Breastfeeding: The First Week

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By: Chrisie Rosenthal, IBCLC
The Lactation Network

Breastfeeding: The First Week

Your little one is here! The first week of your baby’s life is sure to bring big emotions, special memories and a few challenging moments as well. When it comes to breastfeeding, knowing what to expect can make the tough times much easier.

Day 1: When your baby is born, they will be looking to eat right away! Take advantage of their instincts in this “golden hour” by bringing your baby to your chest and latching immediately after birth. Studies tell us that latching in the first hour helps ensure long-term breastfeeding success! However, if you aren’t able to breastfeed in the “golden hour”, don’t worry – breastfeed your baby as soon as you’re together and if you’re separated for more than four hours, it’s important to start pumping to let your body know that you are breastfeeding. If you delivered your baby in the hospital, ask the nurses to assist you. You may also see an in-patient IBCLC during your stay. You are surrounded by a team of people who are there to support you!

It’s a myth that breastfeeding should “just come naturally”! Breastfeeding is a learned skill, for the parent and for the baby. It takes time and practice. Babies need to eat a minimum of 8-12 times every 24 hours, and in the early weeks, it’s common for babies to eat 10-12 times every 24 hours. In fact, in the first few days, Pediatricians generally recommend that you feed your baby every 2-3 hours around the clock, measured from the start of one feed to the start of the next.

Output is also important. On day 1, your baby should have at least one wet diaper and one stool. After that, the number of wet diapers should increase by one for the first 4 days i.e. a minimum of 2 wet diapers on day 2, a minimum of 3 wet on day 3, and 4+ wet diapers on day 4. Stool frequency varies greatly, but you’ll notice that your baby first passes meconium, a thick, dark, sticky stool. Over the next couple of days, it will transition to a light brown or green, and by day 3-5 you’ll finally see “breastmilk stools” which are loose and a yellow/mustard color.

Day 2: If your support team at the hospital has been helping you latch, today is a great day to start latching your baby yourself, and asking them to observe and give you tips. If you have a partner with you, they can help by making note of the tips and techniques you’re learning.

Night 2 may bring baby’s first growth spurt! Growth spurts are marked by frequent feeding, gassiness, a cranky baby, and lots of wet diapers. Baby may feed more veraciously, your nipples may become more sore. Expect this growth spurt to last a couple of days.

It’s a myth that breastfeeding is “just painful, and you have to push through it.” Although you may feel tugging when your baby is latched deeply at the breast, it shouldn’t hurt. If it hurts, an IBCLC (an expert Lactation Consultant) can work with you to create a plan to feed the baby and make it more comfortable for you. Studies support that applying breastmilk to your nipples is one of the most effective healing measures.

Day 3-5: You may already be or may be heading home soon and if you’re feeling overwhelmed by this transition, know that those feelings are very common. Now is the perfect time to request a consultant with your Lactation Consultant, create a plan for breastfeeding at home and troubleshoot any concerns you’re having.

Sometime during days 3-5, you will also experience your milk transitioning from colostrum and increasing in volume. If you become uncomfortably full, cold compresses applied to your breast tissue (in addition to feeding your baby) can help to provide relief.

This is also when most parents have their first outpatient Pediatrician appointment. Your Pediatrician will ask about feeding, diaper output and take your baby’s weight and measurements. They may also tell you that at this point, your baby is allowed one longer stretch between feeds once a day.

It’s a myth that by “doing the right things, you can coach a newborn baby to sleep long stretches at night.” Babies tend to be nocturnal for the first few weeks of their life. Sleep deprivation can be a real challenge! If you have a partner, work together so you both have a chance to rest every day. If you don’t have a partner, lean on your support network at this time and ask for help. The good news is that baby’s sleep generally improves around six weeks.

Day 6-7: You’re nearing the end of baby’s first week, and you’re probably feeling like you’ve found a little bit of a rhythm by now. If your nipples were tender from the first few days of breastfeeding, you should be feeling some relief at this point. You should also be gaining more confidence in latching. If you’ve been using one breastfeeding position (most likely cross-cradle), this is a great time to switch it up and experiment with other positions (consider football or side-lying).

It’s also not uncommon to be feeling big swings in emotions. (Hormones!) Although “baby blues” are common, familiarize yourself with the signs of postpartum depression and postpartum anxiety. Your OB, MD and Lactation Consultant can provide resources if you need them!

It’s a myth that breastfeeding “is all or nothing”. Or that there’s only “one way” to breastfeed. Some parents choose to feed their baby exclusively at breast, or exclusively pump and bottle feed. Most introduce the bottle in the early weeks and feed both at breast and with a bottle. Your feeding journey is unique to you and your baby, but you’re not alone. If you need support, Lactation Consultants can help you reach your goals. You’ve got this!

Did you know that your breast pump and lactation consultations are often covered under your insurance? The Lactation Network is a great resource and can help connect you to an IBCLC in your area.

Source:

How often to breastfeed. HealthyChildren.org. (n.d.). Retrieved November 28, 2022, from https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/How-Often-to-Breastfeed.aspx?_ga=2.190306667.199690818.1668731164-1827075293.1652815044&_gl=1%2A1xjwh9v%2A_ga%2AMTgyNzA3NTI5My4xNjUyODE1MDQ0%2A_ga_FD9D3XZVQQ%2AMTY2ODczMTE2NC40MC4wLjE2Njg3MzExNjQuMC4wLjA

GOODLIN-JONES, B. E. T. H. L., BURNHAM, M. E. L. I. S. S. A. M., GAYLOR, E. R. I. K. A. E., & ANDERS, T. H. O. M. A. S. F. (2001). Night waking, sleep-wake organization, and self-soothing in the first year of life. Journal of Developmental & Behavioral Pediatrics, 22(4), 226–233. https://doi.org/10.1097/00004703-200108000-00003

AAP schedule of well-child care visits. HealthyChildren.org. (n.d.). Retrieved November 28, 2022, from https://www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-Check-Up-for-Success.aspx

Finding a Breastfeeding Friendly Pediatrician

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Melissa Portunato MPH, IBCLC, RLC

Breastmilk is a living substance loaded with nutrients, antibodies, and vitamins, providing the perfect nutrition composition for your growing baby. Experts recommend breastfeeding exclusively for the first 6 months and continued breastfeeding for 2 years or as long as the mother and baby desire. Some mothers exclusively express breastmilk for their babies, while others prefer to nurse directly at the breast. No matter how you decide to provide breastmilk for your baby, you will give them the very best start by feeding them your precious breastmilk. 

