Common Concerns While Breastfeeding - Help! I’m Engorged!

Welcome to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls I receive.  Rather, these are the questions that come from clients and friends in the middle of the night, by text or by email, that don’t necessarily warrant a lactation consultation.  They can often be easily resolved with a few simple tricks.  So, I would like to share those tricks with you!

Check Out My Cleavage!

I remember the first time I knew my milk had ‘come in.’ It was 4am.  My son was 4 days old.  And I woke up to my breasts looking like I had visited the local plastic surgeon a few hours prior.  I immediately woke up my husband and announced with pride, “Take a look at this cleavage!”  Even without a bra I had cleavage!  It was amazing!

Several hours later, those taut, perky breasts had become quite sore and I was searching for any remedy to help soften their powerful fullness.  I knew that they weren’t engorged, but I also didn’t want to get to that point of challenging return.

What is engorgement?

Photo by Lindo Nkwanyana on Unsplash

While breast fullness between days 2-5 postpartum is normal, your breasts should still be somewhat pliable.  Think of a full balloon.  While a balloon is taut, you can also squeeze it and shape it.  This is how your breasts should feel as your body transitions from making colostrum to your ‘fuller milk.’ 

Engorgement is much more severe.  When your breasts are engorged, they can feel heavy, tender, and/or painful.  Sometimes engorged breasts will look tight and shiny, as if the skin is being stretched beyond its elasticity.  Engorged breasts can become so congested that it is difficult to even remove the milk. Engorgement is most common those first few days postpartum or as your baby gets older and begins to sleep for more consecutive hours at night.

What causes engorgement?

Engorgement is caused by milk stasis (milk not moving out of the breast.) There are many reasons that a mom might become engorged.

• Several birth interventions, which may result in lots of IV fluids in the hospital

• Poor latch where the baby is not removing milk efficiently – definitely see a lactation consultant for this issue

• Subsequent children - I was a lot more 'full' with baby #2, than with baby #1. Your body has a memory and your milk often comes in more quickly and forcefully with each subsequent baby

• Your little one slept longer at night than usual

• Skipped feedings

• Inflammation

• Low immunity (caused by lack of sleep, stress as a new mom, stress of going back to work, etc. – Can you imagine that????)

How can I reduce my breast fullness or engorgement?

• Breastfeed frequently and effectively from both breasts. In those first few weeks, your baby should be breastfeeding 8 or more times in 24 hours, actively sucking for about 30-40 minutes per feeding session

• If your baby cannot latch because your breasts are so engorged:

  • Use ‘Reverse Pressure Softening’, which pushes the excess fluid away from your nipple, helping your baby latch more easily.

  • Hand express or pump on a low setting before latching your baby, to help your breasts to become more pliable and easier to latch onto.

• To reduce inflammation, treat your breasts as you would a swollen ankle – ice packs/frozen peas in between feeding sessions to help reduce the swelling.

• Use warm compresses right before breastfeeding. The warmth will help to open your blood vessels and hopefully help your milk to begin dripping, thereby making it easier for your baby to latch on.

• Take a warm shower and lean forward. The gravity and warmth should help reduce inflammation. Use very gentle massage only, as deep massage can cause more inflammation.

• Take care of yourself and your immune system – rest, drink lots of water, eat immunity-supporting foods

• Eat cucumber and watermelon to reduce all-over body swelling (like your hands and feet)

• If your baby isn't latching well or removing milk efficiently, you may find it helpful to pump for about 10-15 minutes after breastfeeding to remove the backed-up milk in your breast.

• Ask your doctor/holistic practitioner for recommendations for inflammation-reducing medication, herbs, and homeopathy.

If your breast engorgement foes not resolve within a few days, becomes worse and turns into plugged ducts or mastitis, definitely call a lactation consultant for some additional assistance!

Celebrating Older Siblings Before a New Baby Arrives

This is Kim, Robin’s sister-in-law. I have three amazing daughters. In my 4.5 years of being a mom, I’ve read a fair amount about parenting and have gotten some really great (and some really terrible, uninvited, and/or borderline-criminal) advice along the way. I thought I’d share some of the highlights with you from time to time.

When I got pregnant for a second and third time, like most parents, I was concerned about how my older children would react. I didn’t want them to feel replaced and I didn’t want them to resent the new arrival. 

