• mamasmaternalhealth

Top Breastfeeding Difficulties



We know how intimidating breastfeeding can be when having your first, second or even third baby. Just because it ‘natural’ for your body to produce milk doesn’t mean that you or your baby know exactly what to do. Because of this there will be some pumps in the road, hopefully you have a great support system to keep you on the right track.


We have talked before about what a good latch looks like and all the ‘norms’ but what happens when it isn’t normal? Do you know what to look for?


In this blog post, we discuss the top breastfeeding difficulties and way to combat them!


First- Avoiding Engorgement and Mastitis

Even the name of breast engorgement sounds painful... especially since it can lead to problems such as lowered milk supply or even mastitis (an inflammatory condition that may lead to infection).

So what causes engorgement and how can you prevent it?

Engorgement feels like the breast tissue is very hard, overfull, and may be painful to touch.

Mastitis is when engorgement turns into an infection of the breast and nipple. If the breast becomes red, hot, and shiny you may have mastitis and should go see a doctor for medical treatment.

The main reason engorgement occurs is from pressure or restriction of the breasts. This happens with the use of tight bras or breast shells that restrict the breast tissue. It can also occur if you are not regularly expressing milk and emptying the breasts. This typically is presented when breastfeeding sessions are missed or the periods of time between breastfeeding sessions are too long and milk begins to build up. Most frequently this occurs from not having overnight feedings.

This could also be a common problem for women who are regularly separated from their baby and unable to pump OR their baby is having difficulty transferring milk resulting in a build-up in the breast.

Another more uncommon issue that causes mastitis or engorgement is anemia which results in decreased milk 'flow'. If women do not have enough iron stores it affects lots of functions in the body and one of them is the milk letdown and flow. That's why we don't just emphasize iron during pregnancy but, breastfeeding as well.

All of these situations can cause engorgement, but being aware may help you prevent engorgement in the future.

But what about if you already have engorgement and want to make sure it does not lead to mastitis?

One of the main ways to prevent mastitis is emptying the breast. If your engorgement is to the point that your baby is unable to latch, you may need to pump or express by hand enough milk to soften the breast tissue so that they can latch on. It is also recommended to wear loose-fitting bras as well as non-restrictive clothing.

Action Item: Express some milk before breastfeeding so that your baby is able to latch on even if you are engorged. This will also help with the letdown in case it is too strong.

Please note: Cabbage leaves have been used to reduce high supply and engorgement but use with caution. If used for too long or too frequently, it may dry up/decrease a mother's milk supply.

"Can I breastfeed if I am engorged or have mastitis..."

Yes, you can breastfeed even if you are engorged and even in most mastitis cases. Breastfeeding/emptying your breasts can help in both cases because the milk flow helps resolve both issues. As we discussed before, you may just need to express some milk so that your baby is able to latch on due to the hardness. When women have mastitis, typically you are still able to breastfeed as long as you feel comfortable. If expressing your milk in another way is more comfortable for you, then that is totally okay as well. You just want to make sure that you are emptying the breasts 1) to help with the mastitis/your comfort level and 2) to make sure your supply doesn't decrease.

Action Item: If you feel engorged or you have mastitis make sure to empty the breasts to speed up healing and reduce symptoms.

Again, if you are showing signs of mastitis, you need to seek help from your doctor so that your breast tissue does not become infected. You should be able to breastfeed in most cases of mastitis, but the severity of each case must be reviewed by your doctor before any conclusions are made.


Difficulty Latching? We've got your back!


We have all heard the horror stories of breastfeeding... everyone has a cousin who had a, b, and c and that she felt like breastfeeding was torture because of x, y, and z. And you know you want to breastfeed because you heard its good for the baby, but now you are mentally preparing for the worst ….right?

But we are here to tell you that it doesn't have to be like that! A lot of problems actually come from the infant latching in a way that causes pain, poor milk transfer, etc. Neither one of you is doing anything wrong! It is pretty common and with some minor adjustments with a lactation specialist, you won't have to constantly 'brace yourself' for the worst.

How do you know if you have a good latch?

A proper latch...

Having a proper latch is important for the effective transfer of breastmilk. If your baby is not latched correctly, it could cause issues with milk transfer which also may cause pain for Mama.

