Archive for March, 2010

Is My Baby Getting Enough Milk?

March 23, 2010

Wouldn’t it be nice if your breasts were equipped with little gauges that indicated how much milk was removed when your baby ate? Fortunately there are other ways to measure milk intake when a baby is breastfeeding.

Your baby should eat at least 8 times every 24 hours. If your baby is eating and not just sucking, you will be able to observe swallows. Swallows will be infrequent immediately after birth, but will gradually increase to about 1 swallow per second around day 4 or 5.

It is possible for a baby to be at the breast for long periods of time but not get enough milk to grow. If baby’s suck is ineffective or the latch is incorrect, he may not get enough to eat in a timely fashion. For that reason, it’s very important to watch and listen for swallows when you’re nursing your baby.

Swallows are audible and visible. A swallow sounds like a softly whispered “kuh” as air is released from your baby’s nose. Sometimes there will be an audible “gulp” when milk is gushing into your baby’s mouth. You can see a swallow by watching your baby’s chin. When his chin is moving rapidly up and down your baby is not swallowing. When he pauses and drops his chin down, opening his mouth extra wide, your baby is swallowing.

If your baby is nursing well, he will be happy and vigorous at the breast—sucking and swallowing rhythmically. When he is finished, your breast(s) will feel softer and your newborn will look content and a little drunk.

What goes in, must come out! A baby should have at least as many wet diapers as his age. A 2-day-old baby should have 2 wet diapers, a 3-day-old baby, 3 wet diapers and so on. After day 5 your baby needs at least 6 pees per day. The diaper will feel heavy and the urine will be pale yellow or colorless.

Counting poopy diapers is important as well. Newborn poop is called meconium. It’s sticky and greenish-black. It gradually transitions to breastmilk poop which is yellow and runny with tiny white curds. A well-fed baby will have at least 2 big poops each day after day 4. Don’t be alarmed if your newborn gives you a poop with every feeding. That’s completely normal for breastfed babies.

Finally…trust your instincts! Nature gave you powerful intuition to help you with mothering. If you ever feel unsure that your baby is not feeding well, check with your pediatrician or lactation consultant.


Breastfeeding Myth: Colostrum

March 22, 2010

I hear this almost every day: My baby had to have formula in the hospital because I didn’t have any milk. Or, My baby wanted to breastfeed constantly so the nurse gave him formula.

Way too many healthy newborns are given formula in the first 48 hours after birth. New moms are often told that their baby is “starving” because they “don’t have milk yet.” Unfortunately, frequent feedings are seen as a sign of inadequate milk production instead of a sign of a healthy baby who is learning to breastfeed.

Your body is preparing to breastfeed your baby even before she is born! Around the 5th month of pregnancy, your breasts produce a yellow,/orange nutrient-rich fluid called colostrum. It is available as soon as your baby is born. Colostrum is the perfect first food for premature as well as full-term infants. It is rich in anti-oxidants, minerals and antibodies to protect your baby. It also acts as a laxative—helping baby rid her body of the meconium or first stool.

Right after your baby’s birth, the sudden drop in progesterone tells your body there is a baby to feed and it switches gears to begin producing milk. The transition from colostrum to mature milk is a gradual process. In the 2-3 weeks following delivery, you will notice your milk becoming thinner, less yellow and more “milky.” You will also notice your breasts becoming heavier and your baby gulping noisily as she breastfeeds.

Immediately after birth, however, your baby is not ready for big feedings. Her stomach can only hold 2-3 teaspoons at a time. In addition, she is learning to suck, swallow and breath rhythmically. Colostrum is delivered to her in small amounts. Perfect for the new baby learning to breastfeed.

Your brand new baby may want to breastfeed very frequently—especially the 2nd day of life. Frequent feedings enable her to get many small doses of colostrum and encourage a faster transition to mature milk. As the milk volume increases, your baby will be satisfied longer between feedings.

So tuck your baby in close and forget about anything else that you think you need to do. The frequent contact in the first few days will allow you and your baby to get to know each other. Enjoy! You are learning to dance together.

Breastfeeding Myth: Sore Nipples

March 17, 2010

Myth: It’s normal to have sore, cracked nipples the first few weeks of breastfeeding.

