Persistent Pain and Breastfeeding

by | Apr 19, 2023 | Breastfeeding, Mom, Baby & Family, Tongue Tie

Sometimes breastfeeding is uncomfortable for the first week or so. This mild tenderness happens only at the beginning of a feeding and subsides as the nursing session continues. It usually resolves without treatment after the second week. Being especially careful with positioning and latch during this time can keep a mom from experiencing blisters or cracks on the nipple, which can be quite painful and can prolong the healing time needed before breastfeeding is pain-free.

Pain beyond the first two weeks, or pain in those first weeks that is severe or is causing nipple damage, is not normal and should be thoroughly investigated by a lactation consultant. Pain lasting longer than two weeks is considered persistent pain. Researchers have found that women with persistent pain wean earlier than those who breastfeed pain-free. When mothers stop breastfeeding in the first month, around one-third say pain or nipple damage is the reason (Berens, et al, 2016). Even when mothers get professional support, almost half still have persistent pain (Lucas, et al, 2019).

What could be causing the persistent pain in breastfeeding?

● Unresolved engorgement

● Oversupply

● Plugged duct

● Mastitis

● Breast abscess

● Improper positioning or latch

● Ankyloglossia (tongue-tie)

● Flat or inverted nipple

● Nipple bleb

● Bacterial infection

● Fungal infection (thrush)

● Dermatitis

● Vasospasm

● Poor pump fit

● Functional pain

● Myofascial pain

Listening to women and taking their pain seriously is one easy step lactation professionals can take to meet women where they are and help them move forward to a better breastfeeding experience.

For mothers and lactation consultants alike, finding the root cause for persistent pain can be trial and error. And it can take a while, which is often discouraging. Typically it starts with making sure the baby is positioned well, has a good latch, and does not have any oral anomalies that would cause nipple damage. If none of these adjustments help, exploring whether the pain is localized to the nipple and areola, or if it’s breast pain, would be the next step. Are there lumps, blisters, rashes, discoloration, or areas of broken skin? What has the breastfeeding mother done to self-treat (such as ointments, pumping, etc)? If she’s pumping, does the breast flange fit properly and are all the parts in working order? Answering these questions will help to narrow down the possible source for the pain.

Two tools for lactation consultants can really help with this. The first is the Academy of Breastfeeding Medicine (ABM) Protocol #26: Persistent pain with breastfeeding, which has a detailed outline for patient history and examination that can be an aid to sorting symptoms. The protocol then follows with descriptions of the possible causes and treatments. It’s available in English as well as six translations, and can be freely accessed online.

The second tool is a collection of algorithms put together by the University of North Carolina Lactation Program. This design is set up for use by healthcare providers in asking the right questions to get to the right diagnosis. But it’s certainly something a breastfeeding parent can look at, too, to get an idea of what might be causing the pain, especially if she doesn’t have easy access to a trained lactation professional.

Women’s experiences of painful breastfeeding need to be investigated further so quick diagnosis can be made and treatment started before weaning occurs. Women shouldn’t have to suffer through pain to provide their babies with breastmilk. Because pain is one of the top reasons for premature weaning, understanding how women perceive that pain and the act of breastfeeding cessation can help to tailor tools to individuals as well as to the whole population of nursing mothers.

Because cognitive behavioral techniques work to help manage pain in other areas of women’s health, Lucas, et al (2019) believe these can be adapted to decrease the number of women experience persistent pain and increase the number of babies who breastfeed longer. In their pilot testing of a Breastfeeding Self-Management (BSM) tool, they used smartphones and text-based communication to provide support and education about common breastfeeding challenges, including persistent pain. Results of their trial showed that the treatment group had significantly less pain at all points in the study compared to the control group.

Painful breastfeeding is often met with surprise – women aren’t expecting it to hurt as much as it does sometimes. And weaning due to pain is often accompanied by feelings of guilt and regret (Jackson, Mantler & O’Keefe-McCarthy, 2019). One of the biggest hurdles is that pain is subjective – what might be mildly annoying to one mom is excruciating to another. Listening to women and taking their pain seriously is one easy step lactation professionals can take to meet women where they are and help them move forward to a better breastfeeding experience. Successful breastfeeding often carries over into confidence with mothering, something all women deserve.