When I got pregnant with my second child, my first was only a year old. She barely understood what was happening. So, I had her talk to the baby through my belly, try out the bouncy chair and the crib, separate the baby’s clothes, and small jobs like that to help her feel a part of the process.

When I got pregnant with my third, my girls were four and two. They were much more aware of what was going on. So, I tried to come up with more involved activities to get the girls excited about being big sisters to a new baby and to help them feel as though they were involved in the preparation for her arrival. Here’s what we did:
 

ART WALL
After we decided on the bedding set for the new baby’s nursery a few months before the baby was due, I went to the art supply store and got a bunch of different sized canvases and paints that matched the bedding. The girls and I then measured the space above the baby’s crib and decided on how we would arrange the canvases. [This is a great math/spatial reasoning project for older children.] Once we planned for the arrangement, I hung the blank canvases on the wall. Over the course of the rest of my pregnancy, we would occasionally take canvases off the wall and paint them. As we finished the paintings, we hung them back up so that we could see the “art wall” take shape. It was great to have a go-to project when the girls were bored, plus it gave us the chance to experiment with different painting techniques. The girls loved seeing their work displayed on the wall, and it was fun for them to make a handmade gift for their sister. The girls actually finished the last canvas with their grandma while mom and dad were in the hospital with the new baby. Perfect timing! And it looks gorgeous!

ONESIE TIE DYE or PAINTING
The girls got a tie dye kit as a gift and they had so much fun making their own shirts, so I thought they would really enjoy another project making clothes for their baby sister. I remembered that when my older girls were babies, I rarely chose to put them in plain white onesies when there were so many cuter outfits to choose from, so we took the plain white onesies and tie dyed them, along with some shirts and a receiving blanket. This activity is definitely better for older kids, since the actual dyeing should really be done by an adult and younger ones lose interest quickly. Alternatively, use fabric paint or markers so that the big sibs can be more involved and you don’t have to do it all in one go (tie dye must all be used in one sitting).
 

BIG SISTER PARTY
Because I was having a third girl and in need of pretty much nothing, I saw no reason to have a baby shower. Instead, I decided to have a “Big Sister Tea Party” to celebrate the girls. I based the activities on a blessingway party, and tailored it for their age. A month or so before I planned on having the party, I started mentioning it to the girls and asked them to come up with a guest list, which I made sure remained small and intimate. Then we went to the store to get them special dresses that were specifically for the party (this helped build up the anticipation, since they were so excited to wear the dresses!). I also made them some garlands for their hair so they would feel extra special. On the invitation, I asked that there be no gifts, but instead guests could bring their favorite quotes about sisters and/or pretty beads. 

At the party, we had a few stations. On the main table, guests could make pages for the girls’ “Big Sister Book.” Before the party, I had cut pages to size and printed out cute pictures of the girl as well as quotes about sisters. Guests could glue those to the pages and decorate them with markers, crayons, and colored pencils. After the party, I laminated the pages and turned them into a book for the girls. 

At a side table, I had various colors of sculpy clay for guests to make beads for the girls “big sister necklaces.” After the party, I baked the beads and we strung them into necklaces that the girls could wear when they met their sister for the first time. If I were to do this again, I would give guests a little more guidance to make smaller beads. The beads ended up being huge and heavy, and the girls found the necklaces uncomfortable to wear. They still had fun though!

Towards the end of the party, we did belly and face painting. It is “traditional” to use henna to paint mama’s belly at a blessingway, but the henna can stain and takes a while to dry. So instead I went with face painting crayons. First, the kids all came and painted my belly, and then the adults helped paint the kids’ faces. What a huge hit!

And what’s a party without a little something sweet? Since it was a tea party, I made little finger sandwiches and tea, and then after that I made cupcakes. I brought each girl a cupcake with a candle, and the guests made wishes for the girls as big sisters before they blew them out.

Obviously, the party took a ton of planning and effort, but I’m sure there are simpler ways to do it. As long as the big sibs feel special and have a good time, mission accomplished!



These are just some ideas for making the transition to being a big sib exciting and fun. There are infinite possibilities! Work with your soon-to-be big sibs to figure out what you would like to do and go for it!

