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Nancy Morhbacher, IBCLC Answers Breastfeeding Questions

Facebook Q&A with Nancy Mohrbacher, IBCLC 12-6-13

QUESTION 1: I need help with low milk supply. Ten days ago I had the flu and was dehydrated. To recover my supply, I’m 1) nursing & pumping a lot, 2) drinking lots of water and mother’s milk tea, 3) taking fenugreek 3x/day, 4) mixing flax meal into my food. It’s helping, but my supply still seems lower than usual. Any suggestions?


NANCY MOHRBACHER, IBCLC: I’m glad you reached out. You’ll be glad to know that milk production is such a hardy process that even mothers who have never been pregnant have brought in milk for adopted babies! You just need to know how it works. First, despite popular belief, drinking more water and eating foods like flax do not affect milk production. Your body knows how much milk to make by the number of milk removals (breastfeeds plus pumps) each day and how fully the milk is removed. (The basic dynamic is: Drained breasts make milk faster and full breasts make milk slower.) If you breastfeed your baby on cue, your baby will do this for you automatically without you even having to think about it, and that is one approach you can use. You just need to breastfeed like crazy (offering each breast as many times as baby wants for as long as baby wants) and your supply will quickly rebound. For most women, 7 or 8 milk removals per 24 hours are enough to keep supply steady. Fewer removals usually mean decreasing milk supply. More than 8 or 9 usually stimulate a gradual milk increase. Taking fenugreek or other herbs will not help if you’re not also removing the milk often or well enough. If you do take fenugreek, you need to take enough: 3-4 capsules 3x/day. Less than that will not boost supply.



QUESTION 2: I have a baby girl who is almost 6 months and was EBF. Her MD wanted me to try formula 1-2x/wk & baby food 1x/day because of her acid reflux. My baby now eats every hour at night, going back and forth on the boob acting like she wants it. But she cries when she’s on then takes herself off. How do I know if she’s trying to wean? I want to nurse as long as I can.


NANCY MOHRBACHER, IBCLC: Babies under 1 year are too young to be ready to wean, because they still have a physical need for either breast milk or formula. When your baby is fussy at the breast, try laid-back feeding positions, which may make it easier for her to get on and stay on. Positions in which baby’s head is higher than her bottom also make feedings less painful for babies with reflux. See how to do these positions here: http://www.nancymohrbacher.com/blog/2010/10/11/some-ins-and-outs-of-laid-back-breastfeeding.html Regarding formula, I’m puzzled that your baby’s MD recommended it. Research shows that because formula stays in baby’s stomach longer than mother’s milk, it aggravates reflux rather than helping. Your baby is very lucky you’re nursing her. Also, many smaller feedings are easier for the baby with reflux to handle than fewer larger feedings. You don’t say whether or not your baby is on reflux medication. If she is, discuss with her MD whether this behavior may be a sign her medication dose needs to be increased, which may be needed as baby gains weight.



QUESTION 3: My 5 mo old is very distracted at the breast, even in a quiet room. Her dirty diapers are now green, sticky, and sour smelling. I have an overactive let down and lots of milk. Her lack of focus started about a week ago. Is she only getting foremilk leading to green poop? What can I do to keep her on track?


NANCY MOHRBACHER, IBCLC: Distractibility is a normal part of breastfeeding the older baby. Your best strategy is to minimize distractions as much as possible and keep your finger near her mouth in case you have to break suction quickly. Regarding your baby’s poops, green is in the normal color range. There are many possible causes for changes in color, including a stomach bug (which can also cause smelly poop) or a reaction to something in your diet. Green poops don’t necessarily mean baby is getting too much foremilk. Some even question whether foremilk/hindmilk imbalance exists. (See: http://www.nancymohrbacher.com/blog/tag/foremilk-hindmilk) If you have oversupply, slowing your milk production may make feedings easier for you both. My blog post on “block feeding” explains how to know if this might be a good strategy and how to do it: http://www.nancymohrbacher.com/blog/tag/block-feeding



QUESTION 4: My son is 3 weeks old & gets strictly breast milk. The past 3 nights he has been awake most of the night & is feeding almost every 1-1.5 hours throughout the day. He eats for 15 minutes then buttons his lips until an hour has passed.  I’ve read about growing spurts. Any tips on how to help make growth spurts a little easier on this exhausted 1st-time mom?