Breastfeeding should not be uncomfortable or painful (other than a slight tugging on the breast), therefore if you are experiencing any trouble, you may need additional help from a lactation specialist.

Possible issues...

Some problems that may occur with an improper latch include painful nipples, chapped/cracked nipples, or engorgement from pressure (because the milk is not being transferred) which could then lead to mastitis (a serious medical condition that could be dangerous to the mother).

Breastfeeding positions...

There are a few positions that every mother and baby dyad can choose from to meet their breastfeeding needs. These include the regular 'cradle position', the 'football' hold, 'laid back position', etc.

Each dyad has to figure out what position works best for them, but here are some tips for a successful breastfeed!

Mama and baby should be tummy to tummy. This tip helps to ensure that the baby is facing Mama with their head, shoulders AND hips. This also helps lead to optimal comfort and breastfeeding latch.

The second thing we look out for is the actual position of the nipple in the baby's mouth. Your baby should be asymmetrically latched on the areola so that the nipple faces the roof of his/her mouth.

To achieve this--- while positioning for a feed, your baby should have their nose adjacent to the nipple. The chin should meet the breast first. When latched, there should be more areola above your baby's mouth than below.

The corner of the baby's mouth should be at a 145-degree angle. This indicates that the baby has a good mouthful (of breast tissue) and there will be no painful nipple sucking for the mother.

Lastly, make sure that your baby's nose and chin are close to the breast. When latching, bring your baby to you, don't bring your breast to the baby! This simple act may decrease a large number of problems you are having while breastfeeding.

Action Item: Make a checklist of these items and see if your baby has each one. If not, you may need to make some simple adjustments.

"My baby seems to be latched but I’m not sure if he is actually drinking my milk?"

One of the ways to assess a latch is to 1) look at the jaw motion and 2) listen for sucking and swallowing. While feeding, a jaw motion should look more like its 'rocking' vs a straight up and down motion.

You may also hear/see a difference in sucking vs swallowing. Swallowing makes a distinct sound (as if you were gulping a drink) while the jaw drops slightly to open the throat. If you can only see a suck and cannot hear a swallow, then the baby may not be transferring milk.

Another way to make sure there has been milk transfer is through assessing the baby after a feed. Your baby should look 'milk drunk' or very relaxed and sleepy. The baby's hand will come off the breast and hang loosely like the rest of the body.

Another option: You can weigh your baby before and after a feed, showing an increase in weight post breastfeed. This will show only a few ounce difference, however, will prove that your baby did indeed receive milk.

Action Item: Look for jaw motion during a feeding and body language after. Listen for a swallow or gulp to see if milk is being transferred.

OR look at/inside their mouth--- milk residue is a great sign that the baby is transferring milk.

A long-term latch assessment would be to watch your baby's weight overtime to make sure they are 1) not losing weight and 2) they are gaining the proper amount of weight according to accepted growth charts.

Please note that breastfed babies may lose a bit of weight within the first week after birth. This is normal as long as the weight reduction is no more than 5-7% of their birth weight.

How long should breastfeeding sessions be and how does that relate to latch?

For lactation counselors, the length of the breastfeeding session can be an indicator of a multitude of things.

Most importantly, the length of the breastfeeding session can help the lactation counselor understand how successfully the baby is transferring milk/how much milk he/she is getting.

How long should the breastfeeding session last?

A feeding session should last ~15 minutes. This time absolutely fluctuates with each individual baby (by ~5 minutes or so is normal).

If the baby takes significantly less time then above, he/she may be too tired/fussy or fatigued to complete a feeding. This baby may 'give up' early, indicating a milk transfer issue or latch problem.

Likewise, the baby's that take longer than the above time frame may be suckling at the breast for self-soothing purposes rather than breastfeeding. This problem may hinder mom from completing any other tasks that do not include feeding her child but this may be favorable for some.

How often should my baby breastfeed?

Your baby will feed 10-12 times in a day.

Interestingly enough, moms that successfully feed their baby 10-12 times daily feel like they have a problem with their milk supply. BUT in all actuality, they are feeding their baby the perfect amount.

If your baby is indeed feeding less that ~10-12 times daily, this indicates a problem (usually regarding poor milk transfer).

Fun Fact:

Around the world, most babies breastfeed for 140 minutes daily.