I’m Sick! Should I Still Breastfeed My Baby?

It’s that time of year again!  FLU SEASON!!!  In San Diego, we have been hit especially hard with the 3-5 day stomach flu these past few weeks.  I am getting phone calls, texts, and emails from worried mothers wondering if they should breastfeed their infants while they are sick.  The overwhelming answer is YES, and this is why.

When we are bombarded with germs in our environment, our bodies create immunity towards these germs so that we can stay healthy.  Sometimes they work, sometimes they don’t.  A breastfeeding mother not only creates immunity for her own body, but her breastmilk contains immunological properties (antibodies) as well, which are passed on to her nursing child.  It’s as if your baby is getting an extra dose of immunity with each breastfeeding session.  Also, by the time a mother and/or baby begin to show symptoms of a cold, flu, etc., they have already been contagious for a few days, so no need to stop now.  This is why it is absolutely imperative for a breastfeeding mother to continue to nurse her child while she sick….it will hopefully keep your baby from getting sick, or at least to a lesser degree.

What Can A Mother Do to Continue to Breastfeed While Sick?

When you have a cold or the flu, all you want to do is climb in bed and sleep the day away.  This is nearly impossible if you have a child in the home, whether she is nursing or not.  Here are some ways to manage those horrible days when you are completely under the weather:

Healing Chicken Ginger SoupStay as hydrated as possible, especially if you have the stomach flu.  When your fluids are low, it may cause a temporary decrease in your milk supply, which can be concerning for a breastfeeding mother.  Drink lots of water and/or coconut water (which has electrolytes!).  Have a loved one make you soup.  My favorite soup to make while sick is this Healing Chicken Ginger Soup.  Add some hot sauce to it and it will clean your nose right up.  If you are dealing with some stomach discomfort, you may want to leave out anything spicy.

Stay away from medications that dry up your sinuses (like antihistamines).  They can temporarily decrease your milk supply.  Instead, use a cool mist humidifier with eucalyptus to help open up your sinuses.  I also love the neti pot, which really clears out your nose.  Just make sure that you REALLY clean it after using it, as there were some concerns raised in the last few months. Check out this article about Safely Using Your Neti Pot. Here is an article about How to Use a Neti Pot. Ask an herbalist about which herbs are safe to take while breastfeeding to relieve your discomfort.

If you decide to take medication to help with your symptoms, check out LactMed to see if it is safe to take while breastfeeding.  You could also call your local Lactation Consultant and ask her to check the medication in Thomas Hale’s book, Medications and Mother’s Milk.

Support your own immunity.  Get as much rest as possible.  Eat a nutrient-rich diet full of Vitamin D, Vitamin B, and Omega 3s or at least take a multivitamin every day.

For more detailed information about medications you can take while breastfeeding, check out this wonderful article on Breastfeeding Basics: When a Nursing Mother Gets Sick.

Please note: there are a very few rare instances when a mother would need to stop breastfeeding due to a serious illness.  Per Dr. Ruth Lawrence, “HIV and HTLV-1 are the only infectious diseases that are considered absolute contraindications to breastfeeding in developed countries’ (Lawrence & Lawrence, 2001.)

Foremilk vs. Hindmilk: The Unnecessary Controversy

Foremilk vs. hindmilk seems to be quite a popular topic among breastfeeding mothers.  If I switch the baby too soon to the other breast, will he get the hindmilk?  How do I ensure that my baby is getting all of the fatty milk that he needs?  Sometimes I feel like too much breastfeeding information can add stress to a new mom.  And this is why….

All breastmilk, whether it is 1 minute into the feeding session or 25 minutes into the feeding session, has both foremilk and hindmilk.  As your baby drinks from the breast, she/he gets both the low-fat milk (foremilk) and the cream (hindmilk.)  The better your baby drains your breast per feeding, the more hindmilk she/he has access to, as this creamier milk hangs out back further in the milk ducts, so it has further to travel.

Here are some ways to know that your baby is getting enough breastmilk in the first few months:

• Your baby is feeding 8 or more times in a 24 hour period
• Your baby is gaining 4-7 oz. per week
• Your baby is having several wet a day
• Your baby is having several yellow-poop diapers a day
• Your breasts feel softer and more pliable after your baby feeds

If your baby is meeting the above criteria, then there is really no need to look at the clock or worry about if she/he is getting enough of the creamy hindmilk.  Follow your baby’s cues….she/he will let you know when she/he is full or ready to feed from the other breast.