NANCY MOHRBACHER, IBCLC: I wish I had a quick fix! What your baby is doing is completely normal and expected at this stage. That’s how he boosts your milk production to meet his growing needs. There are some ways to make this easier on you. For one, reduce the work of breastfeeding by using feeding positions that allow you to relax all of your muscles and rest. One example is laid-back positions (for details, see my blog post: http://www.nancymohrbacher.com/blog/2010/10/11/some-ins-and-outs-of-laid-back-breastfeeding.html) Hopefully, your baby is already in your room at night. (Experts recommend this to prevent SIDS.) And you baby is sleeping near you. The less you have to move around at night, the easier it is to get back to sleep. Make your bed safe for your baby, even if you don’t plan to bedshare, as most parents fall asleep with their baby there even when they don’t plan to. You can also set up a mattress or sleeping bag on the floor and use side-lying positions in which you can nap while baby feeds. Also, nap between feedings during the day. What’s most important is how much sleep you get overall, not how much sleep you get at a single stretch.



QUESTION 5: How long after you consume alcohol should you pump and dump? Do you have to pump and dump if you consume water with said alcohol? How much water?


NANCY MOHRBACHER, IBCLC: As long as you drink moderately (1 or 2 glasses of beer or wine), there’s no reason to pump and dump. Occasional exposure to alcohol in your milk is not harmful to your baby. If you feel strongly that you don’t want your baby exposed to any alcohol, you can simply allow time for it to clear from your system. The alcohol from 1 glass of beer or wine is out of the milk of a 120 lb. woman within 2 to 3 hours. (In other words, if you have a drink right after nursing, there may be no alcohol in your milk by the time you nurse again.) You don’t need to pump for alcohol to pass out of your milk. Alcohol leaves your milk automatically as your blood alcohol levels go down. If you have a stronger drink or more than 1 glass of beer or wine, it takes longer for your milk to be completely free of alcohol. But keep in mind occasional exposure to alcohol is not a concern. Drinking water with the alcohol makes no difference. Obviously, if you’re really drunk, you shouldn’t be caring for your baby no matter how baby is fed.



QUESTION 6: I am expecting my 4th and would like to exclusively breastfeed this one, but I had issues with the 1st 3. My breasts get so large, my nipple almost disappears, and I have a hard time getting the babies to latch. Any ideas on how to fix this?


NANCY MOHRBACHER, IBCLC: It is not unusual for breast fullness that makes latching challenging to develop around Day 3-5 after birth. But there are a couple of easy fixes for latching problems at this and other times. One is a technique called reverse pressure softening. This involves using gentle but firm pressure to move any breast swelling away from the nipple and areola further back into the breast for an easier latch. See a YouTube video demonstrating this at: http://www.youtube.com/watch?v=2_RD9HNrOJ8 You can also read about it at: http://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/ Another strategy to make early latching easier for you and baby is using laid-back breastfeeding positions, as gravity helps your baby get on deeper. See: http://www.nancymohrbacher.com/blog/2010/10/11/some-ins-and-outs-of-laid-back-breastfeeding.html If you’re still having trouble, I would also recommend seeing a board-certified lactation consultant, as often just a little tweaking can make a huge difference. Best of luck!



QUESTION 7: I pump more than my baby eats. I’m away from her at work 10 hours a day. She takes 9-12 oz., and I pump 16-22 oz. total during my 3 pumps at work. Should I keep pumping?  I donate the extra milk but I’m tired of storing all this milk. What should I do?


