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Breastfeeding for New Mothers 
Part 1: Common Questions

When you are an expecting mother, there are many preparations to make for the baby’s arrival. As a new mom, deciding to breastfeed is an option that is not often talked about until you are headed down the path of parenthood. While many see breastfeeding as natural, it is often just as natural to have assistance learning how to do so, or overcoming challenges.  Knowing what to expect and what the process is like can help you feel more confident.  At Women’s Health CT, many practices have lactation consultants on-staff and all our divisions are affiliated with hospitals that have access to lactation support. We talked with Susan Small, MSN, APRN, NNP-BC, and International Board-Certified Lactation Consultant (IBCLC), of With Women Wellness to learn about common issues and questions breastfeeding mothers have:

The baby latched and was feeding right after birth in the hospital, but I am having trouble now that we are home, what happened?

Great question! You are not alone! This is a very common situation that can be attributed to many causes. Most newborn babies go thru phases of initially latching in the first few hours; then a sleepy phase, and then many times cluster feeding. Normally a mom’s milk supply changes from the yellow colostrum seen in the first few days to a thinner white milk usually around days 2-5. Often, moms are given medications and IV’s in the hospital that can modify this process and alter the shape of her nipple-similar to filling a water balloon where the nipple and areola shape become more difficult for the baby to achieve a deep latch and thus decrease the effectiveness of removing milk from the breast. 

There are also many medical reasons for moms to have a delay in this process: diabetes, obesity, hypertension, PCOS, blood loss, epidurals, planned inductions of labor. Sometimes the process can be related to circumstances where the baby may be sleepier due to circumcision on the day of discharge, a late preterm baby who can commonly be sleepier, issues related to birth trauma, or tongue-tie issues making latch difficult. It is very important to not be ashamed and seek help! As women, we think breastfeeding should be a natural process where it “just happens”; the percentage of women who are lucky enough to have things go smooth right from the start is the minority. Getting things off to a great start, in the beginning, is crucial to establishing a good milk supply for future days to come.

How often do newborns breastfeed in a 24-hour period? How often should each session last?

Typically, it’s best to aim for 10 to 12 feeding sessions daily; more is better. Ideally allowing for baby to have unlimited time at the breast. You cannot “spoil” a baby by keeping them close and feeding too frequently. You cannot overfeed, but you can underfeed.  A recent study found many newborns feed closer to 14 to 16 times per day. Usually, it’s best to wake your baby to feed if it has been at least four hours at night or 2-3 hours during the day and your baby has not awakened on their own. Try not to skip the late-nighttime and early morning breastfeeds; this is an important time when mom’s milk-making hormone levels (called prolactin) are highest. Breastfeeding at this time improves your milk supply and has been proven to allow the mom to sleep better. 

What should I be eating to keep up my milk supply? 

For the average person of normal weight and BMI; eating a well-balanced diet with high fiber is key. Some resources will quote an extra 200-500 calories a day, this can be achieved with a few extra healthy nutritious snacks a day. For a mom of a higher BMI, fewer calories and for an underweight mom, likely she may need more healthy well-balanced calories. The recommendations for fluid intake are to “drink to satisfy thirst”. Drinking extra water does not magically make more breast milk. If you are vegan or vegetarian, extra B12, Calcium and Zinc supplements are recommended. If you typically eat a keto diet, it may be best to wait to resume that diet structure until after breastfeeding because a low carb diet will typically decrease your milk supply. 

Is it okay to track feeding in an app? Is there a better way to keep up with the baby’s feeding schedule and to know if the baby is getting enough milk?

There are many types of different apps available for moms to use for tracking feeds, baby voids and stools. However, it is important to be mindful that some apps can cause moms increased stress, while some love their structure. I find a simple paper checklist easiest but encourage moms to do what works for them and follow these basic guidelines: 

  • Most babies have at least one pee and one poop on the first day of life; two on the second and so on. 
  • By day 4-5, usually moms’ milk is in and we expect four wet diapers of light-yellow urine and four poops that have now turned yellow seedy vs. black tarry “meconium” that is seen in the first few days of life.
  • Meconium on day 4 is not normal; this means the baby is not getting enough to feed. 
What is the best way to store my breastmilk?

Breastmilk can be stored in glass, plastic, or storage bags that are made to store breastmilk. Make sure the container is clean, airtight, and cannot leak. Label each container with the date and your name if it's needed for daycare using a waterproof label. Saving volumes of 2-4 ounces will waste less breastmilk if only a partial feed is needed. Storage guidelines vary for leaving at room temperature, refrigerator, and freezer (see chart below). Milk from one day can be collected in the same container before freezing. It is recommended to use the oldest frozen first. Milk frozen in a separate deep freezer lasts longer than milk frozen in a freezer top (or freezer bottom) refrigerator that is frequently opened. 

Thaw and warm milk by placing in a warm basin of water or run under warm water, or if thawed can be warmed in a bottle warmer. We strongly encourage that breastmilk or formula is not warmed in a microwave.  Even when it is checked on your wrist, there can be hidden hot spots that can burn the inside of your babies’ mouth. Also, know that the fat in breastmilk will typically layer out when breastmilk has been sitting in a bottle or container so it will need to be “swirled” for the fats to be mixed back into the milk. Generally, breastmilk should be discarded after 2 hours if the baby did not finish feeding. 