Now, what if your baby has green, frothy poops, lots of gas, and chokes while breastfeeding?

Looking at these symptoms, the first question I would ask is, “Do you have enough breastmilk to feed an entire village?”  If the answer is yes, then what we are probably working with is an oversupply.   If the answer is no, then it is probably time to look into your diet to see if your baby is intolerant to something you are eating. (We will discuss this next week in a different article)

If you have a tremendous supply, your baby is probably drinking a lot of breastmilk.  Since the cream (fat) hangs out further away from the nipple, your baby has to take in more milk to bring down that cream.   When this happens, lactase (an enzyme in your baby’s tummy) is overwhelmed by the sheer quantity of breastmilk lactose it has to digest, so that lactose starts to ferment, causing gas.  By gently slowing down your milk supply, your baby won’t feel so full before she/he gets to all of the milk fat she/he needs, thereby allowing the lactase to breakdown a manageable amount of lactose.

How do you gently slow down your milk supply?

Lean back

If your baby is choking and sputtering while breastfeeding, it is possible that your flow is overwhelming her/him.  It’s like the garden hose has been turned on and there is no reprieve!  So, lean back.  Picture yourself in a lazyboy chair, with your feet up, all relaxed.  When you lean back, gravity naturally slows down your fast flow, thereby helping your baby tolerate your flow and control how much she/he is taking in at a time.  For more information on laid back breastfeeding, see our article Laid-back Breastfeeding: Physically and Mentally and the Biological Nurturing Web site.

Place your baby in an upright position

When your baby is in a more upright position (head higher than bottom) your baby can tolerate a fast flow more easily.  You can do this in many ways:

• Have your baby straddle your leg, almost sitting up, and leaning into your breast
• If your baby likes to feed in more of a cradle position, lower her/his bottom into your lap so that she/he is more diagonal (head above bottom)
• If you are using a breastfeeding pillow, place a blanket under your baby’s head so that it elevates it above her/his bottom

Breastfeed one side per feeding

Feed your baby from one breast per feeding.  This will help to gently slow down your milk supply, as your milk supply is based on how much milk is emptied at each feeding.  Now your baby will pull all of that fatty milk down through your milk ducts, thereby helping him/her to feel more full and satisfied before he/she takes in too much milk. 

Please note: When breastfeeding from one side per feeding, it is important to pay attention to your breasts.  If they begin to feel overly full and uncomfortable, you will want to offer that side to reduce the pressure.  Think of that side as dessertJ  If your baby is not hungry anymore, you may need to hand express or pump the skipped side for a minute or two, just to relieve the pressure.  Once you have been doing this for a while, your milk supply should regulate. 

Another note: Always pay attention to your baby’s feeding cues.  Around 2-3 months of age, many babies end up needing to feed from both sides again.  This means it is time to start offering both breasts during a feed again.

Herbs

Sage tea is a great way to gently reduce your supply.  Since each mother reacts to herbs differently, it is important to try this slowly.  One mom I worked with noticed that her supply decreased by 50% every time she drank sage tea, so she only drank it when her supply had drastically increased over time.  Another mom I worked with drank a cup once a week and noticed that it kept her supply in balance.  Again, pay attention to your body and work with a Lactation Consultant if necessary. 

How Can I Support My Friend Whose Baby is in the NICU?

One of my favorite blogs out there is Secrets of Baby Behavior.  This is a research/experienced-based blog written by the very talented, well-educated, all-female staff at the UC Davis Human Lactation Center.  Their latest post, Supporting Parents of Preemies: Tips for Friends and Family, really struck a chord with me and I had the immediate urge to share with you all. 

While I have never had a preemie, nor a baby in the NICU, I have had several friends who have.  This list just illuminated all of the ways I wished I could have supported them better, and the ways in which I WILL support them if the situation arises in the future.  It is unbearable to watch a friend go through the heartbreak of having a child who is not well, but at least this list shares a few tools to help in a positive way.