The pediatrician you choose for your baby will significantly impact your breastfeeding journey. Some pediatricians are more knowledgeable about breastfeeding than others, and it’s recommended for expectant parents to interview candidates for their baby’s doctor during pregnancy. Read on for questions you can ask and the answers you should look to receive. 

What percentage of babies are breastfed in your office?

The national breastfeeding rates published by the CDC depict that 45% of infants are exclusively breastfed at 3 months, and about 25% are fed only breastmilk at 6 months. Your pediatrician’s practice should have a high breastfeeding rate, but don’t be discouraged if they don’t know the current national breastfeeding statistics. However, they should know the average of breastfed infants in their office and be willing to listen and support you on your breastfeeding goals. 

Do you work with an International Board Certified Lactation Consultant (IBCLC) should any problems arise?

The IBCLC credential is the gold standard in lactation care, providing skilled, evidence-based breastfeeding support. Access to an IBCLC at your pediatrician’s office will make a big difference. It tells the pediatrician understands your concerns and values specialized lactation care for their patients. 

How much breastmilk should my newborn consume daily?

Breastfed babies consume between 25-30 ounces per day. The amount your baby will consume stays consistent for the first 6 months. If you are exclusively pumping, aim for that total, and if you are nursing and pumping about half (12-15 ounces). 

What growth charts do you use in your practice? 

Breastfed babies should not be compared to formula-fed babies. Research shows breastfed babies are leaner over time and grow in different patterns than their formula counterparts. Breastfed babies should be measured on the WHO growth charts, NOT the CDC growth charts. You can download a free WHO growth chart here. Remember, percentiles are just a comparison with your baby among 100 other babies. If your baby is not growing as quickly as their peers, it doesn’t necessarily mean feeding is an issue. Genetics should be considered, and seeking advice from an IBCLC. 

When is supplementation medically necessary, and how should it be given?

On average, your baby should not lose over 10% of their birth weight and be back at their birth weight at 2 weeks. If your baby requires supplementation, your pediatrician’s first advice should be to breast pump and provide breastmilk as a supplementation in addition to nursing directly at the breast. Alternative feeding techniques like a cup, spoon, or syringe should be suggested instead of bottle feeding. If bottle feeding is preferred, the paced bottle technique is the best way to feed your newborn with a bottle. 

When do you recommend introducing solids?

AAP recommends exclusive breastfeeding for the first 6 months, introducing solids at 6 months, and continued breastfeeding for 2 years or as long as mother and baby desire. Your baby does not need any other food, water, or juice – only breastmilk for the first 6 months. 

When do you recommend weaning from breastfeeding?

The answer here should be until mother and baby desire. There is no specific timeline for weaning, and every family should make a personal decision on when to discontinue breastfeeding. Studies show there are benefits to breastfeeding at one year and beyond. Breastmilk continues to be a source of nutrients, antibodies, and vitamins through toddlerhood and early childhood. 

Be prepared and educate yourself before you begin breastfeeding. Finding a pediatrician that supports your decision to breastfeed is important and can influence the achievement of your breastfeeding goals. If your pediatrician is not supportive of breastfeeding, you can always opt for a second opinion. You are your baby’s advocate. 

Need help getting started with breastfeeding? Schedule a complimentary consultation with a Spectra Baby USA IBCLC here. 

We’re here for you, and we support YOU! 

Source:

Kellams, A., Harrel, C., Omage, S., Gregory, C., & Rosen-Carole, C. (2017). ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeeding Medicine, 12(4), 188–198. https://doi.org/10.1089/bfm.2017.29038.ajk

Everything You Need To Know About Biting and Breastfeeding

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Melissa Portunato MPH, IBCLC, RLC

Not all babies bite and the ones that do learn pretty quickly that mama does not like it and stop. If you’re part of the lucky few that does have a baby shark don’t worry mamas! Biting down at the breast is almost always temporary. With patience, time and support your breastfeeding journey doesn’t have to come to an end. Check out our expert tips to keep your baby from chomping down and get you back on track with breastfeeding pain free! 

Why does my baby bite down when nursing? 

Teething 
Every baby is different, but generally babies will start to cut their first tooth between 3 months and 12 months. During this time, baby’s gums can get sore and the pressure of biting down can bring them relief. Freeze a washcloth dipped in breastmilk and before nursing let baby chew on it. Breastmilk triggers the production of endorphins, a natural pain numbing effect. The anti inflammatory properties in breastmilk may also help reduce soreness and pain. Wrap your finger around the cold washcloth and softly massage the gums providing counter pressure before nursing. Massaging the cheeks and ears from the outside can also help soothe pain. These techniques can relax baby before nursing and they will be less likely to bite down. 

Sometimes teething can result in a shallow latch which overtime can make nipples tender. Try “breast shaping” and compression when nursing to better position the baby on the nipple. Using lying back breastfeeding and dangle feeding can help your nipple go deeper into the baby’s mouth. 

Baby not feeling well 
Other reasons babies might bite down when nursing could be because of a sickness like a cold, ear infection, sinus pressure, headache, or a stuffy nose. If baby has nasal congestion, use a mucous removal tool, like a nasal bulb or the NoseFrida, to clear baby’s nasal passage before nursing. Use breastmilk or saline water to moisten the inside of the nostrils before suctioning to make the process less irritating. Nursing your baby in an upright position, straddled on your lap, or using a sling or carrier can help make the airway stay clear and make breathing easier.

Oral Restriction
Sometimes newborns will clamp down when nursing at the breast. It doesn’t always mean there are oral restrictions but it could be an indicator. Oral restrictions can vary and can come in the form of a tongue tie, lip tie, and buccal tie (these ties can be found on the inside of the cheek). The shape of the palette and tongue can also influence how a baby will nurse at the breast. If your baby continues to clamp down when nursing, work closely with your pediatrician and connect with your local International Board Certified Lactation Consultant, IBCLC for a thorough breastfeeding consultation to determine the cause of the issue and develop a plan for resolution. 