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!

Subscribe to Diva Diaries, to get more helpful, current, evidence-based breastfeeding resources.

References

Berens, P., Eglash, A., Malloy, M., Steube, A. M., & Academy of Breastfeeding Medicine. (2016). ABM Clinical Protocol# 26: Persistent pain with breastfeeding. Breastfeeding Medicine, 11(2), 46-53.

Berens, P. D. (2015). Breast pain: engorgement, nipple pain, and mastitis. Clinical obstetrics and gynecology, 58(4), 902-914.

Jackson, K. T., Mantler, T., & O’Keefe-McCarthy, S. (2019). Women’s Experiences of Breastfeeding-Related Pain. MCN: The American Journal of Maternal/Child Nursing, 44(2), 66-72.

Kent, J., Ashton, E., Hardwick, C., Rowan, M., Chia, E., Fairclough, K., … & Geddes, D. (2015). Nipple pain in breastfeeding mothers: incidence, causes and treatments. International journal of environmental research and public health, 12(10), 12247-12263

Balancing Breastfeeding and Medical Procedures

by | Apr 19, 2023 | Bottle Feeding, Breastfeeding, Mom, Baby & Family, Pumping

When mother or baby is experiencing illness, it can be scary for everyone. If mom is the sole source of baby’s food, it can be even more stressful for them to be separated. If you’re breastfeeding and need to have a medical procedure, can you continue or do you need to pump? Or, if your baby needs to have surgery, can you keep breastfeeding? Here are the answers to the most common questions:

I NEED AN MRI. IS THE CONTRAST DYE SAFE WHEN BREASTFEEDING?

Whether it’s an MRI or other radiologic scan, sometimes a contrast dye is needed to get a good image of the way the body’s functioning. It’s important to know exactly what contrast agent the radiologist will use; but, for the most part, these are safe if you’re breastfeeding. There is no need to pump or to wean for any length of time. Often, these same substances are used with infants who need radiographic imaging, and the dose through breastmilk would be less than the baby would get directly. According to the most recent guidelines from the American College of Radiology, most iodinated and gadolinium-based contrasts are transferred to breastmilk in very small amounts. Their recommendation: “we believe that the available data suggest that it is safe for the mother and infant to continue breast-feeding after receiving such an agent.” Kay Hoover has an excellent handout in her Clinical Lactation article that can be shared with your healthcare provider or individual contrast agents can be searched on the LactMed database if you or your doctor need more information.

I NEED A DENTAL X-RAY OR SURGERY. CAN I HAVE IT DONE IF I’M BREASTFEEDING?

Many times moms need to put off dental treatment during pregnancy, but want to have it done once the baby arrives. Or maybe you’re a mom who doesn’t miss her cleaning appointments every 6 months. Whether you’re just there for hygiene or you need dental work done, you can rest assured that it’s fine if you’re breastfeeding. Dental x-rays prove no hazard to your milk or your supply. There is no evidence of harm when it comes to inserting or replacing fillings. Local anesthetics, like lidocaine or bupivacaine, don’t require interruption in feeding as they transfer to breastmilk in very small amounts. Even intravenous sedation for tooth extraction or other procedures does not require you to stop breastfeeding. If you require antibiotics or pain medication after the procedure, one compatible with breastfeeding can be prescribed. There isn’t really any research about tooth whitening agents in relation to breastfeeding, but it’s unlikely the ingredients would be cause problems.

DO I NEED TO PUMP AND DUMP IF I’M HAVING SURGERY?

In general, breastfeeding may need to be interrupted briefly if you need to have surgery, but this depends on a number of factors. It’s unlikely that you would need to wean completely, and the interruption is often short. You will need to pump enough milk ahead of time so that your baby has something to eat while you’re in surgery or recovery, unless you plan to supplement with formula or your older baby is already eating solids and won’t need to nurse during the time of the procedure.

