10 Questions with a Homebirth Midwife

1) Moms planning a home birth are planning for a low intervention birth. Is the same true for their breastfeeding goals? Do women delivering at home plan to exclusively breastfeed and avoid formula intervention?

Yes. Most women who are planning natural birth also plan to exclusively breastfeed. However, there are situations where a mom chooses not to breastfeed. She may be a victim of sexual abuse or was unable to breastfeed a previous child. We ultimately want women to make the decisions they are most comfortable with after having been provided with as much education and support as possible.

2) What kind of support can a homebirth midwife provide to breastfeeding mothers that is different than a midwife in a hospital or birth center setting?

We offer a lending library that includes breastfeeding books. We offer a one hour prenatal visit so the mother has ample time to discuss her questions, goals, and fears about breastfeeding.

3) What role do you take in prenatal breastfeeding education?

In addition to the support and information provided prenatally, we also suggest the utilization of outside resources like breastfeeding classes, lactation consultants, and La Leche League meetings.

4) What aspects of homebirth uniquely facilitate breastfeeding initiation and establishment?

We are adamant about the necessity of skin to skin contact between mom and baby, with as minimal interruption as humanly possible.  Every aspect of the postpartum experience works better when you just leave them alone. Moms heal faster and babies want to nurse when they are not being poked, prodded, and taken away from mom for reasons that could, in most instances, wait.

5) Describe your breastfeeding-specific training. Does it differ from the training hospital midwives have?

I am not familiar enough to speak on the training of hospital midwives. My experience has grown through living and learning. I nursed all four of my babies at various lengths, based on my education and abilities at the time. I am learning all the time through my clients’ experiences ranging from no intervention to the necessity of an IBCLC or pediatric ENT. I also continue to learn through the support of my peers.

6) Describe the well baby care homebirth midwives give in the first 48 hours. How does this care screen for breastfeeding obstacles?

We usually stay with the mother after birth until baby has latched and is nursing well. If this doesn’t happen for some reason, we are in constant contact until it does. We listen to what moms are describing and make the call for further help based on what they are reporting. We may make another trip back to the house, or, if it seems like an issue that is out of our scope of knowledge, we will refer first to an in-home lactation consultant who is willing to assess mom and baby while maintaining the need for skin to skin contact in their own environment.

7) Do women with gestational diabetes, PCOS, or other endocrine disorders birth at home? What special feeding support do these dyads receive from a midwife?

Yes, and we don’t tend to do anything special unless we are finding it to be an issue. The premise is that it is normal and natural unless it’s not. We aren’t in the business of fixing things that aren’t broken. If we need to refer out for these things, we will.

8) Do Homebirth midwives facilitate informal milk sharing between clients? Why or why not?

Yes. However, not all moms are comfortable with that and we support that, too.

9) What signs or symptoms of feeding challenges do you refer out to an LC?

Baby not gaining weight, latch that just isn’t getting better despite our suggestions of different feeding positions,  mom in extreme pain with cracked, blistered, and bleeding nipples.

10) If a client chooses not to breastfeed, what alternative feeding do you recommend and why?

I usually don’t do much recommending of formula, but I suppose an organic formula of some type if they must. It is extremely rare that a client of ours comes to their six week postpartum visit and is not still exclusively breastfeeding. If they are supplementing with formula, they have already been working with a lactation specialist and have made those decisions together.

Bonus question 11) Share your favorite nursing memory.

I remember a moment nursing my last baby. I nursed all four, but I think I was in a hurry for a lot of that time. Hurry up and quit nursing. Hurry up and walk. Hurry up and potty train. With number four, I knew she was my last and I was thankfully in a place in my life where I didn’t want to hurry anymore. I wanted everything to slow down. I am grateful that I was able to have the awareness to enjoy every single stage with her. I squeezed every last drop. Nursing her one afternoon, she was holding my finger and resting her hand on my chest, while staring into my eyes. I felt in the depths of my being, at that very moment, what an amazing gift to be given the ability to nurse my baby, and I wasn’t going to hurry.

 

Rachel Hart I am a traditional midwife and CPM. I moved to Atlanta from Las Vegas with my husband and four children in 2008. I am a graduate of the University of Nevada, Las Vegas with a Bachelor’s degree in English. I began my midwifery journey through an apprenticeship training program in 2005 and began my own practice in 2007.  All four of my children were born at home, the last birth unassisted. I joined Beth at Birthing Way in 2010.

