My
breasts are sometimes engorged and other times, leak between feedings. What causes
this and how can I deal with it?
Many nursing moms experience
one or both of these difficulties. When your milk first comes in, your breasts
may be hard, swollen and very tender, which is engorgement. The result of increased
blood flow to the breasts that causes tissue to swell, engorgement is best countered
by frequent feedings, usually every two hours. Latching onto a swollen breast
can be difficult because the nipple tends to flatten out. Expressing a little
breastmilk by hand or with a pump will soften the nipple, then nurse. Frequent
feedings will help make you more comfortable and will teach your breasts to begin
regulating production. If you let your milk sit, it signals the breast to slow
down, diminishing your supply.
Engorgement can also occur later on, when you're away from your baby and miss
a feeding. In that case, pump your milk and refrigerate or freeze it for later
use. If your milk production is overwhelming your baby during feedings, nurse
more frequently, but from only one side per feeding. Pump, if necessary, from
the other side to prevent engorgement.
Leaking
is brought on by the hormone oxytocin, which regulates the "let-down" reflex that
releases your milk. Unfortunately, sometimes simply hearing your baby's cry (or
even that of another baby) or smelling her scent can cause the same reaction.
Leaking usually tapers off within six to eight weeks, as your milk supply and
your baby's demands start to balance out. In the meantime, though, it can make
life messy and nursing difficult. Between feedings, use cotton nursing pads worn
inside your bra, and carry extra pads, as well as an extra shirt, in case of emergencies.
My nipples are cracked, bleeding and sore. What can I
do to alleviate or avoid these problems?
These common problems
are often a consequence of the baby's sucking on just the nipple, thereby irritating
it, so it's important to check your breastfeeding technique with a lactation consultant
or other qualified professional. As for pain relief, many women find that leaving
milk on the nipples and allowing them to air-dry helps, as does applying ultrapure
lanolin or hydrogel dressings between feedings. If an infection such as thrush
is present, your caregiver can prescribe an antibiotic or antifungal medication.
It's important to take care of problems as soon as they crop up, because they
can lead to clogged milk ducts, which should be treated with warm, moist compresses
and increased fluid intake, or mastitis, which usually calls for antibiotics.
I'm
pumping my milk, but my supply is going down. What can I do?
You
are working to provide your milk for your baby and it's common to run into some
challenges. Fortunately, there are many ways to increase your milk supply. Review
this list of possible solutions to see what might be beneficial for your situation.
- There are
several factors involved in pumping that might be causing a lower supply. You
could look into renting a hospital-quality breast pump (like a Medela Classic
or Hollister SMB) from a local La Leche League Leader or lactation consultant.
These are comfortable and efficient pumps. Check the LLLI catalogue or with your
local Leader for other pumps that mothers find effective.
- Try
pumping both your breasts at the same time. Special adapter kits are available
for pumps or two small hand-held pumps can be used. This double stimulation not
only saves time but also greatly increases prolactin, the hormone needed for milk
production. Some mothers find it helps to take some time to prepare for pumping.
Try using relaxation techniques, breast massage, and warm compresses for a few
minutes before pumping. Stress and tension, as well as cool body temperature,
can inhibit the milk ejection reflex and make pumping less productive.
- Engage
as many senses as possible. Look at a picture of your baby. Inhale your baby's
scent from a recently worn article of clothing. Listen to a tape recording of
your baby's voice. Call your baby's caregiver and ask about your baby prior to
pumping to help your milk flow more easily. More short pumping sessions are more
efficient than fewer longer ones.
- For
working mothers night feedings can be a good time to build up your milk supply
by keeping your baby in bed with you for all or part of the night. It's a great
way to catch up on bonding time, too.
- Make
sure you are getting good nutrition, adequate fluid, and lots of rest. This is
a challenging time and it is important to take care of you. Allow others to help
you with your responsibilities while you focus on your baby.
- Attend
a La Leche League meeting. There you will meet other mothers and get lots of support
for your situation.
- Milk
is produced according to the law of supply and demand so the more frequently you
breastfeed or pump, the more milk you will make. Ten to twelve breastfeeding or
pumping sessions per day is a good goal to aim for.
- If
your baby is having a growth spurt or you have been under a lot of stress, an
"at home vacation" might be very helpful. Use this time off to do nothing but
breastfeed your baby as often as possible and rest. The increased stimulation
and extra rest will help to build your supply.
- Focus
on keeping life as simple as possible at this crucial time. Cut back on outside
commitments. Ask for help with housework and childcare from the rest of the family.
- Make sure you're
eating and drinking enough. And most important, get plenty of rest and breastfeeding
time in when you and your baby are together.
- Another
way to increase milk supply is to avoid supplementary bottles and pacifiers. This
encourages your baby to meet all his sucking needs at your breasts. Doing this
will help to increase your supply. Of course, if supplements are required to avoid
dehydration or to ensure adequate weight gain, you will want to give them.
- Another
idea is called "super switch nursing." When you and baby are together you can
try this technique to help increase your milk supply. It can also be done when
pumping with one pump flange. This involves switching sides two or three times
during each feeding. Moms can watch the baby's sucking and switch to the other
breast as soon as the sucking begins to slow down.
- Repeating
this several times during the breastfeeding increases breast stimulation and let
down.
Many
mothers who have low supply issues or who are breastfeeding adopted babies choose
to do so at the breast with at-breast supplementers such as the Lact-Aid or the
Medela SNS. With this method of supplementation, mixing human milk and formula
does occur. The increased stimulation may improve mother's milk supply while simultaneously
providing the innumerable benefits of breastfeeding for baby. This far outweighs
any disadvantages of mixing human milk and formula.