Experts recommend that a mother can resume breastfeeding as soon as she is “awake, alert and able to hold her infant” (Cobb et al, 2015) even with general anesthesia. You will need to have someone with you who can care for the baby apart from feedings, and you will need to observe your baby for any behavioral changes. Concerns about post-operative pain medications or antibiotics may also present challenges. Most often a drug compatible with breastfeeding can be found.  This is wonderful resource to help preserve your precious breastmilk – Dump the Pump and Dump

MY BABY NEEDS TO HAVE SURGERY. CAN I STILL BREASTFEED THEM?

Whether your infant is 2-days-, 2-weeks- or 2-years-old, the prospect of surgery for your precious little one is fraught with emotion. Whether your baby can continue to breastfeed before the procedure will sometimes depend on whether they will be sedated, will receive a local anesthetic, or will be under general anesthesia. If your doctor has recommended your baby fast before the procedure, according to the Academy of Breastfeeding Medicine, the last breastfeeding session should be 4 hours before surgery. This will help to keep their systems stable but also prevent complications related to possibly vomiting during surgery. So you may need to miss a feeding or two at the breast – plan to pump at these times and save that milk for your baby. Once your baby is in recovery and awake enough or cleared to take clear fluids, breastfeeding can resume. Keep in mind your baby might not feel up to it right away, so plan to provide plenty of closeness and cuddles during this transition. Your baby’s doctor will let you know if a longer post-procedure time is needed – some surgeries might require baby to take nothing orally for a longer stretch as they recover.

With these concerns, or any others, it’s always best to work with your healthcare provider or surgeon, as well as your baby’s doctor. Keep in mind, though, they may not have much background in lactation. Do the research and share resources with them – we’ve provided links to the most important ones below. Look up specific drugs on LactMed. Don’t be afraid to ask questions and keep asking until you get a satisfactory answer. A lactation consultant, like Milk Diva Lactation Services, can be a helpful advocate to have on your team during this time. If breastfeeding really needs to be interrupted, she can help you come up with a plan for maintaining your supply and being sure baby gets what they need. Most importantly, keep the main goal in mind – providing for your baby while keeping them safe.

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!

Subscribe to Diva Diaries, to get more helpful, current, evidence-based breastfeeding resources.

References:

Academy of Breastfeeding Medicine. (2012). ABM Clinical Protocol #25. recommendations for preprocedural fasting for the breastfed infant: “NPO” guidelines. Breastfeeding Medicine, 7(3), 197-202.https://www.liebertpub.com/doi/pdf/10.1089/bfm.2012.9988

Children’s Hospital of Philadelphia. Surgery and the breastfeeding infant. Accessed online 07/18/2019. https://www.chop.edu/conditions-diseases/surgery-and-breastfeeding-infant

Cobb, B., Liu, R., Valentine, E., & Onuoha, O. (2015). Breastfeeding after anesthesia: a review for anesthesia providers regarding the transfer of medications into breast milk. Translational perioperative and pain medicine, 1(2), 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582419/

Cohan, R., Dillman, J. R., Hartman, R. P., Jafri, S. Z., Wang, C. K., & Newhouse, J. H. (2018). American College of Radiology Manual on Contrast Media. American College of Radiology. Version 10.3. pp 99-100. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf#page=82

Hoover, K. (2011). Breastfeeding and the Use of Contrast Dyes for Maternal Tests. Clinical Lactation, 2(2), 31-32. https://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00011#

La Leche League International. Anesthesia. Accessed online 07/18/2019. https://www.llli.org/breastfeeding-info/anesthesia/

Newman, J. (2007). Breastfeeding and radiologic procedures. Canadian family physician, 53(4), 630-631. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1952588/

Puac, P., Rodríguez, A., Vallejo, C., Zamora, C. A., & Castillo, M. (2017). Safety of contrast material use during pregnancy and lactation. Magnetic Resonance Imaging Clinics, 25(4), 787-797. https://www.infantrisk.com/blog/safety-%C2%A0contrast-material%C2%A0use-during-pregnancy-and-lactation