A simple way to check if your baby is getting enough milk is by adding the time of each breastfeeding session together. The total should be about 140 minutes per day. *A baby that nurses 8 times a day for ~17 minutes will get the same amount of milk as a baby feeding 12 times a day for ~12 minutes.

Studies have shown that the breastmilk consumed by infants who feed more often is higher in fat content, and therefore is more conducive to healthy growth and development.

Action Item: Keep track of how long your feeding sessions are and how many (through your log that you are keeping from the low milk supply section), and add the minutes up. They should equal somewhere around 140 minutes total.

Difficulty Suckling

Sometimes, babies have a difficult time suckling, whether its muscle development or coordination and its something that they have to grow and work on. This happens most often in infants that were born prematurely. Often they have a lower muscle tone and their coordination is lowered due to their young gestational age. Never fear, as long as they are given time to build those muscles with some therapy, many babies are able to successfully breastfeed! All you have to do is keep your milk supplies up during this time!

Sometimes, for babies that struggle but are still able to suckle for some amount of time, they may have difficulty initiating the milk letdown. They may get frustrated and become overwhelmed and pull away from the breast. That's totally normal and okay too, its nothing you have done, so don't worry! One way to help your little one start that flow is to hand express or pump a little first just to get the milk letdown. That way they don't have to work as hard at first and they can work on the development of those little muscles-- possibly making it easier as they grow!

If you read this information and it resonated with you today, we would love to talk to you about some of your fears and struggles with breastfeeding. Continue to follow along with us on the "Top 5 Breastfeeding Difficulties" series and continue to learn more!

Action Item: If you think this may be an issue for you and your little one, working with a lactation specialist may help to optimize your baby's latch with little adjustments which can help to increase milk transfer and increase milk supply! (Hint-hint Mamas Maternal Health)


Cracked and Sore Nipples, and how we can prevent them!

We're sure you have heard all about Suzie’s cousin’s friend’s cracked and sore nipples from breastfeeding in graphic detail. It seems that people come out of the woodwork with terrible breastfeeding experiences once you have made the decision to breastfeed yourself!

If you find yourself in this state of mind, bracing yourself instead of enjoying each moment OR you feel like everywhere you turn there are nay-sayers and lack of support, even from people you trust the most.

How do many new moms react to this overwhelming negativity?

They abort the mission, jump ship, and follow what their friends and family are saying, because, after all-- these are the people that will be with you every step of the way.

However, there are some brave souls that put on their blinders and carry on because they are determined to breastfeed. Most breastfeeding moms do not encounter the majority of horrific breastfeeding tales, and those that do may persist through the challenges or give up entirely.

Again, if you were in pain with no foreseeable solution and you could stop said cause of pain any time, eventually EVERYONE would give in.

But what if we said: you could breastfeed knowing that you will have a solution, knowing that you will be supported, and knowing that you will meet your goals.

AMAZING right?

That's exactly what we are here for! To give you tools to prevent and heal when breastfeeding is painful.

We first want to start with prevention. Believe it or not, we actually covered the majority of this previously in this series. That's right, having a good latch can take you from pain to relaxation! If your baby is holding your nipple at the wrong angle or too shallow... it WILL cause you pain and you will NOT adequately transfer milk.

Once you have a good latch-- you are already most of the way there! If you want to further take care of yourself, which if you're reading this I'm sure you do... After a breastfeeding session, all you have to do is take the residual breastmilk and message some around your nipple and areola. This will help hydrate and soothe this area and prevent it from becoming too dry. Similar to how our hands get in the wintertime, if your nipples become too dry -- they may crack and possibly bleed.

Action Item: Use your breastmilk as your first line of defense if you feel your nipples getting dry or cracked!

Okay, so what if they are already cracked, dry and painful.


Never fear, with some time and love they WILL heal --- but lets speed along the process, shall we?

There is a vast amount of products out there to help heal your cracked nipples due to breastfeeding. But what products should you be using?

If the time comes and you want to buy a nipple cream, we encourage you to make sure you read the label to see what is inside each cream-- because not all are created equal in regards to user safety.

Before you go off to buy a cream---


If you feel like you are starting to have issues or want to prevent issues--- there is a very simple solution WITHOUT spending any money at all!

