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How to Have a Great Milk Supply

...even if your breasts are small, even if you have twins, even if you're worried.

The secret to an abundant milk supply is frequent, active feeds. For newborns and even many older babies, this usually means 12-16 feeds in 24 hours. When weight gain is steady, predictable and feedings are easier, it's ok to drop to 8-12 feeds in 24 hours, if your baby is content doing so.

Pay attention to the baby's sucking and behavior.

When babies are rooting or looking hungry, they probably need to breastfeed, even if they don't need to "eat." If you aren't sure, it's fine to offer your breast. You can't overfeed a breastfed baby! We aren't used to breastfed babies and often moms will compare breastfed babies with formula fed babies who typically eat every 3 or 4 hours.

If we remember that a baby's stomach is the size of their fist and that breastmilk is digested easily, it makes sense that they would eat frequently. But why is this important? For one, humans are species that carries its babies. Frequent feeding is easy to accomplish when you carry your baby everywhere you go.

Another reason is that breastfeeding is so much more than food for a baby. It's a source of comfort, connection and soothing. It is a way of feeding that fills all five senses at once and gives both mother and baby a dose of oxytocin, the love hormone.

When we look at other species, it's easier to understand the unique qualities of human milk. 

Cows grow about 1000 pounds in the first year. Their milk is highest in protein because this is the essential nutrient for muscle and bone growth. Whales live in the ocean, which is cold. In order to thrive, they have a thick layer of blubber. Their milk is highest in fat.

Humans develop their brains during the first year. Human milk is full of special sugars that feed brain cells. In addition, constant engagement with the mother means that with every feed, their brain is connecting neural pathways. Breastfeeding means that babies smell, taste, see, hear, and feel their mom. Each sip is not just a sip! It is a brain-bursting experience! 

Don’t wait to feed!

One of the biggest misconceptions I run into is "waiting for breasts to fill up" before you feed your baby. The fastest way to make abundant milk is to keep your breasts empty. Empty breasts signal your body to make milk while full ones tell your body to stop making milk.

It's like being at a buffet. When the serving dishes get low, a waiter keeps bringing new ones. If no one eats anything, the tray just sits there. Your body will continue reabsorbing and producing fresh milk, so, unlike the buffet, the milk is always fresh and ready to eat, but over time, you will make less and less milk. Your baby may show signs of hunger and be less content. Their weight will plateau or drop.

In the early days and months, you will feel your breasts filling and emptying. Between 4 and 6 months, the amount of milk you make between feeds decreases. In other words, you won't feel as full. Your body starts to make most of the milk when the baby sucks, rather than between feeds.

Increasing your milk without pumping or galatagogues

If your baby doesn’t seem hungry, and also, is not gaining or only slowly gaining weight, increase the number of feeds in every day using a "mother led growth spurt." Many babies actually prefer to feed every hour or two all the way through the first year and beyond. A good rule of thumb is if your baby is gaining weight and staying on their curve, 8-12 feeds a day is fine. If they aren’t gaining, or they seem to need more, nurse 12-16 times in 24 hours.

A practice that goes along with this is switching sides frequently. A sleepy baby can suckle gently on one side for an hour and receive little or no measurable milk. If you watch them feeding and switch sides soon after they are done gulping, they will receive more milk with less effort. You may feed on each side several times and notice that each time, their sucking happens in short bursts and then slows down.

If your baby suddenly seems hungry after a few weeks of predictable feeding, follow their cues and feed as much as they want - it's normal and nothing to worry about - it's called "frequency days" or "growth spurts". After a few days of nursing more frequently, you should notice more fullness in your breasts and hear more swallowing when they breastfeed.

Worrying about having enough milk may be the #1 worry of all new mothers! 

Research shows that only 1 to 3% of women should worry about it! The first step, and frequently the shortcut, to a bountiful supply of milk is to offer your baby the breast frequently and encourage your baby to drink as much milk as they can. If you are worried, ask for guidance so that you can be really sure your baby is getting enough milk.

Conventional advice of nursing 10-20 minutes on each side is correct in one way- most babies do nurse about this long - but it does not take into account the QUALITY of the session. Watch the baby - when they are getting milk, you should hear gulping, see the jaw moving. and feel a rhythmic pull on your nipple.