Helping women realize their true power and potential as a woman and mother through the birthing process has been a privilege. I have really enjoyed attending births with the lovely families here in Georgia. I also support the birth community as Secretary of the Georgia Midwifery Association and as Membership Director of the Georgia Birth Network.

 

www.birthingway.com
rachel@birthingway.com
770-597-4478
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Thrush – Yeast – Candida

Thrush is a common diagnosis when mom is experiencing nipple pain. Thrush is an overgrowth of a yeast that lives on the skin and in the gut of healthy humans. Thrush may also be referred to as candida albicans.

How Common is Nipple Thrush?

If you ask a group of moms, they’ll tell you thrush or yeast is very common. If you look at the research, a very different picture emerges. Mothers frequently complain of burning nipple pain, nipple damage, yellow or white discoloration in damaged areas of the nipple, sensations of heat or itching, and pain that radiates into the breast. These symptoms are then lumped together as thrush and treatment is prescribed often without a culture. Frequently, mom’s symptoms improve then return. Frequently, another round of anti-microbial treatment is begun.

The latest research on candida and breast yeast informs us that thrush is often the incorrect diagnosis. More women are shown to have staphylococcus aureus than candida, and not all women with one or both positive cultures have pain. In fact, only 15% of the study group experiencing nipple pain had yeast in the culture from swabbing the nipple. Even fewer, 9% had candida in the milk sample (Amir et al). Does ductal thrush even exist? Could it be something else?

Staph aureus has a white to golden color when present on the breast nipple. The common prescribed treatment for candida is miconazole or clotrimazole. Both of these drugs are effective in treating staph aureus as well as candida.

The largest common denominator in these studies on mothers experiencing nipple pain was nipple damage. Nipple damage is caused by a sub-optimal latch.

How Sub-optimal Latch is Misdiagnosed as Thrush

When a baby latches shallow to the breast and does not draw plenty of the areola into the mouth, the nipple is often exposed to inappropriate friction. The baby then must use the jaw and a clamping motion or bite to hold the nipple in the mouth. This can cause a very common condition called a vasospasm. The pressure from the poor latch causes an interruption of blood flow around the nipple. When blood flow returns to normal, a pain called a vasospam may occur. This pain can feel like shooting or burning pain in or around the nipple or deep into the breast. This pain can happen during, after, or between feeds. The solution for this pain is to fix the latch.

One contributing factor to shallow or clamp-down latch is a high arched palate in the nursing baby. These babies often have milk stains on the tongue because the tongue doesn’t rest against the hard palate and clear itself of milk. The milky tongue may look like thrush. Tongue-tie or ankyloglossia is another risk factor.

Sources:
Amir LH, Garland SM, Dennerstein L, Farish SJ: Candida albicans: is it associated
with nipple pain in lactating women? Gynecol ObstetInvest 41:30-34, 1995
Hale TW, Bateman TL, Finkelman MA, Berens PD. The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis. Breastfeed Med 2009;4:57-61.
http://www.placerconferences.com/wp-content/uploads/2014/05/G.Why-Does-it-Hurt.pdf

What to Do if Your Culture Came Back Positive for Yeast

Medications: Your health care provider can prescribe medications for both you and your baby that are compatible with breastfeeding. Many mothers feel anxiety about medications and breastfeeding. Remember, your doctor prescribes medications because they have more benefits than risks. If you are interested in reading study data on breastfeeding and taking your prescriptions, contact the Infant Risk Center.
Pumping Guidelines: If your baby depends on pumped milk, keep feeding the pumped milk. If you engage in informal milk sharing, it is wise to take a break from donating until the yeast is cured. If you donate to a milk bank, contact the bank about the medications you are using to clear the infection. If you have an open system pump, be careful. Change the tubing completely. The tubing can’t be sterilized well and should be changed if there is thrush. If you have a closed system pump that is functioning properly, just sterilize the pump parts correctly after each time you pump.

