breastfeeding, chestfeeding, milk supply

Chronic Low Milk Supply (CLMS)

As many as 1 in 7 parents experience chronic low milk supply.

An estimated 5-15% of lactating parents experience CLMS (chronic low milk supply).

CLMS is associated with many common metabolic and endocrine conditions like:

  • thyroid disorders
  • PCOS
  • metabolic syndrome
  • hormonal imbalances
  • nutrient deficiencies
  • insulin resistance
  • IGT (insufficient glandular tissue)


Up to 20% of lactating parents may have PCOS

Many parents don’t know why they experience CLMS. There are significant Mental Health impacts from CLMS.

Experiencing CLMS may compound trauma and feelings of inadequacy from infertility, pregnancy, or birth challenges.

Connecting with other parents who have similar experiences and working with your IBCLC to make feeding comfortable and enjoyable can help.

Resources for support:

Wellmama http://www.wellmama.net 541-231-4343

Hope for Mothers Albany 541-812-4475 Lebanon 541-451-7872

Low Milk Supply Foundation https://lowmilksupply.org/

❤ Megan

breastfeeding, chestfeeding, milk supply

Overactive Letdown?

Does your baby gag, choke, and cough during feeding? Are they sputtering and tugging on your breast? Ever notice them clicking or leaking milk? What about gas…do they seem to have an awful of it?

There could be a number of things causing baby to struggle with feeding.

  1. It could be a strong letdown (or as we call it in healthcare Milk Ejection Reflex – MER)
  2. I could be an oversupply
  3. It could be ineffective latch.

Let’s learn about the differences.

Strong MER
Inside your breast are milk making cells that form a sphere. These spheres are clustered together so I like to think of them as bunches of grapes with the stems representing the ducts that carry milk to the nipple.
Each grape is wrapped with muscle fibers. When your baby is feeding (or sometimes just when you think about your baby!) your oxytocin rises. Oxytocin is a hormone which plays a role in bonding, pleasure, and MER. It’s the same hormone that kicks starts uterine contractions during birth. The muscle fibers respond to oxytocin and squeeze milk down the ducts and out the nipple.
To have strong MER you need strong muscle contractions. Over the first 3 months, MER starts to chill out because those little squeezing muscles become less sensitive to it.

Oversupply
We actually just talked about oversupply. If you have an oversupply, when the muscles contract the milk making “grapes” are soo full that milk flows very quickly.

Ineffective Latch
Latch, or attachment to the breast, can be ineffective due to positioning, other medical conditions, tongue tie, or due to something else.

Hmmm, I think I know what’s going on. What do I do about it?

Make an appointment with your Lactation Consultant so they can give you personalized instruction and make a plan which will work for you!

All too often, the difficulty is with your baby and not with you. Your IBCLC can direct you to care which can include changing your feeding plan, adjusting your position, suck training exercises, working with a physical/occupational therapist, or SLP.

We are here to help!

❤ Megan

breastfeeding, chestfeeding, milk supply

Plugged Ducts

Many people think a plugged duct is caused by a backup of thickened milk but the plugging comes from outside the duct.

Our milk ducts carry milk from the milk making cells which are grouped together in alveoli.  The alveoli are like little clusters of grapes which connect to the ducts.  The ducts carry milk to the nipple openings.

A breast “plug” represents an area of swelling in the breast and more accurately reflects lymphatic fluid congestion and dilated capillaries than a “plug of milk.”  The plugging is caused by engorgement and congestion of fluid and blood vessels pressing in on the duct from outside which narrows the pathway. 
Exclusive or excessive pumping, nipple shield use, oversupply, unresolved engorgement, inflammation, or subacute mastitis increases plugging.

To treat plugging, try the following:

  1. Warmth before feeding.  A warm shower or warm pack applied to the breast.
  2. Ibuprofen and/or Tylenol as needed along with a cool pack applied after feeding/pumping.
  3. Avoid massage and excessive pumping (remember it’s not milk that’s plugged).
  4. 5-10 grams daily oral sunflower lecithin supplementation

This should resolve in 24hrs.  If it does not, contact your provider and lactation consultant for guidance.  Therapeutic ultrasound is very effective.  Your doctor may prescribe a single dose of 10-30mg of Pseudoephedrine (Sudafed) which acts as a vasoconstricting agent (i.e. decreases blood flow) and may help with any pain.

Any plug or mass persisting for several days and not resolving with conservative interventions requires referral to a medical provider, who may obtain breast imaging to rule out galactocele and/or other mass.

breastfeeding, chestfeeding, milk supply

Engorgement

Engorgement is common in the first week after delivery.  Rather than a swelling caused by milk, it is an increase of fluid in the breast brought on by the same hormones which transition your colostrum to transitional and mature milk. 

