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Child Care and the Breastfed Baby

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Melissa Portunato MPH, IBCLC, RLC

It’s likely that at some point, your breastfed baby will be cared for by someone else other than yourself. Sometimes it’s temporary while other times it can be long term like when returning to work. Child care options can vary from private stay at home nannies/family members, private home licensed child care, or commercial child care facilities. 

The process to find the perfect match for you and your baby doesn’t have to be stressful. Your breastfeeding relationship can absolutely continue and thrive with this new milestone. No matter who you choose to care for your baby, your breastfeeding goals should be supported and respected. Read on for tips on finding a caregiver for your breastfed baby including how to connect with local resources and how to share valuable education with your child care provider. 

Support and Communication 
Let’s start here. It’s OK if your child care provider isn’t a “breastfeeding expert” but they should be open and teachable when it comes to feeding mother’s milk to babies in their care. They should be willing and ready to accommodate your requests or accept breastfeeding-friendly education. An “open door” policy is one of the ways caregivers can be supportive of the breastfeeding dyad. Allowing mothers to drop in at any time without notice to pump or nurse their baby on demand protects breastfeeding. If your child care facility pushes back on your breastfeeding requests, then it’s probably not a good fit.

Knowledgeable Staff 
A child care provider whether in a private or commercial setting should have basic training on breastfed infant behavior, proper bottle-feeding techniques, and breastmilk storage handling.  All babies, breastfed or not, should be fed using The Paced Bottle Feeding Technique. This feeding method allows the baby to control the flow of milk, preventing overfeeding. Normal milk consumption for babies 1-6-month-old is 1- 1 ½ ounces per hour. Milk leftover from feedings should be discarded within 2 hours of initial use and proper breastmilk milk handling should be carefully followed. Download the handout here to share with your child care team. Breastfed babies should not be fed on strict schedules but rather monitored for hunger cues. For younger babies less than 3 months old this includes moving head from side to side (rooting), bringing fingers to mouth, and for older babies, actively moving arms and legs while gazing at the caregiver. 

Facility Accommodations 
Breastfeeding friendly accommodations on-site should include a designated area to pump or nurse your baby, other than a restroom. A fridge to store breastmilk and a sink to wash pump parts. You will need to label bottles and/or milk storage containers with the name of your baby and date with permanent, reusable, or personalized silicone labels. 

Additional tips for success:

???? Check with your local / state breastfeeding coalition to find breastfeeding-friendly centers here.

???? Take a tour with your prospective child care provider first before making a decision. 

???? Choose a child care provider nearby. You can hop into pump/nurse or simply check on baby anytime. 

???? A low child-adult ratio allows the caregiver to pay more attention to feeding cues and can prevent overfeeding. 

???? Long-standing caregivers provide added security your baby is in the care of an experienced professional. 

???? Send breastmilk in 1-2 ounce increments to prevent milk from being wasted. 

Always remember you are your baby’s advocate. No matter your breastfeeding goals, you should feel comfortable to easily keep an open conversation with your child care provider. 

Do you still have other questions about child care and breastfeeding? Email us at IBCLC@spectrababyusa.com anytime or schedule a complimentary consultation. Our International Board Certified Lactation Consultants are happy to assist you along your breastfeeding journey. 

We’re in this together and we support you! 

Sources

  1. How to choose a breastfeeding-friendly childcare provider. (2020, February 19). La Leche League USA. https://lllusa.org/choosing-a-childcare-provider/
  2. Proper Storage and Preparation of Breast Milk. (2020, January 22). Center For Disease Control. https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
  3. Anne Smith, IBCLC. (n.d.). Caregiver’s Guide to the Breastfed Baby. Breastfeeding Basics. Retrieved January 11, 2021, https://www.breastfeedingbasics.com/articles/caregivers-guide-to-the-breastfed-baby

Night Weaning

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Jacque Ordner BSN, RN, IBCLC, RLC 

Sleep is a sensitive and often sensationalized topic among so-called parenting gurus, authors, and creators of online sleep courses.  However, let me reassure you that if your baby nurses or takes a bottle to drift off and wakes to feed through the night, they are not broken….THEY ARE NORMAL!  In fact, research tells us that babies who sleep through the night at less than one year of age are closer to the exception than the rule.  New parents are often asked, “Is he a good sleeper?” or “Is she sleeping through the night yet?” when babies are barely out of the newborn stage. This helps perpetuate the myth that there is something wrong if babies under one are not yet giving their parents 6-8 hours of uninterrupted sleep.  Well-meaning advice givers often tell parents that their babies will magically stop waking if night feedings are cut-off.  In reality, early night weaning can lead to decreased milk supply and put baby at risk of receiving inadequate intake. At somewhere around six months of age,  you may begin to notice that your little one naturally stretches out the time between feedings and perhaps even stretches the time spent sleeping at night. While I recommend waiting until baby is closer to age one to start actively night weaning, there are some tips that parents can employ to encourage healthy sleep for their babies.  Since sleep is developmental, I recommend following your baby’s cues while eliminating obstacles to good sleep.  Find out more in our blog post, Newborn and Infant Sleep – What is Normal? 

While night weaning can help encourage an older baby or toddler to sleep longer at night, it’s not a guarantee of reduced night waking. This is because sleep is primarily developmental, and children wake for other reasons besides just hunger.  We, as parents, can help shape our children’s environment and behaviors to encourage sleep, but it is important to keep in mind that waking at night is normal even through toddlerhood.  Keep in mind that your child will eventually sleep through the night all on their own! 

Keep reading for our top tips for night weaning. 

Increase Daytime Intake 
When considering night weaning, it’s important to ensure your child is still receiving adequate calories.  Older babies and toddlers will often naturally shift to longer periods of sleep when their daytime intake increases.  Simply offering more nursing sessions or a greater volume of breastmilk via cup or bottle can be enough to encourage less need for night-time feedings.  Increasing solids is another way to get in more daytime calories.  Toddlers often do well with a bedtime “snack” that is nutritionally dense.  Foods that provide fiber, fat, and protein are often most satiating. 