How frequently you feed your baby is always the first benchmark to compare if you feel you need to increase the amount of milk you make.

If you feel anxious, check your baby's weight once a week. Ask to make an appointment at your pediatrician’s office, buy a scale or drop in to New Baby New Paltz any time we are open. We have a scale next to the changing table and a 3 ring notebook if you want to keep a chart.

 

How Much Does a Lactation Consultant Cost?

The answer to this question depends on several factors: 

1.What are the qualifications of the Lactation Consultant?

2. What do you need help with? 

3. Do you have health insurance or low-income qualifications?

Because "Lactation Consultant" is not a professional license recognized by the New York State Board of Regents, there is no Lactation Consultant license in New York (or most states), which means that anyone can say they are a Lactation Consultant. Most Lactation Consultants get a certificate from an organization showing their level of training, but there is no requirement that they do so.

So, it's a good idea to interview several Lactation Consultants before you select one and these questions can help you know which one can help you best.

  1. What is your certification?
  2. What is your professional training in helping moms and babies?
  3. Where have you worked as a Lactation Consultant?
  4. How long have you been a Lactation Consultant?
  5. Do you have a specialty?
  6. Describe your situation and ask, "How would help me in overcoming this problem?"
  7. How many appointments should I expect if we work together?
  8. When are you available to meet?
  9. Are you able to come to my home?
  10. What is your fee?
  11. Do you accept insurance?
  12. What resources do you have available to support me and my baby after our appointment?

International Board Certified Lactation Consultants (IBCLC) are the highest level of Lactation Consultants. In order to be certified, IBCLCs must pass certain college level classes, use a mentor who supervises their clinical training and pass a rigorous test. In addition, they must re-certify every 5 years and take 15 hours of continuing education in breastfeeding every year. Among IBCLCs there are specialties and wide differences in experience. IBCLCs who work in the hospital tend to work more with beginning breastfeeding, the first few weeks and breastfeeding premature babies. IBCLCs in private practice generally see the full range of breastfeeding experience from birth to weaning. In addition, they are free from corporate politics and policy.

Services by IBCLCs are covered by insurance companies both in and out of network. Coverage varies. Some IBCLCs are in network and you pay only a deductible. Most private practice IBCLCs are not in network. You pay out of pocket and be reimbursed. Most accept credit cards. Some offer sliding scale or payment plans. You can expect to pay IBCLCs from $0 in a hospital to $300+.

 

Certified Breastfeeding Counselors (CBC) are RNs who take a 45 hour course and pass the CBC certifying test. You can expect CBCs to charge from $0 at the hospital to $300+ for a home visit. Services of CBC/RNs are covered by insurance companies both in and out of network. Coverage varies. Some are in network and you pay only a deductible. 

 

Certified Breastfeeding Specialist (CBS), and Certified Lactation Counselors (CLC). These certificates are awarded after 45 hours of classroom education. Neither of these certifications requires any supervised training or personal experience before the Lactation Consultant receives their certificate. There is a wide range of experience and knowledge in these designations, from those who take only the 45 hours of classroom education, to RNs and MDs who earn the certificate to better understand breastfeeding. You could expect a consult to cost between $0 for CLCs working in a hospital or medical office, those just starting in private practice, up to $75 for a one-on-one appointment.

 

WIC Breastfeeding Peer Counselor: WIC PCs receive supervised training through WIC. There is a wide range of experience and knowledge in Peer Counselors, from those who have taken 20 hours of classroom education to those who have worked for WIC for decades. The services of WIC PCs are free if you receive WIC. In addition, some WIC offices have CLCs and IBCLCs on staff who are able to see you for a one-on-one appointment.

 

La Leche League Leaders. Technically, a LLL Leader is not a Lactation Consultant, but a highly educated volunteer who has breastfed at least one baby, gone through extensive training and mentorship and agrees to LLL's Ten Concepts of breastfeeding and parenting.  Breastfeeding help received through La Leche League Leaders is free. Yearly membership is encouraged but not mandatory. La Leche League Leaders help women either over the phone or in monthly group meetings that are held all over the world. They are allowed to make home visits, but not obligated.

 

Which is the right one to make an appointment with?