American Breastfeeding Medicine Clinical Protocol #8 Human Milk Storage for Full term Infants 2017:
storingbreastmilk

I am not feeling well and am taking medication, should I stop breastfeeding?

If you are not feeling well or uncertain about medication and breastfeeding safely, the first step you can take is to call your Women’s Health CT provider, or pediatrician to talk about your concerns. That being said, most medications are safe for breastfeeding, and usually, when you are under the weather your body is making antibodies to fight your infection; these antibodies are passed through your breast milk to help protect your baby! However, if a more serious illness, always check with your physician or lactation consultant. Lactmed is a great online source to check medication safety but may have overwhelming information for a non-medical person. Many IBCLC’s use resources by Dr. Frank Nice and Dr. Tomas Hale who are considered experts in this area; there is an app for that! There is also an Infant Risk Center Helpline for health care professions and the general public (806) 352-2519 that will answer calls Monday through Friday 8 a.m. – 5 p.m. central time. 

What causes blocked milk ducts? How do I treat and prevent this from happening?

Plugged ducts can happen when the milk flow is obstructed from exiting out the nipple. Risk factors that contribute to plugged ducts can be skipped feeds, engorgement, latching issues, feeding in the same position, blebs, stress, poor-fitting bra’s, seatbelts, and frequently in moms with careers who need to wear a safety vest such as a police officer or military service member. Blocked ducts are small to large lumps in your breast that may quite painful and be warm to touch. “Heat, massage, empty the breast” is the typically recommended practice. Other options include: 

  • A hot shower or a warm, wet towel.
  • Hanging your breasts into the sink or tub of warm water.
  • A hands-on massage with organic coconut oil with hand expression pumping to work the clogged milk out of the breast.
  • Getting as much rest as possible. 
  • Continue breast feeding, a baby is typically able to pull milk out of a breast better than a pump.
  • Sometimes herbs such as lecithin may be recommended, talk with your physician or pediatrician about changing your routine supplements or diet to be sure it is right for you. 

It’s important that moms know the signs and symptoms of mastitis since a plugged duct can lead to mastitis if not resolved. Call your provider if you develop a high fever, large hot red painful patches are seen on your breast, or if flu-like symptoms develop.  Frequent breastfeeding with an effective latch and appropriate milk transfer is the best way to avoid this from occurring.  

What is tongue-tie?

This is a hot topic and personal interest of mine that I am offering support for at With Women Wellness.  There is  a heightened awareness of “ankyloglossia” or tongue ties; a situation where a small band of connective tissue under the tongue can limit the ability of the baby to latch effectively leading to nipple pain and poor milk transfer for the baby, along with a list of potential risks: poor latch can result in engorgement, mastitis, and decreased milk supply. Some babies have challenges gaining weight, are extra gassy/colicky, potential future cavities from food trapping. In some cases, an increased risk of pronunciation of certain letters are attributed to tongue-tie but is currently considered to be a controversial topic.  

What is important to differentiate is if the presence of the tongue tie is affecting the function of how the tongue is working and if the breastfeeding and pain can be improved by correcting adequate latch issues before rushing to an intervention such as a tongue clipping or laser ablation procedure. Many babies with significant tongue ties also benefit from bodywork with an occupational therapist or cranial sacral therapist. Incorporating developmentally appropriate tummy time, massage, sucking exercises, and tongue stretches into the post-procedure care plan maximizes the best possible outcome following tongue-tie revisions. 

What situations warrant seeing a lactation consultant and who can I turn to for help with breastfeeding? 

There are many ways that you and your baby can benefit from the support of a lactation consultant.
Mom reasons include: Latching issues, sore nipples, flat or inverted nipples, plugged ducts, engorgement, low milk supply, oversupply, mastitis, breastfeeding stress, delay in milk ‘coming in’, returning to work; moms who wish to breastfeed an adopted baby, mom’s with a history of breast surgery (reduction, augmentation, mastectomy, lumpectomy).

Baby reasons are just as many! Difficulty latching, painful latch, poor weight gain, colicky fussy breast feeder, lip-tie/tongue-ties, a premature or late preterm infant, a baby with a medical diagnosis. Babies with significant jaundice can also benefit from lactation consultant support, in conjunction with calling your pediatrician to monitor their condition and progress. Or, anytime you need support and confirmation that you are doing the right thing!

Every Women’s Health Connecticut provider will be able to provide support or refer you to a consultant and resources to help you. Additional assistance varies in different levels of training and experience:  Peer counselors, Certified Lactation Counselor (CLC’s), and International Board-Certified Lactation Consultants (IBCLC’s). La Leche League offers wonderful support and some hospitals and pediatricians also have breastfeeding support contacts. If you prefer a home visit some IBCLC and CLC’s are in private practice. IBCLC’s are listed by each state (and country) on the ILCA website: https://www.ilca.org/why-ibclc/falc.

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