just made sure to give her extra foods at meal times and she was waking at night more frequently to nurse. Normally I try not to nurse her at night, but this was an important exception. I was also fortunate to have a four day weekend and I just let her nurse on demand.

This is an entire days worth of pumping. Less than eight ounces for the day.

Two days after the drops were done, my supply came back. The take away is this: if you’re on medications that are altering your supply or if you suddenly notice a change in milk supply and are trying to figure out what changed while trying to breastfeed, don’t give up. Keep pumping and add extra pumps if you need to. If your baby is under six months or not on solid foods, you may need to supplement or nurse more frequently during the night until your supply increases or returns to normal.

First pump of the day today and pumping is back to my normal volume!!!

 

Fact of the Day: Fenugreek and lactation

- Julie Matheney

Fenugreek is one of the most commonly used galactogogues (supplements taken that are known to increase milk production). Fenugreek seeds (per 100 g) are rich sources of protein (46% of DV), dietary fibre (98% DV), B vitamins, iron (186% DV) and several other dietary minerals. The flavorful herb may be found in many Indian, Persian, Turkish, and Egyptian dishes. It is often the key ingredient in mother’s milk teas and lactation bars. Most mothers typically notice an increase in production 24-72 hours after starting the herb, but it can take two weeks for others to see a change. Some mothers do not see a change in milk production when taking fenugreek. Dosages of less than 3500 mg per DAY have been reported to produce no effect in many women. Interestingly enough, it’s been said if you want to know if you’re taking the correct dosage, you’re supposed to slowly increase the amount of fenugreek until your sweat and urine begin to smell like maple syrup. Got pancakes?

However, like any herb or supplement, be aware of what you are injesting. Some people are allergic to fenugreek, specifically people who have peanut allergy and chickpea allergy may have a reaction to fenugreek. Fenugreek seeds can cause diarrhea, dyspepsia, abdominal distention, flatulence, perspiration, and a maple-like smell to urine or breast milk. There is a risk of hypoglycemia particularly in people with diabetes; it may also interfere with the activity of anti-diabetic drugs. It may interfere with the activity and dosing of anticoagulants and antiplatelet drugs. You should not take it if you are pregnant as it may affect uterine contractions and may be unsafe for women with hormone-sensitive cancers. In summary, those with thyroid, blood sugar issues (such as diabetes), peanut allergies and those taking certain blood clotting medications should avoid fenugreek.

 

References:

Kellymom.com

[Bingel 1991] Bingel AS, Farnsworth NR. Higher plants as potential sources of galactagogues, in Wagner H, Farnsworth NR, eds. Economic and Medicinal Plant Research, Volume 6, Academic Press Ltd, New York, 1994: 1-54.
[Brinker 1998] Brinker F. Herb Contradictions and Drug Interactions. Sandy, OR: Eclectic Medical Publications, 1998, 70–1.
[Dugue 1993] Dugue P, Bel J, Figueredo M. Fenugreek causing a new type of occupational asthma. Presse Med 1993 May 29;22(19):922.
[Hale 2002] Hale T. Medications and Mothers’ Milk, 10th Edition. Pharmasoft Medical Publishing, 2002, p.277-279.
[Heller] Heller L. Fenugreek: A Noteworthy Hypoglycemic
[Huggins] Huggins KE. Fenugreek: One Remedy for Low Milk Production.
[Korman 2001] Korman SH, Cohen E, Preminger A. Pseudo-maple syrup urine disease due to maternal prenatal ingestion of fenugreek. J Paediatr Child Health 2001 Aug;37(4):403-4.
[McGuffin 1997] McGuffin M., Hobbs C, Upton R, Goldberg A. American Herbal Product Association’s Botanical Safety Handbook. Boca Raton: CRC Press, 1997.
[Ody 1999] Ody P. Herbs to Avoid During Pregnancy from Herbs for a Healthy Pregnancy. Los Angeles, Calif: Keats; 1999.
[Ohnuma 1998] Ohnuma N, Yamaguchi E, Kawakami Y. Anaphylaxis to curry powder. Allergy 1998 Apr;53(4):452-4.
[Patil 1997] Patil SP, Niphadkar PV, Bapat MM. Allergy to fenugreek (Trigonella foenum graecum). Ann Allergy Asthma Immunol 1997 Mar;78(3):297-300.
[Reeder 2011] Reeder C, Legrand A, O’Conner-Von S. The Effect of Fenugreek on Milk Production and Prolactin Levels in Mothers of Premature Infants. J Human Lactation 2011;27(1):74. Abstract only.
[Rice] Rice LA. Fenugreek, in Herbal Supplements in Pregnancy
[Swafford 2000] Swafford S, Berens B. Effect of fenugreek on breast milk production. ABM News and Views 2000;6(3): Annual meeting abstracts Sept 11-13, 2000

