When to Pump and Dump

A few years back pumping and dumping was a recommendation given to mamas who consumed alcohol and/or prescriptions drugs that were incompatible with breastfeeding. The thought was by removing the milk, you would also remove the harmful substance. We now know that pumping and dumping does not necessarily remove alcohol and/or a potentially harmful substance from breastmilk. Instead, the substance metabolizes out of the milk the same way it does out of the blood, with time.

So why would we ever need to pump and dump? To preserve your milk supply! For example, if you plan to go out and have a few drinks , you would need 1.5 hours per drink for it to metabolize out if your milk safely enough to feed baby (with a max of 3 drinks). So say you have 2 drinks. It’s recommended to wait 3 hours before safely feeding baby. If you have an infant that nurses every 2-3 hours, you might want to pump within this 3 hour time frame to make sure you maintain your milk supply. In this case, you want to pump to keep your milk supply on track and dump the milk to be sure you don’t expose baby to the alcohol.

Pumping and dumping does not remove alcohol from your milk. But it can be used to preserve your milk supply while you’re enjoying drinks. In time, the alcohol will metabolize out of your milk and it will be safe for baby to nurse wether or not you pump and dump. Stick with the 1.5 hours time after each drink recommendation to stay on the safe side and not expose baby to alcohol. However, if you have 1-2 drinks and you feel sober enough to drive a car before the recommended time is up, it’s probably safe to breastfeed as well!

So what if you have an older baby and you don’t necessarily need to pump or nurse every 3 hours to protect your supply? Do you have to pump and dump? Nope! In time, the alcohol will metabolize out of your milk. There is no need to pump and dump if you’re not worried about a possible temporary dip in your milk supply.

Differences in Milk Output from One Breast to the Other

Many breastfeeding mothers notice a difference in their breasts in terms of size and milk output. You may also notice that baby favors one breast over the other even when they are kept in the same position and just moved to the opposite breast. This is normal! Think of your breasts as 2 different vessels. One may offer more milk than the other. One breast may letdown faster and stronger. Your baby is smart and will gravitate toward the breast that offers the flow rate and milk capacity they prefer.

When you pump you may notice a difference in output. This could be because of the anatomical differences in your breasts. It could also occur because your baby stimulates your milk production more so in one breast than the other. Typically, there is no need to even out the milk supply in your breasts. However, if you want to stimulate more production in the breast that produces less, here are some tips.

On the less producing breast:

-Start nursing sessions on this side

-When you pump, pump this breast a few minutes longer (or one letdown longer) than you do on the other one

-When you switch breasts, put the haakaa on the less producing breast to encourage it to produce more milk

-Hand express a little milk from this breast before latching baby so she gets an instant milk reward

-Use breast compressions on this breast while feeding baby to speed up the flow rate

It’s important to recognize if your baby is preferring a breast or a head/neck/body position. If you notice your baby is preferring a certain position and seems uncomfortable in the less favored position, a pediatric bodywork specialist or chiropractor can help.

I admit I do laugh when my clients refer to their lesser producing breast as the ‘slacker boob’. But I tell them if that breast is giving you any liquid gold whatsoever, it’s not a slacker! 💛

Distracted Nursing

There’s a certain stage of development when baby begins noticing the world. Sights, sounds, smells, mamas new shirt, baby sister, the dog, the sofa…everything except for nursing at the breast is their new priority. We typically see this happen around the 4-5 month mark and we suddenly find ourselves with a distracted nurser.

If you have a distracted nurser, it might be reassuring to hear it’s normal and you’re not alone! This is typical for babies beginning around 4-6 months when their brain development revs up and they begin noticing everything around them. It’s also common for babies to begin teething at this age too, adding to the distraction because of the discomfort on the gums. So what can we do to keep our busy-body baby focused enough to finish a breastfeeding session? Here are some tips!

-Nurse in a quiet, dim lit room with minimal distractions

-Try playing white noise or soft music

-Sing songs or tell baby a story

-Try different positions such as the side-lying or koala position

-Nurse baby before naps when they’re sleepy or after tiring activities such as tummy time, a trip to the store, a walk outside, etc.

-Nurse in a carrier and walk around! This is my #1 go-to and it’s usually a life saver once the mama gets comfortable with it

-Hand Express or pump a little milk before latching baby so she gets an instant milk reward when she’s at the breast

-Use breast compressions to increase the milk flow and keep baby interested to finish a feed

-Dream feed baby at night so they get the extra calories they may be missing due to the daytime distractions

-Wear a nursing necklace for baby to play with or let them hold a small toy while nursing

Distracted nursing can be frustrating for mama. As long as your baby is meeting milestones and gaining 4-6 oz per week (after 4 months of age), there is no need to worry. It’s also important to remember at 4 months + you have an expert nurser on your hands! Baby may be getting all the calories they need in their short distracted sessions at the breast. If you have a distracted nurser, hang in there and know this phase will pass!