Reece-Stremtan, S., Campos, M., Kokajko, L., & Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol# 15: analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeeding Medicine, 12(9), 500-506. https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/15-analgesia-and-anesthesia-protocol-english.pdf

Sachs, H. C. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics, 132(3), e796-e809. https://pediatrics.aappublications.org/content/132/3/e796

Woods, RG. (1997). Dental implications: Drug distribution in human milk. Aust Prescr, 20, 12. https://www.nps.org.au/australian-prescriber/articles/drug-distribution-in-human-milk

Breastfeeding and Alcohol Use, Breastfeeding and Antidepressants, and Co-Sleeping

by | Apr 19, 2023 | Breastfeeding, Mom, Baby & Family, Nutrition, Pumping

The topic of breastfeeding can seem like a sea of endless questions with differing answers. Lately, I’ve been getting some repeated questions about issues apart from basic breastfeeding management that I thought I’d share here.

Alcohol: when do I have to stop pumping and dumping?

According to experts, drinking in moderation is compatible with breastfeeding. The AAP says, “Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk.” Because alcohol moves in and out of your breast milk just as it does in your bloodstream, if you don’t feel drunk, then there’s not enough alcohol in your breastmilk to adversely affect your baby. If you are feeling tipsy, pumping won’t eliminate the alcohol from your milk any faster – only time can do that. For one drink, that’s about two hours (depending on your weight and whether you’re eating with your beverage). If you’re interested in more detailed times until the zero alcohol level in breastmilk based on maternal weight and number of drinks, this study has a handy chart.

If you don’t feel drunk, then there’s not enough alcohol in your breastmilk to adversely affect your baby.

If you have had enough drinks to feel intoxicated, you shouldn’t breastfeed until you feel sober. In the meantime, you may miss a feeding or two (depending on how much you’ve had to drink) and your breasts may get engorged. You should pump if this is the case in order to maintain your milk supply. Once the milk is out of your body, though, your liver isn’t helping to metabolize the alcohol anymore. So, it’s best to dump it and not save it to feed to your baby. If you know ahead of time that you will be drinking to excess, you may want to pump in the days leading up to your event so your baby has some breastmilk to drink while you’re unavailable.

What if you’re hungover the next day? As long as you’re no longer drunk, it’s safe to breastfeed. Even if you feel nauseous or are vomiting, it’s still safe to breastfeed. Just be sure you are staying hydrated and getting some rest. If you still feel a little tipsy, be sure to offer your baby milk you pumped beforehand (or formula, if necessary) instead of nursing.

Should I breastfeed if I’m on antidepressants?

Breastfeeding and postpartum mood disorders are sometimes complicated. They’re kind of a chicken / egg problem – which came first, the depression or the feeding difficulties? If breastfeeding is going well, then continuing to breastfeed may be the best thing you can do to help. But if breastfeeding difficulties are piling up, it could make your depression or anxiety worse.

If you are suffering from postpartum depression, anxiety, post traumatic stress, OCD, bipolar or more, the best thing to do is seek treatment. While interpersonal therapy is likely an important part of your treatment, a pharmaceutical may be necessary, too. Many times, a drug compatible with breastfeeding can be prescribed. For depression and anxiety, the most commonly prescribed antidepressants are usually SSRIs and these seem most compatible with breastfeeding. In their review article, Kathleen Kendall-Tackett, an expert in the field of breastfeeding and mental health, and Thomas Hale, a breastfeeding and pharmacology expert, conclude:

‘the exposure of breastfeeding infants to paroxetine, sertraline and nortriptyline is unlikely to produce detectable or elevated plasma drug levels. … infants exposed to fluoxetine may have higher levels of exposure … Citalopram may lead to elevated levels in some infants, whereas escitalopram produces a lower relative infant dose…. breastfeeding mothers should be advised to observe for any possible signs of adverse reactions including irritability, poor feeding, or major changes in sleep patterns. Premature babies or other unstable infants should be closely monitored for adverse effects.’

