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. 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.
  4. 5-10 grams daily oral sunflower lecithin supplementation to reduce inflammation.
  5. 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

breastfeeding, milk supply

Why I don’t recommend lactation cookies

Over the last few years it seems like everyone is jumping on the lactation cookie trend. New pre-made products have been popping up online and in stores all with strong claims about how they will help.
I love a cookie as much as any one (warm oatmeal or spicy snickerdoodle…yes, please!) but I don’t recommend them as a Lactation Consultant for milk production.

Image: Betty Crocker

This is for a few reasons. I have noticed that lots of my patients come to me already trying to take herbs and alter their diet to support milk supply. They invest hundreds of dollars sometimes without really knowing the exact cause of their milk supply problems. Often the issue is low milk supply perception without an actual issue but when there is a problem, it needs to be addressed by a medical provider who can investigate the source and give you personalized recommendations.

Different problems need different solutions.

A thorough assessment and history taking can often pinpoint the problem and then we can give you the right “medicine” for what’s really going on. Otherwise, it’s like throwing a dart in the dark. It might hit the target, it might get close, but it’s probably just a random shot.

Milk supply is governed by milk removal. When we take supplements to boost our milk supply there may be some effect but it might also temporarily boost our supply without setting us up for good long term habits. At the beginning, prolactin hormone brings in our supply and transitions milk from colostrum to mature milk. Oxytocin hormone is the main reason that milk sprays and drips out. Over time, our breasts become less sensitive to these hormones and what we need for continued supply is a baby who can breastfeed well!

Which brings us to the next issue. If we take herbs or eat cookies that artificially boost our supply it can mask baby feeding problems. If your baby’s suck is weak or uncoordinated, I want to know that right away and get you on the path to healing! We can work with suck training, a physical therapist, or occupational therapist to make sure your baby is thriving. We don’t want to miss those early signs .

Homemade baked goods are about the most delicious thing I can think of but sometimes the ingredients might actually lower supply. Many recipes call for a fair amount of sugar so if the milk supply problem is created by insulin resistance it won’t be supportive. Some of the other herbal ingredients might also lower supply. Some of the most common herbal ingredients for milk supply are not compatible with the medical conditions which are most likely to impact supply!

And lastly, I think it’s important to consider that we do not need to eat a special or different diet while breastfeeding. Our milk can be plentiful and super healthy following standard recommendations for adults. Our diets may need to be altered for medical reasons and if so, ask your provider to help you come up with a plan. Many of the ingredients in lactation cookies are expensive and hard to find. I’d rather see you snuggled up in bed nibbling on a grocery store oatmeal cookie than driving from store to store for specialty ingredients.

As always, take what works for you and leave the rest behind. Know that this Lactation Consultant won’t judge or tell you what to do. We are here to support you. And if you sister or kind neighbor brings you lactation cookies, feel free to eat them if they work for you and you want to. Just know you don’t *have* to eat them to make lots of milk.

If you are experiencing low milk supply check out our local Lactation Consultants for support and up-to-date information.

<3Megan Dunn, IBCLC

breastfeeding, milk supply

Top 3 Things To Do for Breastfeeding Success

  1. Start hand expression at 36 weeks if you are not at risk for preterm delivery

This builds up hormone receptors which help you to make the most milk!  It also gets you familiar with the technique which is super helpful to do at least 5 times a day after birth (for the first 2 weeks).  If you hand express into a clean container you can store the colostrum (early milk) in the freezer and bring it with you in case your baby needs a supplement after birth.

2. Golden Hour

Hold your baby skin-to-skin after delivery until baby has had their first meal.
It takes time to adjust to the outside world!  It’s so bright and loud and cold!  Let baby find their way to the breast and attach on their own –they can do it if we give them time.
Our bodies are also primed from labor to transfer the most colostrum in the first few hours, so make the most of it!

3. Have a Nursing Marathon for 3 days after birth

Feed often (at least 10 times per 24 hours) especially when baby is awake and calm, hold baby skin-to-skin as much as you can, and do hand expression at least 5 times per day after feeds.  This tells your body to make lots of milk and helps prevents swelling (which is also called engorgement).
Keeping baby close by will help everyone rest and recover. Snuggling baby often also reduces crying!

Megan Dunn, IBCLC

Diabetes, galactagogues, milk supply

Breastfeeding with Diabetes and/or PCOS

Many people with diabetes and gestational diabetes meet their breastfeeding goals but others may experience challenges with their milk supply and/or delays in developing a full milk supply. Insulin is an essential hormone for full milk production and luckily there are many things we can do during pregnancy and postpartum to support our bodies and meet our breastfeeding goals.

Working with your Registered Dietitian and a Lactation Consultant as part of your health team is helpful for creating a plan that works well for your individual needs.

Nutritional Supports During Pregnancy and Postpartum:
Fiber!  Oats are a really excellent source of fiber and they can help you feel full longer as well as stabilize your blood sugar.  Try adding a handful into a morning protein smoothie.  Your Dietician can share many other recipe ideas that might work for you. Quinoa is another great choice for protein and fiber!

B12 is a necessary vitamin that we get from animal sources. It gives us energy and maintains our nervous system.  Getting adequate B12 from meat, fish, eggs, cheese, milk, and some fortified whole grain cereals throughout your pregnancy and postpartum period will support milk production.

Vitamin D is very important for lots of functions in our body.  It supports our immune system, maintains healthy bones, and is supportive of our mood regulation.  You’ll find it in milk, egg yolks, salmon, tuna, and in some fortified whole grain cereals.  Be sure to get your recommended daily amount!

Calcium and Protein from dairy-free sources may be advised. Salmon, tofu, dark green leafy veggies, nut butters, and grass fed meat are good sources.

Other foods and herbs
Cumin – anti-diabetic, enhances mammary growth
Dill – works best with other herbs, supports insulin, diuretic (helps with swelling and engorgement)
Fennel – anti-androgenic, digestive support, diuretic
Myo-inositol – natural sugar found in citrus fruits, cantaloupe, and some beans which regulates blood sugars, can also be taken as a supplement

Herbs to support milk production
Each herb does a different job; there is no one size fits all. Below are some common herbs for insulin resistance shown to support milk production

Goat’s rue taken during the 3rd trimester and for the first 6 weeks can encourage glandular growth (the milk making cells).  You can find it in drops called tinctures or in capsules. Vitex or Chasteberry is an herb commonly used for hormonal regulation.  It can also be taken during pregnancy and postpartum.

Discuss the use of these herbs with your provider to determine which is right for your circumstances!

AVOID fenugreek.  This herb is found in lots of lactation blends but it’s not an appropriate choice for people with diabetes as it affects your blood sugar and reduces the absorption of other oral medications.

Milk expression
If you are not at risk for preterm delivery, milk expression during pregnancy is a good idea.  Not only does this stimulate for better long term milk production but you can freeze your colostrum and have it available after delivery if baby has hypoglycemia (low blood sugar).  This decreases the chance that your baby will need donor milk or formula.  Talk with your IBCLC about how to safely do this.

Megan Dunn, IBCLC