How
do I store my expressed breastmilk?
Plastic, zip-close bags, disposable
bottle liners or plastic bottles (avoid glass bottles) are good container options
for breastmilk. Store 4 or fewer ounces in a container, which is usually enough
to satisfy babies for a feeding and helps prevent wasting precious milk that you
have taken the time and effort to collect. Based on the needs of your child, you
may need to provide two containers for each feeding. However, don't use leftover
milk from a previous feeding as it may contain bacteria and could lead to contamination.
If freezing the
milk, leave an extra 1/2 inch of space at the top of the container to allow for
the expansion of milk as it freezes. When storing in either the refrigerator or
freezer, keep your bagged breastmilk in a hard plastic container to protect it
from rips or tears.
Refrigerated
breastmilk is best used within 24 hours. After 48 hours, it should be thrown out
to prevent contaminattion. Frozen breastmilk is best used within one month. Date
your containers and be sure to use the oldest milk first, so that you keep your
supply current. When thawing frozen milk, place the container under lukewarm running
water, continuously shaking the container so that heating is uniform. Be sure
to test a few drops of milk on your wrist before giving it to your baby.
Is
it OK to mix human milk and formula?
Mixing refers to giving your
baby your own milk and formula in the same container. This is actually a form
of supplementation. Supplementation means giving your baby liquid nourishment
in addition to breastfeeding him. Giving your milk and any supplement separately
is advantageous for these two reasons:
- Your
baby will receive the immunological benefits of human milk.
- Less
will be wasted than if the milks were mixed.
Reasons
supplementation of a breastfed baby may be necessary include if the mother's supply
is low or if the baby is separated from mother. However, there are many options
in these cases, so be sure to contact your La Leche League Leader.
- It is important to note
there are cautions to supplementing your breastmilk so be sure to discuss the
issue with your healthcare provider. Such cautions include:
- Giving
formula will fill up your baby, making him less interested in breastfeeding. Supplements
of formula can sensitize some babies to milk allergies or intolerance.
- Since
breast milk production relies on the concept of supply and demand (the more demand
made for milk, the more milk the body produces), mothers who supplement could
affect the quantity their body produces.
- Researchers,
as well as parents, have noticed that babies may get gassy when receiving formula.
Whenever a non-human milk is used, alterations in the baby's gut flora occur and
will cause changes in the frequency, odor and consistency of baby's stool, as
well as affect how the baby settles after a feed. This encompasses all types of
supplementing situations, such as combining human milk and formula or giving human
milk at one feeding and formula at another.
Human milk is, according to the American Academy of Pediatrics, preferred for
all infants. The more human milk they receive, the greater the benefit. Any amount
of human milk is a positive addition for your baby.
What
should I eat and drink-and what should I avoid?
Here's the lowdown
on nutritional needs for breastfeeding moms: First, you'll simply need to eat
more--about 200 calories a day more than when you were pregnant and 500 calories
more than your pre-pregnancy diet--for a total of 2,300 to 2,700 calories a day.
It may help to know that all those added calories are used to produce breast milk
and not to add inches to your hips. In fact, nursing mothers often lose pregnancy
pounds faster than women who bottle-feed their babies.
It's
important as ever that you eat a well-balanced diet that includes enough protein
(about 65 grams a day); at least eight 8-ounce glasses of liquid a day; and 1,300
RD (retinol equivalents) of vitamin A. All women over the age of 19, nursing or
not, need 1,000 milligrams of calcium daily, whether from vitamins or calcium-rich
foods or a combination of the two.
As
for nutritional no-no's, keep your caffeine intake in check until baby is weaned.
Small amounts of coffee, tea, caffeinated soda and chocolate are okay, but too
much may interfere with your infant's sleep or make her agitated. The amount of
caffeine in 5 or fewer five-ounce cups of coffee (less than 750 ml) will not cause
a problem for most mothers and babies. (It might be helpful to measure the number
of ounces in a typical coffee mug, as many are 8 to 12 ounces or more.) Spicy
foods, milk, onions, garlic, cabbage and crunchy vegetables may also irritate
your newborn, sometimes leading to gas pains that may be at the root of colic.
Medications, too, can make their way into your breast milk, so consult your pediatrician
before taking any drug. Non-drug alternatives are good options if they're considered
safe to take while nursing; check with your health care provider.
Contrary
to folklore, beer will not increase your milk production, though an occasional
glass of beer or wine is fine. How much you drink and how close to a feeding you
imbibe matter most. It takes three to four hours for alcohol to be flushed from
you system, so the best time to have a cocktail is after putting your baby down
for the night. And if you overindulge, pump your milk and dump it out.
Can
I smoke and breastfeed my baby?
As more and more information surfaces
on the life-threatening side-effects of tobacco use, it's best for mother and
baby to stop smoking. Heavy smoking can have a number of adverse effects on mother
and baby including decreasing mother's breastmilk supply. In babies, the nicotine
in breastmilk can lead to colic and in some cases, cause nausea, vomiting, diarrhea
and abdominal cramps.
It's
best for mother's who smoke to avoid breastfeeding both during a cigarette and
immediately after having one as it is during these times when the nicotine levels
in the breastmilk will be highest. It's also important to protect baby from any
second-hand smoke.
If
mother wants to quit smoking, cessation aids such as patches or gums can be used.
However, nicotine gums can result in higher nicotine levels in breastmilk than
if using the patch. When working with a health care provider and taking the cessation
aids correctly, the effect on breastmilk can be nominal.