Just like we did for prevention, you can do the same thing with your breastmilk for healing! Did you know that your breastmilk has healing properties? Yup, breastmilk not only works as a moisturizer BUT a healing aid. No wonder it's so good for your babies-- it really works wonders!

If you do want to go out and get a nipple cream, look out for 'Baby-Friendly' labels and ingredients. Your baby may ingest some of the cream while breastfeeding so it's important to be careful when choosing a topical product. You want to specifically avoid fragrances, parabens, triethanolamine, peg-2 stearate (an environmental toxin), and topical steroids because it could mess with your baby's adrenal gland function as well as other bodily functions.

NOTE: It is not recommended to use vitamin E oils, coconut oils, olive oils, etc. They may be ingestible to you, BUT your baby cannot break down these types of lipids (found in oils) at such a young age. An overdose of Vitamin E could also lead to digestive issues for your infant.

Cream example: Lanolin has been around for a while and if you hang around breastfeeding mothers --its one of the most common types of creams. It was probably used by your mother and hers before you!

BUT what is Lanolin?

Its a mixture of alcohol esters and fatty acids that come from... SHEEP'S WOOL! If you're a vegan Mama, you may want to think twice about this product. But it is otherwise non-toxic to both mother and baby and you don't have to wipe off anything before breastfeeding. While it does not have the same recovery rates that breastmilk has for nipples-- it can be a great option.

Apply nipple creams at least 15 minutes before a breastfeeding session, because, while it is safe for your baby to consume, you put it on your nipples for a REASON. You want to make sure there is enough time for it to soak in and actually help your pain.

If your nipples become cracked to the point of infection (a point that we sincerely hope no mother gets to) you may be prescribed antibiotic creams.

These antibiotics are safe to breastfeed with because your baby is constantly building their immune system and microbiome through breastfeeding!

If you are reading this, you are clearly already taking the crucial step in making sure you are as prepared as possible for breastfeeding. You are doing all your homework on breastfeeding, pumping, nutrition during pregnancy, what kinds of foods the baby should be eating, etc.

You are AWESOME Mama!

But when push comes to shove and life hits, how is that google search going to help you after you were up all night with your hungry baby while your nipples were screaming with pain? Or better yet, how will it help you from preventing that from happening in the first place?

This is why support during pregnancy and breastfeeding is not only 'nice to have', but is IMPERATIVE! Whether you have support at home or none at all. No one is perfect and no amount of googling can help you implement and make changes in your life to better both you and your baby.

No one has ever become successful without help--- think of LITERALLY any 'successful person' you know.


Everything you need to know about having a low milk supply


Maybe you struggle with low milk supply or maybe you know someone that has, so you are afraid of experiencing it yourself...

If so, this post will go over EVERYTHING from pumping, formula, frequency, and galactagogues (supplements to increase supply)--SO keep reading!

The first thing to do in order to combat low milk supply is by breastfeeding and/or pumping often! Your baby should be feeding 10-12 times in a day which means you should be emptying your breasts just as frequently. If you have struggled with a low milk supply -- I am sure you are sick of hearing the phrase 'supply and demand' as it relates to breastfeeding... But it is the best aid to remind yourself that the more you pump or breastfeed, the more milk your body will make. It may not happen overnight, but consistent and frequent stimulation will be your best way to increase your milk supply and meet your baby's needs!

Action Item: Even if your baby doesn't meet the 10-12 times/day feeding goal, you should still pump that many times! Pump at least 1 session more than you think you need. Even if barely anything comes out! The stimulation and having an empty breast will stimulate more milk production.

The first hour of life...

In the first hours of life, your baby goes through 9 different stages in preparation for the first breastfeed. Unfortunately, not every woman has been given the chance to be skin to skin, uninterrupted, for a full hour after birth to help complete these 9 different stages.

Many women and baby dyads face complications, such as preterm birth, or hospitals that don't follow this policy (skin to skin for the first hour after birth). BUT, the more you know, the better able you will be to request your first uninterrupted hour with your baby.

Getting to be skin to skin with your baby, even if the first breastfeeding session doesn't produce any milk, is the first response your body has to shift from 'pregnancy' hormones to 'breastfeeding' hormones. This hormone shift is the exact reason that milk is produced-- SO the sooner the shift, the more time you have to start producing milk. The later you start, the less intense your hormones will be because they may be worn off after a bit of time and it may be harder to increase overall milk supply.

