Caffeine and Breast Milk

Caffeine is safe to take while breastfeeding in moderation (up to 300mg per day). Only about 1.5% actually enters breast milk. Caffeine enters your bloodstream about 15 minutes. It peaks in your blood within 60 minutes and has a half-life of 3-5 hours. The half-life is the time it takes for your body to eliminate half of the drug. The remaining caffeine can stay in your body for a long time. The half-life of caffeine is about 97.5 hours in a newborn, 14 hours in a 3-5 month old baby and 3-5 hours in a baby older than 6 months. Because caffeine takes much longer to clear out of a young baby’s system it is possible that high caffeine intake can make a baby irritable. If baby is sensitive to the caffeine now, they may not be when they’re older. Cut caffeine now and try again in a few months.

So if you drink a cup of coffee with 100mg of caffeine at 7am, you’ll have 50mg of caffeine in your bloodstream at 10am. Your baby would get 1.5mg of caffeine.

Every baby is different in how they react to caffeine. If you drank coffee while pregnant, your baby had an IV of caffeine (called the umbilical cord) and is already used to having it in their blood stream. If you didn’t drink coffee or switched to decaf, your baby may have a more noticeable reaction when you drink coffee. When drinking coffee after birth, go low and slow. There’s nothing you can do to decrease caffeine in your system except time. Start with a very small cup first thing in the morning and see how your baby reacts. Drinking your morning cup of coffee while your breastfeeding gives you the most time for the caffeine to peak and start decreasing before your next feeding.

You are what you eat, and so is your baby

Did you know that not only do the volumes of milk produced by the left and right breast differ, the milk made in the left breast can also taste different than that made in the right… during the same feeding!!

What you eat used to change the flavor of your amniotic fluid, exposing baby when they were a fetus to the profile of your diet, preparing them for the flavors they would later experience in your breast milk. Eating a wide variety in your diet while you’re pregnant and breastfeeding exposes your little one to a wide variety of flavors, getting them used to the spices, herbs and tastes of food they will be given when they start table food eaten by your family. The more of a particular food you eat, research says, the better the chance your baby will also like to eat that food.

Eating allergenic foods during pregnancy also protects baby from food allergies, especially if you continue to eat them while breastfeeding suggests new research. So far, there is no evidence that avoiding certain foods while breastfeeding helps prevent baby from developing allergies or asthma. The exception to that might be eczema: avoiding certain foods may reduce the risk of eczema. Allergy studies are challenging because of many factors, including food introduction, genetics, and maternal diet. Most studies conclude that exclusive breastfeeding (even as little as one month) lessens how often some allergies occur. Evidence also suggests that exclusive breastfeeding during the first four months may offer protection against certain types of allergic diseases including cow’s milk allergy and atopic dermatitis. So while oatmeal 24/7 may help increase your milk supply, switch it up for baby’s sake (and yours!!)

Cluster feeding

CLUSTER FEEDING. Two words when paired together that drive fear and trembling to parents. Cluster feeding is NORMAL for ALL breastfed babies. It has nothing to do with your supply. It has nothing to do with the clock. It has nothing to do with what you’re eating or drinking or those supplements you just took. It may not even have anything to even do with being hungry. Babies typically cluster feed in the afternoon/evening. When your milk supply naturally and appropriately dips. When your milk is a smaller water concentration with a higher fat content. As long as baby is happy to feed the rest of the day, is making plenty of wet and dirty diapers, is content and sleeping routinely between feedings, and gaining weight over time, DON’T BLAME THE BOOB!! Even if baby seems like they want to feed constantly. Cluster feeding is normal. It typically happens MORE when baby is going through a growth spurt (body growing), developmental leap (mind/skills growing), or teething/illness. Why does baby want the breast more?

• Preparing for a longer sleep: Some babies just prefer to fill up on milk for a few hours before a longer sleep.

• Milk flow is slower at night: Some babies nurse longer to fill up due to the slower flow.

• A growth spurt: they usually occur around 3, 6, and 8weeks of age.

• They need of comfort. Breast milk has hormones to develop baby’s circadian rhythm. At nighttime baby may just seek comfort to help them sleep.

• Developmental leap: Mental and emotional growth spurts when they acquire new skills.

• Baby is sick, thirsty, or teething: breast feeding is a pain reliever, medicine and hydration all in one

Know that it’s normal. Be patient through the process. Be prepared with snacks and water for yourself, a comfy spot, a good pillow for support and the remote and your phone charger close by to get you through. You’re not alone and it doesn’t last forever!!

Best Parenting Advice

Put them in water or take them outside. This is the best parenting advice I’ve ever been given. When breastfeeding has been established (baby is making good wet and dirty diapers, generally pain free latch, and gaining weight), there will be times when baby will be super fussy and refuse the boob. Many misinterpret this as having low milk supply or something wrong with the breast. Don’t be so quick to blame yourself or to supplement with a bottle. I guarantee you there will be times when you have no idea what to do to stop your baby from crying. The boob won’t work. Changing the diaper won’t work. Burping and rocking and shushing won’t work. I guarantee you there will be times when you will cry right along with your baby and feel helpless to soothe them (or yourself).