As a side note, one of the coolest web sites I have seen lately is Food Tidings.  This is a site we used to organize dinner drop-offs for a friend whose baby was in the NICU.  Wouldn’t it be great if we set up a schedule for food drop-offs for all of our friends who just had babies?  BEST GIFT EVER!

Please click here to read the article about Supporting Parents of Preemies: Tips for Friends and Family.

How Going Gluten-Free Saved Our Family

As parents, we believe that our children are perfect.  Yes, they can be little monsters every once in a while, but it is a tough pill to swallow when we find out that our child may have some challenges that need to be addressed. 

My sweet little Ben was born after a long, arduous labor.  We had our share of breastfeeding challenges in the beginning, but after 2 weeks we had mastered our latch and I was flowing with breastmilk.  His massive amounts of spit-up were somewhat concerning to me, but he was gaining weight, so his pediatrician was not concerned.  When Ben was 6 weeks old, I went to a local breastfeeding support group to find out why he was so fussy, gassy, and constantly puking.  The lactation consultant recommended that I remove dairy from my diet, which I did haphazardly, to no avail (obviously!) 

 While my baby boy continued to gain weight, and actually grow out of his fussy-stage, he slowly began to miss his milestnes.  We thought it was because he had an enormous brain (i.e., head), or maybe was just too content to try anything new.  When Ben wasn’t crawling by 12 months, we asked for a referral for physical therapy to help him learn this new skill.  I was also 5 months pregnant with our second, and Ben was HUGE (over 25lbs) and a challenge to lug around.  Ben finally began to crawl at 15 months.  He didn’t walk until 21 months.  He didn’t talk until well over 2 years old, although he had over 50 signs, which helped us to communicate with one another (and I will be eternally grateful for.)

But, it wasn’t just the delay in developmental milestones that concerned us; it was the unique behaviors that manifested.  Temper tantrums were an understatement…I would prefer to call them massive explosions that lasted for up to an hour at a time, usually accompanied by kicking, hitting, screaming, and rolling around on the floor.  He wore his pants backwards for months because they were ‘more comfortable that way.’  Putting on socks and shoes took over 30 minutes for Ben would scream as if they were sharp knives cutting into his skin.  He refused to ride a bike or go swimming because the helmet and bathing suit ‘bothered’ him.  These behaviors were drastically affecting our lives, in a very negative way.

I was also starting to sink into a very significant depression.  I searched for every explanation for why my beautiful son was so much more challenging than my friends’ kids.  Why was my son so unhappy?  What had I done to cause this unhappiness?  Why was it that no matter what I tried, NOTHING worked???  My husband and I took a Redirecting Children’s Behavior parenting class, but our situation was so unique that the lessons were rarely applicable.  I spent hours at Target, Old Navy, Hanna Anderssen, Tea Collection, etc. looking for the most comfortable clothes I could find, yet I rarely found ones Ben would wear.  Even therapy wasn’t working for me.  I was utterly devastated.

When Ben was almost 5 years old, I took a trip to Portland for a Holistic Practices in Lactation Workshop.  By this time, Ben had not gained any weight in 2 years, nor had he really grown in height.  He had painful bowel movements every day and his sensory challenges were debilitating.  While at the workshop, we discussed food intolerances and how they could not only affect the gut, but the emotional wellbeing, as well.  I spoke with the workshop teacher in private and asked for her guidance with my son.  She immediately asked if I would consider taking him off gluten.  I was petrified.  I forgot to mention that Ben also refused to eat anything, but fruit and gluten-laden products.  What would my son eat?  Could I add one more battle to our relationship?  At this point, though, I was willing to try anything!

With my new knowledge, I made an appointment with a pediatric osteopath as soon as I returned to San Diego.  Within 30 minutes of going over my pregnancy history (during which I was severely gluten-intolerant) and Ben’s symptoms (both emotional and physical), she recommended that I take him off gluten as soon as possible.  Fortunately, she had a functional nutritionist in the office that helped us to figure out what to eat during this elimination diet. 