Latch:

All of the aspects of breastfeeding are tied together, which is why we are going to cross into different categories during each of the posts in this series. Your baby's latch can have an indirect effect on your milk supply when it relates to milk transfer. If no milk is being transferred due to a less than optimal latch, then your supply will not increase and may even potentially decrease-- remember the supply and demand concept...

The pressure from the milk in the breasts will tell your body that the milk isn't being used and therefore, the volume is not needed. As a result, this may decrease the supply ever time.

Action Item: If you think this may be an issue for you and your little one, working with a lactation specialist may help to optimize your baby's latch with little adjustments which can help to increase milk transfer and increase milk supply! (Hint-hint Mamas Maternal Health)

Pressure:

Something as simple as too much pressure can decrease a milk supply. Just as we talked about having too much pressure inside the breast can have an affect on milk supply, the pressure outside can also effect supply. Wearing tight clothes or bras such as sports bras puts pressure on the breasts and will cause milk supply to decrease over time. Similarly, if a woman has had breast implants there may be less space to hold milk in her breasts and may need to empty her breasts even more frequently to make up for volume needs for her baby.

Your anatomy:

Unfortunately, a woman's anatomy may affect her milk supply. Although rare, some women have hormone imbalances or too little glandular tissues which affect the ability to produce milk. In these cases, she will still be able to produce milk and may have to supplement with formula. However, again, this is not very common...

Other times, women may have had breast enhancement, or reduction surgery which could have interfered with nerve endings and her anatomy, causing her body to have a more difficult time producing milk.

Pumping:

Pumping can be easier for some women that struggle with milk transfer because the sucking effect helps to draw the milk out. Other times, women struggle to produce milk from pumping sessions because of the different and sometimes uncomfortable feelings that is less of a baby and more of a machine, which makes it hard to relax.

As we discussed previously, make sure if your baby misses a session of breastfeeding, that you pump to maintain their normal schedule. Alternatively, if you want to increase supply, adding in an extra session of pumping will help to tell your body that your baby needs more!

Another strategy that some mothers find helpful is a method called 'Power Pumping' which mimics cluster feeding. This is essentially telling your body that your baby is HUNGRY, they may potentially be going through a growth spurt, and that you need to produce more milk! There are different recommendations, however, one of the most common routines is as follows: pump for 20 minutes, rest for 10, pump for 10, rest for 10, and pump for a final 10 minutes; totaling 60 minutes.

Action Item: If you want to learn more reach out to a lactation specialist to help you create a pumping/breastfeeding schedule that works for you and your baby!

Unequal Production:

Sometimes, our bodies are different and that can be a really good thing! However, it can definitely be frustrating when it comes to breastfeeding... Sometimes we have one breast that produces WAY more while the other is a little... well, lazy. It can be so frustrating because if the one side just produced as much as the other you wouldn't be dealing with low supply, right?

One of the first things that we need to remember is to NOT get discouraged and blame ourselves! It is incredible that you are producing milk at all and you can make that work!

One of the best ways to combat this is really utilizing the side that produces a lot. Make sure it empties and gets lots of stimulation, and always start on that side. The fuller side will have the most milk and your baby may prefer that side because they will feel more easily satisfied from the feed.

Save the other breast for the end as a 'just in case' your baby isn't full, your baby may get frustrated with the one side not having much or having to work really hard for less. They might become frustrated and not want the other breast at all, which is not only frustrating for you, it brings on feelings of rejection and not being enough, WHICH IS NOT TRUE! If your baby doesn't take the other breast after the fuller one then try to pump so that side still gets the stimulation.

Essentially, what may end up happening is the 'lazier' side may start to produce more from either the stimulation increase or the need for a higher volume than the left can produce on its own.

Galactagogues:

Galactagogues, or supplements used to increase milk supply, have been around for centuries, each culture has their own spin or version. However, the majority of women may not actually need these supplements and should be considered supplemental instead of a first resort action to increase supply. However, some may be safe and others not so much.

Some medications and herbs actually decrease milk supply such as some birth controls, cabbage leaves, sage, oregano, and peppermint. The medications will have a stronger effect, and, don't worry, having oregano in your food when you want won't make your supply diminish.