Dream Feed Just Before Bed 
If your little one generally nods off before you’re ready to hit the sack, consider offering a dream feed to “top them off” just before you go to bed.  Babies will often rouse just enough to nurse or bottle feed without becoming fully awake.  This can give you a longer stretch before baby wakes for the next feed. 

Enlist Help 
If possible, ask your partner or another trusted caregiver to assist through the night during this transition.  This is especially helpful for nursing mothers.  If a non-lactating caregiver is present to comfort and soothe during night waking, baby may be less likely demand a feeding.  The old motto holds true…..Out of sight, out of mind! 

Increase Cuddles and Communication 
It’s not uncommon for toddlers to be anxious about weaning of any sort.  Reassure them with extra cuddles and clear communication about the night weaning process. Toddlers are perceptive and the often understand far more than we adults give them credit for!  Talk about night weaning during waking hours and let your child know when the process will start.  It’s ok to tell your toddler “no” when they ask for a night-time feeding, but follow it up by also letting them know when they can nurse again. For example, “We can’t nurse now, but we can nurse again when the sun is up”. Or “I’m just going to rock you for now, but we’ll get milkies when it’s time for breakfast”. Knowing when they will be allowed to nurse again, can bring an immense amount of peace to a worried toddler. 

Set Limits 
The counting method is often very effective with toddlers!  Let your little one know that they can nurse until you reach a certain number (whatever you are comfortable with).  For example, “You can nurse until Mommy gets to 20”.  Count out loud, going slowly for the first several nursing sessions.  After a few nights, begin to count a little faster.  As your toddler adjusts, you can reduce the number until there is no nursing.  If this approach is taken slowly and gently, it is not uncommon for toddlers to become uninterested in nursing at night. 

Don’t Be Afraid to Stop 
If you begin the night weaning process only to find that your baby or toddler is greatly distressed by it, don’t be afraid to stop and start again later.  If your child is hysterical each night and shows no signs of adjusting to night weaning, try again in a month or two.  There is no one-size-fits-all prescriptive timeline for any sort of weaning and it is rarely a linear process!  

Patience, reassurance, and planning are the keys to night weaning success! 

Tried all the tips and still struggling with night weaning?  You’re not alone!  Our International Board Certified Lactation Consultants (IBCLCs) have years of experience helping families navigate night weaning and many other sleep concerns.  We’re available 7 days a week for FREE CONSULTATIONS.  No matter where you are in your breastfeeding journey, we’re here to support you! 

 

Sources: 

Burnham, M., Goodlin-Jones, B., Gaylor, E., & Anders, T. (2002, September). Nighttime sleep-wake patterns and self-soothing from birth to one year of age: A longitudinal intervention study. Retrieved January 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201415/  

Galbally, M., Lewis, A. J., McEgan, K., Scalzo, K., & Islam, F. A. (2013). Breastfeeding and infant sleep patterns: an Australian population study. Journal of Paediatrics and Child Health, 49(2), E147–E152. https://doi.org/10.1111/jpc.12089 

Kent, J., Mitoulas, L., Cregan, M., Ramsay, D., Doherty, D., & Hartmann, P. (2006, March). Volume and           frequency of breastfeedings and fat content of breast milk throughout the day. Retrieved January 4,        2021, from https://www.ncbi.nlm.nih.gov/pubmed/16510619

Nipple Shields: Yay or Nay?

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Melissa Portunato MPH, IBCLC, RLC

Are your nipples sore from nursing your newborn? Are you thinking of purchasing a nipple shield to prepare for your breastfeeding journey? Wait! Don’t grab that nipple shield just yet! Temporary use of a nipple shield combined with proper guidance can salvage a breastfeeding relationship at times, but nipples shields can be widely misused too! Read on to find the answers to everything you need to know about nipple shields. 

Do I really need a nipple shield? 
Far too often, nipple shields are used to mask breastfeeding issues without getting to the root cause.Truth is, most moms do not need them at all. Nipple shields essentially create a barrier between you and your baby. They are infamous for low weight gain, clogged ducts, low milk supply and a ton of other breastfeeding issues, even Mastitis. Some newer research tells us temporary use of nipple shields could possibly salvage a breastfeeding relationship if it’s combined with skilled lactation support early on. 

What are some instances a nursing mom might benefit from the temporary use of a nipple shield?
It’s surprising for most to learn flat or inverted nipples begin to naturally draw out with breastfeeding. Even with inverted nipples that don’t protrude with stimulation, nursing or pumping will draw them out and a nipple shield is not even needed. There may be instances, where the nipple does not protrude and a nipple shield can be beneficial. 

Other special circumstances include premature babies (born earlier than 36 weeks) and transitioning from bottle to breast. The supervised use of a nipple shield has been linked to temporarily improving or prolonging the breastfeeding relationship in some studies. 

How do I use a nipple shield?
If you decide to use a nipple shield, make sure it’s the right size and made of thin silicone material. The shield should fit securely over the nipple and areola. When a baby is latched and actively nursing at the breast there should be visible movement on and around the breast. Also, there should be breastmilk on the tip of the shield. These are all indicators the nipple shield placement is correct. Working closely with a local International Board Certified Lactation Consultant, IBCLC is critical to ensure your baby is nutritively sucking at the breast and transferring adequate milk to grow and thrive. 

Weaning off the shield
Nipple shields are intended for temporary use which means the goal should always be to wean off them. Switch and bait can be an effective technique when weaning a baby off a nipple shield. Start nursing with the shield, slip it off and then quickly re- latch baby directly at the breast. This approach can take patience and practice. Start feeding sessions skin to skin and offer the breast at early feeding cues. Crying is a late sign of hunger and a “hangry” baby will be much harder to latch. 

Protect your milk supply if your baby is not latching by dual pumping using a Spectra Baby USA hospital strength pump. In addition, introducing a supplemental nursing system can aid at keeping baby nursing at the breast while trying to wean off a nipple shield. 

