Tag: milk supply

How to build a breast milk stash

- Julie Matheney

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

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!

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.

Natural Weaning from the Breast

- Julie Matheney

NATURAL WEANING

Natural weaning is the biological process of gradually decreasing milk supply as baby gets older. This process starts around 7-9 months as baby takes more solid foods and progresses toward sleeping longer stretches at night. It ends when baby finally weans (which may not be until 2-3 years old!!). Natural weaning doesn’t mean that you need to wean baby from the breast. Decreasing milk supply doesn’t mean you’re at risk of losing your supply, either. Your breast is designed to match the stage of development your baby is in. 

Milk supply iss highest from month 1-6 when baby is going through multiple growth spurts. They need to double their birth weight by 6 months. Milk is also the only food in their diet.  Therefore, your milk supply is supposed to be at its highest to meet their nutritional needs. From 6-12 months, weight gain slows but their need for milk volume needs remain stable. It is natural as baby transitions from a full milk diet to a milk+solids diet to then a solids+milk diet that breast milk supply will shift along with it. Your milk supply varies compared to baby’s solids intake and there is a wide range of normal based on your individual baby. Some babies love solids and eat them in large quantities many times a day. Other babies continue on a mostly milk diet until almost 1 year.  At 12 months, milk finally takes a back seat to solids, but still fills in nutritional gaps and acts like medicine against illness. From 12 months on there continues to be a wide range of normal for milk supply depending on your child’s eating and feeding habits. Some babies continue to nurse occasionally over night while others seem to become boob barnacles again and would happily stay on the breast all day, every day.

So what does this mean? If you’re exclusively breastfeeding you may not notice anything.  You can continue to bring baby to breast for as long and often as baby wants. You may notice baby spacing out feedings or not nursing as long. They may want the breast more when teething or going through growth spurts or developmental leaps. They have days with little interest in the breast. 

Moms who pump (either exclusively or because of work) report overflowing milk in the early weeks, often able to pump 4-6 or even 8-10 ounces in a morning pump session. By 4 months supply regulates and mom gets about 3-5 ounces per pump in place of a feeding. By 9 or 10 months it can feel like your trying to wring out a wet rag to get even 2-4 ounces a pump session. As long as baby has unrestricted access to the breast when your not working and you still have a regular pump routine in place no intervention is usually needed. Every journey is supposed to look different because it is your unique journey.

Photo Credit Jermaine Love
@jermainelove44

One Breast or Two?

- Julie Matheney

SHOULD I OFFER ONE BREAST OR TWO WHEN BREASTFEEDING?

Just as no rule says you must eat the same amount at every meal, there’s no rule that says your baby must eat from both sides every feeding.

  • Factors that play a role in offering one side or two include your individual breast storage capacity, and milk supply, when your last feeding was, and your unique baby’s volume needs.
  • Storage capacity is not indicated by breast size, but by glandular tissue in the breast. People with lots of glandular tissue have a higher storage capacity in each breast regardless of the actual breast size. Their babies may only want one side per feeding as each side makes plenty of milk. Some people have smaller storage capacities and their babies will want to feed off of both sides (maybe even multiple times!) to get what they want.
  • You will get to know your breast storage capacity and how quickly your breasts make milk as you get to know your body and your baby.  Every feeding can also be different. There’s no right or wrong. Sometimes a baby will want both breasts if they’re really hungry and sometimes they’ll want only one when they just want to comfort nurse to sleep. Some times you may feel like you’re offering each breast 5 or 6 times in a feeding, rotating constantly!! NORMAL!!! Trust your baby and your body. You can always offer the second breast/side but don’t feel stressed if your baby doesn’t always want it. 

BREASTS ARE SISTER, NOT TWINS

You may also feel like baby always prefers one side or even does better feeding on one side!! That’s because breasts are sisters and not twins!!!! One side can be bigger, one side can make more. Nipples can even be different shapes and sizes, making one side easier to latch to from purely an anatomical perspective.

  • Around 70% of us produce more milk on the right. Which means 30% make more on the left. 
  • It is VERY common for one side to produce more than the other, often double. This is not a reason to neglect one side. You want to make sure you rotate which side you offer first. This can also cause one breast to be significantly larger than the other especially if you continue to only feed from one side.
  • Babies may prefer one side over the other for various reasons
    • They like to lay with their head in a certain direction
    • They prefer the flow (one side may flow faster or slower than the other)
    • They may prefer the flavor (YES!! Milk can taste different from each side during the same feeding!!)
    • They may have tension in their body from positioning during pregnancy or from trauma during birth.
  • If you want to help balance out a slacker boob, you can try offering the slacker first more often.
  • Ending on the slacker can also help, especially if baby just wants to use you like a pacifier.
  • Pumping the slacker side after feedings can also help stimulate more milk production.

Don’t stress too much about a slacker boob if it’s not an issue. If baby is happy, there’s really no need to fret over differences between your breasts. If you start to notice one side is increasing in cup sizes significantly from the other, schedule a consultation and we can get to the root of why baby only wants one side and we can work on it together.

How Much Breast Milk Does Baby Need?

- Julie Matheney

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.

Pumping for a toddler

- Julie Matheney

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

- 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.

Fact of the Day: Milk Fat: Pump that heavy cream

- Julie Matheney

Human milk changes in its composition throughout lactation as your baby grows and is constantly changing to meet the needs of the baby from the first few days of colostrum to beyond the baby’s second year. The composition of your milk can change  from day today especially as hormones ab and flow with your menstrual cycles. They can change during a given day  based on your stress levels, how often your baby feeds, and how well your baby MDs your breast. But did you know that the composition of your milk can also change during an individual feeding  and from breast to breast?!?!  As the baby eats, protein and fat content rise in the milk. There is actually 4 to 5 times more fat and 1 1/2 times more protein present at the end of the feeding than at the beginning. The baby may consume nearly 18% of their calories between minutes 11 and 16 of a feeding.  The fat content at the beginning of a feeding is around 1% milk fat. By the end of a 15 to 20 minute feeding, the fat content can be as high as 4 to 5%! By comparison, whole milk contains just 3.25 percent milk fat.  Fat content varies from mother to mother and from feeding to feeding. The amount of fat in breastmilk is dependent on the length of time between feedings, the degree of breast fullness, and the length of time the baby sucks at the breast. To put it simply, the emptier the breast, the higher the fat content. The fuller the breast, the lower the fat content. By trying to “stretch” a baby to scheduled feedings actually decreases the fat content in a mothers milk. It is always best to feed baby on demand.