 

All Lactation Consultants and Specialists can help you with this:

  • How often to feed and how much
  • What to expect in the early days
  • Baby's feeding cues
  • How to know baby is getting enough
  • How to make more or less milk
  • How to have optimal feeds
  • Suggestions about latch
  • Show you different ways to hold your baby
  • Explain nipple care
  • If you want to pump, they can help you size pump flanges

All Lactation Consultants will observe you and your baby breastfeeding and write out a care plan that focuses on your problems and solutions.

 

An IBCLC is a health professional who, in addition to the basics above, will take a thorough medical history and discuss things that have an effect on breastfeeding. They work with your doctor or midwife if you need blood tests or other medical procedures that impact breastfeeding or milk production. 

 

If you have one of these situations, an IBCLC will probably be more helpful:

  • Your nipples are raw, bleeding, cracked, or hurting
  • You think, or have been told, that you are not making enough milk
  • Your baby is 5 days old and your milk has not come in or is 10 days and has not regained birth weight
  • Your baby is colicky or fussy or you think that your baby hates you and/or breastfeeding
  • You are crying every time you breastfeed because it hurts
  • You can't pump the amount of milk you need
  • You have an ongoing medical condition
  • Concerns about your baby's weight and how they latch or breastfeed,

In these situations, an IBCLC in private practice is more likely to be of help:

  • You need ongoing support and knowledge - continuous care
  • You need a long (hour plus) appointment
  • Your baby is older than 2 weeks
  • You need a specialist in your problem
  • You don't want to go to a hospital or clinic
  • You think, or you are ready to quit breastfeeding because you have tried everything
  • You want information unfiltered by corporate practice, policy or politics
  • It is an evening, weekend or holiday and your baby is hungry

With this information, where can you find a Lactation Consultant?

Most hospitals, WIC offices, and some pediatrician's offices and breastfeeding groups have Lactation Consultants on staff. 

There are many Lactation Consultants in private practice. You can find a geographical listing here: http://www.ilca.org/why-ibclc/falc 

Ask your friends or your doctor for a referral. You can also search online using search terms like "lactation consultant" along with the name of your town or nearby city.

When you are researching, it may seem that using a free or low cost Lactation Consultant is the best way to start. Another way of thinking is that if you never breastfed before, an excellent Lactation Consultant will shorten your learning curve and prevent problems. This is why it's important to talk to several before you make your decision. Remember that the most important thing is that you feel comfortable and overcome your current challenges.

Is this a Nursing Strike?

"Hey, so all of the sudden my three month won't eat. He won't take my breast and if he does it's a very short feed. He screams if I even put him in the position. I have milk and it's leaking out- even shooting out now because I'm so full. I tried a bottle with a slow nipple- he took some and then started crying. He has NEVER been like this before. He loves breastfeeding and his weight is great - 20 pounds at 3 months. He is an awesome eater and I'm worried. Should I call the pediatrician? He's arching his back, do you think he has reflux? I'm worried because of the lack of wet diapers. He needs to eat and I feel like I am going to burst!"

While, their might be a few things happening here, the first thing to start with is your baby's refusing to nurse which is called a nursing strike. 

A nursing strike is when a baby suddenly refuses to breastfeed. You might think a baby is weaning themselves but if they are younger than 12-18 months, that is unlikely. In addition, most babies gradually wean off breastfeeding before they stop completely. 

During a nursing strike, sometimes it is obvious why they stopped and more often, it takes detective work to figure out why.  Stay calm. Since his weight is great, you have a cushion of time. He's not going to starve or dehydrate if he doesn't nurse for a half a day or a day.  You, on the other hand will be very uncomfortable, so express milk to prevent engorgement and plugged ducts. You may need to pump several times to bring relief.

When a baby is refusing to breastfeed, you will make faster progress if you accept that there is a very good reason (in his mind, anyway) to NOT breastfeed. Don't fight that and don't force breastfeeding. Take a longer term view stay optimistic and keep trying.

So, if a baby has a very good reason, why do babies go on nursing strikes?

Babies strike for many reasons. What often happens is that something startled or bothered him while he was nursing and he got scared. He's afraid it will happen again. Therefore, if he doesn't nurse, it won't happen and he won't be scared! 

Think back and see if you can remember what might have happened just before he started refusing. Was there a loud noise? Did he bite you? Did you yell?