Getting skilled lactation support early can prevent the use of nipple shields all together! Nipple shields are not intended for long-term use and should be approached with caution. If you decide to use a nipple shield work closely with a local International Board Certified Lactation Consultant, IBCLC who has experience with using niplpe shields. 

Do you have breastfeeding questions? Schedule a free Spectra Baby USA virtual consultation with one of our experts to help you on your breastfeeding journey! 

We are here for you and we support you! 

Sources:

Chertok, I. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs 2009;18(21):2949-2955.

Meier, P. et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact 2000; 16(2):106-114.

Kronborg H, Foverskov E, Nilsson I, Maastrup R. Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding?. Matern Child Nutr. 2017;13(1):e12251. doi:10.1111/mcn.12251

Breastfeeding and Pregnancy

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mom on couch with breast pump

Melissa Portunato MPH, IBCLC, RLC

Did you just find out you’re expecting a new baby and you’re currently breastfeeding? So many emotions can begin to flood your mind when you start to process that a new little one will be joining your family in just a few short months…excitement, joy, anxiety and uncertainty. If you’re pregnant and breastfeeding, you could be asking yourself questions like “Will I need to stop breastfeeding since I’m pregnant? Can I harm my unborn baby by continuing to breastfeed throughout my pregnancy?” Take a deep breath! We got you covered! Read on to get evidence based answers to everything pregnancy and breastfeeding. 

First things first, is it safe?
Nipple stimulation triggers the release of the oxytocin hormone which can trigger contractions. Research tells us less oxytocin is released when a woman is pregnant making it generally safe for a healthy mom to continue nursing while pregnant but not always. If you are exclusively pumping, remember that is breastfeeding! We recommend scheduling a prenatal exam as soon as possible to thoroughly discuss your personal situation with your doctor. If you are considered a “high risk” pregnancy you may be advised to discontinue breastfeeding to ensure your pregnancy will be safe and smooth. The current data reflects breastfeeding and healthy term births are not only compatible but biologically normal.

Changes in Milk Supply and Composition
Hormonal changes in pregnancy can cause milk supply dips and fluctuations, as well as, increased nipple tenderness. Your nursling might want to breastfeed more frequently or become less interested. Supply and demand, won’t typically hold up even if breastfeeding has been increased. Some mothers do not experience a decrease in milk supply at all while others do. Everyone is different. Milk composition will begin to transition into colostrum during your third trimester. Increased sodium levels in breastmilk can change the taste of your breastmilk and this combined with less milk, could lead to natural weaning yet; some kiddos do not mind at all and continue to nurse. The AAP recommends breast milk as the primary source of food for the first year. Closely monitor your baby’s breastfeeding behavior at the breast, weight gain and diaper output to ensure they are growing and thriving. 

Tandem Nursing
Colostrum will be produced for your newborn during the first few days postpartum even if you have continued to breastfeed an older child throughout your pregnancy. Since colostrum is packed with immune properties and prepares the newborn gut for mature milk you want to make sure you are giving your newborn priority at the breast during the early days after delivery. Nursing both of your babies at the same time, called tandem nursing, can be a way to offer emotional security and extra attention to the sibling. Tandem nursing can also help lessen engorgement and create an adequate milk supply. If you decide to wean your older baby, gradual weaning is always best. Avoid being seen in your typical nursing areas, don’t offer the breast but don’t refuse either. Redirecting behavior when asked to nurse can help the weaning process too, like offering a snack or a favorite toy. 

Pumping To Induce Labor and Colostrum Harvesting 
If you haven’t been breastfeeding since the beginning of your pregnancy it’s not recommended to start now unless you are full term (over 38 weeks) and under the care of your medical practitioner. Pumping or hand expressing can be an effective way to kick start labor! If your doctor approves you can start with hand expression or pumping with your Spectra Baby USA breast pump for 10-15 minutes on a low 38 cycle and low suction strength, just a few times a day. Some mothers will even start to see some drops of precious colostrum. You can use sterile syringes to collect, store and freeze colostrum. This can be even extra important if you already know you will be separated from your baby after delivery. Always check with your doctor first when using pumping to induce labor. 

If you desire to continue to breastfeed while pregnant, you are not alone. Breastmilk continues to have benefits for your older child and many mothers safely breastfeed their older babies while pregnant. Work closely with your health care practitioner and surround yourself with support to ensure breastfeeding can continue safely. Spectra baby USA is here for you and we support your decision to breastfeed while pregnant. Schedule a prenatal consult with us and we can help you reach your personal breastfeeding goals. 

Sources:

Amico, J., and Finley, B., Breast stimulation in cycling women, pregnant women and a woman with induced lactation: pattern of release of oxytocin, prolactin and luteinizing hormone. Clinical Endocrinology, 1986 25:97-106.

Journal of Nursing Research, 20 (1) p 74-80. doi: 10.1097/JNR.0b013e31824777c1

Mohrbacher (2010) Breastfeeding Answers Made Simple, Hale Publishing, ISBN-10: 0984503900

Flower H. (2016) Breastfeeding during pregnancy and tandem nursing: is it safe? Recent research, Breastfeeding Today, 11 April 2016

Philippa Pearson-Glaze, Expressing Colostrum Antenatally, Breastfeeding Support, 24 August 2019, https://breastfeeding.support/expressing-colostrum-antenatally/ (accessed 9 September 2020).

 

The Over Achiever: When one breast produces more than the other

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By: Jacque Ordner BSN, RN, IBCLC 

Have you noticed that one of your breasts seems to consistently produce more milk?  If you’re pumping, this may be even more noticeable.  If your baby nurses, you may have noticed that he or she prefers one side or seems to finish nursing on one side much faster than the other.  Rest assured, this is normal!  One study of exclusively pumping mothers found that in 65.7% of pumping sessions observed, the right breast produced at least slightly more milk.  In another similar study, only 2.6% of the exclusively pumping mothers displayed equal pumping output from both breasts.  

