“I need to drink more water to increase my supply!” I hear this and similar statements from the moms I support all the time. Or, their obstetrician or their baby’s pediatrician told them that hydration is the key to milk production. I know a doctor who prescribes a gallon of water a day to new moms! So the moms chug, chug, chug, hoping that all of this water will transform into milk. Or they blame their low milk supply on their lack of commitment to staying hydrated.
But is dehydration really the cause of low milk production?
No. At least, not the kind of severe hydration that any of us are likely to encounter. If a mother has access to water, she’ll drink when she needs to, and she’ll drink enough to make milk.
According to The Breastfeeding Mother’s Guide to Making More Milk (West & Morasco, 2009), the factors that matter most to milk supply are:
I see a larger number of moms who need to increase milk removal and breast stimulation. The earlier they are able to do this, the better the results. To establish milk supply, most moms need at least 8 breast drainings (breastfeeding and/or pumping) per 24 hours. If they can do more than that, they’ll usually see more milk more quickly.
Mother-baby contact is also really important for milk supply. If a separation is medically necessary in the early days, such as a NICU stay, many moms find that their supply goes up once they are able to snuggle and breastfeed their babies more often. A lot of babies ask to be held frequently, but some are mellower and may be fine hanging out in a bassinet or bouncy seat much of the time. If I am supporting a family whose baby has this personality and the mom is trying to make more milk, I suggest that she wear her baby some of the time in a soft wrap or sling. This physical closeness sends the body a powerful signal that says, “Baby’s here! Let’s make some milk!”
So let’s get back to hydration for a moment. It’s true that many breastfeeding moms tell me they’re thirsty much of the time. And yes, that could very well be because they’re making milk and need to replace those fluids in their body. But even if they were a bit dehydrated, they’ll still make enough milk for their babies. Moms whose production is below their babies’ needs may not be quite as thirsty because they’re making less milk, for one of the aforementioned reasons. See how that might cause some confusion?
I always encourage moms to simply drink to thirst. More water just makes more urine! And any breastfeeding mom will tell you that she already spends enough time waiting for her baby to finish nursing so she can finally go to the bathroom. Ah, the glamour of motherhood!
I see a lot of families in the early days and weeks of their babies' lives. Most new parents are contacting me because they need support feeding their babies, both at breast and by other means (mostly bottle and syringe). Common worries revolve about baby's weight gain, milk supply, feeding cues, and the stress and discomfort of figuring out breastfeeding.
Often when I arrive for a home lactation consultation, the family is already using a feeding plan recommended by a hospital lactation consultant or pediatrician. The plan involves some combination of breastfeeding for a set amount of time (usually 15-30 minutes), pumping, and supplementing with pumped milk and/or formula, i.e. triple feeding. This is a huge improvement over the old advice to "just give formula, and good luck!"
These types of feeding plans are important for many families in order to keep baby well-fed and protect the milk supply. I reassure parents that if they continue feeding their babies any way they can and keep mom's milk flowing, breastfeeding will usually follow. It may take days or even weeks, but they'll get there.
This is a stressful time for the family. They're working so hard, and they don't know things are going to get easier. Numbers rule their lives: timing feedings and pumping sessions, counting diapers, measuring ounces and milliliters, weight checks for baby. Those numbers are important for ensuring that their babies get enough to eat and continue gaining.
For a time, the numbers may crowd out something that new parents crave: simple, sweet, uninterrupted time with their babies. But does it have to be that way? Is there space for snuggling and lingering at the breast with all of these other boxes to check off?
I believe there is. I call it recreational breastfeeding, and I write it into the feeding plan. The goal of recreational breastfeeding is just as the name suggests: fun and enjoyable. It is not about transferring a certain amount of milk into the baby (who may not yet be capable of getting a full feeding at breast). In fact, it isn't really about feeding at all. It's soul nourishment for a family that is working very hard and deserves a brief respite from triple feeding.
The concept of recreational breastfeeding is also a way to plant the seed for what is to come. So often, I see families who triple fed in the past and have graduated to exclusive breastfeeding. They celebrate this milestone, and yet they remain attached to the numbers. It makes sense. What could be more anxiety-provoking than parenting a newborn who is having feeding difficulties? The numbers represent a morsel of control in a situation that may largely felt beyond the control of the parents. So I talk with the parents about starting to do some recreational breastfeeding as a way of gently letting go of the numbers, just a little bit, and trusting that they are at a different stage.
It is a beautiful moment when I see this idea click for a family that has gone through so much. I see them settle in and really soak up the sweetness of their babies. This is what I wish for all breastfeeding families.