If you have been prescribed an antidepressant, or if your doctor plans to prescribe one but would like more information, individual medications can be reviewed in the online database LactMed.

If a breastfeeding-friendly medication cannot be found for your diagnosis, you will need to weigh the importance of getting treated against your personal feelings about breastfeeding. Taking the medication is probably going to win out, as it may be dangerous to leave your condition untreated. And since formula offers a safe alternative (especially in the United States), your baby will still thrive. This can be a painful decision, though, and working through those feelings with a counselor or therapist is important.

Is it safe to sleep with my baby?

As a breastfeeding mother, it’s likely you’ve fallen asleep with your baby nursing. Those nighttime feedings may have been easier lying in bed, and you may have awakened with a jolt later in the night, feeling guilty because you baby is still sleeping beside you in your bed.

The current recommendations from the American Academy of Pediatrics state that babies should sleep in the same room as mom for the first several months (at least) to prevent SIDS, but that they should not bed share, as this poses a danger for baby.

This blanket prohibition, though, is countered by experts who have studied breastfeeding and infant sleep. According to baby sleep expert, James McKenna, co-sleeping a ‘biological imperative’ – babies and mothers are hard-wired to be together, and this doesn’t stop with sleep. For babies, sharing sleep with mom regulates their breathing, temperature, heart rate and more, and they respond to their mom’s movements, keeping them safe as they sleep. They are able to feed frequently and fall back to sleep easily, sometimes barely waking at all.

Mothers across cultures and times have shared a sleep space with their children without adverse effects. Researchers conclude that half of parents report sharing sleep with their babies by age 3 months, and that among breastfeeding parents, 70-80% sleep with their baby at least part of the night.

The best thing to do if you plan to sleep with your baby is to make deliberate choices to make the sleep space as safe as possible. Only bedshare if:

● You are breastfeeding. If you are formula feeding, your baby should sleep in a cot or crib near you.

● You are not a smoker

● You have not been drinking alcohol and are not taking medications that would limit your arousability

● Your baby is healthy and was not born early

● Your baby is lightly dressed and always placed on their back to sleep

● You sleep on a firm mattress that has no places where baby could become entrapped

● You do not have any pillows or fluffy bedding that could cover baby

● You and your partner agree to bedshare

● You do not let any older siblings or pets into bed with you

The most dangerous place to fall asleep with your baby is on a sofa or upholstered chair. So if you feel like you might fall asleep nursing your baby, its better to bring your baby into bed with you and make the sleep space safe.

If you are expecting or are supporting someone who is expecting and would like to prepare themselves for breastfeeding success, prenatally, I highly recommend taking our online breastfeeding course. Check out a free chapter here. This course comes with 9 months of access and a live Q&A with Naiomi Catron RNC,IBCLC.

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!

Subscribe to Diva Diaries, to get more helpful, current, evidence-based breastfeeding resources.

Do I Have to Wean if I’m Pregnant?

by | Apr 19, 2023 | Breastfeeding, Mom, Baby & Family, Pregnancy

Congratulations – you’ve got another little one on the way. But wait – aren’t you still breastfeeding? What now? Take a deep breath and don’t panic. We’ve got answers to your most pressing questions.

Is it safe to keep breastfeeding during pregnancy?

In general, it is safe to breastfeed throughout pregnancy. There are some situations, however, where weaning your child is in the best interest of your newest family member in utero. If your doctor has labeled your pregnancy high-risk, you are pregnant with multiples, you have any bleeding or abdominal pain, or you have been advised to avoid sex, then you may need to wean your nursling.

If, on the other hand, you are having a normal, healthy pregnancy, you can continue to breastfeed if you want. In early pregnancy, you may have some breast tenderness that can make breastfeeding uncomfortable. And if you’re fatigued, you may feel like breastfeeding is just sucking any remaining energy from you. Sometimes nursing will make you feel nauseous or you might just feel agitated. If you can manage those symptoms, then you may be able to continue nursing if you want. Try different positions, including lying down, and practice relaxation exercises while feeding if you’re feeling overwhelmed.