If you can figure out what it is, talk your baby through the event. Apologize if you did something that scared him. Explain what happened and try to coax him back onto the breast by reassuring him that it won't happen again. That you are his mommy and will protect him.

Maybe he's sick?

If he has an ear infection or a sore throat, nursing may be painful. Sometimes babies gag on a forceful letdown of milk.  Sometimes there's a new smell they don't like, like a new detergent, soap or deodorant. 

If he will not nurse, just keep him skin to skin. Try breastfeeding again when he's sleeping or drowsy. Try taking a bath together and see if that relaxes both of you into breastfeeding. Keep snuggling skin-to-skin, and keep offering without any pressure! Your attitude should be one of coaxing or seducing them back to breastfeeding. Making it their choice, not your will.

New or Old Patterns?

You may find settling into a favorite position helps or you may find just the opposite. Try different and unfamiliar positions to break the pattern.

If it continues more than 12 hours, offer a bottle or cup of breastmilk. If he refuses milk for more than a day, it's probably a good idea to see the doctor to rule out injury or illness.

The Step-by-Step Holiday Guide to Plugs, Blebs and Mastitis

As parties, preparations and push-up bras work their evil magic...

Ho! Ho! Ho! and Go! Go! Go! grinds to a halt.

This is the day you don't feel so good and that throbbing pain in your breast may need medical attention today. Yes, TODAY! The day of all days that you can't afford to waste a single minute, let alone cross the whole day off your calendar and go to bed. Here is a step-by-step guide to moving milk and getting back in the game.

Plugged (clogged) Milk Ducts

Plugged ducts happen when milk stagnates in a section of your breast either from compression or inefficient milk removal. It could be a baby who isn’t latching well, or a few days when you are busy and delay nursing, or it could be from clothing that compresses an area of your breast- like an underwire or too tight bra.

The stagnant milk curdles into yogurt and then cheese. This solid milk creates a plug - a tiny string cheese, the thickness of angel hair pasta - which causes a back up of milk inside your breast. The painful lump is not the plug. The lump is a reservoir of milk BEHIND the plugged milk duct. If you start massaging on the lump, you are pressing milk into the plug and increasing the pressure without moving any dried milk out.

If you don’t move the plug and get the milk flowing again, you can develop mastitis.

Start self care immediately. It would be a good idea to call in sick to work and/or get help if you have children who rely on you for everything. Continue breastfeeding and pumping as often as possible. To work on getting the plug out, you may want to take a pain reliever, like Motrin, and give it some time to get into your system. You may not. Everyone has different pain tolerances, but working out a plugged duct is painful, even though it also feels good in a certain way.

It’s easier if someone can take care of your baby while you work on this.  If that isn’t possible, try when the baby takes a nap.

  • Breastfeed or pump, so your breast is less full. Either work in a big bowl of warm water or in the bathtub, with the water high enough that you can comfortably lean over and soak your breasts.  Soak them for a few minutes, to let the heat expand the ducts and soften the skin of your nipple.  
  • Grasp the nipple and pull it down away from the breast. Press it between your fingers and roll it, to your pain tolerance. It doesn’t have to be vigorous. All you are trying to do is work some dried milk out and reshape the curdled milk in the duct, so liquid milk can help to wash it out. You may start to see a white dot or a tiny string cheese on the tip of your nipple.
  • Move back about 1/2 inch and repeat, pulling the nipple down and away from your breast. Then, move back another 1/2” pinching and rolling any lumpy areas down, moving milk down to the plug. You may feel stringy lumps like spaghetti, inside your breast while you are massaging. This is dried milk. Massage any sore areas towards the nipple tip. You may use olive or another massage oil to keep friction to a minimum if you are not working in water.
  • When you are working the thickened milk out, it feels painful, or at least uncomfortable, and when the plug releases it feels immediately better. Sometimes you see the breastmilk string cheese in the water. If you don’t, that’s OK. Your baby may remove it while breastfeeding. It won't hurt your baby to swallow it. It’s just breastmilk cheese and still has all the antibodies and nutrients of your milk.