Extra fluids from labor (IV fluids) and some medications can increase this fluid retention.  You might also notice it in your hands and ankles/feet.  It tends to peak on day 5 after birth.

Sometimes, early mastitis is mistaken for engorgement. If you are still engorged after the first week, contact your Lactation Consultant to discuss what’s going on.

To reduce the engorgement very gentle massage can be helpful. 

Wearing a soft and supportive garment like a bra without wires or a nursing tank is also helpful. 

Frequent feeding will keep your milk flowing and contribute to breast softness.  Aim for every 2 hrs, with rest in between. It’s important to let your breasts rest and the rest of you, too! We all need to sleep and rest to recover properly and ensure long-term milk production.

Excessive pumping will increase the engorgement.  Instead try hand expression for a few minutes. 
Diuretic foods (foods that help you urinate frequently) can also help.  These can include melons, cucumber, lettuces and dark leafy greens.  Avoid caffeine and salty foods.
If the feeling persists, the use of Tylenol and cold packs can provide some relief.  Avoid excessive heat on the breast.

If not resolved with these measures contact your provider and lactation consultant.  Therapeutic ultrasound can be helpful or your doctor may prescribe a single dose of Pseudoephedrine 10-30mg to relieve symptoms.

If your breasts are too full for baby to latch well, reverse pressure softening around the nipple may be helpful.

Hand expressing a little bit of milk may also be helpful. 

Avoid:  Pumping often (milk is not causing the fullness), firm or excessive massage, heat packs (increases inflammation).

You should feel better soon with these tips!

❤ Megan

breastfeeding, chestfeeding, milk supply

4 Things You Can Do to Manage Oversupply

Oversupply or hyperlactation can occur for a variety of reasons but is most common when early and excessive pumping, galactagogue (herbs and foods to promote lactation) use, and exclusive pumping.

You may notice engorgement past the first few weeks, pain, plugging, mastitis, or your baby may sputter or choke on your milk flow or even have a lot of spit up after feeds.

Once baby has reached two weeks of age, they only need 2-5oz per feeding (or about 1oz per hour).  If you are finding that you need to pump after feeds or are producing significantly more than 5-6oz with exclusive pumping, you may have an oversupply.

An oversupply puts you at risk of an inflammatory breast condition called mastitis which can develop into an infection which ultimately will reduce your supply.

Work with your Lactation Consultant to address your oversupply.  In the meantime, you can try a few things on your own.

  1. Cool packs after nursing
  2. Positioning in a side lying or reclined position while feeding
  3. Reduce your pumping time by half or switch to hand expression.  After a few days, reduce the pumping time by half again.
  4. Herbs to gently reduce supply: peppermint tea or sage. 

❤ Megan

breastfeeding, chestfeeding, mastitis

Mastitis, ouch!

Mastitis is an inflammation in your breasts which may become an infection if not addressed.  It affects about 1/3 of lactating parents but can be prevented and treated with quick resolution.


Mastitis is caused by inflammation and can be worsened by massage, excessive heat, overfeeding/overpumping. 
If you’ve recently had a dose of antibiotics, your risk of developing mastitis is higher because a healthy balance of microbes throughout our body reduces inflammation and bacterial overgrowth. If left untreated, it can develop into an infection which will cause fever, fatigue, and overall body aches.

Mastitis may feel like a burning or hot sensation in your breast.  It might start at the nipple and go deep into the breast.  It’s more frequently felt in the lower parts of the breast. You may notice plugging or red areas in the breast.  Early inflammation is sometimes mistaken for engorgement or plugged ducts.

For some parents, the feeling happens during milk ejection (letdown) and can feel like a burning or stinging sensation starting at the nipple and moving deeper into the breast.

Most commonly mastitis occurs during the first 2-4 weeks.  Your risk of developing mastitis is higher if you have diabetes or if you have had antibiotics during or after delivery (ie, Group B Strep).  It’s especially important to feed baby often and well in these situations.

Your milk is safe for baby when you have mastitis

Your Lactation Consultant can help you figure out how to
prevent mastitis from re-occurring.

Self-care can resolve the inflammation in most cases without the use of medication.

To treat mastitis, try the following:

  1. Ibuprofen and Tylenol as needed along with a cool pack applied after feeding/pumping.
  2. Avoid massage and excessive pumping.
  3. 5-10 grams daily oral sunflower lecithin supplementation to reduce inflammation.
  4. High-quality probiotics containing L. salivarius, fermentum, and gasseri. are generally refrigerated and contain 10 billion CFUs or higher. Continue taking the probiotics for 2 weeks after symptoms resolve.

Older recommendations included warm compresses, feeding and pumping very often, as well as vigorous massage. We now know this can increase symptoms.

Multiple studies have reported that probiotics (beneficial bacteria) are effective in treating infectious mastitis and also resulted in a lower occurrence of repeat mastitis compared to antibiotic treatment.

