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!
I had a conversation this morning with a group of moms at a school camping trip about how long people breastfeed. There were a lot of opinions flying around the breakfast table about how long it's healthy and appropriate to breastfeed. Suddenly everyone stopped and looked at me, perhaps expecting that I, as a lactation consultant, could clear up this matter authoritatively and definitively.
Sure, I recited the recommendations from the American Academy of Pediatrics (at least a year) and the World Health Organization (at least two years), but the moms wanted to know what I tell my clients. So I admitted that I don't tell my clients anything about how long to breastfeed. Instead, I ask them what their breastfeeding goals are. Everyone answers this question differently, and in many cases, a length of time is never stated. Moms tell me that their goal is to give their baby milk and comfort at the breast. Or to exclusively breastfeed. Or feed some breast milk and some formula. Or to nurse until their toddler outgrows the need. Or to breastfeed until it's time to return to work. Or to do it as long as the AAP or WHO recommend. And on and on and on...
So I listen to my clients, and I meet them where they're at. Because ultimately, there isn't a standard recommendation that I could give (even if I had one) that holds up in the face of so many different mother-child relationships. One size would never fit all. And who I am to stand outside that sacred relationship and dictate its course? That is not my role, nor would I want it to be.
I have always found it puzzling that so many people want to apply a deadline to breastfeeding. The question usually rears its head very shortly after the newborn rears its sweet little head: how long are you planning to breastfeed?
Have you ever heard anyone talk about how long they plan to let their baby ride in a stroller? I suppose that in the course of human history, this has come up, but it's not a common question. In fact, it sounds rather silly, doesn't it? You push your baby in a stroller until you and baby no longer have any use for that arrangement. And that's it. I would venture to guess that most people would keep their noses out of another family's stroller business and not give the matter a whole lot of thought.
Not so with breastfeeding. It's emotionally charged. People take stances. Friendships are strained. Family members stop speaking.
And it's really no mystery why this happens. Breastfeeding is, and has always been, about so much more than milk. It is two people connecting and communicating. It is dynamic and complicated and sweet and frustrating and beautiful and heartbreaking. Which is why every mom at that table this morning had something to say. She was tapping into her own experiences and the experiences of those around her. Such an electric part of human existence could never adhere to a prescriptive timeline. Breastfeeding is love, and love is boundless.
A friend and I were geeking out about breastfeeding today, and she said, "So what is the deal with foremilk and hindmilk?" She was referring to the thirst-quenching, lower-fat milk that babies get at the beginning of a feed and the satisfying, higher-fat milk that comes toward the end of a feed. These terms can be confusing, and some parents worry that their babies aren't getting enough hindmilk.
So do humans really make two types of milk? Are our breasts like those old-fashioned sinks that have separate faucets for hot and cold water? How much time does it take for a breast to "switch" from foremilk to hindmilk during a feeding?
The fact that we have two separate terms is at the root of the confusion around the fat content of human milk. Our milk always has fat in it, and as milk is removed, the level of fat gradually increases. There is no magical point during breastfeeding or expression when the foremilk shuts off and the hindmilk turns on. Several years ago, I came across a wonderful blog post that explains very well how this works, including a lineup of 12 vials of milk expressed over the course of a pumping session.
I couldn't pull up that blog post as I talked to my friend, who had just poured me a cup of tea. Looking at the tea, just beginning to steep, I saw an apt comparison. I told my friend that even freshly poured, the tea was starting to infuse into the hot water. The longer the tea bag stayed in the water, the stronger the infusion. This made sense to her, thinking of human milk as hot water and a tea bag as the fat. Spot of tea, anyone?
© 2017 Sarah Quigley