When we returned home from our appointment, I began to clean out our cabinets.  Anything with gluten in it was donated to other families.  I headed to Whole Foods, picked up the magazine, Living Without, and used their handy guide to help choose the foods we would be eating for the next three weeks.  In the beginning, the elimination diet was quite costly, mostly because Ben was so picky and we had to find just the right cracker, bread, pasta, etc. that he enjoyed.  Once we found which brand he preferred, the cost went down significantly.  I also purchased a really great cookbook (Whole Family Nutrition) and found a few wonderful web sites (Gluten Free Goddess, Fine Cooks, Gluten Free Girl and the Chef).  I also downloaded Trader Joe’s list of Gluten Free products.

After 3 weeks of eating completely gluten-free, we started to see a remarkable difference in Ben.  Suddenly, there were fewer temper tantrums over getting dressed.  He started to wear a bike helmet and bathing suit.  He no longer cried while having a bowel movement.  His overall demeanor had completely changed.  The defining moment was on Father’s Day.  Ben had spent about an hour in the pool, in his new bathing suit, using a kickboard for the first time.  He turned to my husband, with an enormous grin, and announced, “Daddy, this is the best day I have ever had.”  I just started to cry.  It was the first time I could remember that my son had truly enjoyed an entire day. 

Over the past 18 months, we have still had our ups and downs.  Ben still battles with sensory integration disorder, although the symptoms have lessened drastically.  Buying ‘comfortable’ clothes can still be quite a challenge.  Ben continues to be a very skinny child, although he has put on about 5 lbs. and grown 5 inches since going gluten-free.  Ben remains to be a fairly picky eater, although he will now eat salmon, chili, and a plethora of gluten-free products.  I constantly worry that he is not getting all of the nutrients he needs.

What amazes me the most, though, is Ben now plays t-ball, soccer, and Jiu Jitsu, which all have an array of uniforms I never imagined he would wear.  On good days, we can have conversations that include compromising and problem-solving, without tears.  He is getting physically stronger and stronger every day.  And, Ben has now met and surpassed many of his developmental milestones and is one of the smartest kids in his 1st grade class. 

Most importantly, my relationship with Ben grows stronger everyday.  We appreciate and have found a new understanding for one another.  Every morning I can't wait to see his smiling face and every evening I feel blessed to have such a wonderful child as my son.  He has taught me more than anyone I have ever known.

Going gluten-free has completely saved our family and I will be forever grateful for the practitioners who helped us along this journey.

Now, why have I shared this deeply personal story on my blog? 

One, I hope that other parents who are dealing with similar issues in their families will be inspired to try alternative therapies/diets to heal their children. 

Two, I hope that I can help to remove the fear parents feel when it is suggested that they try an elimination diet. 

Three, I want to break the cycle of gluten-free diets being seen as a fad or a weight loss program. 

Four, I hope to set the foundation for a few future articles about Breastfeeding and Food Intolerances.

So, You're Going Back To Work?

A few months ago, this spunky, firecracker mama started attending our weekly breastfeeding support group and I knew from the start that she was amazing!  Over these past months, Jessica has warmed the hearts of all of the moms in the group, as well as lifted their spirits with her quick wit and sass.  Well, Miss Jessica landed this fabulous new job a few weeks ago and ended her maternity leave a little sooner than she had planned for.  I have missed her parenting insight, so I thought I would interview her about her return to work, as a breastfeeding and pumping mama.  Well, as you can see, her insight prevails!

Thanks, Jessica for your candor and advice for those breastfeeding mamas returning to work!

First day back at work

What did you do to prepare for going back to work?

Finding a good childcare provider was a huge part of overcoming my fear of returning. I don't have family here and my partner works full-time as well. I probably went to a dozen home daycares and a handful of corporate ones. You have to find someone who has a philosophy similar to your own and you feel comfortable with. As I went to providers, I discovered there were alarm bells for me: if the television was on the entire time I was there, if the provider interacted with a child in a way that I didn't like, if the terms of the contract were suspicious. I went with my gut. In the end, I found a nanny I could trust.

Breastfeeding was the surprise stressor. I was depressed I wouldn't get to breastfeed Ellie during the day and I was worried about pumping. To get used to pumping, I started pumping at home. It helped me stockpile a supply. Since I was starting a brand-new job, I made sure to thoroughly read their policies on pumping. Read the laws and understand your rights. You don't have to go in waving a boob flag or anything but you can gently inform and educate employers. Be ready to offer options like suggestions for places to pump. My employer did not know I was pumping when I was made the offer and I didn't ask any questions until I had accepted. After that, when I ran into a snag, I made sure to ask the HR rep.

