Breastfeeding is MORE than Milk

 Breastfeeding provides perfect nutrition for infants, but it also does much more! Direct nursing at the breast has a whole host of benefits that are easily overlooked in a culture so focused on the milk. Nutrition is only one aspect of infant feeding that leads to growth and development.

Muscle Mechanics:

  The muscle mechanics involved with nursing facilitate optimal cranial-facial development. You’ve probably heard about importance of “tummy time” for the development of head control. Nursing your baby in a laid back position is tummy time made easy! Breastfeeding also coordinated the right and left hemispheres of the brain because the baby is moved from left to right on the mother’s body. This brain development is critical to other developmental milestones like crawling, walking, and later reading. The developing infant palate, mouth, and skull are shaped by feeding. Feeding at the breast helps the baby achieve normal oral motor function and growth.

Skin to Skin:

    Breastfeeding inherently provides the skin to skin contact newborns need for early neurological development, body temperature regulation, and blood sugar regulation. The mother-baby bonding that occurs while a baby is at the breast is unparalleled. Studies show held babies have lower stress hormones.

Increased Maternal Rest:

    Exclusively breastfed infants who sleep in close proximity to their mother replicate their mother’s REM cycles.  Since their sleep is in sync, the baby is more likely to wake for nursing when the mother is not in a deep sleep state.  Maternal sleep is a crucial part of postpartum recovery. Studies show that breastfeeding moms actually sleep about 45 minutes more per night than formula feeding moms.

Better Maternal and Infant Mood:

    Breastfeeding facilitates the release of the “feel good” hormone oxytocin in the mother during “let down” or milk ejection reflex. Mothers of breastfed babies experience less postpartum depression.  Breastmilk contains multiple hormones that promote happiness and relaxation in infants. Breastfed babies also are less likely to have colic.

Infant Sleep/Wake Cycle Regulation:

    When babies are first born they do not make their own sleep hormones. The newborn receives the sleep hormone melatonin directly from breastmilk. The act of suckling at the breast releases a hormone in the baby called CCK, which makes him or her feel full and sleepy. Nursing to sleep is good for babies!

Protection from Sudden Infant Death Syndrome:

    Frequent night wakings to nurse are a large part of normal infant sleep, and serve as nature’s protection against SIDS. Bottle feeding human milk through the night has not shown to be as protective in preventing SIDS as direct nursing at the breast.

The American Association of Pediatrics recommends exclusive breastfeeding for the first six months of life, and continued breastfeeding with complementary solids until at least age 1. Continued support is a huge factor in long term EBF success. A prenatal visit with a lactation consultant or lactation counselor is the first step. An LC can answer your questions and assist you with formulating a breastfeeding friendly birth plan.  If you have already had your baby, schedule a home visit or clinic visit with your LC for an in depth consult that can help your family realize all the benefits of breastfeeding.

Bringing Your Newborn Home

Bringing your infant home can be both exciting and scary. You may wonder what your family’s new normal will look like. Many refer to this period of time as the “fourth trimester,” or the period of time when mom and baby both adjust to their new physically separate states. This adjustment takes place over the course of several months. When your baby is first born he or she has no experience with the world beyond the womb. Certain things can facilitate the ease of this transition from the womb to your arms. Bonding is the name of the game during the first days home. “Eat, bond, sleep, repeat” becomes the new mother’s mantra.

    The natural habitat of the human infant is mother’s breast. Your baby will likely spend most of his or her time there for the first few months. Since newborn nutrition is such a large part of life with a new baby, taking a prenatal breastfeeding class is essential. You may wish to speak to an LC one on one to discuss your questions or concerns specific to your family prior to your baby’s arrival.  A prenatal breastfeeding consult is a helpful tool for preparing you with information about establishing the nursing relationship. Most of the time in Atlanta area hospitals, you will have the opportunity to receive a quick consult from a hospital lactation consultant prior to your discharge. This consult is generally brief. Many families still have questions and concerns regarding breastfeeding after returning home. Many new moms prefer to schedule home visits with their LC to stay in the comfort of  home during the recovery period.

 Breastmilk is digested in 90 minutes. Expect to nurse your baby 10-15 times per 24 hours. Many first time mothers worry that their baby nursing frequently is a sign that they do not make enough milk. This is usually not the case. Colostrum, or newborn milk, is present in your breasts starting early in the third trimester. It is nutritionally rich and very little is required to fill a new baby’s tiny stomach. If your baby experiences the common condition “jaundice” also called hyperbilirubinemia, colostrum is a powerful laxative that will help resolve it. Within the first few days your milk will transition to “mature milk.” Each time your baby nurses, it signals your body to make more milk. Frequent on-cue nursing during the newborn period generally equates to a robust milk supply in the long term. Exclusive breastfeeding or “EBF” and avoiding formula are common goals for many mothers. This goal is attainable with access to breastfeeding education and breastfeeding help if necessary.