NANCY MOHRBACHER, IBCLC: Actually, there’s an easy solution to this high-class problem. Here’s what you can do: Cut back to 2 pumps at work and stop pumping at each session after you’ve gotten 6-7 oz. total. That should keep you comfortable during your workday, provide plenty of milk for your baby, and allow your milk production to gradually reduce to be more in line with what your baby needs. If at any point you feel uncomfortably full, either breastfeed or “pump to comfort.” This means pumping just long enough so that you feel comfortable and no longer. If you’re just pumping to comfort as needed and not draining your breasts fully, this will not prolong the problem. It will simply keep you comfortable and prevent plugged ducts. Any need to pump at first will decrease over time until you’re good to go. 



QUESTION 8: I’ve been on a dairy elimination diet for several months. What is the best way to determine if by baby still reacts to dairy? Are there certain dairy products (cheese, butter, cream) that are easier for the transition back to dairy?


NANCY MOHRBACHER, IBCLC: The good news about a dairy sensitivity is that most babies outgrow it by about 6 months, some sooner. The most reliable way to know if your baby still reacts to dairy is to do a challenge. This means you consume dairy and watch for a reaction, which should occur with 24 hours. If baby reacts, you need to wait longer to introduce dairy back into your diet. Typically, babies react to the protein in dairy, so butter (which is mostly fat) is a good place to start. Cheese and yogurt tend to produce less of a reaction because they have undergone processing. If you try one of these dairy products and see no reaction, a glass of straight cow’s milk should tell you for sure whether or not your baby is ready for you to go back to your regular diet.


QUESTION 9:  My daughter was 5 weeks early and spent 9 days in the NICU. I pumped and then we began breastfeeding but she latched only for a short time, which we followed with bottles. A month later she’s latching better, but even if she nurses for a while, she still seems hungry and may take a 2 oz bottle. I’d like to EBF, but I am afraid she is not getting enough.


NANCY MOHRBACHER, IBCLC: Breastfeeding is in large part a confidence game. Keep in mind that babies’ feeding patterns differ when fed by breast and bottle. If a breastfeeding baby acts hungry, just go back and forth from breast to breast as many times as she wants. Unlike a bottle, your breasts are never empty. It’s not uncommon for a baby this age (your baby is now a full-term newborn) to spend the whole evening nursing. Try just going with it. The shortest distance between where you are now and EBF is to devote a few days to keeping your baby on the breast as much as possible. You will know she’s getting enough milk if her number of wet diapers and poops per day stays the same and if your breasts feel comfortable. (If she isn’t taking enough you would feel fuller and fuller over time.) If you want more reassurance, arrange for weight checks at her MD’s office or rent a Medela BabyWeigh scale for a week and do daily weight checks at home. (Go to http://www.medelabreastfeedingus.com/bnnsearch, enter your zip code, click on the “Rent Products” tab, and then on BabyWeigh Scale.) Babies younger than 3 months typically gain about an ounce per day. If needed, you can also eliminate bottles and reinforce breastfeeding by supplementing her at the breast. For help with this, consult a lactation consultant near you by going to www.ilca.org, click on the “Find a Lactation Consultant” link, and enter your zip code. I know you can do it! 



QUESTION 10: I am a type 1 diabetic and EBF my 2-mo-old DD. Before and during pregnancy I had tight control of my blood sugar but now one minute my sugar is high and the next it’s low. Is high sugar bad for the baby? Should I not be breastfeeding at all? I want to do what’s best.


NANCY MOHRBACHER, IBCLC: As you know, type 1 diabetics don’t produce the hormone insulin, so they need daily insulin replacement to prevent their blood sugar from becoming dangerously high. Your blood sugar level doesn’t affect the amount of sugar in your milk. In fact, breastfeeding is the best thing you can do, because EBF reduces your baby’s risk of developing type 1 diabetes. As far as you’re concerned, breastfeeding increases insulin sensitivity, which is a plus. Most moms need less insulin while they’re breastfeeding. It may help to keep your blood sugar stable if you have a protein-and-carb snack each time you feed your DD, as blood sugar often dips about an hour later. When it’s time to wean, doing it as gradually as possible may help make maintaining blood-sugar control easier.