Adventures of a Lactation Consultant

TOP 6 BREASTFEEDING QUESTIONS & ANSWERS FROM THIS YEAR

So many changes have happened over the last year! With coronavirus, economic challenges and a world in upheaval, it can seem overwhelming and like things have changed too much. But two things remain the same … 1) babies are born and need to be fed and 2) parents have many of the same breastfeeding questions as they ever have. The commonality of our experience can bind us and help us not feel so alone in a time of great social uncertainty.

With that said, I’d like to take a moment to answer some of the most common questions I have gotten as an IBCLC this past year (yes can you believe its only been a year for Milk Diva?!):

How soon after birth should I have a lactation consultation?

Learning as much as you can about breastfeeding before the birth of your baby gives you the opportunity to get things off to a good start. And many hospitals have a lactation consultant on staff who can help you in the first hours and days with your new baby. But then what? 

While there are not set-in-stone guidelines for when seeing a lactation consultant is best, scheduling a visit in the first week of your baby’s life, preferably the day after your milk comes in, is ideal. This gives you and your baby a chance to get started, but will head off any issues (like sore nipples or patterns that might lead to low milk supply) before they become bigger problems.

Am I nursing him too much? He wants to nurse 10-14 times per day. Is that too much? 

It’s almost impossible to nurse your baby too much. If they aren’t hungry, they just won’t latch. Sometimes moms start with offering the breast anytime their baby is fussy. If that doesn’t work, then you can search for other solutions.

It’s normal for newborns to eat 8-12 times in 24 hours. Some babies need to be at the breast more often, and some of the feedings might be clustered together. Let your baby set the pattern, while watching their diapers to be sure they’re getting enough. We would expect the wet diapers to increase in the baby's first week of life until they are having at least 5 heavy wet diapers per day. A breastfed baby should also have at least 3 yellow, soft, non-formed bowel movements per day after day 4. Your baby may lose a bit of weight in the first few days, but should be back to birthweight by 10-14 days and gaining about ½ ounce - 1 ounce per day.

Other signs that your baby is feeding well include your breasts feeling fuller before feedings and softer after, hearing or seeing swallows while your baby is at the breast, and relaxed arms and hands at the end of a feeding. If latching is painful, your breasts still feel heavy after feeding or your baby seems fretful even after being at the breast, working with a lactation consultant can help you find a solution.

Am I nursing long enough? How do I know if 5 minutes of nursing was enough?

While the average is about 16 minutes per breast per feeding, babies don’t always stick to that average. Many moms find that their babies feed longer on the first breast and shorter on the second. Some babies get really efficient and can finish quickly. Some moms have strong letdowns or a larger storage capacity that gets milk to the baby faster. And some feedings may be short while others are long - just like us, babies sometimes just want a sip of something and sometimes want a big meal. If your baby is having enough output and gaining weight as outlined above, then however many minutes they are at the breast is just right for them. Feed your baby when they show signs of hunger, let them finish the first breast before switching sides, and always offer the second breast. If you’re following your baby’s cues, then the number of minutes is unlikely to matter much.

Which is the best nipple cream? 

While mild tenderness is normal in the first days of breastfeeding, it shouldn’t last past the second week. If you are experiencing sore nipples, especially if you have broken skin, working closely with a lactation consultant can help you figure out the root cause and work toward the best solution.

While you’re working on more comfortable feedings, using a nipple cream may give you a little relief (in fact, some moms even use these creams prophylactically so their nipples don’t crack or get chapped). Several brands of purified lanolin can easily be found in the breastfeeding supply area of any store, and some companies may have lanolin-free and organic options. Be sure you’re using something specifically formulated for breastfeeding so that you don’t need to wipe it off before putting your baby to the breast (for example, you don’t want to use your regular hand lotion on your sore nipples).

Other options that have some research behind them include: olive oil, coconut oil, peppermint gel, medical-grade honey (this is not the product in the sweetener aisle at the grocery store), hydrogel pads, expressed breastmilk, and even just warm compresses. “All-purpose nipple ointment” is a prescription combination cream that may be useful when broken skin isn’t healing well. A 2014 review of the literature on these treatments, however, cautions “[t]here was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone, or the all-purpose nipple ointment significantly improved maternal perceptions of nipple pain” (Dennis et al, 2014).

When can I start pumping? 

Used appropriately, breast pumps can be an important tool. But they can also cause a great deal of confusion. When to start pumping and how long to continue depends on the situation.

If you are separated from your baby at birth, starting a regular pumping routine as soon as possible will help you to bring in a good milk supply and will get colostrum and milk to your baby. Regular pumping will need to continue until you and your baby are together and your baby begins breastfeeding well.

If you are engorged when your milk first comes in, pumping occasionally just to relieve the fullness may help keep you more comfortable. These short pumping sessions can decrease the pain of overly full breasts, but they shouldn’t be needed long-term. When your baby is breastfeeding well, this initial engorgement should last more than a few days at most (day 5 can be the worst).

If your baby isn’t gaining well or your milk is slow to come in, your lactation consultant may suggest Triple Feeding. To do this, you would feed your baby at the breast, pump immediately afterwards, then feed your baby right away whatever you’re able to pump. Once your milk supply is established and your baby begins to gain weight, you can gradually decrease the frequency of pumping.

If you want to start pumping in order to ‘stockpile’ milk for your eventual return to work, most lactation consultants recommend waiting until after the first month. This allows you to build a strong milk supply and for you and your baby to learn to breastfeed well. Once breastfeeding is going well, adding pumping occasionally can help you to get a few ounces in the freezer to take the pressure off the first days back at work.

If you have a dip in your milk supply at any time during breastfeeding, you may need to pump, in addition to increasing feeds at the breast, to increase the amount of milk you’re making. How long you need to keep up this regular pumping will depend on your individual circumstances. Working closely with a lactation consultant will help maximize your production and navigate how long to continue pumping.

What is the best bottle to use? 

Anyone who has walked through the baby section at any store has seen the overwhelming variety of bottles available. Most babies aren’t picky about bottles, though some are. So it may depend on your baby’s preferences and it might take some trial and error on your part to find the one that works best.

Some babies have particular needs that make certain bottles better than others. For instance, if your baby is having difficulty drinking from a bottle (if they are choking or if they have tethered oral tissue, for instance), the Evenflo Feeding Premium Proflo Venting Balance Plus Wide Neck Baby, Newborn and Infant Bottles are a great choice. 

Bottle shape and size may make a difference, but what may be more important is the nipple flow rate. The bad news is that even nipples / teats that are all marked ‘slow flow,’ for example, have vastly different flow rates. In their study of a variety of bottle nipples, Pados and colleagues found a huge variability in flow rates and caution that this should be taken into account when choosing a brand, especially for babies who have any feeding difficulties. They include in their report a helpful chart with some nipples that are currently still available in stores.

References:

Dennis, C. L., Jackson, K., & Watson, J. (2014). Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews, (12).

Pados, B. F., Park, J., Thoyre, S. M., Estrem, H., & Nix, W. B. (2015). Milk flow rates from bottle nipples used for feeding infants who are hospitalized. American journal of speech-language pathology, 24(4), 671-679.

Walker, M. (2013). Are There Any Cures for Sore Nipples?. Clinical Lactation, 4(3), 106-115.