Why does this happen? So, we know it’s normal for one breast to produce more or to have a greater pumping output, but WHY? Breasts aren’t typically symmetrical.  Like many other parts of the human body (eyes, hands, feet, ears, etc.) a degree of asymmetry is normal.  This can mean a difference in the amount of milk making tissue (alveoli) or even in the amount and size of milk ducts.  Many times, mothers can readily observe a difference in the size of their breasts and also notice that one commonly feels “fuller” than the other. Other less common reasons for this discrepancy include previous breast surgery and previous injury or trauma to the breast. Rarely, asymmetry is caused by a disorder known as Poland Syndrome.  This syndrome is evidenced by missing or underdeveloped muscle tissue on only one side of the body and often results in one breast being dramatically smaller and less developed than the other. In general, breast asymmetry is completely normal as is having one breast that produces more milk.  We like to call that breast the Over Achiever. 

We’ve compiled a few tips to help “even out” milk output: 

  • If you’re pumping, consider trying different settings to see if each breast responds differently to certain cycles/vacuums.  Once you determine which settings are best for each breast, determine a plan to incorporate these settings into your typical pump session.  For example, some woman report that one breast responds best to Massage Mode (cycle 70) while the other responds well to an Expression Mode cycle.  Moms often have great success with switching between the two modes like the example below: 

            -5 minutes at cycle 70 

            -5 minutes at cycle 54 

            -5 minutes at cycle 70 

            -5 minutes at cycle 38 

*Remember that higher vacuum doesn’t necessarily mean more milk!  We never recommend increasing the vacuum to an uncomfortable level. 

  • Consider adding more stimulation for the lower producing side. If you’re pumping, this can be as simple as starting or ending the pumping session with just a few extra minutes of single pumping on the lower producing side.  If you’re nursing, consider starting sessions on the lower producing breast or adding a few minutes of single pumping on that side after nursing. 
  • Do YOU have a preference? It’s not uncommon for mom to unknowingly develop a preference for feeding from one side over the other.  We often prefer to keep our dominant hand free, and therefore may feed more often or spend more time on the opposite side.  Keeping a simple log of feeding times for each side can help highlight any preferences you might not have noticed otherwise.  
  • Encourage better nursing and greater pumping output with your hands! If baby tends to stop nursing on the less preferred side sooner, consider incorporating breast compressions while nursing. This can help keep the flow a bit faster and more interesting for baby. It can also make milk removal easier. Similarly, Hands On Pumping is a technique that can help elevate your lower producer to Over Achiever status.  Check out this video from Stanford University: https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html 
  • Add in hand expression. One breast may give less output because it just doesn’t respond to pumping as well as the other.  Hand Expression is a technique that can help increase pumping output not only for the lower producing breast, but even for the Over Achiever breast as well!  A few ways to incorporate hand expression include in between pumping or nursing sessions, following pumping or nursing sessions, or when you’re running short on time and can’t fit a full pumping session in.  Here’s a link for a fantastic resource on the topic: https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html 

Keep in mind that it is normal for one breast to be the over achiever and it’s absolutely ok if you choose to do nothing to even out the supply.  Having a lesser producing breast doesn’t mean there is something wrong, it just means our bodies aren’t perfectly symmetrical! However, if baby consistently fully refuses one breast, if there is a noticeable change in size or shape of only one breast, if there is a lump that doesn’t go away or grows, or if there is a lump that doesn’t move with the breast tissue, reach out to your healthcare provider as soon as possible. Additionally, if baby seems uncomfortable turning toward one breast or always seems to turn his or her head in the same direction, reach out to your pediatrician for further evaluation for conditions such as torticollis.  Should you desire to bring both breasts to Over Achiever status, incorporating the tips above is a great place to start! 

Keep on keeping on, mamas!  We know you’re doing your very best to provide your babies with the best start and we support you! If you have questions about uneven milk supply or any other breastfeeding related topics, we can help! Our International Board Certified Lactation Consultants are available for free consultations at www.spectrababyusa.com/lactationservices.  You can also email us at ibclc@spectrababy.com  Happy pumping! 

References 

Engstrom, J. L., Meier, P. P., Jegier, B., Motykowski, J. E., & Zuleger, J. L. (2007). Comparison of Milk Output from the Right and Left Breasts During Simultaneous Pumping in Mothers of Very Low Birthweight Infants. Breastfeeding Medicine, 2(2), 83-91. doi:10.1089/bfm.2006.0019 

Hill, P. D., Aldag, J. C., Zinaman, M., & Chatterton, R. T. (2007). Comparison of Milk Output Between Breasts in Pump-Dependent Mothers. Journal of Human Lactation, 23(4), 333-337. doi:10.1177/0890334407307575 

 

Bereavement Pumping: Our Senior IBCLC’s Journey

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Bereavement Pumping: Our Senior IBCLC’s Journey
Jenn M. Foster, MA, CD, IBCLC, RLC

It’s been 4 months, nearly 5 months, since we lost our little “dove baby”, Nolan. His birth date was November 2, 2018. Yes, I say “birth date” because he was born. We held him in our arms, loved him and kissed him. My husband, Chris, even wrote him a poem which was read to him with such endearment.

Since his passing, his milk has helped so many babies. His story has touched so many lives, even reaching mothers in the UK!

I have pumped over 450 hours since November 4, 2018. Last week, I shipped 100oz to Mother’s Milk Bank of Florida and donated 400oz to local babies in need.

Yes, I do formal and informal milk donations. Formal milk donations through a milk bank and are provided to fragile babies in the NICU. Other babies in need receive human milk through milk banks that qualify.

For informal milk sharing, I seek to find local mothers in need. I find these mothers in need through Facebook groups, such as Human Milk 4 Human Babies. There is a lot of controversy over informal milk sharing. The controversy lies in the fact that such milk could be donated to milk banks across the country. However, there are babies who aren’t eligible for human milk from milk banks, such as our third (Emery) and fourth (Lincoln) babies.

