Breastfeeding Q&A Part 2 with The Pump Station
Lactation Consultant Corky Harvey, RN, IBCLC, MS, answers your questions about breastfeeding, thanks to our partner The Pump Station & Nurtury.
August is National Breastfeeding Month and we’re excited to bring you the second installment of our Breastfeeding Q&A series with The Pump Station & Nurtury founder and one of their respected lactation consultants, Corky Harvey RN, IBCLC, MS, to discuss common questions about breastfeeding. Learn more about early allergen introduction and breastfeeding here.
How do I know if baby is getting enough milk?
As a new mother, you have enough milk in your breasts to meet your baby’s needs. Your baby should be nursing at least 8 to 12 times every 24 hours. Your baby should regain their birth weight between 8 and 14 days of life. Once they do, you can allow your baby to feed on demand. Some babies will still need 11+ times in 24 hours, and some might only need to feed seven times. It really differs from one nursing duo to another. Frequent weight checks can help a mother gain confidence that her baby is thriving and that she is doing well with her breastfeeding.
- They should also swallow during nursing, and be satisfied after most feedings; all babies experience the “witching hours.” They will have a 3-hour period each day when they don’t appear satisfied, and are on and off the breast frequently. Parents often think it is about food, but it is really about a baby’s wakeful time. These little ones don’t have an attention span that involves toys and mobiles, so parents (and other helpers) are the whole deal. We encourage the frequent nursing, with breaks where the partner takes a turn bouncing the baby on the yoga ball (the Happiest Baby on the Block 5 S’s), puts the baby in the wrap and goes out for a little walk, etc. But for sure back to the breast as often as needed.
- By day six, they should have 6 or more wet diapers every 24 hours, and 3 or more yellow bowel movements every 24 hours.
- Also, they will regain their birth weight by two weeks.
When deeply latched onto the breast, a baby should be able to compress the areola with their jaws and take enough milk.
- However, if your nipples are extremely sore, scabbed, or bleeding, this likely indicates that your baby is not latched deeply enough and might not be able to obtain enough milk. Getting help at this time from a Lactation Professional would be very helpful. It isn’t supposed to hurt like that.
What drives your milk supply is the effective removal of milk. Your baby will need to feed frequently for you to maintain your milk supply. So, nurse as often as your baby desires.
Indicators that baby is hungry include:
- Hand-to-mouth movements
- Tongue movements
- Light sleep
Don't wait for your baby to cry to alert you that they are hungry, as babies use crying as their last feeding ”cue.”
What is engorgement and how can I relieve it?
Engorgement is the over-fullness of the breast. When a mother experiences engorgement, her breasts become very full, firm, and hard, and the skin can be red, taut and shiny.
Starting when baby is 3-5 days old, the volume of your breast milk, and the volume of body fluids in your breasts, increases. It's perfectly normal for your breasts to get larger and feel heavier, warm and tender at this time. In fact, it is an important sign that your breasts function well.
As long as your baby is nursing frequently and removing milk well, these sensations will disappear in about 24-48 hours. However, if your baby is not nursing often, or not removing milk well, or if you're not pumping enough when you're separated from your baby, this situation can worsen and the result is a lowered milk supply. Removing the milk is essential to a good milk supply.
You can relieve engorgement by:
- Breastfeeding at least 8 times in 24 hours (nursing every 1-2 hours is even more helpful)
- Applying heat to the breast for 5-10 minutes before nursing (use warm compresses, or take a warm-hot shower)
- Applying cold compresses to the breast or 15-20 minutes after nursing, to reduce swelling and inflammation
- Gently massaging firm areas of the breasts during nursing, to help with milk drainage
If your breasts are so hard that your baby has trouble latching, soften the areola around the nipple by removing a little milk. Try manual (hand) expression, or use a breast pump on a low setting to remove a bit of milk and soften the areola before latching.
What advice do you have for maintaining/increasing my milk supply while working outside the home?
After you've returned to work, nursing your baby as much as possible while at home will help you maintain (or increase) your milk supply.
Try some of these tips:
- Feed baby when you first get up, and then take a warm shower (which will improve let down). If possible, try breastfeeding or pumping right before leaving for work.
- Try pumping while nursing on your second breast.
- Nurse as soon as you get home, all night feeds, and most weekend feedings.
While at work, making the time and space to pump as much as you need to is crucial to maintaining your supply.
- For best results, you'll need to pump as many times as you would breastfeed if you were at home. This will usually be at least 3 times. Try pumping on the way to work, mid-morning, lunchtime, and mid-afternoon. Nurse your baby as soon as you arrive at home or at daycare. A hands-free nursing bra, a pump that does both breasts at the same time and works well for you, is essential.
- A hands-free bra is SO helpful (a new one on the market called Super Mom does three things: it is a comfortable bra, a feeding bra, and a pumping bra).
- An electric car adapter so you can pump while driving will be helpful.
- The new in-bra pumps can be helpful, but they do NOT maintain milk as well as most other pumps. It should not be your main pump, but can really help at times when you do not have the ability to sit down and would have missed the session.
- Find a clean, private space that will be available for you to pump anytime you need it (anywhere that is not a bathroom). This could be your workspace with a curtain installed for privacy. Be part of the solution on this—moms are really inventive. Sometimes they head for their parked car as the best and most relaxing place.
- Advocate for your pump time, and always make sure you set aside consistent times to pump.
- Don't wait until your breasts are full to start pumping. Allowing your breasts to get full every time will actually lower supply. The full breast stops producing. The breast makes more milk in response to milk being removed.
