One of the many perks of breastfeeding is that it delays the return of your menstrual cycle. Some women don’t resume their cycle until they have completely weaned. Other mothers, however will resume it while they are still breastfeeding. If your period has returned, you might notice a transient drop in supply before or during this time frame. Your baby might want to nurse more frequently due to your making a bit less milk. This is good because he is trying to bring the supply up again! Some babies even reject one or both breasts during this time, usually just for a day or two. Whether this is due to a “different taste” of your milk or the lower supply is unclear. In addition, you might feel a bit more emotional than usual, as well as your breasts feeling more tender. What we do know is that once your period is gone, everything goes back to status quo.
There are a wide variety of affordable and efficient breast pumps available to nursing mothers today. This happily coincides with the large number of mothers that must return to work after the birth of their babies, usually between the 6 and 12 week post-partum time frame. One of the most common questions I am asked as a lactation consultant is “when can I start to pump?” If your baby is latching well- great! No need to pump.
In the process of teaching your baby how to breastfeed, we know that breastfeeding only- no bottles, no pacifiers especially in the first several week as they are learning is critical. After about 2 weeks of age, your supply should be well established and calibrated to provide for your baby’s caloric needs. Any time after this, you can start pumping to start stockpiling. Your milk supply is highest when you first wake up for the day, until about one o’clock in the afternoon, and lowest in the late afternoon /early evening. Whereas you can pump after any feeding in the day to start to stockpile, if you pump after a morning feeding, you will probably get the most volume for your effort. Pump right after you breastfeed, and pump for about 10-15 minutes. You might not get as much as you think you should the first several times you do this, but as your body relaxes with pumping and learns to release the milk to the pump, you will eventually get more.
According to the Affordable Care Act (ACA) which became law in 2010, health plans are required to cover breastfeeding services and supplies. Coverage varies from insurance plan to insurance plan. It does not apply to Medicaid or WIC.
As a result of the ACA, many mothers have top of the line commercial grade pumps available to them. Some insurance plans have provisions for commercial grade pumps and hospital grade pumps, some provide for one or the other.
A baby who breastfeeds well is the best stimulus for milk supply. However there may be times when it is advisable or even necessary to use a pump.
The type of pump needed depends on the situation. If a baby is breastfeeding well, and the mother is pumping to stockpile milk a commercial grade pump should work just fine. A hospital grade pump is advisable in any case where there is an absence of a good breastfeeding baby. For example, a baby in the NICU, a premature baby, or a baby that is having trouble at the breast. The frequency with which a mother would have to pump to well-establish her supply without a baby setting /calibrating it is not meant to be accomplished by a lesser pump. A hospital grade pump would also be indicated for a mother who has a low milk supply and is not seeing an increase in production from using a commercial grade pump. If you are having a difficult time deciding which pump is appropriate for your use, contact your lactation consultant for direction.
In most parenting partnerships, both parents experience a heightened sense of awareness of parenting tasks due to their new parenting role. For the primary support person (SP), an increased desire to take care of the new baby and mother (whatever the tasks), and share the parenting responsibilities manifests itself.
I am frequently asked by the support person , “How can I help with breastfeeding? Would it be helpful for mom to pump and hand a bottle over to me so I can help her get her rest?”
The answer is, in most cases, “NO!, especially in the first couple of weeks as the mother and baby are trying to establish breastfeeding and a breastfeeding relationship. It is most important to try and breastfeed only , at least in the first several weeks, if not longer, to well-establish the mother’s milk supply, and to help the baby learn to breastfeed correctly without interference from other textures, flow-rates, etc. If the support person wishes to give a bottle, but mother still has to pump for that feeding, it would be much easier overall to just breastfeed!
However, there are many ways to support the breastfeeding mother during a feeding, and not directly breastfeed. Here are some suggestions. A” tag-team” approach to a feeding is usually very helpful. When the baby wakes for a feeding, the SP can go get the baby, change the diaper, etc. in preparation for the feeding, and bring the baby to the mother. Mom can breastfeed on the first breast. When baby is done, the SP can burp, check the diaper , and offer mother something to drink. When the mother is ready for side #2, the SP can hand the baby over for the feeding, and assist with comfort measures. When baby is done, they would also be responsible for settling the baby after the feeding: rocking, rechecking the diaper, etc. As a breastfeeding mother can definitely use a second set of hands, the support person can be intimately involved in this way with a feeding, without ever putting baby to breast!