I used 20% donor milk at breast with an SNS to make up for the supply that I wasn’t able to produce. They were our first little ones after having breast cancer and subsequent surgeries. Despite nursing on demand and pumping after every feeding, I was still only able to produce 80% of their daily intake.

For mothers who choose to obtain milk through informal milk sharing, there needs to be diligence on the mother’s part to ensure that the donor is free of harmful conditions, such as HIV and other illnesses. It’s important for the mothers who donate to follow the HMBANA guidelines to ensure they are healthy to donate the milk that is being shared is safe for ingestion.

Mothers can donate their milk through the Human Milk Bank of North America, by finding a milk bank in need that is within their region of the United States. There is always a need for human milk. In fact, there are measures being taken to ensure that insurance companies, including Medicaid, cover milk from a milk bank in order for NICU babies to have its’ life saving properties.

Now, back to my journey…

Every day, I pump my heart out to store Nolan’s milk. I use a hospital strength breast pump and express every 2 hours. I use a pumping app to track the time I’m pumping and quantity I pump each time. I even have alarms set on my phone to let me know when I need to pump.

I have a special pumping station set up that houses my milk storage bags, extra pump parts, breast pads and breast milk sanitary wipes. I keep my “Nolan Bear” (bear that was next to Nolan after birth at the hospital) next to me for every pumping session. Knowing that he is with me helps when it gets hard, and it is hard!

No one talks about bereavement pumping. It’s something that often isn’t even supported or offered at birth. When in the hospital, not one nurse or IBCLC talked to me about pumping his milk or even what I would do when my milk “came in”. Honestly, I hate when people say “when the milk comes in” because mothers at birth already have the perfect milk: colostrum. So, let’s say “when the milk increases in volume”.

I requested a pump to use at the hospital on November 4, 2019 (two days after his birth due to the trauma I was dealing with from his death). That started my journey of wanting to pump for one year.

Though I know that pumping is healing, it is hard to not have him at breast. Seeing all the posts on Facebook and Instagram of these amazing nursing photos and milestones that friends are experiencing with their newborns is heart wrenching. I want more than anything to have him here with us.

Every pumping allows me to still connect with Nolan. It’s so healing. I’m now looking into providing a webinar on “Bereavement Pumping”! I started a Bereavement Pumping group to find other moms that are on the same journey.

Support Resources:

https://stillbirthday.com/

 

10 Breastfeeding Friendly Foods

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By Melissa Portunato, MPH IBCLC

Alright, let’s be real. As a new mom, the only thing that gets you excited for dinner is pizza with a side of ice cream. And besides, with all the nursing and pumping you have been doing, who has time for self care anyway?? Though it’s totally fine to indulge every once in a while, maintaining a balanced diet will give you energy, keep you satisfied longer, and can help your breast milk flow easier. Try working the following 10 items into your diet rather than going for a full blow diet change off the bat.

Making milk for a tiny human is no joke so we created this list for you to take it along the next time you make a grocery run! Let’s go!

High quality protein

Scrambled, sunny side up, or a’la flambe! Pasture-raised eggs are a high quality source of protein and aren’t very expensive which makes them an easy go-to meal. Eggs have a long list of health benefits but the top of the list includes improving eye health, aiding in weight loss, and preventing disease.

A lack of iron can suck the energy out of you, consuming iron packed grass-fed beef can help increase your iron and Vitamin B-12 levels. Both are helpful in sustaining your energy and will aid in keeping up with your busy schedule.

Wild caught salmon

Salmon is a powerhouse loaded with DHA which is exactly what newborns need for healthy, neurological growth. All breast milk contains DHA, but pretty cool evidence tells us, moms, who intake DHA regularly have higher levels! Ah-ma-zing!

If you’re vegan or vegetarian, Legumes are loaded with iron and protein too! Especially the dark ones!

Leafy greens

Leafy greens are nutrient dense, low in calories and carbs, and packed with vitamins and minerals like Calcium, Vitamin K, Folic Acid, and Iron. Spinach is a heavy hitter when it comes to leafy greens! It can be cooked with pretty much any meal, raw in salads, and blended in smoothies. It can be pureed and added to sauces too!

Fresh fruit

Fresh fruit can be added to yogurt, oatmeal and is a simple, nutritious snack!

Blueberries are one of the most nutritious fruits in the world providing Vitamin C, Vitamin A, Vitamin E, and Antioxidants. Eating 2 servings a day of fresh fruit like berries can help amp up weight loss, decrease inflammation, and promote digestion which is beneficial to breastfeeding moms recovering from childbirth.

Nuts and seeds

Flaxseed is one of the world’s first superfoods. Its benefits include improving skin and hair, balancing hormones, and even helps to bust sugar cravings. Adding flaxseed to your diet is a quick and easy way to consume fiber and essential fatty acids. Flaxseed will ensure your body performs at optimal health to make your breastmilk and give you more energy to care for your newborn baby. Make sure you are grounding your flaxseed for best results. Ground flaxseed can be sprinkled on toast, yogurts, blended in smoothies, and even sprinkled on salads.

Packed with protein, calcium, magnesium, and iron, raw almond butter makes for a simple snack for busy breastfeeding moms. Spread almond butter on bananas, apples, or eat it straight from the jar! I mean why not, right? Read labels, sugar can be sneaky! Raw almond butter is best.

Healthy fats

Avocadoes make a great food for breastfeeding moms because of the variety of minerals, especially the high levels of Vitamin K. This vitamin can help with blood clotting and help postpartum moms recover faster from labor and delivery. The healthy fat found in avocados helps to keep you fuller longer. Load up avocados in salads, add to smoothies, or pour olive oil over it and eat it straight from the skin!

Complex carbs

Complex carbohydrates include many plant-based foods that are nutrient dense and rich in fiber, vitamins, and minerals needed for overall health and to support breastfeeding. Complex carbs like sweet potatoes are excellent in providing energy for busy moms on the go and they can help fulfill those carb cravings! Complex carbs from starchy veggies can help satisfy a sweet tooth without adding sugar or inflammatory grains.