Photo of one of my distracted nursers that sums up how she felt about it

The Tongue Tie

As I finish a continuing education course on tongue ties, I continue to be fascinated by the complexity of this diagnosis. Most mothers hear the term tongue tie or oral tethers and wonder if this could be the reason for the problems they’re experiencing while breastfeeding. I wanted to give you a few simple facts regarding tongue ties, how to recognize one and what it could mean for your baby if they are diagnosed.

-Tongue ties refer to a tight frenulum when the tongue can not freely lift, cup and extend the tongue well enough to breastfeed functionally

-It may present as a shallow latch despite efforts to correct it, clicking sounds while feeding, breaks in suction on the breast, weight gain issues, reflux, oversupply or low supply of milk, nipple problems, long/tiring feedings, etc.

-There are 2 types of tongue ties (anterior and posterior) and varying levels of each. Anterior ties are more visible to a professional or even a parent. Posterior ties are more difficult to diagnose.

-Treatment may or may not need to include tongue tie release by a dentist or ENT. However, treatment should always include body work whether the tie is released or not. Body work refers to hands on touch and therapy to release tensions build up in the soft facial tissues.

-Tongue tie releases enables function but does not facilitate function. It will take time and patience to help baby exercise and use the new tongue functions.

-Often times exercises and manual body work/therapy can help stretch minor ties without a release

-The baby will need to work with a Lactation Specialist to prefect the latch and exercise the enabled functions after a release, body work therapy or both.

-If severe oral tethers are not treated, speech problems, dental problems and further feeding issues can present sooner or later in life.

If you think your baby has a tongue tie that affects your breastfeeding relationship, meet with an LC who understands oral ties and get an evaluation by a dentist or ENT to diagnose and recommend the course of treatment.

Increasing Milk Supply

Can supplements such as fenugreek increase milk supply? According to research, probably not. To date, there has not been enough evidence based research to prove that any food or supplement can increase milk supply.

To be honest I was pretty shocked to learn this in my CLC cert class. When I was breastfeeding my girls, I took fenugreek, ate lots of oatmeal and increased my water intake. Only to find out, there is no evidence to back up the claims that this will actually do anything to help my milk supply. But I could have sworn it did! So why did I see an increase in milk supply while making these changes?

Oxytocin! When you are relaxed, happy and less stressed, your oxytocin increases which is the key hormone needed for milk to flow abundantly. Taking supplements may spark a placebo effect making mom calm and more comfortable knowing she is taking supplements or foods to help increase her milk flow.

I never steer a Mom away from doing what she thinks may help her milk supply. But I do give her the most recent updated research on the topic so she doesn’t spend too much time and money on something that’s not proven to help.

Here’s my advice on supplements/foods said to increase milk supply. First, if it doesn’t hurt mom or baby (like a safe food, drink or supplement) then why not try it? Secondly, research is always changing! Maybe one day we will have evidence based research that tells us that oats for example, does in fact increase milk supply. So what’s the harm in eating them? Thirdly, the only thing that has been proven to increase milk supply is to remove more milk! So nurse, nurse, nurse and pump/hand express after a feeding if you want to try a research proven way to make more milk.

The Flipple Technique

The ‘flipple’ is a word combination for ‘flip the nipple’. It is a technique I love to teach mamas who have babies that just can’t get that deep latch they need for their nipple comfort and good milk transfer. The flipple technique is great to use if your baby is a premie with a small mouth or your if baby has a mild oral tether that makes it difficult for them to latch deeply. You can also use the flipple if your nipples are sore or damaged and you need to make sure baby gets a very deep latch to prevent further pain and chafing.

Here’s how to flipple!

-Get in your most comfortable nursing position leaving one free hand

-place you’re thumb or a few fingers near the base of your nipple

-press in an upward motion so the nipple lifts up and is tilting away from baby’s nose

-Wait for baby to open wide, pull her closer and let the bottom of your breast be the first part that meets her bottom lip. -You can then release your fingers so the nipple ‘flips’ into baby’s mouth or you can tuck it in there so it is far back in the baby’s mouth.