Medications such as Reglan or Motilium, typically used to increase gut motility, have been prescribed by doctors to increase milk supply. However, they may not be as effective as once thought and may put the mother at risk of developing cardiac issues and other risks.

Safe herbs for tea are: chickory, orange spice, peppermint, raspberry, red bush tea, rose hips

Fenugreek, a very popular galactagogue, has actually not been proven to increase milk production or the corresponding hormone, prolactin. It may also interfere with medication effectiveness for moms.

Foods that have been typically used as galactagogues are oats, nuts/seeds such as flax. These foods have high amounts of fiber, which has been shown to aid in increasing milk supply. And herbs such as ginger or garlic, spices such as cumin, chickpeas, and dark leafy greens.

Brewers yeast is another item seen in lactation cookies and other lactation snacks that have been thought to increase milk supply, however, there is not a lot of evidence that proves so.

Don't beat yourself up about formula supplementation:

Breastmilk contents are so unique, they cannot all be copied and made into infant formula. It provides immunities and micro/macronutrients specific to the mother/baby dyad. It's really a win-win for both mother and baby.

We also understand that for many women, breastfeeding is not easy. They face impossible roadblocks such as preterm infants staying in the NICU, minimal to no maternity leave that creates difficulty with milk supply, lack of family support, lack of support from health care providers, a latch that leaves them in pain with no one to turn to, etc. These are only a FEW instances of many that would lead to the possible use of formula.

When giving formula, it is important to note that when bottle-feeding milk comes out faster than breastfeeding and often infant might become frustrated with breastfeeding after being fed with a bottle. Try to pace the feedings in a bottle whether its breastmilk or formula. Also, note the number of ounces that your baby is taking in. If they take a lot of formula, they may not be hungry for the next breastfeeding session.

After formula supplementation, women often feel discouraged, like they failed. But Mama, that is not the case at all. If you had to give formula for the first couple days, but then were able to breastfeed, you succeeded. If you were never able to breastfeed but pumped and gave them breastmilk anyway, you succeeded. If you were able to give your baby any breastmilk you succeeded. If you did what you could, you succeeded, and that is enough to make you the best mom in the world.

We want to say that if there is or was a time during your breastfeeding journey where you had to or will have to supplement with formula, that is okay. That does not mean you are done breastfeeding if you still want to. You were courageous enough to make a decision that you may have not wanted in order to give your baby nourishment (even if it isn't your milk). Again, this supplementation isn't game over. On the contrary, its just a little needed break that is necessary to complete your next steps. Many women have given infant formula for a couple of days, like we said, to get over a rough patch or hump in their journey. BUT if willing, most are able to keep on breastfeeding either by themselves or with a little help from a lactation specialist. There is no shame in this, in fact, it shows how strong you are that you chose to keep going even when times got tough.

At Mamas Maternal Health, we know it can be difficult. If no women ever had issues breastfeeding there would be no such thing as a lactation specialist. And these issues are very common!

What frustrates us the most is that many women are unsupported during this time and therefore give up breastfeeding. That is why we became a company-- to support mamas and show them just how powerful and capable they are.

Dirty/Wet Diapers as an indicator:


The number of diapers a baby goes through can be daunting, but it can also be an indicator of proper milk transfer and nourishment. Women fear having a low milk supply when in reality, they might be doing well! Here is the amount of diapers your baby should be soiling for each stage after birth to help you track intake...

(Cool, right?)

Your baby should have their first urination within the first 8-24 hours of life. They will have 2-6 wet diapers per day for the first 2 days and can be up to 20 times per day after those 2 days. This is because infant's kidneys during this time are unable to concentrate urine and therefore excrete a lot of fluids.

After the first week of life, your baby will be putting out 200-300ml every 24 hours. Some infants may have red or pink stains in the urine, which may be attributed to uric acid crystals. Although most likely normal, this should still be checked out for possible blood in the urine and hydration status.

Since stool coloring and texture are relatively related to the maturation of both the infant gut and breastmilk composition, the progression is easier to follow than urine.

First, your baby will have what is called meconium (black tarry stools) within the first 24 hours. What is mainly in the stool is secretions from the intestine, mucosal cells, and other bodily fluids that your baby is excreting.