One of the biggest worries many moms have is whether the oxytocin released by breastfeeding will cause early labor.

While oxytocin does cause uterine contractions, these are usually mild and unlikely to be strong enough to open the cervix. If you have any risk factors – like a history of miscarriage, preterm labor or preterm birth – you may want to discuss with your healthcare provider whether or not you can safely continue breastfeeding or if weaning is the best course for a healthy pregnancy. Here’s a link to a new study on Breastfeeding and Miscarriage.

What if I want to wean?

Sometimes breastfeeding is difficult during pregnancy. If you’re experiencing morning sickness, if you are losing weight, if you are moody or feeling touched out, or if you simply don’t want to breastfeed any more, then you’ll want to start the process of gently weaning your nursing child. A gradual weaning is always preferable to quitting ‘cold-turkey’ though occasionally that may be needed. A baby younger than age one will still need formula or pumped milk by bottle.

Weaning strategies will depend on the age of your child. A younger baby may not have the cognitive ability to understand some of these strategies. But for a toddler or preschooler, these steps might help:

  • Don’t offer / don’t refuse

  • Provide a distraction

  • Postpone the feeding by a few minutes more each day

  • Set time limits on nursing sessions

  • Cuddle more at non-feeding times

  • Have others help at normal feeding times

Often naptime and nighttime weaning is the hardest – those are usually the last nursing sessions to be eliminated.

What if you’re wanting to wean but your child isn’t ready? Often this will show up in your child’s behavior – they may regress in areas such as toilet learning. They may have more tantrums and night waking, and may be more clingy. If possible, slow the weaning process down a bit. Consider a weaning party or present – something for your little one to look forward to as they nurse less often. And give yourself and your little one some grace – it’s okay to change your mind about weaning, and it’s perfectly normal for you and your child to be sad about losing that connection.

What if I don’t want to wean – will I make enough milk for two after the baby is born?

Be sure you’re getting enough to eat each day – don’t forget that your not only making milk but growing a baby, too. So your calorie needs may be increased. Be sure you are staying hydrated and getting enough rest.

Around the 4th or 5th month of pregnancy, your body will start to change back to newborn mode and the milk will change to a weaning milk and eventually colostrum, and your milk supply will decrease. This change is guided by pregnancy hormones, and pumping or nursing more often won’t help to increase it. Your breastfeeding child may not like the flavor of this milk, or might get frustrated with the smaller quantity.

When your new baby arrives, the colostrum will be available, and two to five days later your milk will ‘come in,’ just like if an older baby wasn’t nursing. One great side benefit is that you may be nursing so often – and your older nursling may be so efficient – that you don’t experience any painful engorgement.

There is no need to use one side for the newborn baby and one for your older child. Additionally, it’s not necessary to always nurse the baby first. Your milk supply will still be based on milk removal – the more milk that is removed, the more milk you will make. And with two nurslings, your body will adjust with a larger supply (much like a mother of twins).

What if my weaned child wants to breastfeed again when they see the new baby nursing?

It’s not unusual for a child who weaned while you were pregnant to want to nurse again when they see their new sibling cuddled in your arms and feeding. Some moms are open to allowing breastfeeding to begin again while other moms are adamant that weaning is final. Some moms find that they offer to allow their toddlers or preschoolers to nurse again only to find the child has forgotten how. Go with your gut and what works best for your own family.

How do other women manage?

It can be difficult to know how often women tandem breastfeed or nurse during pregnancy because many women keep it hidden for fear of criticism from friends, family or healthcare providers. In one study, 61% of women breastfeed throughout pregnancy, and more than one third breastfed both children when baby arrived. So you’re surely not alone whether you decide to breastfeed through pregnancy or wean your older child.