Breastfeeding with a plugged duct

Because a baby’s tongue massages your breast when they breastfeed, try changing up positions when you nurse. Try to line up their nose or chin with the sore spot and breastfeed. Some mothers swear by “dangle nursing.” Get on your hands and knees with the baby beneath you and breastfeed.

Be persistent and stay on top of milk removal. Try to figure out the cause and prevent that from happening. Some women have overabundant milk and their baby can’t remove it fast enough. If their baby oversleeps one night, they develop a plug. Some women are so exhausted they sleep in one position for 5 hours compressing a spot on their breast. Babies go through teething, a distractable phase, or have stuffy noses and leave breasts half-full. And, don't forget the above-mentioned parties and bras.

If you don't work out the plug you may develop a....

Nipple Bleb

A bleb is a milk pimple. It starts when milk sits in the nipple so long that it skins over. The treatment is the same as for plugged ducts. If nursing, massage or gentle exfoliation doesn’t open the skin, you may need to see your doctor to have it lanced. It sounds awful, but it is less painful than a bleb and brings immediate relief. Once the skin is opened, diligent and persistent plugged duct treatment is needed, or it will re-form. Both plugged ducts and blebs can also be a symptom of poor latch and tongue tie.

If you ignore blebs and plugs, you may develop...

Mastitis

Mastitis is an infection inside your breast. It happens when milk stagnates in a section of your breast and you are exhausted. Milk stagnates when there is incomplete removal of milk either from compression or a baby who isn’t latching well. 

Mastitis starts with a plugged duct and a lump in breast which you may or may not notice until it becomes infected. The first sign many women notice is an overnight decrease in milk production on one side. If nursing, pumping and massage don’t move the plug and the milk behind it, a pink or red patch will develop on the skin. Over time the red patch will grow, often into a stripe from nipple to the lump and into the armpit. You will become feverish, often engorged in one breast and feel awful. Mastitis has sudden-onset, flu-like symptoms: fatigue, aches, fever, chills and a sore or throbbing breast.

Mastitis can come on suddenly, in a matter of hours. It is a serious condition, that if untreated, can lead to breast abscesses or hospitalization.

There are two components of treatment.

The first is to get the milk flowing and the second is to address the infection. Getting milk moving is addressed in the section above on plugged ducts.

To treat the infection, you are going to have to decide how sick you are and what your treatment options are. It's not easy to decide to go to the emergency room when it's an hour away and you have 2 sick kids and a baby. Or, you've been fighting a yeast infection for months. Or this is your third round of mastitis in the past few months. Or, maybe it's Saturday night and you can go to the Urgent Care doctor in 12 hours.

If you can get the milk moving within an hour or so, you may start to heal with self-care alone. Your first action should be to massage the plug out and use your normal home remedies for sickness. Some people take vitamins, garlic, herbal teas or tinctures, zinc, chicken soup - whatever your favorite healing remedy is - take the time to massage your breast, get the milk flowing and go to bed. Your routine for the next few hours or 1/2 day should be sleep, nurse the baby, hand express/pump and massage the plug out. 

If you have done self-care for 12 hours and you are not getting better, or feel worse, it's time for medical attention.

If you know you are too sick for self-care, call your primary care, midwife or obstetrician, go to urgent care or the emergency room. They will prescribe an breastfeeding-friendly antibiotic which usually clears up the infection in a day or so. They may also take a culture when they examine you. You still need to unplug the duct but it will be easier when the infection is reduced. 

Mastitis is almost always a sign that you are trying to do too many things without enough rest. An exhausted mom will take not time to attend to make sure every latch is perfect, every feed complete. Because she is tired, it seems overwhelming to unplug yet another plugged duct. Mastitis is a call to simplify, to let go of something, so that you can take care of the most important person in your family, YOU.

If you need help resolving your plugged ducts, call or text Donna Bruschi, IBCLC at (845) 750-4402 for an appointment.

What do I register for?

Ask any parent and you will get a confusing list of "must haves" and "must avoids"

This is because we all have personal preferences and guess what? So does your baby!

So how do you buy a gift for someone you've never met? And equipment for a game you've never played?

Here's a place to start:

Essentials. Babies eat, poop and sleep. They need diapers, breastfeeding, a car seat, if you have a car, and a place to sleep.