Forceful Letdown 
If mom has a forceful letdown this can also cause a baby to clench down on the nipple. Using nursing positions that are counter gravity can slow the overactive letdown and baby will be able to manage milk flow easier. Nursing lying back with baby’s body flat directly over you or sitting baby upright to nurse can slow the flow, allowing baby the rhythmic suck and swallow necessary for nutritive feeding. In addition, hand expressing first or pumping for 5 min prior to nursing sessions can help baby latch on easier and slow forceful letdown too! 

What else can I do to make baby stop biting? 

No matter the reason for biting it can be painful. Try not to scream! Instead, put your baby down in a safe place and leave the room. It’s important to know a baby that is actively nursing can not physically bite down on the breast. Babies tend to bite down towards the end of a feeding, when distracted, or not interested. Watch your baby closely when nursing and end the nursing session before baby has the opportunity to bite down. Babies are pretty keen at sensing our body language and behavior. Talk to your baby often when nursing. Tell your baby things like “we don’t bite mama” or “biting hurts mama, outchy.” Babies look for facial expressions to communicate. Be expressive with your emotions when you talk to your baby. Smile and positively reassure your baby when latch on happens carefully and smoothly. 

Managing Nipple Pain and Milk Supply
If baby’s biting has your nipples sore, caused abrasions, or cuts be sure to treat them to prevent infection. Air dry as much as possible and wash with non antibacterial soap in the shower. Applying a cool hydrogel can soothe sore nipples and keep them healthy. For deeper cuts and abrasions temporarily applying a mupirocin, prescribed by your doctor, can help speed up healing and avoid infection. Small amounts on the nipples do not need to be wiped away before nursing. Always remember mamas! Your doctor is always a quick call away if something doesn’t seem right. 

If nursing directly at the breast has become too painful, pump to maintain your milk supply. Use the slow 38 cycle steady with the Spectra breast pump S1/S2 and lubricate the tunnel well with breastmilk or olive oil to prevent friction and further discomfort. Be gentle on your breasts and nipples. Use massage and compression to stimulate more effective letdowns allowing for less time on the pump. 

Remember you and your baby are a dyad. You are one. Your baby will learn quickly biting hurts mama and they will stop. Your baby loves you and doesn’t want to knowingly hurt you! You’re an amazing mom and your baby thinks so too.

References

Nishitani S, Miyamura T, Tagawa M. et al. The calming effect of a maternal breast milk odor on the human newborn infant. Neurosci Res (2009) 63(1): 66-71

In: Drugs and Lactation Database (LactMed). Bethesda (MD): National Library of Medicine (US); 2018 Oct 31.

http://www.nancymohrbacher.com/breastfeeding-resources-1/2016/6/10/your-breastfeeding-baby-is-biting-you

Re-lactation: One Mother’s Journey

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By Jacquelyn Ordner BSN, RN, IBCLC, RLC

I had met my breastfeeding goals with three out of my four children, with the fourth still nursing once or twice a day.  Number four was about 2.5 years old and had decided he only needed “milkies” at naptime and bedtime.  I was comfortable with this, and we were moving through this transition happily.  But, when my husband and I decided we were going to adopt, my thoughts around weaning began to change. What if my next child needs my milk too?

As we completed the international adoption application process and began the home study process, we really began to think about the little person who would be joining our family.  We had told the agency that we’re open to parenting a child with significant medical needs. Our child could need a myriad of medical interventions, and I immediately began thinking that I needed to store breastmilk to help support him or her.  I’m an RN and IBCLC, so that’s just how my mind works. I KNOW that just 15 ounces of breastmilk can provide up to:

29% of a toddler’s energy requirements

43% of their protein requirements

36% of their calcium requirements

76% of their folate requirements

75% of their vitamin A requirements

94% of their vitamin B12 requirements

And 60% of their vitamin C requirements (Dewey 2001).

Breastmilk does not suddenly become non-nutritious or suddenly lose its bioactive and immune boosting components at a certain age! So, in the waiting and through the mountains and mountains of paperwork, I could be working toward making more milk to save for our fifth child! 

I began with the basics…..pumping! In an effort to store every ounce, I gently encouraged our current youngest to cut back to nursing just once a day.  This was easy at first, and he didn’t even seem to mind me pumping. I was double pumping with the Spectra S2 just 3-4 times a day to start. Let me tell you, this wasn’t very encouraging!  I was only yielding a total of 1-1.5 oz per DAY! That’s when I hit the first major setback….my toddler became jealous of my pump! He cried when he saw me pumping and asked for “milkies” multiple times per day.  I felt so conflicted at this point because my natural instinct was to scoop him up and provide that loving comfort as we had done thousands of times before. However, I also knew my goal was to collect and store as much milk as possible before we brought kiddo #5 home.  Knowing that an effectively nursing baby (or toddler in my case) was far more efficient at stimulating milk production than my pump, I allowed him to nurse up to three times per day while I continued to pump 3-4 times per day. 

We were hitting our stride, and my pumping output was SLOWLY increasing, when we had another setback.  My work schedule changed, and this put stress on the whole family. My little guy had to start a new daycare during at this time as well.  So, I took a break from pumping for a couple of weeks. I could kick myself for this now, but I can’t go back to change it. That two week break set me all the way back to the beginning. Still, once we found our new rhythm, I was determined to get my production up.  I began faithfully pumping 5-6 times per day and VERY SLOWLY started to see an increase! Over the course of 4 weeks, my pumping output went from 1-1.5 oz per day to 3 oz per day in addition to the milk I was providing to my nursing toddler. Though my output is small, I’m confident that I can continue to increase my supply with dedicated pumping. Re-lactation takes time!   If you are considering starting the re-lactation process, there are a few things to keep in mind:

  •  Milk supply is easier to influence in the first 4-6 weeks postpartum.
  • The amount of time and pumping needed to re-lactate depends on many factors such as how long you were nursing or pumping before stopping, how long it has been since you stopped nursing or pumping, and how much milk you were producing at the time you stopped.
  • Pumping alone can be an effective way to stimulate re-lactation.  The use of galactagogues should only be done so with the help of a knowledgeable practitioner.
  • An effectively nursing baby is the MOST efficient way to stimulate milk production.  If your baby will latch, this is very helpful to the re-lactation process. The use of an at-breast-supplementer can be significantly helpful as well.
  • The knowledge and expertise of an International Board Certified Lactation Consultant, who has experience with re-lactation, can be extremely beneficial for a mother who is pursuing this goal!

Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).

The American Academy of Pediatrics (AAP) Issues Updated Breastfeeding Guidelines

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By Melissa Portunato MPH, IBCLC, RLC

On June 27, 2022, The American Academy of Pediatrics updated its existing policy statement on breastfeeding. The revision has come at a controversial time amidst the current formula crisis, failed legislation, and the recent Supreme Court ruling on reproductive health rights. Read on for the full breakdown and what this means for public health in the US. 

What’s NEW?
The previous AAP policy recommended breastfeeding for the infant’s first year and has now been updated to 2 years and beyond. The policy now states, 

“ The AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond.” 

This wasn’t the only change that came with the revised policy. Social and cultural calls for action were also at the center of the guideline revisions to support parents who want to meet the new recommendation. The official statement includes the need for paid maternity leave and more support in public, child care, and workplace facilities. In addition, maternity care practices were urged to improve breastfeeding initiation, duration, and exclusivity. The organization also acknowledges that babies born to gender-diverse families may not have equal access to human milk, and clinical support may be more challenging. Overall, the AAP calls for clinicians to equip themselves to provide evidence-based quality medical care to ensure all families best meet their personalized breastfeeding goals. 

Why Now?
As the formula crisis rages on, parents may be asking themselves, why now? The truth is this has been a long time coming, but the formula shortages did help to revive the conversation. Significant research has long backed up the nutritional and immunological benefits of human milk feeding past one year. The extensive studies are not limited to the above benefits; instead, they reveal psychological advantages when the young child continues to nurse directly at the breast and boast benefits for the mother as well. It’s important to note that the new revision is now in line with the World Health Organization’s long-standing breastfeeding recommendations for 2 years or beyond. 

Now What?
We all know exclusive breastfeeding is the goal, but that can seem far-fetched or unattainable for families struggling to make enough milk, experiencing latching difficulties, or simply lacking breastfeeding education or support. Nevertheless, many experts still agree the revision to the AAP policy is a step in the right direction. It will likely prompt the availability of more community resources for pre/post-natal education, diversity of lactation clinicians, and easier access to low-cost breastfeeding support platforms, i.e., telehealth.

Unfortunately, the Pump For Nursing Mothers Act which would extend breastfeeding mothers pumping rights to 2 years, was denied in the wake of the AAP’s updated guidelines. The failed legislation covered salaried breastfeeding individuals that were not covered under the Affordable Care Act. Another bill already introduced to the Senate, the Pregnant Workers Fairness Act, prohibits employers from discriminating based on pregnancy, childbirth, and related medical conditions. This bill appears ready to pass soon and is set to protect working breastfeeding families similarly. Good news! 

How can Spectra Help?
Breastfeeding for 2 years or beyond may not be realistic for all families, yet there are ways Spectra baby USA is making it easier for parents that decide to breastfeed past one year. All Spectra Baby USA’s high-quality electric breast pumps have a 2-year product warranty. Complimentary virtual consultations with a Certified Lactation Consultant (IBCLC) are available with the purchase of any Spectra baby USA breast pump. No matter the amount of breastmilk you can provide or the length of time, breastfeeding is an accomplishment, and human milk provides irreplaceable health benefits to your baby. If you have questions about achieving your breastfeeding goals, message us at ibclc@spectrababyusa. In addition, we always recommend connecting with your local International Board Certified Lactation Consultant for evidence-based advice and community support. 

Sources:

American Academy of Pediatrics calls for more support for breastfeeding mothers within updated policy recommendations. Home. (n.d.). Retrieved July 5, 2022, from https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-calls-for-more-support-for-breastfeeding-mothers-within-updated-policy-recommendations/ 

Text – H.R.3110 – 117th Congress (2021-2022): Pump for Nursing Mothers act. (n.d.). Retrieved July 5, 2022, from https://www.congress.gov/bill/117th-congress/house-bill/3110/text 

Bonyata, K. (2018, January 15). Breastfeeding your toddler: What to expect • kellymom.com. KellyMom.com. Retrieved July 5, 2022, from https://kellymom.com/ages/older-infant/toddlernursing/ 

 

When and How To Drop A Pumping Session

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By Melissa Portunato MPH, IBCLC, RLC 

The first 12 weeks of your breastfeeding journey requires frequent breastmilk removal, stimulating healthy milk production. Studies show moms who exclusively pump for a minimum of 120 minutes per day can make enough to feed their babies primarily breastmilk. After 12 weeks, your body has gotten the hang of milk making, and it could be an optimal time to drop a pumping session. Every breastfeeding experience is personal and unique. 

Read on to decide if you are ready to drop a pumping session and how to do it the most effective way.

How Often Are You Pumping and How Old Is Your Baby?
Trying not to go more than 4 hours without pumping/nursing is a general breastfeeding rule while breastmilk is being established. It’s best to wait until after the first 12 weeks to start eliminating pumping sessions. Frequently draining the breast every 2-3 hours will ensure your body produces enough milk and avoids engorgement. If you reached the 12-week milestone and pumping 8x or more per day, dropping a pumping session can be safely considered. 

How Much Milk Do You Currently Make Per Day?
Babies from one to six months old will consume on average 25oz per day. Research tells us exclusively pumping will yield a range from about 19oz to 30oz per day. On average, that’s 2-4oz combined every 2-4 hours. Milk production usually peaks at around 40 days postpartum, and it’s normal for this amount to fluctuate from day to day or session to session too! If you are nursing your baby at the breast and currently adding in pumping sessions, expect to see half the amount, ½ -2oz combined. 