You may be able to find online support forums and groups for tandem nursing mamas. Or you might enjoy reading Hilary Flower’s book Adventures in Tandem Nursing – it is full of information, tips and tricks interspersed with mom’s stories.

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!

Subscribe to Diva Diaries, to get more helpful, current, evidence-based breastfeeding resources.

Resources:

Flower, H. (2003). Adventures In Tandem Nursing: Breastfeeding During Pregnancy And Beyond, La Leche League International.

LLLGB. (2016). Pregnant and Breastfeeding? https://www.laleche.org.uk/pregnant-and-breastfeeding/

Mohrbacher, N. (2010). Breastfeeding Answers Made Simple. Hale Publishing.

Low Milk Supply? 9 Tips To Increase Milk Supply

by | Apr 19, 2023 | Breastfeeding, Mom, Baby & Family, Pumping

Low milk supply can be one of the most frustrating things a breastfeeding mom can face. Solutions aren’t always easy, and sometimes it can take a while to narrow down the root cause of the decrease in production.

 
 
 

One of the best ways to build a good milk supply is to nurse your baby early and often. Start as soon as they are born, and keep going any time baby signals that they might be hungry. You can’t overfeed a baby at the breast. It’s normal for newborns to nurse eight to twelve times a day – sometimes more. Feedings are typically every two to three hours, though they won’t always be evenly spaced around the clock. Sometimes babies will cluster feed and sometimes they will go a little longer between feedings.

You can’t overfeed a baby at the breast.

One misunderstanding some new parents have is that lactation professionals count these feedings from the start of one to the start of the next (rather than end to start). Just by timing feedings in that way, you can often get one or two extra times at the breast in per day. Always let your baby feed as long as they’d like on the first breast and always offer the second breast.

But even with the best breastfeeding management, some moms still have low milk supply. Working closely with Milk Diva Lactation Services (or a board-certified lactation consultant near you) is one of the best ways to sort out what is happening in your individual situation to cause your diminishing supply. As you’re working through the problem, here are some quick tips to boost the amount of milk you’re making:

Milk Supply is Mostly Based on Milk Removal

Want more milk? Then you might consider pumping or emptying your breasts more often. The baby is usually more efficient than the pump (unless your baby is having latching or milk transfer issues). But getting those hormones stimulated additional times each day can be the easiest way to get your body to recognize that it needs to crank up production.

Get to the Root Cause

This can take some detective work and often needs some professional input. Is it something in the way you are holding your baby? Is it something related to your health history? Is it a medication you’ve been taking? Did you have significant blood loss? Or is it related to your baby? Do they have a shallow latch? Do you have pain when nursing? Do they have low suction or do they fall asleep quickly at the breast? Do they have a tongue tie or another anomaly that would cause them to have problems getting the milk they need from the breast? If not enough milk is being removed, your body thinks it needs to slow down production.

Feeding Improvements

Even if your baby is already a few months old, go back to the basics of positioning and latching. Be sure your baby is turned toward you (tummy-to-tummy) with their head at breast level and no space between your bodies. Wait for a really wide open mouth and bring the baby to the breast (rather than the breast to the baby). If you need help with this, book either an in-person or virtual consultation with Milk Diva or another qualified IBCLC.

Try breast compressions at the end of a feeding on each breast. This will get a little more milk into your baby each time. If your baby routinely falls asleep very early in the feeding, consider switching sides several times to keep them awake.

Pumping Improvements

Check all of your pump parts to make sure they’re in working order. Replace any membranes that you think may be worn. Make sure the flanges are the proper size for your anatomy. Play around with the suction and repetition levels. Massage your breasts before and during the pumping session.

Power Pumping

Power pumping can be done in a variety of ways, but the theory is that you can use the pump to mimic baby’s cluster feeding as a way to increase your milk supply. Theoretically this is what baby’s do naturally when they go through a growth spurt, and you can trick your body into thinking the pump is the baby and more milk is needed. To do this, set aside one hour, once per day and pump on and off for 10 minutes at a time (pump 10 minutes, rest 10 minutes, pump 10 minutes, rest 10 minutes, etc. until you get to 60 minutes). You can play around with the amount of time for each pumping session or how many sessions per day you do.