Call your doctor if you experience:

Fever over 101F
Flu-like aches
Nausea and chills
Pain and swelling in the breasts
Red, hot, tender area which is often wedge shaped
Red streaking toward the armpit

You should start to feel better in 8-24 hours.  If you are not feeling better with self-care or you develop a fever, flu-like symptoms, or any signs of infection you will need to see your physician.  Most people feel much better after 2 days but it’s important to take all 10-14 days of your medication or you may develop an abscess which requires surgical treatment.  The most common antibiotics prescribed for mastitis are dicloxacillin or flucoxacillian.  

Antibiotics can cause digestive symptoms so follow your doctor’s directions and taken your probiotic dose 2-4hrs after your medication.

Work with your Lactation Consultant to prevent mastitis from happening again. 

If you get mastitis frequently or it’s always in the same area, your doctor may order an ultrasound to get more information.

❤ Megan Dunn, IBCLC

Uncategorized

Reasons you should feed your baby responsively

New parents are given lots of advice about how to feed their baby.  Where to feed, when to feed, how to hold baby, how long to feed, and so much more!

You may have been told to feed your baby at least 8 times a day or every 3 hours but feeding on a schedule doesn’t really meet baby’s needs.

Baby has a high need for frequent feeds to keep them alert and build their brains!  Research shows that with responsive feeding there is a high variability in how many times a day baby will feed but it’s much closer to 12 times per 24hours than 8.  

Preliminary research from Swansea University regarding how many times per 24hrs babies feed

Reasons you should feed your baby on cue:

Readiness – Feeding your baby when they cue means you are offering a meal when they feel hunger and are alert enough to communicate that to you.  Imagine being offered your favorite meals when you are super tired…would you feel ready to eat?  Or would you have just enough before falling into a deep sleep?

Meeting all baby’s needs – Baby wants to feed and be close to you for lots of reasons!  You are their home.  You smell like home, you sound like home, you taste like home.  Feeding our baby promotes bonding, reduction of stress hormones, brain development, and so much more than just calories and nutrients!

Milk supply – Your baby doesn’t feed on a regular schedule and your body doesn’t make the same kind of milk every 3 hours on the dot.  AM milk is different from PM milk.  Milk composition changes, too.  At different times of the day it will have higher fat or sleep hormones to help set your baby’s clock and meet their nutritional needs.  If we schedule all the feeds we miss the opportunity to give baby the perfect custom meal each time!

Feeding when baby asks also supports a robust milk supply! Frequent feeding communicates a need to your body to keep making lots of milk!

Capacity – Different breasts/chests hold different amounts of milk (no, this isn’t related to size).  Some people have smaller capacity and can make all the milk baby needs but they need to feed more often.  Scheduled feeds or expectation of only 8 feeds in the day can make parents feel like their milk supply is low – when it’s totally normal!

Responsiveness = communication, trust, and independence – What do all these words have in common? They are what happens when we are responsive feeders.   When we respond to baby’s needs and pay attention to their body language (rooting, sucking, wiggling, lip smacking) we tell them they are heard.  When we respond to our babies they build trust and know their communication will be heard and they will get their needs met.  And that’s how we get independence!  Studies show that responding to our children and meeting their needs results in more independence in toddlerhood and beyond.

❤ Megan

Uncategorized

Not pumping enough?

  1. Is your pump new?  Your insurance will provide you a new pump with each baby.  The motor wears out with use!

  2. Are you using the right size flange/shield?  It should be just big enough to comfortably fit your nipple.

  3. Have you tried other settings?  Many pumps have a “letdown” mode with stronger and faster cycles to start MER.  When your milk slows turn this mode back on.

  4. Visualization makes milk flow! Sit in a comfortable place, take some deep breaths, and imagine your milk flowing easily.  Cover up the bottle so you can relax and not worry about how much you are pumping.


  5. Membranes, valves, and tubing need replacing regularly (between 3 weeks and 6 months depending on how often you pump).

This is also a good time to explore what “enough” is. Some bottles are really huge! And other parents on social media share huge pumping session successes which may not reflect what is average or achievable.

On average, exclusively pumping parents can express 3-4oz (90-120mL) with each session. Whereas, parents pumping after feeding baby will express about 1.5oz (45mL).
This is a reflection of what baby’s stomach can hold. Around 4-6 weeks most babies reach their maximum intake and can hold up to 5oz at a time. This doesn’t mean they need all 5oz (I don’t want to feel Thanksgiving dinner full after every meal!).

Over the course of a day, baby will take 27-30oz and this does not increase with age for breastfeeding babies!

So….how are you doing? Are you expressing 3-4oz when you exclusively pump?

If not, try some of the tips above and if that doesn’t work, check in with your IBCLC for a full evaluation and support!

❤ Megan