Rather than spending your precious time preparing complicated meals, make it easy by preparing smoothies, soups and crockpot meals! Planning ahead will definitely make it easier to eat healthy. Overall, you will be burning 300-500 extra calories by breastfeeding. You want these extra calories to be full of nutrition to boost your energy. Though there is no particular breastfeeding diet, it’s important to eat balanced to maintain a healthy body for yourself and to care for your baby. Avoid empty calories and choose real fresh foods instead. Keep taking your prenatals or choose a non – gmo multivitamin.

And don’t forget to hydrate! An easy tip to remember – drink ½ your weight in ounces every day to stay hydrated! Carrying around a refillable water will help get those ounces in. Add some fresh lemon, berries, or cucumber for a hint of flavor.

Has breastfeeding made you feel hungry? Any cravings? Share with us! We would love to hear more!

https://youtu.be/YaJAQKnWvNo

I Think I Want to Use a Breast Pump. Now What?

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by Bonne Dunham. IBCLC

Ok, you are making milk and you want to pump…now what?  What kind of pump do I use? How often should I be pumping and when? How much milk should I expect to see come out? These are just a few of the many questions that new mothers often ask when taking their first journey down Pumping Lane. You are not alone!  Here are some tidbits that should help with this journey.

What kind of pump should I use?  Not all pumps are created equally.  When selecting a pump, you need to ask yourself what kind of use you will want from it; will you be an occasional user or a daily user?  For the occasional-use-mother, who plans on pumping once or twice a week, a manual pump, also called a hand pump, might be a reasonable and affordable choice.  For the regular-use-mother who is planning to use the pump daily while away at work or school, an efficient, electric double pump will likely be the best pump choice.

A hospital strength pump is a more powerful machine; it’s the Cadillac of pumps! It is oftentimes issued by a Lactation Consultant as a multi-user pump or obtained through insurance as a personal use pump.  This pump is used to help mothers build a milk supply when separated from their babies, as in, preterm deliveries or when baby needs to spend some time in the Neonatal Intensive Care Unit (NICU).  There are a handful of other maternal health conditions that make it more difficult for a woman to make milk. A hospital grade pump might be a good option if you fall into this category. Speaking with an IBCLC for specific guidance in these scenarios would be the best option.

How often should I be pumping and when?  If you are planning on exclusively pumping, then you will want to pump at least 8-12 times a day to keep your milk supply up, especially until your baby starts on solids.  If you are breastfeeding and hoping to create a milk stash, here are some tips for you:

The bottom line is, you can pump whenever you have a free, and often hard to come by, moment. If you want to maximize your pumping output, pumping in the morning hours when  milk supply is at its highest is the best time. Waiting about 30-60 minutes after a breastfeeding session is ideal. Pumping once or twice a day is often enough if you are looking to make your storage stash, but if you are separated from your baby for whatever reason, you will want to try to pump as often as your baby may have fed during that time. This often looks like every 3 hours or so.

How long should I pump each time?  Most moms need to pump for at least 10 minutes, but no longer than 20-30 minutes is the simple answer. It’s always a good idea to pump 5-7 minutes past the last drop of milk.

How much milk will I be able to pump?  A good thing to know is that if you are pumping between breastfeeding sessions, the average mom will express between 1-3 ounces per session combined breasts  (not per breast).  If you are pumping in lieu of a missed feeding, expect to pump around 3-4 ounces. Keep in mind that this amount can vary based on your breast storage capacity.  If your pumping output is less than this and you are concerned, please reach out to a qualified lactation consultant to help you troubleshoot your concern.

Try not to compare yourself to your friends or co-workers, as some mothers may be able to express far more than the average bear. Every ounce is precious and pumping output is not a good indication of milk supply. So, always seek professional guidance from a trained specialist in the area of lactation (IBCLC).  You can find a Spectra Certified IBCLC near you here.

To Sleep Or Not To Sleep?

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by: Bonne Dunham, IBCLC, RN

That is the question that so many new breastfeeding Mothers will ask when their babies start sleeping through the night, yet their breasts are overflowing with milk.

Of course, as mothers, we spend those first few months of motherhood dreaming about the day more sleep will arrive.  Yet, when that shift comes, we often start to worry about how this chunk of hours when baby is not breastfeeding will affect our milk supply. We put so much time into building and protecting that milk supply, nursing every two to three hours around the clock, even when our heart and soul and body would love to be sleeping, in the wee hours of the night. Rest assured (no pun intended!), that with a little understanding of how milk production works and adjusts to your baby’s growth and development, you can both have a sound sleep at night and plenty of milk to meet your child’s needs.

It may take a few weeks for your body/breasts to adjust to your baby’s new sleeping pattern, but it will.  Initially, most women will wake to find themselves in a pool of breast milk, or hard, swollen breasts, only to find that their baby is sound asleep and not in need of a breastfeeding snack at this moment. Most women will find that they wake naturally in those first few weeks, either because of the sensation of very full breasts, or just because their body rhythm has been doing so for several weeks or months.  To help your body adjust, to protect your milk supply, and reduce the risk of getting a plugged duct or mastitis, it is a great idea to relieve that pressure by pumping or hand expressing. The following tips will help you through this new stage of breastfeeding your baby.

1.)   It’s ok for you to harvest a little more sleep during this transition. If you are accustomed to feeding your baby every 3-4 or so hours at night, it is fine to sleep a couple of more hours before you relieve some of that milk by pumping or hand expression.  Keep in mind that going longer than 4-5 hours does result in the milk making hormone (prolactin) to lower in your blood which can result in less milk produced. What you remove from your breasts is what you will make. So, ultimately when you stop nursing or pumping at night your body starts the weaning process.

2.)   To help your body make this adjustment to producing less at night, you need only to express milk until your breasts are soft if your baby is not nursing during this time. Often, this looks like about 2-5 minutes of expression.  Longer than this time does result in elevating your amazing milk making hormones to continue to produce. Remember, after just two to three weeks of doing this, you will likely not experience swollen or leaking breasts at night, and can, therefore, stop expressing and start sleeping!