Nursing Guidelines: It’s perfectly safe and beneficial to nurse through thrush. The direct mouth-to-breast nursing is a closed system and transfers antibodies and biochemicals back and forth. Infant saliva on the nipple actually helps change the make up of the milk to meet a babies unique immune needs. The living cells in the milk help fight the infection during the nursing process. The sucking also can help relieve some of the discomfort babies experience when baby also has thrush.

Nipple Care: Your health care provider will probably provide a nipple ointment that is anti-fungal. There are many on the market that are perfectly safe for your baby’s mouth. You may want to consider saline nipple soaks to ease the discomfort and facilitate healing any damage. Using disposable breast pads can reduce staining in your nursing bras and clothing from the ointment.

Laundry and Dishes: Many moms are worried their bras, cloth breast pads, and cloth diapers are harboring yeast. Contact your cloth diaper manufacturer for instructions on how to strip your diapers. Other fabrics can be soaked in vinegar for 24 hours then laundered normally. Pacifiers and bottle nipples can be sterilized daily.

This blog post is informational only and does not serve to diagnose or treat any condition. See your healthcare provider if you suspect a nipple infection.

 

10 Questions with a Pediatric ENT

1) How can an ENT be part of a breastfed baby’s healthcare team?

Successful and efficient breastfeeding requires the tongue and lips to have adequate mobility (structure) to stably maintain an airtight seal between the tongue, lips, palate and nipple during the process of extracting milk, as well as proper strength, coordination, and movement (function) of these tissues. This is why optimal treatment of breastfeeding problems may require a team effort between the pediatric ENT to address the structural concerns, and a lactation consultant and/or occupational therapist to address the functional concerns.

2) Is tongue tie a fad diagnosis? Why has there been such an increase in tongue tie revision in the last decade?

Tongue ties have always been around, but the increase in emphasis on benefits of breastfeeding, and less willingness to accept the advice just to bottle feed if breastfeeding is difficult, have led to an increased exploration and awareness of tongue tie as a treatable structural concern that may improve the comfort and efficiency of feeding.

3) What is the reason for controversy about tongue tie? Why do so many healthcare providers disagree on this diagnosis?

There is a spectrum of ways in which the tongue can attach to the floor of mouth, and some tongue ties, particularly those that are anterior, are more obvious than others. The presence of a tongue tie that is less obvious is diagnosed by the feeding pattern more than the exam. Those who do not have a good understanding of the ways in which the relationship between the tongue, lip, jaw, palate and nipple can affect breast feeding, may not be willing or able to recognize a functionally significant tongue tie if it is not readily visible. The tongue-tie feeding pattern is a consequence of inability to maintain an airtight seal due to an imperfect relationship between these structures, which leads to a cascade of potential issues including shallow latch, frequent separation/repositioning, nipple pain/cracking/blistering, plugged ducts or mastitis, clicking/air swallowing which makes the baby gassy and fussy after feeds, biting or chomping behaviors (as the baby works as hard as they can to maintain the latch given the structural limitations), leading to fatiguing during feeds before obtaining adequate milk intake, resulting in frequent, inefficient cluster feeds. If these symptoms are present, it should prompt evaluation for an oral tie.

4) Do all tied babies need a frenotomy? Are there evidence-based non-surgical options to resolve this issue?

How likely the frenotomy is to be helpful for breastfeeding problems depends on how much tethering tissue can be released, relative to how restricted the movement is. If the baby has feeding issues suggestive of tongue/lip restriction, then a frenotomy is likely to be helpful. Beyond breastfeeding, the frenotomy is particularly recommended for babies with anterior tongue ties, which are more likely to affect speech articulation.

Non-surgical treatment cannot address the structural restriction of the tongue and lip. Although some babies may gain more strength and coordination, and be able to compensate better, the structural relationships do not change. Toddlers will often fall and lacerate the labial frenulum, but it’s not exactly a workable treatment plan.

5) What is the role of the palate in diagnosing tongue tie?

The tongue must have enough mobility to rise up and pin the nipple against the palate to maintain an airtight seal. If there is a high arch to the palate, then the tongue has to elevate further in order to achieve enough surface contact to achieve this seal. So it is often more the relationship between the tongue and palate, rather than the tongue itself in isolation, that determines whether the baby will have a tongue-tie feeding pattern.

6) Plenty of moms are posting photos on Internet forums asking if their babies have a tie. Can you make a diagnosis from a photo? Is there a difference between form and function when diagnosing ties?