Are You OK with Supplementing?
This could be a deal-breaker for some parents. If your baby has only received breastmilk up until now, you may be a bit more hesitant to offer formula. Others may supplement from the beginning and are comfortable adding additional formula if it means less pumping. Having an open and honest conversation with your trusted pediatrician can help you decide what’s best for you and your baby. No matter what you choose, you love your baby and are doing the very best you can. 

How Do I Start Dropping a Pumping Session?
Gradual weaning from the pump is always best. Start with eliminating a pumping session by 3-5 minutes until eliminated. It can take about a week or more to drop the session completely, and even then, set the alarms and listen to your body. Hand express or pump for 5 min for relief if needed to avoid clogged ducts and engorgement. Pumping on a low vacuum (3-5) and slower expression cycle (38 with the S1/S2) can gently drain the breast, allowing an easier transition. Once a pumping session has been dropped, the remaining sessions can be spaced out more evenly. 

Need help dropping a pumping session? Our IBCLCs are experienced with pumping schedules, weaning from the breast pump and more. Schedule a complimentary consultation with us today. 

Sources: 

Bonyata, K. (2018, January 02). Exclusive Pumping • KellyMom.com. Retrieved September 21, 2021 , from https://kellymom.com/mother2mother/exclusive-pumping/ 

Bonyata, K. (2018, January 16). I’m not pumping enough milk. What can I do? • KellyMom.com. Retrieved September 21, 2021, from https://kellymom.com/hot-topics/pumping_decrease/ 

Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession. Philadelphia, PA: Elsevier. 

Mohrbacher, N. (2012, November 27). How Much Milk Should You Expect to Pump? Retrieved September 21, 2021 from http://www.nancymohrbacher.com/articles/2012/11/27/how-much-milk-should-you-expect-to-pump.html 

 

A Guide to Pumping on Vacation

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Melissa Portunato MPH, IBCLC, RLC 

Are you ready to hit the road with your breast pump this summer? Planning ahead will eliminate unnecessary stress so you can enjoy the time away and make long-lasting memories. Read on for our practical and easy-to-follow guide to pumping while on vacation. 

Ring Before You Go
When booking a hotel, make sure you have a freezer you can use. Ideally, there will be one in your room. However, you may be able to use the hotel’s main freezer if there is no other option. If you’re struggling with hotels, opting for a private home or condo may be a great option.

Have a Good Flight
In case you were wondering…YES, you can absolutely pump on a plane! And your breast pump does NOT count as an additional carry-on. Find out more about the TSA guidelines on carrying a breast pump and breastmilk here. Don’t pump in the restroom! Most airports now provide private pumping pods where you can nurse or pump in a clean, quiet space. Download the app to plan ahead and find the nearest pod if you need to pump before boarding. 

Vacay Must-Haves! 

  • Rechargeable Breast Pump – A portable breast pump like the S1 or 9Plus will give you more flexibility when pumping on vacation. We recommend charging your Spectra rechargeable pump for 3-4 hours; leaving it to charge overnight can ultimately damage the battery.
  • Grab a Car Charger! Spectra has car chargers for both the Spectra 9 Plus (9 volt) and the Spectra S1/S2/SG (12 volt). In addition, if you’re traveling abroad, Spectra baby USA beast pump power cords are internationally compatible, which means all you need is the country converter, and you’re all set!
  • Cooler Kit – Keep your breast milk cool when a refrigerator is unavailable. Transport refrigerated/frozen milk by placing breastmilk in an insulated bag or cooler with a frozen cold pack. According to the CDC,  milk should be refrigerated or frozen within 24 hours. Instant ice packs are nice to have on hand!
  • Extra Parts – It’s recommended that you wash your pumping parts (except tubing) after every use in a designated basin with warm soapy water. The CDC recommends sanitizing parts once daily for extra germ removal. If you know you won’t have access to a sink, bring enough sets of pump parts to get through the day. Placing pumping parts in the refrigerator in between uses is not recommended.
  • Hand Pump – Every mom should have a hand pump as a backup. They are lightweight, convenient, and can be your lifeline in an emergency! Throw it in your pump bag and never get left without pumping if you run out of battery or can’t find an outlet.

Pump and Chill 
Go ahead and sleep in or enjoy a late-night dinner! It’s OK if you don’t pump at the same time every day! Skipping a pumping session or going over in-between times occasionally shouldn’t have a drastic effect on your supply. Pumping every 3-4 hours should be the goal, but you don’t have to be a stickler with exact times. Pump before you head out; always pump before bed and in the morning when you wake up. If you miss a pumping session, pump as soon as you can but most importantly, cherish the time away and the memories that will last a lifetime. 

Pumping Packing List 

✔ Pump Bag

✔ Power cord 

✔ Breast pump 

✔ Car adapter 

✔ Extra accessories – duckbills, backflows, flanges, bottles, caps, and disks

✔ Wet bag for used pump parts

✔ Milk Storage Bags

✔ Cooler kit with an ice pack

✔ Hand pump

✔ Nursing Cover

✔ Paper Towels or Napkins for spills

✔ Hand Sanitizer 

Have more questions before your epic vacation? Email us at IBCLC@spectrababyusa.com! 

We’re here for you, and we support you! 

 

Do I Have Elastic Nipples?

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Do I Have Elastic Nipples

By: Melissa Portunato MPH, IBCLC, RLC

There’s been quite the buzz on “elastic nipples” lately. Whether you’re on social media or part of a virtual mommy group you’ve likely heard the term. It’s probably left you wondering if YOU have elastic nipples and if you’re even using the correct flange size. Don’t worry mama! We’ve got you covered. Read on to get the real 411 on elastic nipples. 

Here’s the deal. The skin on and around your nipple (areola) was intended to be stretched by breastfeeding. The nipple stretching is actually a good thing! Moms with truly inverted nipples or skin that is less elastic, are at an increased likelihood to experience issues with low milk supply, soreness, and nipple discomfort. Now if nipple elasticity is associated with low milk supply, pain, redness, or discomfort then it definitely needs to be addressed. Pumping shouldn’t hurt.

But how much should the nipple stretch when pumping to be experiencing “elastic nipples?” For the most part, the nipple should stretch a little less than half way down the flange when pumping. If it’s way past that – like hitting the backflow protector or end of the flange and you’re experiencing pain or low milk output, then it’s time to troubleshoot. Otherwise, elasticity itself is no cause for concern. 