1. Diapers - cloth or disposable. Even if you plan on using cloth, a pack of disposables eases the learning curve of parenting
2. Wipes - cloth and disposable - babies are wet and messy. Plain water cleans most messes and has no chemicals. Even if you use disposable wipes when you go out, washclothes are bigger and more absorbent than disposable wipes.
3. Breastfeeding support - even if you don't have a horror show beginning, you will have a ton of questions and Lactation
Consultants can answer them to your satisfaction, unlike Google.
4. Domestic help so you can breastfeed. Housekeepers are not just for the rich! There is a special kind of housekeeper called a Postpartum Doula or Baby Nurse who is like your mom, only better. They cook, clean, hold the baby so you can sleep or shower, do laundry and hold you when you cry.
5. Meals so you can take care of your baby. Ever try to cook with only one arm? It's possible. But imagine how much nicer it is to pop a ready to eat meal made with love by your relatives? Buon Appetito!
6. A safe place to put the baby when they aren't in your arms. The American Academy of Pediatrics just updated their Sleep Policy. It's a long read and complicated, but please read it.
7. A car seat. Even if you don't have a car, you might want one for taxis and planes. Have two cars? You will be happier with two car seats.

Anything that makes essentials easier is next on the list.

Nice To Have Items:

For Breastfeeding:

1. 4-6 nursing tanks and bras. You will appreciate expensive ones if you have them, so ask for them.
2. Breast pads. cloth or disposable. You may not need them after a few weeks or you might. Ask for a variety. You will have a preference and you won't know until you use it.
3. Nipple butter or salve. Natural ones made with olive oil and calendula top my list for soothing and healing.
4. Burp Cloths - it's nice to have a dozen. Cloth diapers work well too for catching active letdowns and leaking on the other side.
5. Breastfeeding Pillow - Personally, most women would do better without this until breastfeeding is going well because breast pillows are often too tall or too short. When babies are breastfeeding well, they are convenient and cozy.

For Naps and Sleep

1. Rock N Play is #1 for parents. Somehow, the magic RnP keeps babies mostly happy or sleeping when you aren't holding them. It's some kind of miracle.
2. Bassinet that attaches to the parent's bed - These are wonderful for breastfeeding moms and babies. If nobody told you yet, most babies only want to be held by you. It's biological and while some babies don't mind being put down, our brains need the safe feelings and interaction with adults to grow.
3. Crib - While expensive, do not use a secondhand crib unless it has all the original hardware and the sides do not drop.
4. Pack and Play - Many people have this with the changing table/bassinet in the living room and something else in the nursery/bedroom. It's convenient for traveling, too.
5. 2-3 Sheets for the above

Taking care of the Baby

1. Baby clothes - You will have too many newborn and 3 month sizes. Your baby will probably be too big or too little for what ever you stock up on. Be flexible.
2. Blankets- A heavy blanket for the floor or stroller, 3 or 4 swaddle blankets
3. Sleep Sacks/Swaddles These ensure that your baby is warm, but not too warm, while they sleep.
4. Diaper Bag. This can be any tote bag or backpack or can be the real deal.
5. Bathtub or foam mat for sink and a towel
6. Natural Diaper cream and a natural soap/shampoo/bodywash. Skip the Johnson's Baby and Desitin. While natural products are more expensive, you don't need much. Plain warm water is the gentlest, most effective cleaner.

At some point, your family and friends go home & you are left alone to take care of the baby & the house.

For Getting Things Done

1. Enough clothes - There is a balancing point in having too many clothes and scrounging around in the hamper for your baby's or your's "least dirty" dirty shirt.
2. A baby carrier. The average family has 4-6 baby carriers because babies grow and your preferences change. Mobywraps are wonderful stable carriers for the early weeks but can be complicated to learn. Ergobaby, tulababy, Onya and Lillebaby are all great carriers that fit people differently. It's hard to guess while you are pregnant but know that many people are very happy with each of these.
3. Bouncy seat, swing or vibrating seat. This equipment is only useful for a few months - the most painful months. They are worth it.
4. A stroller. While a new baby might not appreciate it, most babies do at some point. A stroller allows you to get out for walks which help you feel better. They are great for combining errands without the in-and-out of the car and they hold a lot of shopping bags, diapers and library books.

These are the essentials! Happy Registering! 

Start Your Registry Here!