    The best indicator of adequate intake is output. Normal diaper count is 6-10 wet or dirty diapers daily. In the first week, counting diapers can give you reassurance that your baby is indeed eating enough. Your baby should have at least one stool per each day of life. Day one- 1 poop, Day two- 2 poops, Day three- three poops, and so on. “Cluster feeding” or blocks of frequent nursing are common. Although nursing is frequent, it should never feel painful. Your baby will likely love to be held on your chest close to your breasts even when he or she is not nursing.

    Skin to skin contact is crucial for your newborn.  Skin to skin regulates the infant’s body temperature and blood sugar. It also facilitates important early neurological development. The simple act of holding your baby skin to skin stimulates production of hormones in both the mother and baby that keep everyone feeling relaxed and calm.  Your partner can help you with this important bonding process by doing things like screening phone calls, entertaining visitors, bringing you food and drinks, changing diapers, and caring for older children. Your partner should encourage you to rest as much as possible while your baby sleeps.

Newborn sleep gets a lot of publicity. When babies are born, they do not make their own sleep hormones. They receive their sleep hormones from their mother via breastmilk and suckling. This is why many babies nurse to sleep. Nursing to sleep is biologically normal and natural. Many people refer to babies “having their days and nights confused.” This is not the case. Babies are not born with a light/dark cycle. One will eventually develop with time, but during the newborn period frequent night wakings are to be expected.  Frequent waking to nurse is part of nature’s protection against SIDS. The American Academy of Pediatrics recommends a form of co-sleeping that is referred to as “rooming in” for the first six months of life as a measure of SIDS risk reduction. Sleeping in close proximity to your baby also allows to have a heightened awareness of your baby’s hunger cues throughout the night.

Your new baby’s first days at home will likely seem like more of a whirlwind than pregnancy.  Prenatal breastfeeding education and accurate expectations of the newborn period can make this transition much more manageable for families. However, there will be times that you don’t know what to do. When in doubt just do less, nurse more, and call your LC!

Are My Breasts Empty?

Our lactation counselors are frequently told that the mother feels her breasts are empty or not full any more. This anxiety often causes mothers to end exclusive breastfeeding prematurely or begin supplementing with formula when it is not needed. One of the most common misconceptions about breastfeeding is that breasts, like tanks or bladders, fill and empty. Here are some facts about the way human lactation works to help nursing mothers understand what is going on in there.

Fact: Breasts contain glands, not bladders. Milk production is continuous.
Human milk is made by specialized cells called myoepithelial cells. Blood is supplied to these cells, and they turn blood into milk, drop by drop. The milk is continuously being produced by these cell as well as continuously reabsorbed into the blood stream. During periods of engorgement, the body tries to reabsorb the milk faster and slow down the production. When the baby is actively nursing or mom is actively pumping, the reabsorption is slower and production is faster. Breasts can never be empty until after the baby is fully weaned off breastfeeding.

Fact: Babies don’t take all of the available milk during nursing.
Using ultrasound, science has determined that babies take about 65% of the available milk in the breast during a feeding session. This is why pumping milk after feedings is recommended for mothers who are pumping and storing milk for future separations.

Fact: The more rapidly milk is removed from the breast, the more rapidly new milk is made.
When milk is being removed from the breast, the milk making hormone prolactin is highest. Frequency of nursing and pumping is key to making more milk. Women who “save up” or try to wait for the breast to feel full before nursing are actually lowering their prolactin levels. This is why supply and demand is the law for breastfeeding and making more milk. Moms who remove milk the most frequently will make the most breastmilk.

Fact: Even a hospital grade double electric breast pump cannot empty the breast.
Because milk making hormones peak during milk removal (nursing, pumping, or hand expression), the body will always rush to make more milk every time mom is pumping.

The Take Away

Continuous breastfeeding or breast milk removal is the key to high levels of milk production. If a mother is doubting her milk production capabilities, milk production is easily assessed by an LC at a home visit or office visit. LCs employ techniques like weighed feeds and latch assessments to determine how well the baby is “transferring” or getting enough milk. When in doubt, it is always better to nurse more and pump more. Supply and demand is the ruling principle of lactation. Feelings of fullness do not happen for all women who make a full milk supply. Feelings of fullness may come and go but do not indicate milk production levels or how well the baby is eating.