One of the most common reasons women give for not initiating breastfeeding is “I’m afraid that it will hurt.” Breastfeeding is not supposed to hurt! Ever! Think of all the mammals who nurse their babies. Are they grimacing? Are they trying to avoid breastfeeding because of pain? Absolutely not. They look peaceful and relaxed. We are mammals too! Breastfeeding is a normal process that is meant to be enjoyable for mother and baby.

So, what are normal sensations when breastfeeding?

There should be no nipple tenderness at all in the first 24 hours. For the first few days your nipples may feel slightly tender when the baby latches on, but feel fine as the baby continues to nurse. What’s the difference between tenderness and pain? The tenderness is fleeting and mild. It doesn’t make you cry out or gasp. You look forward to breastfeeding. Your nipples look healthy.

Pain, however, often lasts throughout the feeding. You feel tense. You dread breastfeeding because it hurts. You also may find yourself ending the feeding before the baby is finished. Your nipples may look creased or flattened after feedings. There may be bruising. You wonder how long you can continue with this.

When the baby is latched on correctly, you will feel some gentle, rhythmic tugging. Some women feel the milk-ejection reflex (let down). It is often experienced as a tingly sensation around the areola or a mild ache in the breasts. Experienced mothers welcome this feeling–it means baby is getting lots of milk!

If breastfeeding is painful, enlist the help of a lactation consultant. She’ll help you breastfeed comfortably so you can truly enjoy nursing your baby.

See also: “Cures for Sore Nipples”

Breastfeeding and Milk Supply

March 14, 2010

Why do some mothers seem to be overflowing with milk and others barely keep up with their babies? The answer to that questions remains a mystery. We do know, however, which practices enhance milk production and what may decrease milk supply.

Newborns need to eat frequently. All that early suckling before your milk “comes in” helps set the tone for later milk production. Think of as your baby placing an order to be filled at a later date. On the other hand, restricting breastfeeding in the first few days may lead to decreased milk production overall.

You’ve probably heard that milk production is based on supply and demand. That means that the more milk that is removed from your breasts, the more milk you will produce. If more milk is consistently removed from your right breast, your right breast will consistently make more milk than your left. If baby regularly sleeps from 10pm to 4 am, but breastfeeds every 2 hours during the day, you will eventually have less milk in the middle of the night than during the day.

How do your breasts know that your baby is growing and needs more milk? Very simply; the baby asks for it! Your baby will breastfeed more frequently when he needs more milk. After a few days of what may seem to be constant eating, your breasts catch up and all is well. When your baby gets older and doesn’t need to breastfeed as often, your milk supply will naturally decrease.

As long as your baby is gaining weight appropriately, just let your baby be your guide and your milk supply will take care of itself!

See also:  “Can I Increase My Milk Supply?”

Can I Increase my Milk Supply?

March 14, 2010

Do you feel that you are breastfeeding  “all the time”? Does it seem that your baby is never really satisfied at the breast? Is your baby wakeful? Fussy? Sometimes, despite doing all the “right” things, you may find yourself producing less milk than your baby needs. Here are some things you can try:

  • First, check with your lactation consultant or pediatrician to get an accurate weight for your baby. Then you will know if your baby needs some extra nutrition while you are working on your supply.
  • Go to bed with your baby for a whole day and breastfeed and sleep. Arrange for help so that you are not getting up for anything but bathroom breaks. Sometimes getting more rest and a day of unrestricted breastfeeding can give your body a much-needed boost.
  • Try pumping (double) immediately after feeds for 5 minutes or so. The purpose of this is to tell your breasts to make more milk. It’s ok if you don’t actually pump out any milk. But if you do get extra milk, you can offer it to your baby at the next feeding!
  • Eat well! Now is not the time to try to lose weight. Losing more than 1 pound a week may interfere with milk production.
  • Try a bowl of oatmeal every morning. Many mothers have found this delicious intervention helpful.
  • Avoid hormonal birth-control methods. Even the progesterone-only “mini” pill can cause a reduction in milk supply.
  • If you’re back at work, try adding an extra pumping session during the day.
  • Discuss the issue with a lactation consultant. There are herbs and prescription medications that can help with milk supply but you need professional guidance. There is a possibility of side effects and incompatibility with just about anything!
  • If your milk supply is truly inadequate for your baby’s needs, be sure to supplement as necessary with human milk or formula. Aside from normal weight loss in the first few days of life, it is never OK for a baby to lose weight. See your health care provider or a lactation consultant for guidance on supplementation.