When the breast doesn’t work: put them in water or take them outside. It works. When your baby is falling to pieces for no apparent reason and the usual tricks don’t work, go outside or get in water. It works on adults, too!!

What do my Labor and Delivery have to do with breastfeeding?

All babies are born with innate instincts and reflex to get them to the breast soon after birth. Every baby, when placed skin to skin on their mother immediately after birth, will do the breast crawl and have a first latch within approximately 60 minutes of delivery, even medicated or c-section births. In the first 24 hours, babies are often sleepy. Waking for brief periods to feed and go back to sleep. The second day (and usually the second night) is when babies make up for the first day after delivery, ravenously cluster feeding for hours, much to the dismay of now extremely fatigued parents. But your labor has more of an impact on breastfeeding than you may realize.



We learning and understanding how our bodies prepare for breastfeeding during pregnancy, how what happens during labor and birth sets the stage for breastfeeding, and how the first minutes and hours after birth can have a lasting impact on the entire breastfeeding journey. The way baby is born  powerfully influences the first hours and days of breastfeeding. Unmedicated, vaginal birth sets the stage for problem-free breastfeeding, where biology, instinct and reflex can take center stage. In contrast, a complicated, intervention-intensive labor and birth increases the risk of problems.

How long you labor is really out of your control. The length of your labor may actually increase breastfeeding difficulty. For really long labors (over 24 hours), pushing for 4 hours or more, or very intense short labors, both you and baby may be so exhausted that rest and recovery take precedence over breastfeeding. Baby may be too tired to breastfeed often in the first few days, which increases your risk of not stimulating the breast well which in turn delays colostrum transitioning to mature milk and can decrease the overall volume your breast may be able to make in the future. Long, medically intervened labors also usually mean increased bags of IV fluids, which can cause excess fluid in your body which in turn delays the transition of colostrum to mature milk up to 10-12 days. It can also cause your hand, feet, and breasts to swell with extra fluid, called third spacing, which can make latching baby a challenge. (See my videos on Instagram about reverse pressure softening for help with this).

Events surrounding birth can inadvertently sabotage breastfeeding, as birth is supposed to be a well orchestrated series of events and hormone releases, setting you up for successful breastfeeding. Many of the birthing practices that are considered almost routine (induction, epidurals, separation of the mother and her baby for cleaning, weighing and foot printing) interfere with this hormonal dance resulting in poorer breastfeeding outcomes.

The routine progression of hormonal changes during  labor and birth perfectly prepares the body to breastfeed immediately after birth. During labor, oxytocin surges are responsible for increasingly stronger and more effective contractions. As oxytocin goes up, and the pain that accompanies the strong contractions increases, endorphins are released. High levels of endorphins help you cope with painful contractions and contribute to their becoming more instinctive. As the baby moves down the birth canal, almost ready to be born, catecholamines are released. The surge in catecholamines creates an energy boost and allows the baby is born with high levels of catecholamines as well (; ). This results in a vigorous, alert baby and an energized mother ready to breastfeed for the first time.

 

Skin to skin contact immediately after birth helps these same hormones continue to work in preparation of the first breastfeeding moment. Baby’s body weight on mom’s uterus, baby hand and head movements on her body, and then baby sucking at the breast stimulate even more oxytocin release (). Oxytocin helps the placenta separate and contracts the uterus further, preventing excessive bleeding. After birth, high levels of catecholamine in the baby insure alertness for the breast crawl and first latch. The endorphins present in mom pass on to baby through her breast milk, helping the baby stay calm and relaxed. After the first feeding, these hormones peak and allow both mother and baby 

Prolactin and oxytocin, the. milk making hormones, are released by baby’s sucking at the breast. Prolactin makes milk and oxytocin causes your letdown or release of milk. Prolactin, AKA “the love hormone”, is responsible for nurturing behaviors. Oxytocin makes you feel relaxed, sleepy, or calm feelings during milk letdown. 

All Labor pain-relief drugs have been shown to delay the onset of milk production and increase the risk of breastfeeding difficulties. This was well documented in a 2014 study by Lind et al. Pitocin, unlike naturally occurring oxytocin, does not cross the blood/brain barrier. As a result, the pituitary is not stimulated to release endorphins. Without the pain-relieving help of abundant endorphins, people who are induced with pitocin are more likely to require epidurals. In a vicious cycle, whenever an epidural is given and all pain is removed, naturally occurring oxytocin levels drop, requiring increased amounts of pitocin to continue contractions (Lieberman & O’Donoghue, 2002). Without the high levels of oxytocin and endorphins that would normally be released, a surge in catecholamines does not occur immediately before birth. This hormonal disruption during labor results in women giving birth with relatively low levels of naturally occurring oxytocin, endorphins, and catecholamines. Consequently, the outcome of low hormonal levels is a less responsive mother and baby which in turn impacts vigor at the breast ().

