Tag: lactation

Empty breasts make milk faster than full breasts

- Julie Matheney

FULL/EMPTY BREASTS

While it seems counterintuitive, the emptier your breasts are, the faster they make milk. A full bread has no place to store or hold the milk, so milk production slows to prevent plugged ducts and breast discomfort. Cluster feeding on an emptier breast actually tells the body to make more milk at a faster rate!! Some incorrectly assume you have to wait for the breast to “fill up” before feeding your baby or for pumping while at work. This will eventually lead to less milk, as a fuller breast tells your body baby isn’t eating very often and to slow milk production. The more frequent you empty the breast, the higher the fat content in that milk and the faster milk is made. The longer often you wait and the fuller the breast, the higher the water content in that milk and the slower your body will make milk overall.

W atch the baby, not the clock. Breasts may feel really full between feedings in the first few weeks after birth, but they’re also not supposed to stay engorged. There will come a time when they stay soft and don’t feel full between feedings or pumping, so waiting for that as a cue to feed will also sabotage your supply. Don’t be alarmed when your breasts no longer feel full between feeding. You’re entering a new stage where you’ll still make plenty of milk for your baby as long as you’re routinely emptying that milk. Trust your body. Trust your baby.

The science vs the art of breastfeeding

- Julie Matheney

SCIENCE AND ART

Breastfeeding is the perfect blend of science and art. There are basic principles that apply, but within those principles is a lot of variation

🔬Science says you should switch which breast you start with at each feeding to keep milk supply balanced

🎨Art says this mom always starts left to try to increase supply on the slacker boob while that mom only feeds one breast per feeding. This mom needs to block feed and that mom offers whatever breast passes the boob shake fullness test

🔬Science says babies should poop at least once a day

🎨Art says some babies poop every time they sit in the car seat and others in the bathtub🤷🏽‍♀️ Some babies poop after every feeding and others have just one a day (or every other day)

🔬Science says eat whatever you want

🎨Art says one can eat dairy without a problem for baby and for another it causes a rash and digestive upset in baby

🔬Science says having baby in a good position will get you a deep latch.

🎨Art says you over here love koala hold a rolled up wash cloth supporting your breast to help reduce reflux. While you over there do better in cross cradle sitting up.

🔬Science says as baby ages they can sleep in longer stretches at night

🎨Art says many babies still wake up 1-3 times a night to nurse until 18 months and need help from an adult to transition back to sleep

🔬By understanding the science behind breastfeeding, we can understand typical patterns of behavior which helps guide us when things aren’t going well.

🎨By appreciating the art of breastfeeding, we can celebrate the unique differences of every feeding baby within its own family dynamic.

🔬If you’re struggling with the science of breastfeeding, find help.

🎨If breastfeeding is going well, appreciate the art of your own masterpiece that you’re creating with your little one.

Vitamin D supplements and breast milk

- Julie Matheney

VITAMIN D

Were you told by your pediatrician to give your baby vitamin D drops? Vitamin D is absolutely critical strong bones, because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease where the bone tissue doesn’t mineralize properly, leading to soft bones and skeletal deformities. Recent research also tells us that vitamin D is key in maintaining our immune systems for regulating both infection and inflammatory pathways. If you shun the sun, have a milk allergy, or follow a strict vegan diet, you may be at risk for vitamin D deficiency. Known as the sunshine vitamin, vitamin D is produced by the body in response to skin being exposed to sunlight. It is also occurs naturally in a few foods like certain fish, fish liver oils, egg yolks, and fortified dairy and grain products.

Our bodies are designed to make very large amounts of vitamin D through exposure to the sun (10,000—20,000 IU in 24 hours, after 15—20 minutes of summer-sun exposure in a bathing suit/45—60 minutes of exposure for those with darker skin tones). However, in an effort to decrease our risk of skin cancer from over exposure to the sun, we’ve limited our ability to keep our vitamin D status at a normal level from absorbing it directly from the best source. That said, those living where clouds often cover the sky or in cities with polluted air quality will have a hard time getting sun exposure for natural vitamin D. People with darker skin tones are more likely to have low levels of vitamin D, as well, due to the increased pigment in their skin. They require nearly four times the length of sun exposure in order to penetrate the skin to manufacture vitamin D.

Vitamin D is essential for babies. Your pediatrician cannot tell you to put your baby in the sun, even though that is the best source of vitamin D, because of the risks of skin cancer. So they should have advised you to give your baby 400 IU of vitamin D each day, usually given by drops in the mouth.

All formulas sold in the United States have at least 400 IU/L of vitamin D; so if your baby is drinking 32 ounces of formula, vitamin D supplementation is not needed.

But what about from breast milk? Human milk is a very poor source of vitamin D, usually containing less than 50 IU per quart. This is why the AAP recommends all breastfed infants be supplemented. This does not mean there is anything wrong with the milk, but an issue in the recommended amount of vitamin D the lactating parent should be taking. This goes back to the sunlight recommendation. If you were getting 15-45 minutes of sunlight (depending on how dark your skin tone is) 3-4 times per week, your body would have plenty of natural vitamin D to pass through your milk to your baby. Many who live in the US either don’t live in a location where that’s possible year round (hi, Chicago in January) or maybe can’t get out in the sun because of needing to work. The Academy of Breastfeeding Medicine (a global organisation) recommends that “The breastfeeding infant should receive vitamin D supplementation for a year, beginning shortly after birth in doses of 10–20 lg/day (400–800 IU/day) (LOE IB). This supplement should be cholecalciferol, vitamin D3, because of superior absorption unless a vegetable source such as ergocaliferol vitamin D2, is desired. … Vitamin D also may be delivered adequately through human milk.” Research has shown that as long as you as the lactating parent is taking 6,400 IU of vitamin D daily, there is no need to supplement the baby as your milk will have adequate amounts.