 

Breastfeeding and Maternal Diet

There are thousands of myths about what mothers should or shouldn’t eat when breastfeeding. The current recommendation is that the mother should eat a varied diet of healthy foods that are typical for her geographic region or culture and not limit or include any special foods without medical indication.

To understand why maternal diet should not be restricted, it’s best to examine how milk is made. Milk is made inside glands from the blood stream. Breast milk is NOT made from the mother’s stomach contents. The foods mom eats are broken down in the digestive system. Blood reaches the milk glands where it delivers carbohydrates, nutrients, white blood cells, enzymes, pro- and pre-biotics water, fat, and proteins into the gland.

The foods that mom eats have a long trip to the milk. Not every food is able to pass a whole protein or fat or carbohydrate out of the GI and into the blood stream. Most of the proteins moms eat are broken down substantially in the digestive system. Insoluble fiber is a component of mom’s diet that never leaves the GI and never reaches the milk.

When considering foods to include or avoid when breastfeeding, we must remember that the whole food does not enter the milk. Here is a list of common food myths for nursing mothers and the facts:

MYTH: Broccoli, cabbage, beans, and cucumber give the baby gas.
FACT: Vegetables cause gas because of insoluble fiber mixing with gut bacteria. Insoluble fiber does not leave the GI tract and cannot reach the milk.

MYTH: Spicy food will make the breastmilk spicy.
FACT: Human milk is very sweet. No evidence has been found of capsaicin in human milk. Many moms taste-test their own milk after eating well seasoned food.

MYTH: Strong flavors a like garlic or onions will give the baby colic.
FACT: In a garlic breastmilk study, the babies in the garlic group spent more time at the breast and took more milk. Garlic might be helpful for moms who need to nurse more.

MYTH: If the baby is fussy or has colic, cut dairy.
FACT: Cow milk protein allergy is only in 2-7% of the population. Fussiness is not a symptom for diagnosing cow milk protein allergy.

MYTH: If the baby is gassy or has colic, switch to lactose-free milk
FACT: Lactose is the primary carbohydrate in human milk. It does not come from lactose in mom’s diet. The breast glands make lactose. Lactose intolerance in a newborn is a serious metabolic issue that needs to be addressed by a medical doctor.

MYTH: Mom should avoid soda because it gives the baby gas.
FACT: Carbonated drinks don’t carbonate the blood. The bubbles can’t reach the milk.

MYTH: Peppermint (tea, candy, essential oil) will dry up your milk.
FACT: Some folklore and historic herbal texts list peppermint as a lactogenic herb. There is no science to support either claim. Peppermint is one of the herbal teas listed as compatible with breastfeeding by The Academy of Lactation Policy and Practice.

MYTH: You have to drink milk to make milk.
FACT: Plenty of dairy-free women make milk.

 

Have your own favorite dietary myth to add? Leave us a comment! Breastfeeding myths are a favorite topic at our regular free mother to mother support group.

 

Does drinking a beer really help milk supply?

In short, no.

This pervasive breastfeeding myth is one a lot of moms really want to hold on to. Here we dissect the science and why some women really feel a beer helps their milk production despite overwhelming scientific evidence that alcohol inhibits milk production and let down.

Some women feel engorged after a beer. This could be happening for several reasons:

1. Babies take in less milk when mom has consumed alcohol. Since the baby has more “left over” milk in the breast, mom may not feel empty and be tricked into think her production is higher.

From Developmental Psychobiology (Mennella, Beauchamp 1993)

“The infants consumed significantly less milk during the 4-hr testing sessions in which their mothers drank alcoholic beer compared to when the mothers drank nonalcoholic beer; this decrease in milk intake was not due to a decrease in the number of times the babies fed. Although the infants consumed less of the alcohol-flavored milk, the mothers believed their infants had ingested enough milk, reported that they experienced a letdown during nursing, and felt they had milk remaining in their breasts at the end of the majority of feedings.”

2. Mom lets down less milk when alcohol is in her system. Again, more milk is left in the breast to trick mom into thinking her production has increased.

3. Timing is powerful. Most of us drink in the evening hours when babies are asleep and going longer between feeds. Prolactin, the milk making hormone, peaks late at night/ early in the morning. This is the time the body is naturally set to make the most milk.

Some women report greater pump output in the morning after having a beer with dinner. Again, if the baby nursed through the night, studies show the baby took in less milk and less milk was let down. There are more “left overs” to pump out, but not actually more milk produced.

But WAIT! Beer is made from lactogenic foods, right?