After 2-3 days, your baby's stools will transition through a few stages. This is also when more mature milk begins. They will turn to a more greenish-black color and transition to a greenish-brown, then more of a yellow color. The texture does vary more from watery to thick---this is not a concern as it is normal, however, they will have less of an odor and will be less 'sticky' than the previous meconium.

Eventually, once solid foods are introduced, stools will become more brown and solid as added fiber and solids are incorporated.

Breastfed babies will pass stools up to four times a day, but can vary. Formula-fed babies are less frequent and can be as little as twice a day or even every couple of days. So it's important to keep those differences in mind!

Donor Milk Options:

Within the last few years, donor breastmilk banks have become increasingly more accessible. But what exactly do they do?

In general, the idea behind donor milk is to provide milk to infants whose parent's cannot provide milk themselves. It is considered similar to blood banks because they test and treat the milk through the pasteurization process to make sure it is sterile for the infant.

Although this may alter the milk in some ways, the protective elements as well as other important components--- that formula does not have-- are kept intact. For premature infants (with or without other medical conditions), breast milk is viewed as medicine do its healthful properties.

It also gives women who may otherwise be unable to provide their own breastmilk (due to specific medications or diagnoses) a 'loop hole' in the system ---

...with a fee of course. UGH.

Some insurance companies may or may not pay for the costs of obtaining donor breast milk. This may be a turn off for some women because costs are significantly higher than that of formula. Why? This is due to increasing demand as well as a shortage of breastmilk donors. But just a reminder, as we look at breastmilk vs formula, we know that breastmilk straight from the mother's breast is the best option, then donor breastmilk, and then formula.

Many women feel that the cost of donor breastmilk is worth the extra dollar due to the protective properties of breastmilk that come with its unique composition. Others may not feel this way or may not be able to afford it. Feeding your baby PERIOD is ultimately the most important --- no woman should feel guilty about the way she chooses to feed.

Action Item: Keep a journal or a log where you track time and length of feedings, times you pump and the amounts, and when you supplement and how much. This will help you to get a better picture of how much your baby is eating and when, while giving you answers as to where you can make adjustments.

If you found this information helpful or it resonated with you and your struggles with breastfeeding, know that you aren't alone! Women all over struggle not only with breastfeeding but the EMOTIONS behind breastfeeding. It is a rollercoaster ride and you should not have to feel isolated because it's not a perfect journey. Just know that we are here for you and we are SO proud of you for all you have and will accomplish as a mother... YOU are enough and don't let anyone try to tell you otherwise!

High milk supply


For every mom that has a low milk supply, there is a mom that has a very HIGH supply. While it may not come with the stress and panic of "what am I going to feed my baby?" followed by feelings of defeat, Moms with a really high supply can struggle with infants not taking the breast because the letdown is too strong. What do you do then?


There are a couple of ways to handle increased let down, but let's start with positioning...


When feeding your baby, the most common position is the cradle hold, however, if you have an increased let down, this position may not be the best. When was the last time you stood under a big stream of water and tried to drink, swallow, breath, and not choke at the same time? Well if your last drink from a waterfall is not as fresh in your memory, we can assure you it's almost impossible!


One way to help your baby is to switch up your positioning! Try a laid back position so that gravity can help you pace your feedings. This way the let down won't be as strong and they can suckle at their own pace!


Another way to work with your baby and reduce the letdown strength is to pump or express a little beforehand. This takes that initial stream out of the equation and lets your milk steady itself-- AND your infant can pace their feeding!


Action Item: Try the laid back position to help with your rapid letdown, also express milk beforehand to control the flow!


If you do have a very high milk supply, you want to make sure that you don't miss a feeding or take too long to empty breasts between feedings. This includes nighttime. You shouldn't be going too long during the night without emptying your breasts, otherwise, your milk will build up! Waiting too long may become uncomfortable and it can put you at risk for engorgement. THIS could lead to mastitis. Something we will talk about next in the series!


There are a few things you can do if you make more milk than your baby drinks throughout the day...


The first thing would be to save it for days you might be away or miss a feeding (because we all know that does happen -- even if we have the best of intentions not to). You can begin to build a supply in your fridge/freezer. Remember to use the first in first out method to make sure none of your precious milk goes to waste.


The next thing you can do is become a milk donor or share your milk!