Where are you getting your feeding advice from?

- Julie Matheney

Feeding “advice” we would never tell an adult:

⌚️It hasn’t been 3 hours yet. You can’t possibly be hungry again

⏱It hasn’t been 3 hours yet. You can’t possibly be thirsty again.

🧊You need to drink all 64oz of your daily water intake in 4 equally portioned cups. If you can’t drink 16 ounces in one sitting, something is wrong with you.

🍽Clean plate club. Finish everything on your plate regardless of how full your stomach feels.

🍏Eat food purely for their nutritional value. 🍦Never have food simply for the comfort or enjoyment of it.

🔦Eat alone in a dark room and never with anyone else

💡How could you get so distracted while eating? Focus and pay attention.

🪑Eat until you’re done then leave the table immediately. Don’t hang out at the table for longer than needed.

🛌Never eat a bed time snack

🛏Wake up in the middle of the night thirsty? Too bad. Go back to bed you can have some water in the morning

⏰You have 15 minutes to eat. Tic toc. When the clock hits 15 you need to stop whether you’re done or not

🍴3 meals, 2 snacks. That’s it. 7, 9, 12, 3 and 5. Hungry or thirsty at a different time? Here’s a pen cap to chew on

🍔There’s only one way to eat and if you don’t eat like me and my family you’re doing it wrong

Do you get where I’m going here? Too often we analyze the science of breastfeeding instead of considering the art of feeding and eating. We try to make a literal formula for how our baby should eat when some times we have to appreciate feeding for what it is: an enjoyable and pleasurable sensory experience that is social and includes more than just calorie intake.

Forever milk

- Julie Matheney

Did you know that you will ALWAYS be able to make milk? You’ve had the milk making glands in your breasts since puberty. They’re like little empty clusters of balloons at the back of the breast. Pregnancy activates your milk making hormones, allowing the glands to expand and start filling with milk between 16-20 weeks gestation. In the early days after birth, the more stimulation the breast has (from feeding or pumping), the more the milk making glands and their corresponding hormone receptors multiply. The milk balloons fill and empty milk multiple times per feeding.

After at least 40 days of not expressing any milk, once you completely wean, your milk making balloons deflate and become dormant, like before pregnancy. But they aren’t dead. Pregnancy and breastfeeding hormones caused a permanent change in your body. Your milk making glands will FOREVER remember how to make milk. They can ALWAYS make milk again, no matter how long it has been. They just need enough of the right stimulation to turn on and start filling again. Some times years after breastfeeding a mother may feel the tingle of let down if she hears a baby cry. Or she may leak if her partner does enough nipple stimulation. There are grandmothers in other cultures who bring back milk to breastfeed their grandchildren! Our bodies are AMAZING!! Now you know!

Nipple shields

- Julie Matheney

Not all nipple shields are created equal. Nipple shields are a great tool that can be used to help baby latch and stay latched, help you heal from nipple damage or trauma, or transition baby back to breast from using a bottle. Nipple shields are a great tool and can be used as long as needed. There are risks to long term use, the biggest one is a decrease in milk supply if baby isn’t able to trigger let downs or remove milk efficiently. If you weren’t given a plan for transitioning off the shield, a qualified lactation consultant can help!

Why should I see an IBCLC or lactation consultant

- Julie Matheney

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.

Coffee while breastfeeding

- Julie Matheney

An average cup of coffee contains 95mg of caffeine, but some types contain over 500mg. That’s important to be aware of when breastfeeding as it’s generally considered safe to drink up to 300 mg per day— about 2–3 cups of coffee or 3–4 cups of tea.

The caffeine content of coffee depends on many factors, such as:

• Type of coffee beans: different varieties of coffee beans naturally contain different amounts of caffeine.

• Roasting: Lighter roasts have more caffeine than darker roasts.

• Type of coffee: caffeine content can vary significantly between regularly brewed coffee, espresso, instant coffee and decaf coffee.

• Serving size: “One cup of coffee” can range anywhere from 30–700 ml (1–24 oz), greatly affecting the total caffeine content.

• One cup of brewed coffee (8 oz) contains about 70–140 mg of caffeine, or about 95 mg on average

• One shot of espresso is generally about 30–50 ml (1–1.75 oz), and contains about 63 mg of caffeine

• Instant coffee usually contains less caffeine than regular coffee, with one cup containing roughly 30–90 mg

• Decaf has about 0–7 mg per cup, with the average cup containing 3 mg

Want to enjoy a coffee alternative that gives all the feels while still being breastfeeding supportive? My two breastfeeding friendly favorites are @wearerasa and @milkstabrew.

Foremilk/Hindmilk and Making Fattier Milk

- Julie Matheney
IMG_9459

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.

 

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.