Skin to Skin

Whether it’s while you’re feeding or if you’re just sitting around binge watching your favorite show, strip your baby down to their diaper, place them between your breasts, wrap a blanket or shirt around the two of you and relax together. This skin-to-skin contact will stimulate your hormone production.

Night Nursing

If your baby has started to sleep longer stretches, this has the potential to impact how much milk you’re making. While a 5-hour stretch of sleep for baby may not cause any supply problems for one mom, another mom may see her supply decrease. Or maybe the 5-hour stretch doesn’t cause problems, but when the baby sleeps 8 hours straight on a regular basis, mom feels like her supply has tanked. But it all depends on how much baby is nursing within a 24 hour time frame. A baby who still feeds every 2 hours but then sleeps a 5-hour stretch at night will still probably get plenty of milk hence keeping mom’s supply pretty even). But a baby who is only nursing a couple of times a day and sleeping all night may have a mom who struggles to keep up. So keep an eye on the big picture of how much a baby is taking over the course of 24 hours.

So keep an eye on the big picture of how much a baby is taking over the course of 24 hours.

If you notice that your supply is decreasing (whether it’s from your baby sleeping longer at night or not), take advantage of your higher prolactin (the milk-making hormone) level at night by nursing your baby. You don’t even need to wake them very much. Sometimes you can just lift them out of their crib and tickle their lips with your nipple, and they will latch on and have a good ‘dream feeding.’

Foods, Herbs, and Supplements

Be sure you are eating enough calories, staying hydrated and getting at 4 hours of uninterrupted sleep, per day (I know, this sounds like a tall order). Adding some specific foods to your diet can be one of the easiest interventions to support making more milk. These foods are healthy and won’t have any negative side effects. Consider lactogenic foods such as oatmeal, almonds, dried apricots, and flax, among others. Some herbs are also used as galactagogues. Fenugreek is the most common one, though there are others that may be used to increase milk supply, too. Work closely with a lactation consultant and herbalist or naturopath if you choose herbs to try increasing your supply – many of them interact with your body the way a medication would and some of them have contraindications if you have particular health problems.

Is Your Supply Actually Low?

Milk supply problems are one of the most common reasons mothers supplement with formula or wean from the breast altogether. Perceived insufficient milk supply – when a mother thinks her supply is low based on her baby’s behaviors – can cause a mother baby dyad to end their breastfeeding relationship before either of them were ready. The best way to avoid this is to learn what’s normal. Understanding infant feeding cues and normal breastfeeding behaviors can help a mom understand her baby is just doing what is expected. Learning that breast milk supply varies depending on time of day and in relationship to baby’s age can help her to intervene only when appropriate. Working closely with a lactation professional can help a mom sort out whether her supply is truly low, or whether she’s doing just fine and simply needs a more thorough explanation of how the whole thing works!

At Milk Diva we use a scale that is very sensitive to measure how much milk your baby gets after a breastfeed. Cool, huh!

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!

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References:

Buckley, S. (2010) Ecstatic Birth – Nature’s hormonal blueprint for labor. E-book.

Galipeau, R., Baillot, A., Trottier, A., & Lemire, L. (2018). Effectiveness of interventions on breastfeeding self‐efficacy and perceived insufficient milk supply: A systematic review and meta‐analysis. Maternal & child nutrition, 14(3), e12607.

Kent, J. C., Prime, D. K., & Garbin, C. P. (2012). Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic & Neonatal Nursing, 41(1), 114-121.

Neifert, M., & Bunik, M. (2013). Overcoming clinical barriers to exclusive breastfeeding. Pediatric Clinics, 60(1), 115-145.

Riordan J & Wambach K. (2010). Breastfeeding and Human Lactation. 4th ed. Sudbury, MA: Jones & Bartlett.

West D & Marasco L. (2009). The Breastfeeding Mother’s Guide to Making More Milk