Thomas Hale’s Medications and Mothers’ Milk (12th ed.):

“Beer, but not ethanol, has been reported in a number of studies to stimulate prolactin levels and breastmilk production. Thus it is presumed that the polysaccharide from barley may be the prolactin-stimulating component of beer. Non-alcoholic beer is equally effective.”

Moms could choose to eat barley. There is nothing inherent in the brewing process or present in alcohol that increases milk production. Also, simply increasing prolactin is not sufficient for increased milk production. Mothers will need to pump or nurse more frequently as well. Increased prolactin will not increase breast storage capacity either.

Where on earth did this myth originate?

No one really knows when the first brewed beverage was recommended for a nursing mom, but we have some great recent history to show about the power of this myth. A long discontinued product called “Malt Nutrine” was made by Anheuser Bush and widely marketed as a health tonic. Antiques aficionados are a great source of info on this marketing campaign directed at pregnant and nursing mothers and even children. See some of these old time advertisements in this gallery! Convents and monasteries were also breweries and provided public health services in times long ago. Nuns often served as midwives and brought brewed drinks to new mothers.

So is alcohol dangerous?

Dr. Jack Newman, from his handout “More Breastfeeding Myths”:

Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers.

 

Scientific Studies for Further Reading

Marks V, Wright JW. Endocrinological and metabolic effects of alcohol. Proc R Soc Med 1977; 70(5):337-344.

De Rosa G, Corsello SM, Rufilli MP, Della CS, Pasargiklian E. Prolactin secretion after beer. Lancet 1982; 2(8252):934.

Carolson HE, Wasser HL, Reidelberger RD. Beer-induced prolactin secretion: a clinical and laboratory study of the role of salsolinol. J Clin Endocrinol Metab 1985; 60(4):673-677.

Koletzko B, Lehner F. Beer and breastfeeding. Adv Exp Med Biol 2000; 478:23-28.

Mennella JA, Beauchamp GK. The transfer of alcohol to human milk. Effects on flavor and the infant’s behavior. N Engl J Med 1991; 325(14):981-985.

Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol 1973; 115(6):817-821.

Mennella JA. Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcohol Clin Exp Res 2001; 25(4):590-593.

How Do Moms Pump Enough to Return to Work?

Many moms want a safety net of pumped milk in the freezer for their return to work away from their babies. While it’s only necessary to have enough milk saved for the first two days back at work, many moms want to save several days or even weeks worth of feedings during their maternity leave.

Please read What to Expect When Pumping to trouble shoot and get the most out of your pumping experience. This article addresses how to juggle pumping during your maternity leave and during the working day.

When to start building a “stash”

Most women start with over production. The first 10 weeks of breastfeeding are the easiest for milk collection. This is also a critical time for conditioning the body to respond to a pump. Ideally, moms should nurse on cue and spend a great deal of time resting skin to skin with their babies for the first 2 weeks. Once baby has regained birth weight, around day 10-15, it’s time to try pumping.

Milk collection is easiest in the morning hours when the milk making hormones are highest. Beginning at this favorable time will help make pumping a more positive experience. After nursing the baby, pump either one or both sides for 20 minutes each. Even if the milk stops flowing, continue pumping for 20 minutes per side.

Weeks 2-4, pump one time per day in the morning after nursing. Expect to collect 1-2 ounces each day. Remember: 20 ounces is enough milk for about 16 hours of mother-baby separation.

If you wish to increase your daily milk collection, add a second daily pumping session weeks 4-6. Pumping only twice a day will help you collect several days worth of milk before returning to work.

If your baby cues to nurse after pumping, just nurse. The breasts are never truly empty until you wean. The more milk removed, the faster the glands work to produce more milk. No pump is as efficient as a baby who is properly latched. There is no need to feed the baby the pumped milk in place of nursing.

If your maternity leave is longer than 6 weeks, continuing pumping 1-2 times per day as is possible for the duration of your leave. This helps maintain a conditioned response for more efficient pumping in the future.

When to Pump at Work
No two work environments are the same. No two work days are the same. Not every work environment allows for predictable or scheduled pumping sessions. Things to consider:
– aim to pump every 1-3 hours. This is a range. Babies and breasts are flexible.
– don’t feel trapped on a schedule
– if you anticipate a long meeting or event you cannot break out of, consider pumping once an hour for 2-3 hours beforehand and/or afterward
– your body does not require you to pump on a set schedule just as your baby does not feed at set time
– a hands free pumping bra can help you pump during your drive to and from your work location
– hand expression may help moms who have a short break but can’t make it to the pumping room
– taking a lunch break to nurse your baby may be easier than pumping as frequently at work

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