When I was pregnant with my first baby, I assumed that there was no need for me to take a breastfeeding class because my mother is a lactation consultant. After all, she’d teach me everything I needed to know, right? I was surprised when she suggested that my husband and I sign up for a class at the hospital where we planned to deliver, but I decided it certainly couldn’t hurt.
The class was held on a weekday evening and was about 3 hours long. Honestly, I don’t remember a lot about what was covered, but I was pleased to see how many partners attended. In many ways, the class was structured to educate partners so that they knew how to support the new moms and babies in their lives. Nobody would argue with the value of that.
I have been teaching hospital breastfeeding classes for the better part of a year, and I expect I’ll continue until I finally break into the modeling industry. And yes, I think that all expectant parents should take a breastfeeding class. It would probably be helpful for the grandparents, too, along with anyone else who is going to be supporting the new family.
Last week, I was at the hospital where I teach, and a dad-to-be asked me, “Do we really need to take the breastfeeding class? I mean, won’t it be enough to get help from the lactation consultants at the hospital?” How interesting that this thinking persists: lactation consultants are a shortcut to understanding breastfeeding and solving your problems! Well, sometimes…
Of course I told the dad that he and his partner should take the class because:
Ten years ago, I was teaching writing classes at the University of San Francisco and doing the final copyedits on my first novel. The written word was my world, and I was getting paid for my art. I was an artist. It was pretty awesome.
I continued my writing endeavors after my first baby arrived, but I found that I was spending at least as much time reading about breastfeeding and parenting. When my novel hit the shelves in 2009, I was working on a second manuscript and had also applied to become a La Leche League Leader. I eventually ditched the manuscript to make more head space for learning about breastfeeding, and I welcomed a second baby. At that point, I told myself that I could go back to writing novels whenever I felt called to do so. I expected I would also return to teaching writing.
The families that I have supported through La Leche League have been some of my greatest teachers, and they have changed me in ways I never could have imagined. I learned the art of listening (REALLY listening) and keeping the conversation focused on the family’s situation rather than sharing something personal. No one needed to tell me that word choice matters, and I learned language for the art of reflective communication. I learned the art of praising new parents without being overly flowery or giving false hope. Most of all, I learned the art of holding space for people in times of need.
What really came as a surprise was that I was also learning A LOT of science. I had never considered myself a “science person.” Math was always fun for me, but science just wasn’t. I did okay in the science classes I took in high school and college and paid a bit more attention when learning about human sexuality. Ultimately, though, science was not my jam. Not yet, anyway.
La Leche League changed all of that. Without even realizing it, I became a science person very quickly. I read stacks of breastfeeding books, research articles, and blogs written by lactation consultants. I attended breastfeeding conferences. I geeked out about breastfeeding with pretty much anyone who was willing to talk about it.
I enjoyed every second of my coursework when I decided to become a lactation consultant. Anatomy and physiology was particularly life-altering for me in that it got me thinking about how all of our body systems work together. And of course, I adored my 90 hours of lactation classes, which were chock-full of information on my favorite topic.
There are a lot of aspects of my lactation practice that remind me that I’m now officially a science person. I have a pediatric scale accurate to 2 grams, and I use a calculator to make sense of infant weight loss and gain. I write medical reports to share with my clients’ other health care providers. I’m constantly reading and learning about the impact of medical practices, maternal health, and cultural norms that impact breastfeeding. I’m carefully inspecting diapers full of newborn poop. I’m examining moms and babies’ bodies and figuring out how they fit together for breastfeeding.
The art of listening and responding with empathy continues. So does the art of finessing breastfeeding so that mom and baby are comfortable and content. But now the science is there, constantly pushing me to learn more, ask questions, examine my practice, and reflect on what I can do to better support breastfeeding families. It’s a beautiful merging of art and science, and it is exactly what I want to be doing.
I teach prenatal classes at a local hospital, and one of my favorite class activities is to have expectant parents brainstorm about how to deal with a crying baby. I put them in groups, armed with poster-size sheets of paper and Sharpies. After they make their lists, one person from each group presents the ideas. What follows is a compilation of some of the best ideas generated by class participants:
Reasons Babies Cry
3. Diaper issues
4. Embarrassing outfit (see photo)
5. "That's not a breast!"
6. Incompetent swaddle
8. Existential dread
9. Thermometer left in rectum
10. Vomited in public, and everyone saw
11. Genitals exposed in public, and everyone saw
12. Smooth jazz playing in all rooms of pediatric clinic
13. Conflicting pressure to gain a lot of weight AND sleep more
14. Have to stay wherever adults put them
What is missing from this list?