Anterior tongue ties, where there is an obvious tethering band restricting movement of the tongue tip, can be diagnosed from a photo or examination alone, although the history is still helpful in determining how much it is affecting feeding. Less obvious tongue ties are diagnosed much more by the feeding pattern than the exam. There is not always a good correlation between form and function, because there are so many other factors beyond the visible structure of the tongue and lip which may affect the latch. My approach is that the feeding pattern (function) tells you that a tie is present, while the exam (structure) tells you how much of a target you have to improve the situation.

7) What are the long term consequences of untreated oral ties? Is there a way to predict if a tie will be problematic down the road?

Untreated oral ties can contribute to feeding problems with handling certain textures of solid foods, dental hygiene problems including cavities (imagine not being able to use your tongue tip to dislodge crumbs caught between the gum and cheek), and speech difficulties (try to talk while holding your tongue tip against the inner surface of your lower teeth, and you will hear the effects on articulation).

Again, since form and function do not always correlate, it is difficult to predict for sure how much these effects will occur if the tie is untreated. As a rule, the closer the tie is to the tip of the tongue, the more likely it is to affect speech. As the procedure is easier and better tolerated in younger infants, and it is better to prevent the speech problems than to treat later and need speech therapy to re-learn articulation, I am in favor of early treatment once a tie is identified.

8) Why do so many healthcare providers seem to miss this diagnosis? Many moms report being told the latch looks great even though they experience pain. What should they be looking for instead?

Again, this comes back to frequently poor correlation between the exam and the feeding pattern. Many providers are trained only to recognize the structurally obvious anterior ties, or may have even been taught that tongue ties do not affect breast feeding, because some babies with visible tongue ties are able to breast feed without difficulty. (This is like saying that smoking does not cause cancer, because some people smoke their entire lives and never get cancer). Recognition of the tongue tie feeding pattern (see #3) should help determine when a baby could benefit from tongue tie evaluation and/or treatment.

9) Other than oral ties, what other conditions do ENTs treat that may require special breastfeeding support?

Conditions that affect the tongue, jaw and palate, such as cleft lip and palate, Pierre Robin and other craniofacial syndromes, or tongue cysts, may make breast feeding difficult or impossible and require special support.
10) Laser vs scissor: any truth that one is better?

There are no head-to-head studies comparing them, although some providers are laser proponents because there may be less bleeding, which potentially allows the procedure to be done without a local anesthetic (numbing injection), or because it may allow for a more precise cut. On the other hand, laser is possibly more dangerous if the baby moves, certainly requires more setup time and precautions, and is a much more expensive piece of equipment. So I see no convincing evidence to prefer laser over scissors, especially for office-based procedures.
Bonus question 11! Share a memory or reason breastfeeding had a positive health impact for your family.