See also: “Breastfeeding and Milk Supply.”

Hidden Hazards of Nipple Shields

March 12, 2010

As I’ve stated many times to anyone who will listen,  nipple shields can be helpful if a baby is having trouble breastfeeding. In the wrong hands, however, they can be downright dangerous. Just today I saw 2 moms who were given nipple shields in the hospital within 48 hours of their babies’ birth.  Their 2 stories had very different outcomes.

Story number 1:  Three -week- old baby. Mom given nipple shield day 2 because baby was having a hard time latching. Baby was able to latch with the shield, but he nursed for 45 minutes to an hour each feeding and never seemed satisfied. Things seemed to go OK the first week, but at a routine check-up 2 weeks later, baby hadn’t gained any weight. The pediatrician told mom to start supplementing immediately and referred her to me. I saw her the next day.

After a little guidance, baby latched on to the breast easily and nursed well. Mom’s milk supply is very low, of course, since baby was not transferring milk well with the nipple shield. Now this mom has quite a bit of work ahead to increase her milk supply. In the meantime, this baby will need to be supplemented with formula.

Story number 2:  Three- day- old baby. Mom was given a nipple shield after the very first attempt at breastfeeding because her baby’s latch was incorrect and her nipple felt pinched. Fortunately, this mom had arranged to see me prior to her son’s birth and I consulted with her in her home.   The baby latched easily after I showed his mom how to help him find the breast. He breastfed happily while his parents watched in awe—surprised that he could do so well without the nipple shield. Mom was absolutely comfortable and delighted that breastfeeding did not hurt!

Story number 2 turned out well. It likely would have had a very different ending, however, if this mom had continued to use the nipple shield.

The lactation consultants who dispensed the nipple shields (2 different hospitals, by the way!) did not attempt to correct the underlying problem BEFORE resorting to plastic.  In addition, they did not teach the moms how to assess the babies’ effectiveness using the shield while breastfeeding. Finally, there was no follow -up offered or suggested to ensure that either of the babies were transferring enough milk to gain weight.

I wish these 2 stories were isolated incidences. They are not. I see more or less the same scenario several times a week. So how can you avoid this very common problem?

  • Know that your baby was born to breastfeed!
  • Avoid nipple shields in the first 24 hours.
  • If you’re having trouble breastfeeding, insist on getting help. If the hospital cannot provide you with timely, knowledgeable, REAL help, ask a nurse for a referral to a private lactation consultant.
  • If you decide to use a nipple shield, make sure someone in the hospital evaluates an entire feeding with you to help you feel confident.
  • Arrange for a lactation consultant visit and a baby weight check as soon as possible after leaving the hospital.

What is a Nipple Shield?

March 10, 2010

Nipples shields are molded silicone “nipples” that fit over a natural nipple. They look a bit like a sombrero, and the rim or base of the shield extends out about an inch to adhere to the breast. There are usually 4 holes in the nipple that mom’s milk can flow through. They are very thin and made in several sizes and styles. They are designed so that baby can latch on to the shield and get milk from mom.

So why on earth would anyone want to use a plastic nipple?

Nipples shields can be helpful when a baby is unable to form a strong vacuum at the natural breast. Sometimes, if baby’s tongue is not doing what it should, a nipple shield can enable a baby to breastfeed who otherwise would need to be bottle fed.

Nipple shields are also commonly used when a baby has nursed incorrectly and caused nipple soreness. A shield can make breastfeeding more comfortable while mom and baby learn to breastfeed comfortably.

Always seek guidance from an experienced lactation consultant before considering the use of a nipple shield. Improper use can lead to inadequate milk intake and subsequent weight loss, which, in turn could lead to a decrease in your milk supply.