 

Pumping Log: When to throw in the towel

- Julie Matheney

I’ve never been a super pumper. I’ve diligently pumped three times a day at work for the last 8 months. I’ve almost always made just enough for the next day of feedings. Sometimes I’ve even had a conservative stash in the freezer for low pump days or when my husband and I want to go out. There are definitely times when I have to work on my supply to keep it up enough to feed my daughter. Oatmeal for breakfast, teas at lunch, a Guinness with dinner, more tea before bed. Pump. Breast massage. Pump. Repeat. It’s exhausting. Especially since my uninvited monthly visitor has me with a low supply. As I come up on my daughters first birthday, I’m torn.  Continue the schedule I’m on with the highs and lows of constant pumping? Drop the pumping and only breastfed when I’m home and offer something else while I’m gone? Or gradually wean all together? The professional side of me (the crunchy, granola, die hard side) says, “Stick it out!!! It’s not that bad!! Breast is best!!! Your baby needs your milk!!! Show your boobs who’s boss.” While the personal side of me screams, “Screw it! You’re working so hard! Give yourself a break. You went a whole year. You did the best you could with the support you had. Some other milk won’t kill your kid. She’s eating like a champ and she won’t even notice.” I get it now. I understand why some moms give up breastfeeding, especially working moms. I also get why mom’s push through and keep going. We all just want the best for our babies. I’m still on the fence. We’re T minus 1 month to the big one year birthday. I’ll keep you posted on what I decide. But for now, Happy Pumping!!

Pumping Log: Got Milk?

- Julie Matheney

It’s struck again. My monthly reminder of my womanhood and with it a drop in my milk supply. It’s a good reminder, though, for every mom out there that a sudden dip in milk supply doesn’t mean anything is wrong. It just means you have hormones. Congrats. 🎈🍾  When I’m breastfeeding from the boob I don’t notice any difference. My daughter doesn’t seem to want to nurse more frequently or longer. I really only notice it when I’m pumps. “My poor supply” I think to myself. And yet I would never know except that I’m working. On these weeks I usually just eat more oats, make sure to stay hydrated, drink an extra cup of Mothers milk tea, and add an extra pump session at night. And wait for the crimson tide to stop messing with my liquid gold.

First and second pump of the day.

Third pump of the day after a cup of chamomile tea.

Fact of the Day

- Julie Matheney

Babies are the best pump. They empty the breast better than either hand expression, manual or electric pumps. Even as the most efficient pump, babies never completely empty the breast. Breasts work on what could be called the “80:20 concept.” The 80 percent is the average amount of milk removed by your baby each day. The 20 percent is the residual amount of milk that remains in your breasts. If more than 80 percent of the milk is removed, supply increases to maintain the 80-20 ratio. If less than 80 percent is removed, supply decreases to maintain the 80-20 ratio. Even though this is an over-simplification of a very complex process, as new research emerges this core principle proves true.

Fact of the Day

- Julie Matheney

Fact of the day: Babies actually control how much milk is in the breast through milk removal. The more that is removed, the more the breast makes. Research shows that the mother’s diet, her fluid intake, and other factors have little influence on milk production. If the “milk removal” piece of the puzzle is in place, mothers make plenty of good milk regardless of dietary practices. If the “milk removal” part isn’t there, nothing else can make up the difference.