Check out these 4 tips on how to get relief if you have “elastic nipples” and pain when pumping:

#1) Lower The Vacuum Strength

Please don’t think you have to work up your nipple tolerance to level 12 vacuum. Vacuum strength should always be set to comfort. Moms are surprised to see they pump the same amount whether pumping on a high suction or medium / low suction. Every mom is different. Keeping the cycle steady and lowering suction strength can help lessen the elasticity of the nipple. Pumping with your S1/S2 steady on the expression cycle 54 vacuum between 5-6 for 15-20 min can help minimize discomfort. 

#2) Check Your Flange Size

This part could be tricky. Typically a flange that’s too big will cause the areola to be pulled farther into the tunnel but if a flange is restrictive the nipple will rub inside the tunnel and stretch it farther too. That’s why it’s important to work directly with an International Board Certified Lactation Consultant. It’s normal for nipple size to fluctuate. Measure to know your nipple diameter. But this only tells us a piece of the story. Some moms will benefit from going up a size or changing sizes throughout their breastfeeding journey. 

#3) Lubricating Before Pumping 

Hand express a few minutes before pumping and squeeze a few drops of breastmilk to lubricate the inside of the tunnel. This can help keep your nipple in place and help with soreness too. You can do this with lanolin or a few drops of olive oil too! Reposition your flanges every few minutes while pumping if needed. Hand express for a few minutes after pumping and let breastmilk air dry on them to help heal and keep them healthy. Bonus – hand expressing before and after pumping can trigger more milk production. 

#4) Silicone Inserts / Massagers 

A massager or silicone insert can offer relief sometimes but not always. Spending a ton of cash on accessories that either don’t work or fit properly can be frustrating.Too often moms find these products can actually decrease suction and they find them hard to keep in place. If you’d like to try one of these, go for it! But it’s best to look for an insert that offers a money back guarantee or can send you multiple sizes to find the best fit. If you do find it hard to keep an insert in place, try moistening it with a few drops of water or breastmilk. Moisture can help create a better seal. 

Correct flange sizing and lower suction can usually be a quick fix to get relief from elastic nipples. But what if you’ve tried it all. You have the correct size, low suction and still have your nipple stretching way past the halfway mark but don’t have any pain? Then you’re good mama! Pump on! Your body is doing exactly what it was intended to do. 

Schedule a virtual consultation with us and we can help with tips to manage pain and discomfort associated with elastic nipples. We can help with flange sizing and troubleshoot your pump too. You’re doing really great at breastfeeding mama. We’re proud of you! 

 

 

Navigating the Formula Crisis

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Melissa Portunato MPH, IBCLC

Though most women have the initial desire to breastfeed, the CDC reports only 25% of babies meet the recommendation of exclusive breastfeeding for the first six months. As the baby formula shortages continue in the US, many parents are now faced with the unprecedented stress of keeping their babies fed. If you are concerned about your baby’s well-being, contact your pediatrician immediately for supplementation guidance and continued support. 

Read on for important information and resources every family needs to know about the current formula crisis. 

Brand Alternatives
Many families rely on specialty formulas to feed their babies and have been feeling the effects of the shortages even more. However, if you can not find the brand or specialty formula for your baby, often brand alternatives are available. For a formula compatibility chart, click here. 

DON’T
Experts warn against making formula at home or diluting formula. This can be dangerous and harmful to your baby. To find or exchange formula in your community, visit this free online tool – https://freeformula.exchange. 

Relactation 
Relactation is reestablishing your milk supply after your body has stopped lactating after several weeks or months. To start relactating, if you have a baby that will latch to the breast, take it back to the basics. Practice lots of time skin to skin and bring baby to the breast often. If your goal is to pump exclusively, start pumping every 2-3 hours for 20-30 min each pumping session. In order for relactation to be successful, experts recommend using a hospital strength pump like those available at Spectra baby USA. At first, you may only see drops of milk, but with commitment and support, milk supply will start to increase over time. Work with a skilled International Board Certified Lactation Consultant that can help you meet your breastfeeding goals. Find a local IBCLC here. 

Practice Safe Breastmilk Sharing 
For safe breastmilk sharing, ask your donor about their lifestyle, medical history, and medications. Ensure they are safely handling breastmilk and consider home pasteurization. To learn more about milk sharing, visit https://www.eatsonfeet.org/safeMilkSharing.

Become a Breastmilk Donor 
Breastmilk donors are in high demand. Consider becoming a donor if you are currently breastfeeding. For more information on how to become a breastmilk donor, visit these resources:

https://www.hmbana.org

https://www.eatsonfeets.org/DonatingAndRequesting

At Spectra baby USA, we believe breastmilk is the perfect composition for your baby and every mother should have access to support. If you are expecting a new arrival and would like more information on getting off to the best start with breastfeeding, schedule a complimentary consultation with a Spectra IBCLC today! 

Paced Bottle Feeding

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Jacque Ordner BSN, RN, IBCLC, RLC 

Are you worried your precious little one will grow to prefer the bottle over your breasts?  Are you concerned you might not be able to keep up once baby begins taking bottles regularly while you’re away? Are you exclusively pumping and looking for tips on bottle feeding?  We’ve got you covered with our full guide on Paced Bottle Feeding.  

Research indicates that infants will take more from a bottle than they would when nursing.  This can result in overfeeding, mom losing confidence in her milk supply, and can even contribute to later obesity.  One large study compared formula fed infants (via bottle) and breastfed infants (via direct nursing) and found that the bottle-fed infants consumed 49% more milk at 1 month, 57% more at 3 months, and 71% more at 5 months. In comparison, we know that directly breastfed infants do not increase the volume of breastmilk intake from one to six months of age.  The average daily intake for a breastfed infant from one to six months remains about 25 ounces per day.  

 Why do bottle-fed infants tend to consume more?  