The medication used in the epidural does, in fact, “get to the baby.” Epidural narcotics or anesthetic drugs cross the placenta and can be found in cord blood. More research is needed, but we are starting to learn the neurobehavioral effects of medicated deliveries. Babies exposed to epidurals have a higher risk of have difficulty with latching on and an uncoordinated suck/swallow response for hours or days after birth (; ). Epidurals are also documented to lengthen the second stage of Labor and increase the likelihood of needing a C-section. The trauma of c-section birth, versus the natural positioning of coming through the birth canal, can make it painful for baby to assume the natural, instinctive positioning for breastfeeding and can make it difficult to latch. 

Elective induction of labor is also a risk to breastfeeding because of the potential of added intervention and the increased likelihood of the baby being born prematurely. The more premature a baby is, even at 37-38 weeks, the more immature and uncoordinated sucking and swallowing can be. Babies practice the coordination of sucking and swallowing in utero without expiation to feed, so the longer they are able to practice in utero, the more coordinated and ready they are to feed at birth.

So now what? You’ve had the baby and had a long, medicated delivery. Knowledge is power. You cannot change your birth story, but you can influence your breastfeeding journey.

  • Keep baby in skin to skin contact as long dn often as possible to help restore your oxytocin levels. Every 60 minutes 1-2x/day has been found to exponentially increase milk supply
  • Offer the breast frequent and often. Work on getting baby into a good position to ensure a deep latch
  • If you are separated from your baby or baby is super sleepy, hand express and/or start pumping. You will want to hand express or pump every 2-3 hours during the day and every 3-4 hours at night. You will get more colostrum from hand expression than pumping int he first three days, but pumping will help stimulate the nipples. Don’t be discouraged if you see little milk from a pump. The stimulation is needed until baby is able to latch
  • Stay hydrated and eat good foods full of protein
  • Use a paced bottle feeding technique and try not to over feed baby if you need to supplement. Always supplement with your own milk first, followed by formula. Babies need very little milk in the first 3 days.
  • Find lactation help as soon as possible to help create a plan to get breastfeeding back on track
  • Anderson G, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). 2003. In The Cochrane Library, 3. Oxford: John Wiley. [PubMed]
  • Baumgarder D. J, Muehl P, Fischer M, Pribbenow B. Effect of labor epidural anesthesia on breastfeeding on healthy full-term newborns delivered vaginally. Journal of the American Board of Family Practitioners. 2003;16(1):7–13. [PubMed] [Google Scholar]
  • Declercq E. R, Sakala C, Corry M. P, Applebaum S, Risher P. 2002. Listening to mothers: The first national U.S. survey of women’s childbearing experiences. New York: Maternity Center Association. Also, retrieved December 13, 2004, from  www.maternitywise.org/listeningtomothers. [Google Scholar]
  • Kroeger M, Smith L. J. 2004. Impact of birthing practices on breastfeeding: Protecting the mother and baby continuum. Sudbury, MA: Jones and Bartlett Publishers. [Google Scholar]
  • Lamaze International. 2003. Promoting, protecting, and supporting normal birth: Six care practices. Washington, DC: Author. Also, retrieved December 13, 2004, from www.lamaze.org/about/policy.asp and  http://normalbirth.lamaze.org/institute/default.asp. [Google Scholar]
  • Lamaze International. Six care practices that promote, protect, and support normal birth [entire issue]. Journal of Perinatal Education. 2004;13(2) [Google Scholar]
  • Lieberman E, O’Donoghue C. Unintended effects of epidural analgesia during labor: A systematic review. American Journal of Obstetrics and Gynecology. 2003;186(5):s31–68. [PubMed] [Google Scholar]
  • Matthiesen A. S, Ransjo-Arvidson A. B, Nissen E, Uvnas-Moberg K. Postpartum maternal oxytocin release by newborns: Effects of infant hand massage and sucking. Birth. 2001;28(1):13–19.[PubMed] [Google Scholar]
  • Newton N. The fetus ejection reflex revisited. Birth. 1987;14(2):106–108. [PubMed] [Google Scholar]
  • Odent M. 2003. Birth and breastfeeding: Rediscovering the needs of women during pregnancy and childbirth. East Sussex, England: Clairview Books. [Google Scholar]
  • Ransjo-Arvidson A. B, Matthiesen S, Lilja G, Nissen E, Widstrom A. M, Uvnas-Moberg K. Maternal analgesia during labor disturbs newborn behavior. Effects on breastfeeding, temperature, and crying. Birth. 2001;28(1):5–12. [PubMed] [Google Scholar]
  • Righard L, Alade M. Effect of delivery room routines on success of first breastfeed. Lancet. 1990;336:1105–1107. [PubMed] [Google Scholar]
  • U.S. Department of Health and Human Services & The Advertising Council. Breastfeeding awareness. 2003. Retrieved December 13, 2004, from http://www.adcouncil.org/campaigns/breastfeeding/
  • Uvnas-Mobert K. 2003. The oxytocin factor: Tapping the hormone of calm, love and healing. Cambridge, MA: Da Capa Press. [Google Scholar]