-Your nipple should be the very last thing in the baby’s mouth before she latches (see photo)

If your baby still isn’t getting that deep latch, unlatch and try the flipple again. If the flipple alone doesn’t help to get a good deep latch, try making a C shape with your thumb on top and fingers underneath and ‘sandwich’ your breast with the nipple flipped up, above baby’s nose before latching. Sounds complicated right? It’s not! I’d be happy to demo it for you if you think it would benefit you and your babe.

It’s important to note that the sandwich technique is a short term solution for a premie, a baby with a small mouth or mild tongue tie. It can sometimes cause milk ducts to compress (or get sandwiched) and cause inefficient milk transfer.

This pic was a screenshot of a video on the flipple technique posted by LactationMotovation.com, a UK based BF support website

Weight gain Issues in the Breastfed Baby

A major stressor for mom in the first few months of their baby’s life is making sure they gain the weight they need to thrive. Has your baby’s pediatrician expressed concern about your little ones weight gain? You’re not alone! Unless we do a weighted feeding, we don’t really know how much baby is consuming at a session when they’re getting all of their calories from the breast. But it is the BEST and healthiest way for them to get the calories they need.

After birth it is very common (the norm, really) for your baby to lose weight until about day 2-3 of life. A weight loss under 9-10% of their birth weight is usually not a cause for concern. From day 3 on, baby should start to gain about .5-1 oz a day until they are around 4 months old. A good indication that breastfeeding is going well early on is when baby’s birthweight is met or exceeded by 2 weeks of age.

So what happens if along the way your infant doesn’t gain the average 5-7oz per week? Try not to stress out. If baby has a week or two of slow weight gain, we need to look at the whole picture, evaluate and make a plan. Is baby acting normal and content? Having increasingly longer periods of awake time and restful sleep? Is baby having at least 6 very wet diapers a day? If you said yes to all of these questions, it’s probably just a matter of getting baby to nurse more times throughout the day and night to put on weight. But you should get baby’s latch and milk transfer assessed by an LC to be sure this will be effective.

Here are some tips for increasing baby’s weight. Nurse more often throughout the day (not longer sessions, just more sessions). Wake baby every 3-4 hours at night for a dream feed. Use breast compressions to keep baby actively drinking milk at the breast. And very importantly, get baby’s weight checked by the pedi or your LC once the feeding adjustments have been made. We want to be sure we’re getting back on track and meeting the goals for their expected weight gain. Weighted feedings can be super helpful in these situations and can be done by your LC in between your pedi visits. When we know how much baby is drinking during a nursing session via a weighted feeding, we can average it out and suggest a minimum number of feedings you need in a 24 hour period.

We also must consider baby’s growth in areas other than weight such as length, head circumference and milestones to be sure she is thriving. It’s also important to make sure your pedi is using the WHO chart to track your baby’s weight and growth. The WHO growth chart should be used to accurately evaluate a breast fed baby’s weight gain. Many of the other growth charts used by pediatricians are based on formula fed babies who gain weight differently.

If you’re dealing with slow weight gain in your infant, hang in there mama! Use your resources efficiently (LC, pediatrician) and together we’ll come up with a plan to get baby’s weight up in no time.

The Poop of the Breastfed Baby 💩

How much poop should we expect, what color is normal and what can poop tell us about the health of our baby?

Baby’s first poop should come within 24 hours of birth and is called meconium. This poop is black, tarry and difficult to clean.

Day 2 of life baby should have 2 stools that begin to look less black and more of a greenish color. This poop contains a mixture of leftover meconium and digested colostrum.

From about 3 days old until 6 weeks we should see 3 poops per day (a bit larger than the size of a quarter) and the poop should be yellowish/orange in color.

We expect to see 3 poops a day at 3 days old until 6+ weeks. This tells us our baby is getting enough milk. After 6 weeks+ some babies begin to go a few days between stools and this can be normal. However, baby should still be making 6-8 very wet diapers in 24 hours. Anything less than 6 very wet diapers can be a red flag that baby is not getting enough milk.

Three days after birth and on, the color of the poop doesn’t vary as much. Anything from a bright yellow or dark mustard color to even greenish in color is in the normal range. Some poops are seedy looking and some are smooth like hummus. Both are normal.

I’m often asked if greenish color poop is normal. Some babies have occasional green poop and it’s nothing to be concerned about. However, green poop can sometimes give us important information about our baby’s health. If your baby is gaining weight appropriately and seems to be acting normal, green poop is not worrisome. If you’re baby’s poop is consistent, abundant, frothy and/or slimy looking, this can be a sign that mom has an oversupply of milk. The milk is consumed so quickly and moving so fast through the digestive tract that it comes out green and slimy. An oversupply of milk can sometimes cause gas and discomfort for baby. (Contact me for tips to help with an oversupply).