3.)   Babies are amazing creatures, and will adjust themselves by either nursing more frequently during the day, or taking in more milk per breastfeeding session. Starting around 3-6 weeks postpartum, babies drink an average of 30 ounces of milk per day, right up until solids are introduced. This average doesn’t really change much during those months, however, babies do become more efficient feeders as they grow, taking in more ounces per feed, and may space the feedings out depending on their needs.

4.)   It is wise to keep a watchful eye on your baby and your perception of your milk supply as you make this adjustment to less breastfeeding at night. If you suspect that your milk supply has decreased, there are ways to balance it out during your waking hours. You may benefit from speaking to a lactation consultant about your concerns, or to get extra stimulation on your breasts from a daily pumping session.

5.)   You got this!!!

 

If you missed the Live Q&A, don’t worry!  We got you covered.

…Sweet Dreams

10 Tips to Boost Milk Supply

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10 Tips to Boost Milk Supply

So you’ve decided you’re going to breastfeed your little one:  way to go mama! Breastfeeding can be tough but you can be sure you are giving your baby the best nutrition possible.  Whether you are brand new to breastfeeding, have a growing babe, or are returning to work there are plenty of reasons you may be concerned with how to increase your milk supply.  Here are 10 basic tips to follow to get you headed in the right direction:

  1.    Double check your baby’s latch

First and foremost, your breasts produce milk based on supply and demand.  This requires your baby to be able to efficiently suck milk from your breast.  If they are latched on poorly they won’t be stimulating your body to make the milk required to match your baby’s needs.   In general, baby should be able to get a large amount of breast into their mouth (including the areola) and it shouldn’t hurt. Think latching baby on “bottom to top” of the breast; just like you would fit a hamburger in your mouth. It’s not a “bulls-eye” approach. If you’re not sure, there are lots of resources out there, including Spectra Baby USA lactation specialists.  Bottle feeding your baby with pumped milk instead? Make sure all your pump parts are working right with good suction.

  1.    Feed on demand and often

Again with supply and demand, feeding your little one on demand (especially in the first few months to establish a strong supply) will keep your breasts stimulated and producing to keep up with your baby’s needs.  This generally means feeding your little one every 1-3 hours in the first 3 months (except maybe at night) for a frequency of 8-12 times per day. Worried you’re teaching your baby bad eating habits? Most experts agree that in the first year of life it is impossible to spoil your baby when providing them with their basic needs. So, do lots of baby-wearing, skin to skin time and snuggling!

  1.    Empty the breast or pump after feeds

When feeding, the biggest “trigger” for producing more milk is an empty breast.  Make sure one breast is empty before switching to the other side to optimize this trigger. If baby can’t empty both adequately with each feeding, keep track of which breast you start with each session and alternate so they are both emptied throughout the day.  If this still isn’t enough, consider pumping right after a feed to finish emptying the breast before the next feeding (5-7 minutes of pumping is plenty of time). If you are exclusively pumping, your supply will reduce to a slight drip when your breast is emptied. If you want to further stimulate a boost, try pumping for another 5 minutes after this point.

  1.    Nourish your body

Breastfeeding requires approximately 500 more calories per day.  Plus, your body is taking a lot of vitamins and minerals from what you’re eating to provide your baby with the best milk possible.  Keep in mind that just like when you were pregnant and the body took all the nutrients for the baby first; this is the same concept when you are making milk.  You eat well in pregnancy to ensure a healthy baby and healthy mom (since the nutrients go to baby first). With breastfeeding, the nutrients are taken to protect the milk supply first and then, what is remaining is given to mom. If you aren’t replenishing your reserves it will be hard for your body to keep up with milk demand.  You should be eating a balanced diet to optimize your milk production. Although the research is limited, foods that are claimed to boost supply in addition to having an adequate diet include oatmeal, almonds, spinach, garlic, fenugreek, and fennel. On the other hand, there are some foods believed to decrease milk supply to avoid such as alcohol, caffeine, parsley, mint, sage, and oregano.

  1.    Stay hydrated

Breastfeeding requires an increase in water intake to not only make up for direct loss in your breast milk but also the increased demand breastfeeding places on your body.  Dehydration will most definitely affect your milk supply, so don’t wait to drink water until you’re thirsty! Try to stay ahead and drink water periodically throughout the day.  A trick a lot of moms use is to keep a glass of water with them when feeding with the goal of drinking at least one glass per feeding. The amount you need will vary but doing a quick urine check (it should be clear to light yellow) will ensure that you are hydrating adequately.

  1.    Get rest

Getting enough sleep is tough with a baby yet it can greatly impact your milk supply if you are always exhausted.   Try your best to sleep when the baby sleeps. This might mean asking for more help from a friend, family member, or significant other or letting your to-do list slide for a while longer.  Checking out resources to help your baby sleep better through the night may help you get more rest as well. Your body needs time to recover to be able to “run” optimally!

  1.    De-stress

When you are stressed, your body releases hormones that can impact the breastfeeding hormone that helps to release your milk. Everyone alleviates their stress differently.  Being tired with a new baby may make it seems hard to “relax” but start small: ask for help, meditate while feeding, focus on some deep breaths, start a light yoga or exercise routine (if your doctor gives you the go-ahead), or take some time to talk to a good friend or family member.

  1.    Add an extra pumping session

If your baby’s eating frequency simply isn’t enough to increase your supply as you would like, consider adding a pumping session between feeds.  Generally, with a good double pump, this means a 10-20 minute session.

  1.    Talk to your doctor about supplements

There are homeopathics and herbs that are believed to help with milk supply, just make sure to get the ok from your doctor first.  Herbs are easy to find in capsules and teas in natural food stores such as fenugreek, thistle, stinging nettle, alfalfa, and goat’s rue.  Homeopathic may require a subscription.