  • The flow from a bottle can often be initiated by gravity alone, triggering innate sucking reflexes present in babies under 4 months old.  In other words, baby will often continue to suck and swallow milk from a bottle long after they’ve reached “fullness”.  In contrast, the flow of milk from the breast requires a coordinated suckle and does not flow consistently.  An infant can pause, breathe, relax, and reassess before initiating additional flow from the breast.  This puts the baby in greater control of the feeding.  
  • Formula fed infants regularly consume more than their breastfed counterparts because more formula is required to meet their nutritional needs.  Formula also does not contain hormones such as leptin and adiponectin which regulate hunger and metabolism.  It’s especially important to keep this in mind if your baby receives breastmilk and formula or if you are tempted to compare your breastmilk fed baby’s intake with that of a formula fed infant.  

 What are the benefits of Paced Bottle Feeding? 

  • Paced Bottle Feeding allows infants to develop and practice their innate feeding cues and skills rather than only responding to the consistent flow of the bottle over which they have no control.  This is especially important for newborns (particularly pre-term newborns) who require supplementation early.  Allowing newborns to develop natural feeding cues and skills can be instrumental in helping them return to the breast or to transition from breast to bottle and back.   
  • Babies often develop a preference for the fast and continuous flow from the bottle. In the past, this might have been labeled as “nipple confusion”, but we now call it flow preference.  We now know that when baby prefers the bottle over the breast, it’s almost always due to the preference and ease associated with the faster flow of the bottle.  Babies are smart, and once they learn that they don’t have to wait for milk from the bottle they may start to refuse or become frustrated at the breast. Paced Bottle Feeding helps to mimic the slower and non-continuous flow of milk that occurs during nursing.  
  • Paced bottle feeding allows time for baby’s satiation signals to be recognized.  Most of us know the experience of scarfing down a big holiday meal in 10 minutes or less only to realize we’re painfully full.  Similarly, a baby can often take copious amounts from the bottle, due to its rapid and persistent flow, before the brain has had a chance to realize the belly is full.  This can lead to a gassy, fussy, spitty baby. Over time, baby’s tummy can come to expect those large feeds even if the volume isn’t necessary for baby’s complete nutrition.  Additionally, the same large study mentioned above found that caregivers often encourage baby to finish a bottle even when they’re displaying signs of satiety. Caregiver pressure to empty the bottle is another contributing factor to overfeeding. This can also lead mom to believe her supply is inadequate when baby is actually being overfed. 

 What are the principles of Paced Bottle Feeding? 

  • Feed on demand following baby’s hunger cues (rooting, sucking on fists, smacking lips, restlessness, etc.) Remember crying is a LATE sign of hunger.  
  • Choose a slow flow nipple.  Not all slow flow nipples are as slow as they claim.  Click HERE for to check the flow rate of many popular brands.  
  • Feed baby in a nearly upright position. 
  • Allow baby to “latch” onto the nipple rather than inserting it into his or her mouth. 
  • Hold the bottle parallel to the ground so that milk just enters the nipple. 
  • Provide frequent breaks by tipping the bottom of bottle down or completely removing the nipple from baby’s mouth. This is especially important if baby begins to gulp. Watch baby’s cues! 
  • Switch sides halfway through the feeding to mimic a nursing session. This also provides cross-connectivity in the brain. 
  •  Feedings should take 15-30 minutes.  
  • Don’t force baby to finish the bottle.  Allow baby to determine when he or she is full rather than encouraging them to finish a specific amount.  

*These techniques are appropriate for babies under 6 months of age.  

Click HERE for a video demonstration of Paced Bottle Feeding. 

Paced Bottle Feeding helps protect the nursing relationship, reduces the risk of overfeeding, and gives baby control of their feedings.  Have concerns about bottle feeding?  We can help!  Our Board Certified Lactation Consultants can develop a plan to help you introduce or manage bottle feeding.  Click HERE to schedule your free virtual consultation or email us at ibclc@spectrababyusa.com.  We’re here to support you! 

References 

 Arenz, S., Ruckerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity–a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28(10), 1247-1256. 

 Dewey, K. G. (2009). Infant feeding and growth. In G. Goldberg, A. Prentice, P. A., S. Filteau & K. Simondon (Eds.), Breast-Feeding: Early influences on later health (pp. 57-66). New York, NY: Springer. 

Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. (2004). Feeding effects on growth during infancy. Journal of Pediatrics, 145(5), 600-605. 

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395. 

Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2008). Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants’ risk for excess weight at late infancy. Pediatrics, 122 Suppl 2, S77-84. 

Doneray, H., Orbak, Z., & Yildiz, L. (2009). The relationship between breast milk leptin and neonatal weight gain. Acta Paediatrica, 98(4), 643-647.

Talking “Self Care” With Dr. Rachel

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By Dr. Rachel Goldman Ph.D., FTOS, Licensed Psychologist

Self-care. We have all heard about it and we know we “should” do it, but do we? Self-care is a broad term that encompasses just about anything that we do to be good to ourselves; it’s about being kind to ourselves. It doesn’t need to be going to a 5-star resort or having a spa day, although wouldn’t that be nice? I am talking about something we do more regularly, something you can do on a daily basis that is for YOU. You are probably thinking, how is that possible when I am a mom, have a baby to take care of, need to pump/breastfeed, change diapers, and keep this little human alive, but it’s not only possible, but it is actually necessary. Think about the instructions flight attendants give on an airplane- we need to put our oxygen mask on before we put anyone else’s on. Think about your cell phone- we don’t let our cell phone batteries run low, but we instead keep an eye on it and charge it when needed. Self-care is about knowing when your resources are running low and taking a step back to replenish and recharge.