Green poop can also be a sign that baby is fighting a virus or infection. If you see specks or red in the green poop, this could mean baby has an allergy or intolerance to something in the milk. Common culprits are dairy and soy.

If your baby is over 3 days old and having 3+ yellowish poops a day, this is a great sign that breastfeeding is going well. If baby’s poop is green we need to look at the overall health of baby. Is this a sudden change in color? Is she having trouble gaining weight? Is she fussy and irritable? Does she seem uncomfortable throughout the day? If the answer to any of these questions is yes, we will need to dig deeper into why baby is having green poop. If the answer is no, I’m not worried about green poop and you shouldn’t be either!

Continue reading “The Poop of the Breastfed Baby 💩”

The Eye of the Lactation Professional

You might glance at this pic and think it is just a beautiful photo of a baby nursing (and don’t get me wrong, it is beautiful!) But to the trained eye of a lactation professional, there are several adjustments that could be made to be sure milk is transferring efficiently, mamas nipples are protected and baby/mama are as comfortable as they can be.

First, I would suggest taking mamas hand off the back of babys head and placing her arm around the base of babys neck. For a baby to get a proper deep latch and be able to transfer and swallow milk without difficulty, they need to be able to have free range of motion to tilt their head back. Have you ever tried sucking and swallowing with your chin down toward your chest? Not so comfortable or easy to swallow right?

Another problem is the latch. It looks very shallow. Babies should open their mouth wide before we bring them in close to the breast. Think as wide as a yawn, 140+ degree angle of the mouth. Wait for baby to make that big gape before bringing them into the breast and latching.

Babys nose is not even close to the breast as it should be. I would move her to the left so that she has the opportunity to get a proper asymmetrical latch and take in enough of the lower part of the areola. Let her chin come close to the breast first and then her head will rock forward, allowing her nose to snuggle close to the breast. This shallow latch is likely causing a piston motion with the jaw, chomping down on the nipple. When there is enough breast in the mouth, the jaw should look like it is rocking back and forth.

A proper latch is everything! If you haven’t had your baby’s latch assessed by a lactation professional, please do! It can really make all the difference in terms of comfort for mom and baby and allowing adequate milk transfer. Nursing is always a beautiful picture but it can also be enjoyable and efficient when you and baby learn and practice your latch the correct way!

Tips for Calming Colic and Surviving the Witching Hour

Colic is when a baby cries inconsolably for 3+ hours a day. It typically occurs at about 4-6 weeks of age and sometimes lasts until baby is 4 months. You’ve probably also heard the term ‘the witching hour’ referring to the period of time in the evening when babies tend to be fussier than they are during the day. Some mamas believe that their baby’s ‘witching hour’ means they are experiencing colic. But colic typically involves longer crying periods and is more consistent than the witching hour. Colic consists of daily inconsolable crying for hours on end.

To name a few culprits, colic can be caused by reflux, gas, an oversupply, overstimulation, an allergen in the milk, hunger or a need to be close to mom in a calm space.

So what can you do to calm your baby if they experience the evening fussiness of the witching hour or even worse, colic?

Keep your baby as comfortable as possible and close to mom or another loving caregiver as you work towards settling her. Here are a few tips to try and calm your baby during a colic or witching hour episode.

-Keep YOURSELF calm. Put on your headphones and listen to relaxing music or a podcast. Comfort baby at the breast and let her nurse as long as she wants. Side lying position is perfect for these long, comfort nursing sessions.

-Carry baby around in a wrap or soft carrier. Go for a walk outside or just simply walk around the house.

-Hold baby in the colic hold. On your forearm, baby facing out, legs dangling.

-Take a warm bath with baby

-Try white noise, dim lights and skin to skin

-Massage your baby

-Make sure baby is dry, fed, not too hot or cold and close to mom or dad (preferably skin to skin)

-Bicycle baby’s legs, lay them on their belly and rub their back to try and release possible gas build up

-Use a probiotic (both mama and baby)

-Get your baby a chiropractic evaluation and adjustment with a chiro who specializes in infant care

Some mothers think colic has something to do with their breast milk. But the fact is Colic is much more common in formula fed babies! Keep nursing and using the tips above to get though the fussy episodes. And consult your doctor especially if there is a change in feeding patterns or diaper output. This too shall pass, you’re doing great!