  1.   Stick with it!

Don’t get discouraged and start skipping feedings.  Talk to other mom’s that have been there for support and seek out a lactation specialist if you are struggling.  You are not alone in your breastfeeding journey!  

Let us know your tips below!

Returning to Work: Planning and Pumping

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by Bonne Dunham, IBCLC

The prospect of returning to work after your baby is born can be a very frightening and overwhelming prospect for some Mothers, but with a little extra planning and knowledge about how to do this, you can smooth out this transition quite a bit.

In case you didn’t already know, there are several benefits to combining work and breastfeeding.  Knowing this might help give you a little bit of extra strength to leap over some of the more common hurdles that women face when re-entering the workforce AND taking care of a baby!  It’s not easy, but you got this!

Here are some benefits of combining work and breastfeeding:

Benefits to Baby:  Making the decision to supply breastmilk to your baby while you are working provides protection from ear infections, respiratory infections, allergies, colds, viruses and diabetes to name a few.

Benefits to Mother: Reduced risk of breast, uterine and ovarian cancer; decreases the risk of osteoporosis and allows for precious time to reconnect with baby.

Benefits to Your Wallet: One-day absences to care for an ill child occur more than twice as frequently for women who formula feed their infants as compared to those who breastfeed. And if you haven’t checked out the cost of formula…it isn’t cheap!

Setting Goals and Planning Ahead Will Reduce Stress

  •    Speaking with your supervisor about your plans for pumping at work BEFORE maternity leave is a great idea. If not before, than as soon as possible.
  •    Locate the lactation room in your workplace; does it have a fridge to store your pumped milk or will you have to bring a small cooler?
  •    Order you pump BEFORE your baby is born and understand how it works. While you are at it, gather your other pumping supplies ahead of time; collection bottles, storage bags and cleaning supplies.
  •    Plan your day: how will pumping fit into your workday? Consider making a mock-up of what your day will look like, from the moment you get up to when you step back through your doors. When and where will you pump? For most moms, pumping every 3 hours or so when separated from baby, for much of the first year, will help to keep your milk supply up and running.

Introduction of Pumping & Bottles

Week 1-4: Avoid pumping. Take this time to be with your baby! Allow the infant to naturally ‘program’ and establish your milk supply.

Week 4-6: Begin pumping once a day for 10-15 minutes and introduce a bottle. Adding this pumping session in during the morning or evening can be the best for when your milk supply is at its peak.

Weeks 6 and Beyond: Pump daily to store your milk or to have ready for your workday.

Milk Storage Strategies…The best tip I ever received!

The freshest is the bestest! Ok, bestest is not really a word, but I bet you get the picture: Always try to give your baby the freshest milk you have on hand, it will be highest in nutritive quality and deliver the most health benefits. Think “first in, first out”.

However, it’s also a good idea to rotate your frozen stash a bit too. Here is a way to do that: On Sunday night, take a days’ worth of frozen milk out of the freezer to thaw overnight in the fridge to feed baby on Monday. The milk you pump for Monday while at work will feed baby on Tuesday; Tuesdays’ pumped milk feeds baby on Wednesday, etc. No need to freeze this milk in-between, just keep it cool in the fridge.

Remember: Take a deep breath, take care of yourself too, and ask others for help. Leave us a comment about how you returned to work while breastfeeding and pumping.

How Pumping Enhanced My Breastfeeding Journey

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By Ericah Miller #RealMomStory

Motherhood is a gift. It is also one of the most important full-time jobs you’ll ever have. You’re responsible for loving, protecting, shaping, and nurturing this adorable little human who was next in line to join this world we live in.  It’s a big deal. It’s a 24/7 job actually. There are no paid breaks for every four hours worked. No paid time off, vacation time, and no paid sick time. You’re paid in sweet little coos, smiles, and giggles which turn into sweet phrases and affectionate little hugs to mommy. As they grow, you feel a moving satisfaction watching them thrive at their own pace. It’s amazing. It’s one of those gifts in life I’ll never understand how I was fortunate enough to experience.

However, for me, it is a job you learn on the fly. I wasn’t warned that motherhood would leave me sleep deprived to the point of tears. Given, I decided to breastfeed without supplementing, that eliminated even more sleep from my regimen. But when one great lactation nurse introduced me to pumping, it totally enhanced my life. Pumping my breast milk allowed me to receive help from my spouse with nightly feedings. Although I was never the mom with an overflow or a freezer supply, pumping even made it possible to occasionally have an outing for myself and the occasional date night with my husband. With the twelve weeks of my maternity leave, cabin fever may eventually set in for moms like myself. You need an outlet—some quality time alone, aka ME TIME. Pumping milk allows you to do this. Also, when that maternity leave ends for us working moms, that milk gives both you and baby that warm, fuzzy feeling while you’re apart. Well, maybe not warm, fuzzy right away for mom, but it definitely gives you the security that your baby has what they need while you’re apart.

I’ve literally tried several different pumps and landed on the Spectra S2Plus.

Occasionally, I was discouraged by the amount of time I spent pumping and my output. Although my supply wasn’t in abundance, I typically had what my baby needed. It just took an eternity to get it out with the other pumps. Spectra was my fifth pump and it helped lessen the time tremendously with an even better output. I often got more ounces out with it. Another plus was that it didn’t leave me feeling like someone had attached a blaring vacuum cleaner to my chest lol. My Spectra was so quiet that I was able to pump in the office quietly without distracting anyone walking past the office like my others. A great pump can change the trajectory of your breastfeeding journey. It’s extremely easy to want to quit if you’re pumping and experiencing difficulty with supply or time allotted at work for pumping. A friendly and efficient pump can enhance the journey so much that you’ll look up like me and realize it’s already been fourteen months! I have no plans of stopping for at least the next ten months. Both of my children are pretty healthy and I honestly believe the use of my Spectra pump is a part of that success. Makes me wish I’d had my Spectra the first time around almost eight years ago!

If you’re thinking about what pump to get, trust the other thousands of us who have tried many others and stick with Spectra.  Check here to see if your insurance covers it.