“So, how does the latch look?”
I get this question a lot. Many new moms tell me that the hospital nurse or lactation consultant talked with them about what to look for when baby is latching: baby’s wide-open mouth and smooth cheeks (no dimpling), upper and lower lips flanged out, a generous amount of the areola in baby’s mouth, no clicking noises or loss of suction, a round and elongated nipple after breastfeeding, and no pain. Often, moms are tripped up by the last item on the list. If the latch looks good, why is it still painful?
Because in breastfeeding, looks aren't everything.
Pain is a signal that something needs adjustment, whether it’s the baby’s position or the breastfeeding pair’s emotional state or the way the baby is sucking. Sometimes the adjustment is as simple as manually flipping a baby’s bottom lip out, which can be hard to see when that little chin is deeply buried in the breast. Flipping out the upper lip may help, too, but there is evidence that this is not as critical for a deep, comfortable latch as was once believed.
If a baby’s mouth is not wide open when latched, I find that pushing down on a baby’s chin typically doesn’t help. Instead, I recommend moving the whole baby! Often I see babies being brought to breast with their chins tucked into their chests, so pushing on the chin is futile if baby is curled up in this way. The snuggle and slide move is very useful in these cases.
When breastfeeding has been stressful, I find that moms and babies are often holding tension in their bodies as they attempt positioning and latching. Relaxed babies tend to open wider, and relaxed mothers tend to feel less pain. I like to look for ways to help the pair relax together, particularly the mom since her baby will take cues from her. Often a few deep breaths and some measures to soothe the baby, such as skin-to-skin holding, make for a much better experience initiating breastfeeding.
I also encourage moms to take a few moments to let baby relax into a latch. If baby came to the breast very hungry or fussy, her mouth is likely to be tighter, and she may need a minute or two to settle in. Rather than unlatching baby immediately to get a “correct” latch, I ask mom to see what happens if she waits a short time. Does baby open wider? How does the latch feel now? Often, the improvement comes quickly, and without the frustration of baby going on and off the breast several times until she gets it “right” (which can lead to more soreness for some moms).
It’s also possible that have a baby who is latching well and to have some lingering nipple soreness, especially if there were wounds in the early days. As those wounds heal, it’s normal to continue feeling some discomfort, particularly in the first 30-60 seconds of the latch. If the pain subsides, that is an encouraging sign that baby is not continuing to latch in a way that is causing further damage.
If, despite these adjustments, pain continues and breastfeeding feels unsustainable, there may be other factors at play. A full assessment with a lactation consult, who may loop in mom and baby’s doctors, can be useful to determine the cause of the pain and possible treatments.
Positioning a newborn for breastfeeding can be an awkward affair. Their little bodies are wiggly and floppy. They love to put their hands by their faces and sometimes bat at the breast, sabotaging their own efforts to latch. After a few minutes of getting baby into the right spot and (presto!) achieving that latch, they come off the breast after a few sucks. And so the process starts again.
Once baby is finally sustaining the latch, a lot of moms still have a “pinchy” sensation. They usually consider two choices: A) unlatch the baby and start over, or B) grin and bear it. Neither option is particularly appealing, particularly if it took a lot of effort to get the baby on the breast in the first place. Let me offer choice C) snuggle and slide.
This simple maneuver works in any breastfeeding position. All mom needs to do is put her hand on baby’s back (not the head, which can lead to arching and fussing), and slide her baby’s body in the direction the feet are pointing. Sometimes, baby just needs to move an inch or two in order for that pinching sensation to subside.
Why does this work? Bringing baby in closer to mom’s body often deepens the latch, and sliding creates a bit of space between baby’s chin and chest to allow baby to open wider. This move also gives baby a better airway and swallowing ability, both of which are essential for good drinking.
Breastfeeding is a dynamic activity, an interaction between two live bodies, so it makes sense to continually adjust throughout the feeding. I encourage my clients to experiment with moving their babies’ bodies across or slightly up or down and course correct if that pinchy feeling returns. It’s an empowering and effective strategy that gets moms to drop into their own bodies and find their own ways to breastfeed comfortably. And lest you think that I coined the adorable term “snuggle and slide,” it actually comes from one of my favorite papers by Dr. Pamela Douglas and Renee Keogh in the Journal of Human Lactation.
Need in-person help with positioning? Book an appointment with me!
I’m excited to share a brand new resource that I’ve contributed to, More to Mother, which launched today! Check out my article, Fourth Trimester: Lactation Consultant, which explains why you might want to hire a lactation consultant, what to expect, and more.
More to Mother was created by two San Francisco-based women who saw a need for more resources on their journey to becoming parents. The site provides evidence-based guidance from preconception through the postpartum period.
Please follow along with @moretomother on Instagram, and sign up to get updates when they launch their City Guides (list of trusted practitioners and resources in various cities).
Do you live in San Francisco, Marin, or San Mateo county, CA? I'm your local breastfeeding resource! Book an appointment with me.
Looking to increase your milk supply? Want to pump more, and in less time? Breast massage and compression are your best tools. Invest in a pumping bra, or make one yourself by cutting holes in an old sports bra. The idea of going “hands-free” is very appealing so that you can text or unlock the next level of Candy Crush, but using your hands may make all the difference! Experiment with where and how you massage your breasts and see how your body responds. Some people need only a light touch to get the milk flowing, while others find that placing a fist on either side of one breast and pressing is most effective.
Depending on your anatomy and the fit of your flanges and pumping bra, it may be easier or more challenging to massage while pumping. I’ve had some clients who couldn’t massage without causing a break in suction while they pumped. They had good results massaging before pumping and then tucking heat packs into the pumping bra (such as these, or using a sock filled with dry rice).
Wireless pumps such as the Willow and Elvie make it much more difficult to massage and compress while pumping. It can be done but again depends on the individual. Anyone who relies heavily on using their hands while pumping for a good breast draining may want to refrain from dropping a lot of money on one of these pumps. I encourage people to use the pump they can get through insurance and use these massage techniques instead.
Need help with pumping? Book an appointment with me!
“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!
Need help with breastfeeding? Book an appointment with me!
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.
Want to learn more about recreational breastfeeding? Book an appointment with me!
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:
Want a private, in-home breastfeeding class? Book one with me!
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.
Let's do some art and science together! Book an appointment with me.
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
Find out how to soothe your baby at the breast! Book an appointment with me.
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.
You don't have to jump off that cliff alone! Book an appointment with me.
One lactation consultant's musings about milk.
© 2017-2020 Sarah Quigley