What worked? Would you do anything differently?

Ask about your work schedule! The biggest surprise to me was that my employer let me have a flexible schedule. I found that getting to work by 6:30am worked very well for my family. My daughter wakes at 5AM, I nurse her and put her back down to sleep. Then I get ready and leave. My partner then takes over the morning routine until the nanny get there. My daughter doesn't have an emotional separation from me in the morning and neither do I! Then, I come home early so we can hang out most of the afternoon.

I also can't say enough about BabyConnect. It's an app on my smart phone. It tracks feeding, sleeping, diapers, medication, etc. I used it religiously before I went back to work and my nanny has the app on his smartphone as well. There is something very comforting about glancing at my phone and seeing that she went down for her nap. It tracks how much breast milk she's taking by bottle so I know if what I am pumping at work is on par with what she's eating.

What advice can you offer to a breastfeeding mom going back to work?

For breastfeeding moms, whether they plan to go back to work or not, I recommend finding a way to have a relationship with your pump. In the same vein, let your child take a bottle once in a while. You may want to leave the house one day. You might not think so in the beginning, but eventually, you will. And the more practice you and your baby have, the less stressed both of you will be.

I had a very negative relationship with the pump because of some difficulties when I first started breastfeeding but I had to get over it. I started by letting myself eat chocolate while pumping, then moved to trashy magazines. At work, I run through my to-do list for the week or look at pictures of my daughter. My point is the pump is a tool to help you continue breastfeeding.

Jessica Hilt is fiction writer that works in the technology field. In the BC era (Before Child), I hosted elaborate dinner parties, drank heavily, and stayed up late. Now I love my slow cooker, drink more water than a fish, and think 9PM is late. But it's all worth it when my seven-month-old Ellie gives me that big, gummy smile.

Also, check out Jessica's video about why she loves going to a breastfeeding support group!

Breastfeeding Multiples

Every time I meet a mom with twins, I am completely in awe of how she is functioning on a day to day basis.  While my boys were practically Irish twins, I still had mastered breastfeeding and sleep by the time my second son arrived.  So when I stumbled upon this article, 10 Tips for Breastfeeding Multiples, I just had to share with my readers.

All rights reserved by viernulvier via FlickrFor those with singletons, there are a few gems for you, like ‘find your breastfeeding cheerleaders’ and ‘set up a nursing station’…which, by the way, I like to refer to as the Breastfeeding Basket.

For those with multiples, I love that this article breaks breastfeeding down into a few critical tips to get breastfeeding off to a great start.

In my humble opinion, the only other thing I would add to this list is to find a Breastfeeding Multiples class, if there is one in your area.  While a typical prenatal breastfeeding class is helpful, one specifically for multiples should also cover breastfeeding premature babies, as well as the unique situations that breastfeeding mothers of multiples may face.

And, definitely don’t forget to:

• Pick up Karen Kerkhoff Gromada’s book, Mothering Multiples, and check out her website.
• Find a lactation consultant in your area that you can speak to prenatally, if possible.
• Find a twins club in your area

What is Weaning and When Should I Wean my Baby?

Weaning is a very personal and emotional topic for all breastfeeding moms.  My personal experience with weaning my two boys was not what I expected nor anticipated.  As my milk started to dwindle when my boys turned three months, I didn’t have the breastfeeding support or knowledge I needed to ramp up my supply.  At that time, I was not a lactation consultant.  Instead I was a full-time working mom, breastfeeding while with my son and pumping, 2 times a day, while at work. 

I was devastated that my milk supply was ‘failing’ me, but I did the best I could to eek it out as long as I could.  I made it to 7 months with my first son and to 8 months with my second son.  I had hoped to breastfeed until my boys were at least a year, but my body had another plan in mind.  I weaned as slowly as I could, for I didn’t want to let go of breastfeeding completely.  The emotional tie was too great for me to let go of.

So, what is weaning?  What does it really mean?

Some women feel that anytime the baby is sucking on something other than a breast, it is considered weaning (i.e., pacifier, bottle, complementary foods starting after 6 months).  However, in the United States, I would say that most women consider weaning to be when a mother begins to breastfeed less, with the end result being that she is no longer breastfeeding.