Most of the families that I support have babies that are two weeks old or younger. There's a lot going on: recovery from the birth, figuring out who this little person is, and of course, round-the-clock feeding. It's an intense time for everyone, and new parents want so badly to do everything right. They took the classes, read the books, bought the gear. They're feeding every 2-3 hours, tracking all of baby's meals and diapers on an app. Breastfeeding often happens in a chair with a nursing pillow using a position that a nurse or lactation consultant taught them at the hospital. If there are issues with milk supply or baby's ability to breastfeed, pumping and bottle-feeding sessions are thrown into the mix as well.
It often takes a few weeks to get feeding sorted out, and my role as a lactation consultant is to support families through this time. After an initial home visit to assess a family's needs and put together a short-term plan, I provide unlimited for two weeks as part of my service package. Parents can email, text, or call with questions and updates. I frequently do follow-up home visits to provide more hands-on help and do a weight check on baby. A lot of the families I see have multiple concerns around breastfeeding, so I encourage parents to address one or two issues at a time. I see very good results with families that get ongoing support.
I have also observed a common phenomenon: difficulty letting go of newborn breastfeeding practices. Particularly when parents have worked very hard to reach their breastfeeding goals, they can be reluctant to make changes that seemingly loosen their control around feeding. Those changes include feeding on cue, letting their baby sleep longer stretches, reducing pumping or bottle-feeding, trying new nursing positions, venturing out of the house. And it makes sense that parents would be hesitant to rock the boat, as they've probably had some very rough moments trying to feed their babies. They may know, logically, that they have the milk supply and a capable little nurser, but their past experiences give them pause. Can they really trust their bodies to make enough milk? Can they trust their babies to feed well at the breast? What does that even look like?
One amazing new mama that I recently supported told me that transitioning to exclusive breastfeeding was like jumping off a cliff. What an apt comparison! Even with the safety of the shining water below, taking the plunge is terrifying. I took this mama's hand in mine, and we jumped together.
"Why is breastfeeding so difficult? I thought it was supposed to be natural!"
How many times have I heard this from new parents? Countless trillions, really. And yes, it's a valid question. After all, it doesn't make a lot of evolutionary sense that something so basic to the survival of our species would be so fraught with challenges.
The main source of parental distress is hiding under the assumption that breastfeeding is completely instinctual and doesn't need to be taught. It ain't true! Breastfeeding is a learned skill. Even chimps and gorillas in zoos don't know how to do it if they've never seen it before, so humans have come in and nursed their babies to show the other primates what to do.
New parents can be so hard on themselves (should have done more reading, should have taken more classes, should have known the unknowable). That's when I bring in the bike analogy. It's nothing original--I heard someone else talking about it and felt it was a message worth spreading.
There are many parallels between learning to breastfeed and learning to ride a bike. Both activities can be awkward and wobbly at first. Slow. The idea of falling (literally and figuratively) is scary. Actually falling hurts a lot. There are tears. But you get back up and keep practicing and trying. You may need some extra help as you find your balance (bike: training wheels, breastfeeding: nipple shield). Eventually, though, you will find your balance. You'll go faster. And after a while, you'll take off easily, enjoying yourself and feeling free.
So new parents, take heart. There will be bumps in the road, but you'll find your balance in time. Until then, be gentle with yourselves and reach out for support.
A lot of families contact me with the goal of transitioning from bottle-feeding to breastfeeding or chestfeeding. In the vast majority of cases, the families originally intended to exclusively breastfeed, and their plan was derailed by early feeding challenges. Baby may be breastfeeding some of the time but need extra milk if the family is still working on increasing milk supply, or if baby has trouble breastfeeding effectively.
Guilt, shame, and disappointment are common emotions that come up for new parents who haven't yet reached their feeding goals. One of my most important roles as a lactation consultant is to validate parents' feelings. In our competitive and impatient culture, it's easy to feel less-than when our efforts don't immediately lead to the results we seek. I invite parents to step back and recognize it will likely take some time to figure everything out. In the meantime, focusing on The Three Keeps from The Womanly Art of Breastfeeding (La Leche League International, 2010) is very helpful.
1. Keep your baby fed.
I call this Rule #1. Parents who are using bottles, formula, or donor milk often feel bad about it, and I always praise them for keeping their babies well-fed. Babies who are getting enough food are typically more alert and thus easier to feed by any method, especially breastfeeding. Families who are supplementing their babies' feedings with extra milk should be working closely with their health care providers (lactation consultant, pediatrician) and getting regular weight checks to ensure that they are feeding appropriate amounts.
2. Keep your baby close.
Babies who spend a lot of time in close physical contact with their lactating parents typically return to the breast sooner. Skin-to-skin contact is important for helping babies to orient to the breast, so I encourage families to do as much of this as they can. Babies need to return to the breast on their own terms. If the breast has become a battleground, with baby actively resisting breastfeeding, then it's time to work on creating positive associations. A great starting point is lots of snuggling without any attempts at breastfeeding. Parent and baby may enjoy a warm bath together (with parent getting into the tub first and having partner hand over baby). Sleeping together also helps, as long as the family is following safe bedsharing guidelines.