As we enter the cold and flu season, a common concern is the continued health of our babies. If a mother becomes ill with a cold, flu or mild infection, the obvious concern is potentially passing this onto the baby. If a mother is ill, should she continue to breastfeed???
The answer is YES!!! As your baby is always in close proximity to you, they have already been exposed to whatever is causing you to feel unwell. Your body will quickly produce specific antibodies that will help to protect against your illness. Hopefully, your baby will not get sick at all, and if they do, they may get a milder case due to the protection you are passing on to them. Good hygiene, especially good hand washing is always important.
Try to conserve your energy. Crawl into bed with your baby, rest, and nurse. Increase your fluids as you normally would if you had a cold or flu. Tylenol or ibuprofen might be helpful. Try to avoid any medications that can “dry up secretions” if possible, as they may have a negative effect on your supply.
Call your lactation Consultant if you have specific questions about medication or a treatment plan for your situation.
Returning to the work force can be daunting for many breastfeeding mothers. Finding the time to pump at work, providing an adequate supply of expressed milk for your baby, and keeping your supply up while adding more pumping to your routine adds an extra layer of stress to your life.
Your day care provider may be supportive of breastfeeding, but here are some ways that they can help you to maintain your breastfeeding relationship:
- Have they every breastfed, or are they supportive of your breastfeeding? It helps to tease this information out a little bit as, if they are not supportive, they may not be comfortable handling the milk, etc., and may actually sabotage your breastfeeding efforts.
- Are they correctly informed on how to store/warm up breast milk?
- Are they supportive of your nursing:
- Prior to leaving for work?
- At break or lunch?
- Are they willing to hold off a feeding for a short time as you are heading home at the end of your work day?
- If your baby is taking more from the bottle than you are pumping, and more than they normally would take at a feeding, are they willing to “pace” your baby’s feeding? (See August APL Lactation Services blog for more info.).
Investigating these points before the “big day” will help to ease your transition back to the work force.
We encourage you to attend a Working Mom’s Class as provided by APL Lactation Services.
Please call the lactation consultants at APL Lactation Services for further information at 847-398-0434.
When your baby first latches onto the breast, they do very rapid, or non-nutritive sucking to stimulate the release of your milk. Once that milk is released, they go into a slower, more rhythmic sucking pattern. This “releasing” of your milk is called the milk ejection reflex (MER), or let-down (“let-down”, interestingly enough is a dairy term for cows!). The MER tends to be quite forceful in the early weeks of lactation due to the fullness of the breasts. Over time, this forcefulness lessens, and is self-limiting. For some mothers (and babies!) a forceful MER tends to be a problem for weeks, sometimes a month or two. Babies of mothers with an over-active MER have a hard time keeping up with the flow. They come off frequently, coughing, choking, and spit up a lot. With the fast flow of a forceful MER, the babies get a lot of the foremilk very quickly, and not as much hind milk. The foremilk is high in lactose, hind milk higher in fat. This creates a foremilk/hind milk imbalance. The lactose dumps through the baby’s bowel very quickly, and this makes them gassy and cranky, especially in the evening hours. They may have green explosive stools, have a lot of spit-up, and pass a lot of gas. Some babies struggle so hard to keep up with the flow that they actually may develop an aversive behavior to breastfeeding, and refuse the breast. Some mothers think this is colic, or reflux. Talk to your lactation consultant or pediatrician to help you determine if over-active MER is your issue.
The solution is quite simple. One breast per feeding. If your baby comes off the first breast and it is within the first hour, offer the first breast again. After the first hour, if they are still hungry, they can go to the second breast. Managing the forceful MER in this way enables your baby to get more of the hind milk to offset the large amount of foremilk that they got in the beginning of the feeding. If the second breast is uncomfortably full, pump only to relieve the pressure and only if needed for your comfort, so as not to overstimulate this side. As stated above for fine-tuning of this plan, or to discuss your particular scenario, consult a lactation consultant or your pediatrician for further assistance.