Becoming a Milk Donor:


How can you become a breastmilk donor?

Most places have a few requirements for becoming a milk donor. This includes but is not limited to being able to donate a minimum amount, making sure you are able to provide in excess so that your own baby is not deprived, some have infant age limits (milk composition will change over time), not taking certain medications/herbs, and/or being overall a healthy individual.


There are different places to donate through, some will pay you, others won't --depending on whether they are keeping costs down for other mothers. Here are a few:

https://rmchildren.org/mothers-milk-bank/donate-milk/

https://www.milkbank.org/get-involved/donate-your-milk


Many local children's hospitals and/or other clinics may also take your breastmilk.

Each state may have different regulations, therefore you may have to do your own personal research for your area.


What to expect?

You will typically receive little containers to place breastmilk in and once you have enough, you will either turn it in (to the milk bank) or mail it. Many places will cover the cost of shipping, so no need to worry there.


Or...


If you are breastfeeding and do not have a problem with milk supply, donating milk could be a great way to give back to your community and impact not only the life of another baby but their whole family.


Lastly, you could try to decrease your supply if it becomes too much for you, your baby, and your storage space.


Cabbage leaves and breastfeeding have been tied together for a number of reasons, one being that they help decrease milk supply. Isn't nature fascinating? All you have to do is place cabbage leaves on both breasts for ~10-15 minutes once, twice, or a few times depending on how high your supply is. It has been proven to work, and no we aren't crazy!


Here are a few more tips!


Wear tight clothes and bras and don't empty your breasts as frequently. This will mimic your baby not being hungry if milk doesn't leave the breast or if there's pressure-- it tells the body that it doesn't need to produce as much milk. Be careful, because some women can become engorged easily which causes pain and risks for mastitis. If you start to feel uncomfortable, express some milk out so avoid becoming engorged. It may take some time to decrease your milk supply when following these directions, but always be patient with yourself!


Action item: Take one of these three steps to manage your milk supply and make breastfeeding good for you and your baby again!

And Lastly- Infant Jaundice


Jaundice is characterized as a condition where serum bilirubin levels are high due to rapid breakdown of red blood cells. Bilirubin builds up in the liver and could result in damage to the infant. It is most often characterized by its physical yellow appearance on the infant's skin and in the eyes.

Jaundice can indeed occur in adulthood, however mainly within the population of individuals that have impaired liver function. It is most common in newborn infants--- approximately two-thirds of all infants experience it typically within the first weeks of life. This is because infants tend to have high levels of hemoglobin and blood volume for increased oxygenation after birth.

Formula-fed infants usually resolve jaundice symptoms after 1 week, whereas breastfed infants may take a bit longer at around 3-6 weeks. This is not uncommon and considered normal for two reasons.

1) Colostrum is more calorie-dense than formula and therefore a baby will have less output (wet and dirty diapers)---which is the way the body discards excess bilirubin.

2) Also, there is an unknown element in breastmilk that causes increased absorption of bilirubin which is attributed to higher levels in breastfed infants.

Some believe that this form of bilirubin may have an antioxidant effect and may be beneficial, however---we still encourage medical supervision in any case of jaundice.

Jaundice can also occur from poor feeding and/or milk transfer and may be a late indicator of difficulties with breastfeeding. This issue should be evaluated by a lactation specialist.

Here is a list of other factors that may cause 'hyperbilirubinemia':

- genetic factors

- prematurity

- blood abnormalities

- maternal diabetes

- UTI

- hypothyriodism

-etc.

A very severe form of jaundice called kernicterus --if not resolved-- can cause brain damage due to encephalopathy. This damage can range from cerebral palsy, deafness, paralysis to upward gaze, inability to sit or stand, walk, or swallow.

In these extreme cases, phototherapy may be used to turn these fat-soluble particles into water-soluble---which helps the excretion of bilirubin more quickly.

These are rare cases and the most effective way of preventing or diminishing signs of jaundice is to make sure your baby is feeding well and has a good latch.



While all of these issues are 100% scary, most of them are preventable and easily remedied. Do not lose sleep at night wondering about the what-ifs and hows! The best thing to do is to find a breastfeeding support person that you can go to for education prenatally and support postnatally. Both combined are the winning formula for breastfeeding success!




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