When my wife and I were in residency and she was on call, I would pick up my son from daycare and bring him to her to breastfeed, then pick up all the bottles she had pumped during the day so that I could feed him overnight. It was nice for them to have that bonding moment in the midst of her busy day, and put him in a better frame of mind to come home with me for the evening.

~~~~

From very early on, Dr. Erik Bauer has been fascinated with language and communication, which led him to an interest in hearing and speech, and from there to the versatile specialty of pediatric otolaryngology. Born and raised in Chicago, Dr. Erik Bauer graduated from Harvard University magna cum laude before enrolling at the University of Michigan Medical School. He went on to surgical internship and residency in Otolaryngology-Head and Neck Surgery at Washington University in St. Louis, Missouri, then stayed on for the Pediatric Otolaryngology fellowship at St. Louis Children’s Hospital. This fellowship prepared Dr. Bauer to recognize and treat a full range of pathologies including pediatric hearing loss, cochlear and BAHA implantation , chronic ear disease, congenital and acquired airway problems, foreign bodies, and sinus disease.

Dr. Bauer joined Pediatric Ear, Nose & Throat of Atlanta in September 2006. In practice, Dr. Bauer has developed a special interest in tongue and lip ties, especially as they affect infant breast feeding. He feels fortunate to have learned a lot about this previously under-recognized issue, and to have the opportunity to help many infants and moms navigate this challenging territory.  Allowing babies to feed more comfortably and effectively has turned out to be one of the most rewarding aspects of his practice.

Outside practice, Dr. Bauer does his best, along with his wife Mandy, a breast radiologist, to keep his two active boys entertained, between helping with science fair projects and social studies homework, shuttling to soccer and chess tournaments, and attempting to make sense of their video games. He also enjoys travel, dining, live music, and trying to teach himself languages with varying degrees of success.

Dr. Bauer is a diplomate of the American Board of Otolaryngology, having received his board certification in June 2006, and a fellow of the American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Pediatrics. He practices at our Main Office, Alpharetta, and Marietta locations.

www.childrensent.com

404-255-2033

 

 

What is a Normal Feeding Routine? How Does it Change with Age?

The one thing that is certain with babies is they change every day. Knowing what the range of normal is for infant feeding can help parents make better decisions about the family rhythm.

Exclusive Breastfeeding and Human Milk Feeding

0-6 weeks: This is the time when babies nurse constantly. Their tiny tummies want a constant and steady fuel supply, just like they were accustomed to in utero. The placenta nourished the baby so well, hunger is something completely new after being born. It’s easiest to feed babies before they show signs of agitation. Nursing in clusters is common. Nursing every 1-3 hours day and night is normal. Nursing sessions may last 5-35 minutes at a time. Babies frequently fall asleep at the breast and nurse in their sleep. Expect 10-15 nursing sessions per 24 hours. Babies should be fed on cue or on demand. No medical organization endorses scheduled feeds for breastfeeding infants.

6-12 weeks: This period is usually full of what most people call growth spurts. Babies this age are still nursing around the clock. Remember, human milk is digested in about 90 minutes. The tummy is still small, maybe as little as 2 or as many as 5 ounces. Some babies will have a “witching hour” in the early evening where they feed in a cluster of sessions. Babies who have been separated from mom during the day may be particularly interested in a marathon evening nursing session. Nursing and bottle feeding human milk should continue on cue or on demand.

3-6 months: The World Health Organization and the American Academy of Pediatrics recommend that babies continue to receive only human milk at this time. Babies in this age range have a variety of sleep patterns and growth patterns. Teething may begin during this stage which may disrupt feeding or increase night wakings. All of this is normal. The stomach size is 3-5 ounces. Babies in this age range may increase their nursing or cluster feed just as newborns do. On cue feeding should continue at this age.

Breastfeeding with Complimentary Solids

6-9 months: Most babies will have a first tooth appear at this point. Babies who have a tooth, can sit well unsupported, and have lost the tongue thrust reflex are ready to begin solids in compliment to human milk. Human milk is still recommended as a primary source of nutrition. Ideally, the baby is nursed first then solids are offered as “dessert.” You may have heard “food before 1 is just for fun.” Small amounts of complimentary solids are important for iron and other minerals as stores from birth are utilized by this age. Human milk should be offered on cue. Solid foods can be offered at scheduled meal times.

9-12 months: Most babies are interested in self-feeding. They have mastered the pincer grasp and can put bits of food into their own mouths. Human milk is still the bulk of their nutrition. Some babies may not have had a tooth erupt yet. Nursing through the night is very common.

Nursing a Toddler

12- 15 months: The American Academy of Pediatrics feels this is a safe time to replace human milk with other foods including the milks of other mammals. Many mothers continue to nurse their toddlers for nutrition. Toddlers at this age are busy and may have nutritional gaps because they are out exploring the world instead of eating. Their stomachs may only be a few ounces bigger than they were a year ago. Continuing to breastfeed at this age can help a growing toddler meet nutritional needs during a “picky” phase.

15-18 months: Children who are still nursing may continue to do so at night as well. Mothers commonly explore night weaning around this age. Other mothers are glad to nurse through the night to help with the pain and wakings associated with eruption of molars.

18-24 months: By this age, most children are well established on solids interested in eating with the family at more regular times. Self feeding has been mastered. Many children can drink out of a small cup unassisted. Toddlers who are nursing may nurse frequently or only once a day. The range of normal is very wide.

Full Term Nursing

2 years and beyond: The World Health Organization recommends that children breastfeed for a minimum of 2 years with nursing continuing if both mother and child so desire. Children often self-wean some time after the second birthday. Pregnancy or extended separation may motivate a child to wean faster from nursing.

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.

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.

 

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