frequently asked questions: a lactation consultant tells all
Mama Rachele has three children, now 8, 6, and 3. She had her very own breastfeeding experience and specifically describes it as that because everyone has their own experience. Each of her children were different; each child had unique challenges. Rachele shared with us, "My oldest child breastfed for 13 months, into the second trimester of my second pregnancy. My milk was pretty much gone when we stopped and it was painful. We were both happy to end. My second child breastfed for 19 months, until a case of thrush forced the end for that breastfeeding journey. My third child breastfed for 2.5 years. She was the most difficult to wean."
Rachele is passionate about breastfeeding, and women’s rights related to breastfeeding, along with helping women get the most out of their breastfeeding experience. She is an International Board Certified Lactation Consultant, or IBCLC. She has 10 years of experience as a labor and delivery and postpartum nurse, as well as NICU experience.
She has so graciously offered to share her knowledge of some frequently asked breastfeeding questions so that we can share it all with you.
FREQUENTLY ASKED QUESTIONS, ANSWERED BY A LACTATION CONSULTANT
When should my milk come in? Does this differ with baby #1 and subsequent children?
In a healthy women with no other medical issues, whose labor and delivery followed a normal course with no complications, milk should be coming in around 72 hours after delivery. There are a lot of factors that can delay milk coming in. some examples are, but not limited to retained placenta, diabetes including gestational, high blood pressure, medications in delivery… I could go on.
Generally milk does come in sooner with subsequent children. If you are at risk for your milk coming in late there are things you can do. Breastfeeding works by demand, as in the more stimulation you create, or milk you “demand”, the higher the supply will be. Pumping after feedings can give more stimulation. Skin to skin time can help hormone levels. Feeding frequently (every 1.5-2 hours) can also help.
If you are not feeling your milk come in by 5 days postpartum you need to contact a lactation professional.
Is nipple pain and soreness normal? What can I do about it?
This is a tricky question. Everyone perceives pain differently, so something that I find mildly annoying may be excruciating to you. Nipple tissue is sensitive. Breastfeeding can feel weird. Some discomfort should be expected as your nipples have never been used this much before. Some tenderness is normal, especially at latch on. Pain throughout a feeding is not normal. Cracking, bruising and bleeding are not normal.
If you are having what you think is abnormal pain or discomfort the first thing that needs to be done is to have the latch assessed by a professional. If the latch is not corrected, the pain will not go away.
There are many ointments available over the counter to help keep nipples moisturized, and help with soreness. Some are lanolin based, some are olive oil based, some are coconut oil based. Hospitals hand out lanolin because it is given to us for free (at least at the hospital I work at). I really prefer non-lanolin ointments, my favorite is “Earth mama angel baby.” And no, I don’t get anything from them for telling you this. I just think it works well.
There are other products on the market such as “soothie pads” and “hydrogel” pads. These can help your nipples feel better, but cannot be used on nipples with open sore areas. Some professionals will offer a nipple shield for painful nipples, however I would advise against this because (1) Usually the latch isn’t fixed, and (2) Damage usually occurs again when you try to feed without one.
What are your tips for engorgement?
I love engorgement (insert sarcasm font)!
While it is uncomfortable, it is normal. Some women become very engorged, others, only slightly. Both are normal. Engorgement usually lasts 3-5 days, but can last up to 10. Softening your breasts before feedings with warm compresses, hand expression, or a little pumping can help so much. Ice packs after feedings is recommended. I have heard there are special ice packs that are donut shaped just for this!
Does it get easier?
Breastfeeding can be difficult, especially the first time around. Almost no one knows what they are doing the first time. I think this often surprises people, as we think of breastfeeding as “natural” so it should be easy. Right?
One of the questions I often ask women when they are struggling is “How many women have you actually seen breastfeed, up close, uncovered?” The answer is usually 0. So how do you expect to just know something if you have never really experienced it before? Generally it does get easier as time goes on and momma + baby begin to know each other better. 2-3 weeks is a typical time frame for most to get through.
If you are struggling, don’t give up! Ask for help! Often making one small change can greatly improve your breastfeeding relationship and make it seem much ‘’easier.”
What if my baby is favoring one side over the other?
This is normal. All women’s breasts are not created equal. Milk ducts and volume can vary between breasts, as well as flow rate. In the beginning, a side preference is usually due to some discomfort from delivery, and a simple position change can encourage the baby to eat on both sides. Later on it is usually because one side has more milk, and/or the flow is faster. Flow rates unfortunately cannot be adjusted. Volumes can be made closer by always starting baby on the lower volume side. Most women will have one side that always produces more than the other.
What are the best holds to try?
There are many ways to hold an infant, all have advantages and disadvantages. The bottom line is momma should be comfortable!
Get a chair you love, get all the pillows and get set up to sit a while (i.e. have water, snacks, etc. available within arms reach). The most common positions are cradle and cross cradle (infant laying across your chest, the difference is hand position), football (infant is held at your side, like a football), laid back (infant lays on mothers chest while she is in a reclined position), and side-lying (mother lays on her side, infant lays next to mother).
In the beginning laid-back and football are probably the easiest ways to learn. Cross-cradle also works well because it gives the momma good control. Later (around a month), I love recommending side-lying.
Do you have any pumping tips?
If you are exclusively pumping, it needs to be done at least 8, preferably 10 times a day to get a good milk supply. Spending time with your baby skin to skin before pumping can help your body have a better hormone release, thus creating a better result that session. If you are pumping away from your baby, smelling something like a blanket or sleeper they used can help, as well as looking at a picture of your baby. Breast massage during a session, or hand expression immediately following a pumping session can also increase volumes. Something else to keep in mind is to make sure you are using the correct flange size. If it is too small, volumes will be reduced.
What are the basics of milk storage?
I like “the rule of 5’s” because it is easy to remember: 5 hours at room temperature after pumping, 5 days in the refrigerator, 5 months in a freezer.
Milk can be kept in a deep freezer for up to a year. Store milk in clean containers or bags. If storing in bags, lay flat to freeze so you have more space. Use an old gift bag with a slot cut in the bottom to stack your milk in. This way you will use older milk first, before it “expires.” Label each with the date and time of day.
Store in 2-3 ounce portions so you don’t have waste when making bottles. I also liked to have 10, 1-ounce bags on hand. Most breast fed babies will only take 3-4 ounces for the whole duration of breastfeeding, so small quantities are practical.
Breast milk changes to meet needs over time, so volume does not increase. Neat, huh?
Do you have any night weaning recommendations?
Start slow. Don’t totally cut all feedings at once overnight. Start with one.
If your little one really struggles, start by shortening the feeding and then giving a pacifier or other lovey. If the child is older, tell them “I love you, but we are not going to do “word for nursing” right now. I will cuddle you and hold you instead. You could say this to a younger baby as well, they just may not understand you.
Use your partner. Have them go comfort the baby instead. They need to be patient.
Know any weaning can be difficult for momma and baby. I do not recommend weaning at night until 9-10 months at the earliest, as waking at night is biologically normal, and can be well into the second year.
We love to be a resource for mamas and so does Rachele. We share her passion about helping women reach their breastfeeding goals, whether they want to breastfeed for 2 weeks, 2 months or 2 years.
What other questions (or tips) do you have?