How do you know when to start weaning?  Is there a right time to wean?

This is a very personal decision – one which mom, partner, and baby need to figure out on their own.  I recommend to all of the pregnant mothers I work with to talk with their partners about what their goals are for breastfeeding, prenatally.  How long would they like to try to breastfeed for?  This is not something that should be influenced by family members, friends, in-laws, media, etc.  Everyone has an opinion about breastfeeding duration, but no one’s opinion is truly that important as the mother’s, partner’s, and the eventual baby.  Once this decision is made, this is now your minimum goal.  If you reach your goal and you and your baby want to continue, then keep going!  If you reach this goal and are ready to wean, then you can be incredibly proud of yourself that you met this wonderful goal of breastfeeding your baby. 

Sometimes, a woman’s body begins to produce less milk, as in my situation, before she and her baby are ready to wean.  This is definitely a time to seek out the help of a lactation consultant.  Knowing what I know now, there are quite a few ways that I may have been able to increase my supply, to help me meet that goal of breastfeeding my boys for a full year.  It is all about support and knowledge.

When a mother doesn’t feel pressure to wean her baby, her baby would most likely breastfeed for at least 2 years.  This is very biological.  Remember, breastfeeding is not only something that is done for the nutritional value, but also for comfort and illness protection. 

So, what is a good process for gentle weaning? 

What are some helpful techniques, which take into account the needs of you and your baby?

My Newborn Is So Sleepy!

How am I supposed to breastfeed my newborn, 8+ times in 24 hours, if I can barely keep her awake?

Why does my newborn fall asleep as soon as he starts to breastfeed?
How can I keep my newborn awake while breastfeeding?

These are very common questions that I get asked from moms on a weekly basis.  Newborns are so sleepy.  And if they've had a long, challenging journey into the world, they are often even sleepier!

So, what is a new mom to do to keep her little one active and efficient while breastfeeding?

In order for your baby to gain sufficient weight and to stimulate an adequate (and hopefully copious!) milk supply, your baby needs to breast feed 8 or more times in a 24-hour period.  Many newborns are very sleepy in the first few weeks, making it difficult to keep them awake to have really ‘efficient’ feeding sessions.  An 'efficient’ feeding session may be characterized by active sucking at breast for a total of 15-20 minutes, with less-vigorous sucking throughout the rest of the feeding.  You should hear swallowing throughout the feeding, as well.  Your baby should also be meeting his/her diaper counts and gaining weight that is appropriate for his/her age.

If your baby seems to fall asleep often at the breast and is not having 8 or more ‘efficient’ breastfeeding sessions 8 or more times in 24 hours, you can use the following techniques to help him/her until he/she begins to stay awake on his/her own.

Tips fo keep your newborn awake while breastfeeding:

1. Loosen his/her clothes or undress him/her down to his/her diaper.  Skin-to-skin contact will keep him/her warm while feeding.
2. Dim the lights in the room.  Newborn babies are very sensitive to bright lights and they may cause him/her to close his/her eyes and fall asleep.
3. Gently rub the palm of his/her hand with your thumb.  Babies have a feeding reflex there and this stimulation often helps to rouse them and remind them to keep feeding.  This also works if you rub along your baby's backbone or his/her foot.
4. Use breast compressions (picture squeezing your breast like an orange and holding it for 10 seconds at a time.) This should give your baby a squirt of milk in his/her mouth and wake him/her up.
5. Switch to the other breast when your baby begins to lose interest in active nursing (this is called switch nursing.)  As soon as your breast is removed from his/her mouth, this should wake him/her up.  Also, when he/she latches on the other breast he/she should get the benefit of another let-down as he/she vigorously sucks.  You can do this every few minutes, if needed.  Your baby should eventually begin to stay awake on his/her own.
6. Burp and change your baby’s diaper.  Sometimes this change of position will rouse him/her enough to go back to breast and try again.

If your baby continues to have difficulties staying awake for a full feeding at breast, it is worth it to have a lactation consultant observe your breastfeeding session.  

Most of this sleepiness is very temporary and you will be amazed by how efficiently your baby will breastfeed as he/she becomes older and stronger