3. Keep your milk flowing.
Some babies are part-time breastfeeders as parents work on building a full milk supply with pumping and hand expression for added breast stimulation. In other cases, the lactating parent is only pumping and hand expressing, and all feeds are given by bottle. In either case, consistent and effective milk remove is critical! I see the best results when there are at least 8 breast drainings per day. I also talk to parents about the importance of avoiding long stretches in which milk just sits in the breasts; 4 hours is about the maximum amount of time anyone should go without removing milk as they're trying to boost supply.
Babies who have difficulty latching will likely need some extra support, and this is something that I do all the time. Often a few adjustments to positioning make a big difference. There may be a physical issue that we need to address, such as a tongue tie. Some babies do well with the assistance of a nipple shield for a brief time, and this is definitely a tool that should be introduced with help from a lactation consultant.
A parting thought: babies are born to breastfeed, and this instinct stays with them for many months. I have heard of cases in which an older baby of 8 or 9 months was adopted and breastfed for the very first time! It often takes patience, persistence, and good support to get a baby back to breast, but it can absolutely be done.
People might be surprised to learn how much time I spend helping mothers with pumping. After all, I'm a lactation consultant, so isn't my job all about helping moms and babies with positioning and latch? Sure, we work on those things, but based on personal experience and observation, a lot of the mechanics of breastfeeding get ironed out as mom and baby get to know each other. I like to tell moms that there are no rules when it comes to positioning as long as everyone is comfortable and baby is feeding well.
Pumping is a different story. It involves a machine that operates one way, with the same assembly and basic function for all users. Not everyone responds the same way to every pump, though, and thus some tweaking is often helpful to make pumping more effective and efficient. At consults, I'm able to assess a mom and baby's unique needs and tailor my suggestions accordingly. However, there are several tips that all breast pump users should know.
For those of you with pumping experience, what pearls of wisdom can you share?
This question came up over the weekend when I was teaching a breastfeeding class at Kaiser San Francisco. A sweet dad-to-be approached me during the break and said that he was under the impression that breastfeeding wasn't really possible unless a mom had access to a pump. I talked him through some of the common uses of a breast pump:
I didn't think he was silly. We live in a culture dominated by technology and commercialism. Reliance on electronics has become second nature for most of us. New parents are marketed so many new products: breastfeeding apps, seats and swings that can be programmed to bounce and make noise, baby monitors with cameras, forehead scanning thermometers, and on and on. How are we supposed to know what we really need?
A lot of people see the breast pump as a must-have, and it goes on the baby gift registry automatically. I learned this a few years ago when a dear friend was expecting her first baby. Her registry included a heavy-duty electric double pump, as well as sets of bottles, several packages of milk storage bags, extra flanges, and pump cleaning supplies. We hadn't been in touch for much of her pregnancy, so looking at her registry, I assumed she was planning to return to work. Turns out, she wasn't! But all of her mama friends had told her that she needed those items, so on to the registry list they went. She ended up pumping a few times for date nights, but most of the supplies went unused and were passed along to a mom who worked outside the home. My friend probably could have gotten by with hand expression (or using an inexpensive hand pump) and a couple of bottles.
I devote a good portion of my breastfeeding classes to talking about hand expression. There are many good videos, and I show this one by Maya Bolman. It's always fun to see the reactions of the students, many of whom didn't even know that it was possible to remove milk this way! In my private practice, I teach hand expression to every mom who doesn't already know how to do it. In many cases, skilled hand expression is as effective as a high-quality pump, and it's certainly cheaper. Perhaps this is why hand expression is still not widely trusted as a good way to remove milk; there isn't much money to be made in telling people to use their hands.
A parting thought that I share with all breastfeeding families: a breast pump is not an accurate gauge of milk supply. Many moms worry that if they don't pump out a certain amount of milk that they are not making enough. Or perhaps they have been pumping for a while and notice a decrease in their output. It may appear as though their supply as dropped. Yikes! But as my wise lactation consultant mother once said to me, "Before you doubt your body, doubt the machine." Our bodies are very well designed to make milk, and our babies are good at getting it out. Pumps, however, can vary in quality. They can wear out. They can be defective. And yet new parents continue to put their trust in electronics to help them navigate the uncertain waters of infant care and feeding. I invite them to turn that notion on its head, and trust themselves instead.
Stay tuned for more thoughts on pumps and troubleshooting common challenges!
© 2017-2019 Sarah Quigley