Whether to alleviate soreness, or to help a baby who is learning to suck properly, a nipple shield is a temporary fix. Your lactation consultant should provide you with a detailed plan for the use of the shield and when and how to discontinue its use. When your baby is ready, he will breastfeed happily and comfortably without it!

Renee Beebe, M.Ed., IBCLC

Can I Meet with a Lactation Consultant While I’m Pregnant?

March 4, 2010

Many lactation consultants are happy to meet with you prior to your baby’s birth to help prevent problems. It can be very helpful to establish a relationship with someone before a situation is urgent and you’re feeling stressed. These prenatal meetings are particularly helpful under the following circumstances.

  1. You were unable to breastfeed your first baby. Perhaps you felt you didn’t have enough milk, or breastfeeding was painful. Or maybe you breastfed a previous baby but it was not enjoyable.
  2. You want a private, individualized breastfeeding class.
  3. You have had any trauma or surgery on your breasts or chest—including augmentation or reduction.
  4. Your breasts are very different from each other in size and/or shape. Breasts are never absolutely identical, but marked assymetry can indicate an underlying problem.
  5. You are expecting a baby who may have special challenges.
  6. You are expecting twins or more!
  7. You have a medical situation or injury that may require creativity when positioning yourself and baby for breastfeeding.
  8. You were unable to get pregnant naturally—needing help with fertility
  9. You have endocrine problems such as hypo- or hyper thyroid or diabetes.
  10. You are taking medication that you’re concerned about continuing while breastfeeding.

Ten Reasons to Call a Lactation Consultant

March 4, 2010

Breastfeeding should be enjoyable for you and your baby! If either one of you is not having a good time, something is not right. As a new mom, you have instincts to guide you. Your baby has instincts and very strong reflexes to guide him. But neither one of you has ever done this before and, most likely, you have never seen a baby breastfeeding. It’s likely you will need some help.

Contact a lactation consultant immediately if you experience any of the following:

  1. Any nipple pain in the first 24 hours after birth. Breastfeeding is not supposed to hurt—ever! Listen to your body. It’s telling you that something is very wrong!
  2. Bleeding, cracked or bruised nipples that are not feeling and looking better every day.
  3. Inadequate weight gain or inadequate wet/dirty diapers at any time.
  4. Baby cannot latch on to the breast or seems to latch on but “falls off” after a short time.
  5. You have difficulty getting the baby to “latch.”
  6. Baby is at the breast for long periods of times (over 45 minutes of continuous nursing) after day 2 or wants to go to the breast very frequently (every hour or less).
  7. Baby does not seemed satisfied after feedings.
  8. Baby stays on the breast for a very short period of time (less than 5 minutes) or is not interested in feeding at least every 3 hours.
  9. Redness, pain or severe swelling in the breast.
  10. You have twins or more.

If you are in need of a lactation consultant,  you may use the form below to get help.

See also: “Why do we Need Lactation Consultants?”

What is a Lactation Consultant?

March 4, 2010

Breastfeeding is a normal, biological process for babies and moms. It is not a “condition” that requires medical training. Your doctor helps you with medical concerns. A lactation consultant will help you with breastfeeding. Lactation consultants may work in hospitals, clinics or may come to your home.

A lactation consultant is a skilled healthcare professional who specializes in the science of human lactation (breastfeeding), and in the assessment of breastfeeding women and their babies. Lactation consultants come from a variety of professional backgrounds. To ensure that a consultant has the minimum competencies recognized in the field, see an International Board Certified Lactation Consultant (IBCLC). “Breastfeeding specialists” or “lactation educators” have not met those minimum competencies.

A lactation consultant must be certified by the International Board of Lactation Consultant Examiners (IBLCE). IBLCE requires several hundred hours of hands-on experience and classroom education before a candidate is permitted to sit for the certifying exam. The exam is offered once a year all over the world. When certified, the lactation consultant must maintain her credential with continuing education and periodic exams.

The credential of IBCLC stands alone. That means that an IBCLC with a PhD is not necessarily better than an IBCLC with a bachelor’s degree. When selecting a lactation consultant, however, feel free to ask about her experience and qualifications! It’s important to trust the person who will be helping you to begin your breastfeeding journey.

See also:  “Why do we Need Lactation Consultants?”

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