You may be thinking this is a bit selfish to put yourself first, and especially with a baby at home, but I call it a “healthy selfishness”. When it comes to our health and wellbeing we have to be a little selfish. A “healthy selfishness” is knowing what you need to do (within reason) and allowing yourself to do it. If you think about everything we do for survival, such as sleeping and eating, those are examples of behaviors associated with a “healthy selfishness”. We need to participate in these behaviors in order to survive. We also need to participate in other behaviors to be healthy, both physically and emotionally, such as taking time out of our day for us, for “me time,” and to relax or de-stress. For some that may be going on a run or going to the gym, for others that may mean a quiet and relaxing bath. Whatever it is, it is needed to allow you to de-stress, refocus and be able to be productive and accomplish what you need to accomplish, which includes being a mom and being emotionally and physically available to take care of your little one. Without some of these behaviors and acts of “healthy selfishness” we will eventually burn out and not be productive in any aspect of our life. We may even start to feel regret, sadness, and anger, which is not uncommon feelings during the postpartum time, especially since your life has just drastically changed by having a new baby. These feelings are also signs that it is time to take a step back and to do something about it. We need to monitor and check-in with ourselves in order to see what we need in order to function to the best that we can at that given time. Keep in mind, what we need today may be different than what we need tomorrow. This may also look very different for different people and can change with different life circumstances.

So now what? Here are some things to think about to help YOU find the time YOU need to be the best YOU.

  • Make Yourself a Priority- think of the instructions regarding putting on an oxygen mask on an airplane. Decide that you deserve self-care.
  • What does ‘Me Time’ mean to YOU? This could be just a few minutes to yourself or can be an activity that you enjoy, so you will actually do it. We tend to make excuses for things we don’t enjoy doing, so think about activities that do not cause stress, but rather relaxes and recharges you. Besides the gym and running, I have made pumping be part of my self-care routine. I have my husband give our baby a pumped bottle while I pump, so I have some quiet time to relax and destress. This is also helpful as stress can affect our milk supply, so having this quiet time has been useful and works for me.
  • Use Relaxation Techniques – relaxation techniques, including meditation, massage, yoga, imagery, and breathing are very effective at decreasing stress levels and helping you relax. It can be useful to practice these techniques while you are pumping as well to ensure you are calm and not stressed.
  • Schedule – make sure you set aside time each day just for you (‘Me Time’). Consider this time like an appointment that you wouldn’t miss. Since I pump a minimum of 2 times per day (first thing in the morning and before I go to bed), this is already scheduled for me. I do schedule additional ‘Me Time’ though, including exercise and physical activity.
  • Create a Daily Routine – make it something you look forward to and will become part of your lifestyle. Your daily routine should also include what I call the key health behaviors (water intake, nutrition, physical activity, and sleep). AND these are also all key behaviors to helping your milk supply!
  • Be Assertive and Ask for Help – don’t say yes to everything. Learn to say no or to delegate responsibilities. For instance, my husband gives the morning bottle while I pump. I had to ask him to do this, but when I asked him and explained to him how it would help me (which would also help our baby), he was willing to do it. You don’t know until you ask ☺
  • Find Support – get support from your family, friends, and colleagues. Talk to them about your stress, your ‘Me Time,’ and your plan. Also, find people going through similar things and support each other.
  • Seek Professional Help – if stress and anxiety is impacting your daily functioning and is getting in the way of you fulfilling your responsibilities, there is help. Increased stress for prolonged periods of time can be bad for your physical and mental health, but can also impact your milk supply, and those around you, including your little one.

To YOU, taking care of YOU, YOUR health, and YOUR pumping and breastfeeding journey!

Connect with Dr. Rachel at www.DrRachelNYC.com

Tips to Manage Nipple Pain

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Melissa Portunato MPH, IBCLC, RLC 

Nipple soreness in the first few weeks postpartum is normal as you navigate breastfeeding, but wanting to cry every time you turn on the pump or latch your baby is NOT normal. Painful nipples can be caused by challenges with latching baby at the breast, incorrect flange sizing, or even just pumping on too high of a vacuum setting. Read on to learn our top tips for managing nipple pain during your breastfeeding journey. 

Latch
You’ve probably heard about “THE LATCH” and its importance to your breastfeeding success. The short answer is yes, the latch is everything when nursing at the breast. A proper latch will ensure your baby is nutritively sucking at the breast, which is needed for your baby’s healthy growth and development – your nipples will thank you too! Also, a proper latch will NOT be painful. You will always feel tugging or pulling when pumping or nursing but not pain. If you are working on getting a better latch, try the “laid back breastfeeding’” position. A hangry baby will be much more difficult to latch and will likely not latch. Practice every feeding starting with skin to skin and in between feeds when your baby is calm and alert. Pump with a hospital-grade breast pump if baby is not nursing well or draining the breast to maintain an optimal milk supply. 

Lubricate 
You can treat sore nipples with your very own breast milk! Studies show the antibacterial properties of breastmilk make it the perfect substance to heal nipples and keep them healthy. Hand express breast milk on your nipples after every feeding and allow them to air dry. Combining breastmilk with a cool hydrogel will get your nipples feeling better in no time! 

Lower the Pump Vacuum
If pumping is hurting, try lowering the vacuum. A higher vacuum doesn’t mean more milk. On the contrary, it could be the leading cause of your nipple pain. Depending on your Spectra Breast Pump, you have between 10-15 vacuum levels! That’s a whole lot of suction. You don’t need to work up to high vacuum levels. Moms are surprised that using a medium/low vacuum level can better drain the breast and cause less soreness. Try pumping only on 38 expression mode and set the vacuum to comfort. This setting can help ease nipple pain! 

Check Flange Sizing
If your flange is not the correct size, it can cause soreness and issues with milk supply down the road. Measure your nipples before nursing or pumping for an accurate assessment. Keep in mind that you want your flange size to be 2-3mm larger than you measure.

You can use our easy-to-follow breast shield guide to find the perfect fit. 

Red Flags, Call the Doctor 
Nipple soreness should start to subside about 2-3 weeks postpartum. If you have cuts, cracks, or abrasions on your nipples, you are more susceptible to an infectious form of mastitis. Wash your nipples daily with non-antibacterial soap and allow them to air dry. Make sure you change your breast pads frequently; this will help prevent any infection and allow your nipples to heal faster.

Consult your health care practitioner and a local IBCLC if you have the following symptoms:

  • Prolonged nipple pain or tenderness 
  • Itchy, scaly, or shiny nipples or breasts 
  • Bright red areas of the breasts and hot to the touch 
  • Flu-like symptoms that persist for more than 24 hours 

Spectra baby USA has a team of IBCLCs ready to assist you with your breastfeeding questions and provide local resources to ensure breastfeeding success! 

Schedule your complimentary consultation with us today!