- To promote an increased milk supply, lengthen your pump session by 5-10 minutes or add another short pumping session. For instance, if you normally pump for 10 minutes, increase your pump time to 15-20 minutes.
- Many working moms get up at night to pump even if their baby is sleeping a longer stretch. Pump just before you pop into bed.
- Remember: When a baby takes bottles, they usually take more than if they were breastfeeding. Often, moms feel they are falling behind when what really is happening is that the baby is overfeeding on that bottle. Stick with slow flow nipples for feeding the baby, and try to store lots of milk in the freezer before you return to work. We recommend about 200 ounces!
Have a backup plan in case something goes wrong with your pump:
- Invest in a manual pump, in case your electric pump breaks.
- Keep extra pump parts at work. Moms LOVE not having to wash parts at work. They take a new set of parts for each pumping session and wash everything at home that evening. It saves so much time
- Even better, see if your office has a breast pump that you can keep at work, or consider renting a pump for work.
When can I introduce a bottle during breastfeeding, and how often?
Once your milk supply is established and breastfeeding is going smoothly, you can introduce a bottle. There's no "perfect time" for this, but introducing the bottle when baby is 2-4 weeks old usually works well. There's a chance a baby will reject the bottle if we wait until 6 weeks or after to introduce it.
When deciding how often to offer the bottle, you'll need to strike a balance between keeping baby familiar with the bottle and maintaining a strong breastfeeding relationship. Offering a bottle 3-4 times a week, and no more than once a day, should maintain this balance.
When giving a bottle, touch the baby’s mouth with the nipple and wait until the mouth is open wide. This mouth opening is called the rooting reflex, and it is an essential behavior for latching at the breast.
If your baby starts to prefer the bottle over the breast, reduce the number of bottle feedings relative to breastfeeding sessions, or go back to breastfeeding alone until baby breastfeeds normally. Remember: if you choose to bottle feed, you'll need to pump to protect your milk supply, or else your supply will drop. For a good milk supply, remember the rule: if the baby receives a bottle, mom needs to pump.
What if baby refuses the bottle? How can I encourage them to take the bottle?
Try these tips:
- Sometimes, babies won't take a bottle when they know mom is around. So, mom may need to leave the room or the house, while dad or another caregiver offers the bottle.
- If baby will only take the bottle from mom, have mom start the bottle feed. Then, have dad/caregiver offer the bottle in the middle of the feed, so baby gets used to the idea of taking a bottle from others.
- Move baby to different positions, such as:
- A more upright, but semi-reclining, position
- Holding them so that their back is leaning on dad's/caregiver's chest and baby is looking outward
- A bouncy seat or stroller
- (Whichever position you choose, remember to never prop the bottle!)
- Use distractions during bottle feeding, such as movement, taking baby outside, singing, or a mobile.
- Associate bottle feeding with breastfeeding by using similar "cues."
- Try holding and cuddling the baby similar to breastfeeding.
- Try holding a blanket or stuffed animal during breastfeeding, then having dad/caregiver hold the same comfort object during the bottle feed.
- Or, if you sing a song during breastfeeding, use that same song when offering the bottle.
- Try offering the breast first, then switch to the bottle when baby is sleepy (or after your first let down).
What do the new AAP guidelines (March 2019) recommend regarding breastfeeding and early allergen introduction?
The new AAP guidelines reinforce that there is no conclusive evidence to prove that breastfeeding can help prevent food allergies on its own.
Also, there is no evidence that excluding foods from a breastfeeding mother’s diet can protect her baby from developing a food allergy. Thus, you should not restrict your diet while breastfeeding in an attempt to prevent your baby from developing food allergies.
The AAP recommends early and sustained allergen introduction while breastfeeding, starting as early as 4 months, and regardless of your diet. This recommendation is based on the results of landmark clinical allergen introduction trials. 4 months of age, though, is usually earlier than when most parents want to introduce solids.
At The Pump Station & Nurtury, we recommend Ready, Set, Food! because it lets mothers continue exclusive breastfeeding while also starting early, sustained allergen introduction. Ready, Set, Food! easily dissolves in breast milk, so breastfeeding mothers can continue to exclusively nurse without having to introduce solids before their baby is ready. At the same time, the system helps parents lower their child’s risk of developing food allergies, using the same amounts of allergens used in the clinical trials that provided the basis for the new AAP guidelines. Ready, Set, Food! contains only organic peanut, egg, and milk powders, with no added sugar or artificial additives.
We’re excited to offer this much-needed solution to our parents in our mission to nurture, support, and empower parents with compassionate service, quality information & outstanding products like Ready, Set, Food!
About Corky Harvey, MS, RN, IBCLC: Corky is the founder of The Pump Station & Nurtury, the first new parent resource center of its kind. She is a registered nurse with a Master’s degree in maternal/newborn nursing from the University of Maryland. She is an International Board Certified Lactation Consultant, a certified Happiest Baby on the Block educator, and was a long-time Childbirth Educator. Corky does one-on-one lactation consultations, teaches Prenatal Breastfeeding, Baby Care, and new Grandparents classes. She was on the faculty of the UCLA Lactation Educator and Consultant programs for many years and still lectures at hospitals, conferences, and parent venues. Corky has three grown children who were breastfed and she loves to claim that their intelligence is linked to this. In her spare time, she enjoys traveling with her husband Dean, especially to Germany where her two darling grandsons live.
Visit The Pump Station & Nurtury® - Santa Monica, (310) 998-1981, at 2415 Wilshire Blvd., Santa Monica, CA 90403 and The Pump Station & Nurtury® - Hollywood, (323) 469-5300, at 1248 Vine St. Hollywood, CA 90038.
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These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease. If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.