It is most important to breastfeed only, in the first couple of weeks as you work on setting your milk supply, and to give your baby the opportunity to latch well from your breast. However, there are times when offering a supplement while breastfeeding is necessary. There are different methods of doing so, some more “breastfeeding friendly” than others. For example, you could use a cup, medicine dropper, syringe, teaspoon, or a medicine spoon. It is always a wonderful idea to supplement the baby directly at breast when possible. To do this, you could use a Supplemental Nursing System (a silicone tube attached to a reservoir of a supplement which is attached directly to the breast, so that the baby gets the supplement at the breast as he also draws out your milk). The reality of the situation is that sometimes parents just choose to give a bottle, and feel more comfortable doing so. If that’s the case, how can they do this in a breastfeeding friendly manner?
First, it is most important to choose a bottle that has a slow flow. This will help to pace your baby, and help them to regulate the flow a bit. Even a “so-called” slow flow nipple tends to flow quickly. Pick one with which you feel comfortable, and that your baby is able to easily handle.
Using a nipple that has a wider base that the baby’s mouth can accommodate is helpful. For example, the Medela nipples (not a personal endorsement) are designed in such a way that the baby’s lips can get all the way down to the base of the nipple- not on the nipple only. With whichever nipple you choose, try to get as much of the nipple in your baby’s mouth as possible without causing them to gag. This will reinforce the “widely flanged lips” that they need to have when on your breast. Use an upright feeding position. This will work with the flow of gravity to slow the flow of the fluid in the bottle.
When offering the bottle, stroke the tip of the bottle nipple against your baby’s top lip to get them to root and open wide. Wait until they do open, before advancing the bottle nipple into their mouth. They are not likely to open wide to accommodate your own nipple if it is not reinforced when offering them a bottle nipple. Once again, try to get as much of the bottle nipple in your baby’s mouth as possible without causing them to gag.
Lastly, try to pace their feeding. If the flow is too fast for your baby, and they are having difficulty controlling it, pull the tip of the bottle nipple out of their mouth a bit, but not entirely, still maintaining contact with the lip. Tip the bottle downward a bit to stop the flow, and then, when the baby is ready to resume, advance the nipple in their mouth again.
Bringing home an infant can be overwhelming. They require constant attention and frequent feedings (as many as 10-12 per day). Sure, your support person can help in many ways (changing the baby’s diaper, burping them, rocking, etc.), but they can’t breastfeed the baby. They can also help with entertaining the older sibling, but that child, too, needs and wants your attention, especially when they have been without you for a couple of days while you were in the hospital. How can you give both children what they need as you try out your new role of being a parent to more than one child?
It’s a good thing you’re breastfeeding! Preparing bottles with formula, washing them, then bottle feeding would consume a lot more time than breastfeeding does, and would afford you less time to spend with your older child. I would suggest having what I call a “nursing bag” on hand. Fill a special bag or box with toys/DVDs/special books that your older child can ONLY play with while you are nursing. The essence of this bag is that having access to it only at certain times makes it a special treat for them, and they will look forward to it. If you are an experienced mother with breastfeeding, chances are that the breastfeeding experience the second time around will be “like riding a bike”, and you will get the hang of it more quickly. Once you get your baby latched on, this is the perfect time to read a book or watch a movie with your older child. Have them cuddle next to you while you are nursing, and give them some special one –on-one time. Give them small, simple tasks to let them help you with the baby such as bringing you a diaper, or handing you a wipe so that they feel like an important member of the family. Finally, for those times when your new baby is in a “milk coma” after a feeding, spend some time with your older child, maybe taking them out for a special treat or to the park during a window of opportunity. The first two weeks are the hardest, but it will get easier as you get more into a routine!
After the “deep freeze” of the winter, people are finally starting to dig their way out of their homes and enjoy the beautiful weather and sunshine. Exercise is not just beneficial for the body, but also for the mind. It is an effective method of stress-relief, and gives us a new perspective on dealing with difficult situations in our lives. A 2007 study by Blumenthal et al found that exercise is as effective as an anti-depressant in some cases in alleviating depression.
Several studies have shown that moderate exercise does not pose a risk to a breastfeeding mother’s milk supply. As is the case whenever one exercises, be sure to stay hydrated, and build up your endurance gradually. If you are in the sun, be sure to apply sunscreen to both yourself and your baby.
You may be accustomed to exercising by yourself, but there are many ways to include your baby in your exercise routine. Try taking a brisk walk with your baby in a stroller- they like the fresh air and change in scenery, too! Consider a jogging stroller if you want to go to the next level and try running. Many local YMCA’s/park districts have exercise classes specifically designed for the both of you to enjoy exercising together. Invite a friend along! Be creative, and enjoy the many benefits that regular exercise provides.