How to Prepare for Breastfeeding Before Your Baby is Born

Dear SDBFC,

What should a first-time expectant mother who wants to breastfeed expect at the (big, traditional) hospital in the way of breastfeeding support? It would be nice to know what we're allowed to expect/ ask for. Should the hospital lactation consultants be sufficient or should we plan on working with an independent LC right away? Is there anything we can do before birth to help ensure smoother breastfeeding?

Sincerely,

Jenny

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Dear Jenny,

That is an excellent question, and to be honest very difficult to answer.  The type of breastfeeding support you will find at a hospital will vary greatly depending on which part of the United States you live in, whether the hospital is Baby-Friendly, its yearly breastfeeding rates, if they have certified lactation consultants (IBCLCs) on staff, and if their postpartum nurses have had recent breastfeeding training.  One hopes that the hospital lactation consultants will be fabulous, but that may not always be the case.  Also, a new mom typically won’t even see a lactation consultant in the hospital unless she is high-risk for breastfeeding challenges or she asks for one directly.

Since much of this may feel like it is not under your control, there are many steps YOU CAN make to ensure that breastfeeding gets off to a great start, regardless of the breastfeeding savviness of your hospital.

Here are my top 10 tips to prepare for breastfeeding before your baby is born:

1. Have a long chat with your partner.  Take turns discussing each person’s goals for breastfeeding and what type of support you may need from one another as a new parent.  Our article Partner Support: Can it make or break your breastfeeding experience shares different ways a partner can support a breastfeeding mom.

2. Take a fantastic breastfeeding class!  Don’t settle for the status quo.  Search for a class that not only covers the basics (latching, common concerns, how to know that your baby is getting enough), but also discusses local resources and is taught by a dynamic teacher with a background in lactation.  My favorite comment I saw on an evaluation of a breastfeeding class was, “the teacher even made my husband wish he could breastfeed!”  Now that’s a great class to attend!

3. Do some research about which hospital/newborn procedures are necessary during and after a birth.  Some hospital procedures are protocol, yet are not medically necessary for every baby, and can often negatively impact breastfeeding. 

4. Read an informative and fun breastfeeding book, such as Latch: A Handbook for Breastfeeding with Confidence at Every Stage. (Written by our very own, Robin Kaplan!)

5. Attend a breastfeeding support group, prenatally!  First, you can see the lay of the land (where to park your car, where the group is located, and if the women seem like the type of ladies you would want to hang out with.)  Secondly, you can see women breastfeeding in their ‘natural habitat’….meaning, baby on boob, minus the cover, without feeling the need to cover up.  Thirdly, you can sit next to a woman who has a newborn and ask her all of those questions about being a new mom that you have been dying to ask someone.  Last, but not least, you will feel an abundance of support for your desire to breastfeed and know that this is a safe and fun place to return to after your baby is born.

6. Come up with a ‘Visitor Policy’.  Those first few days after your baby is born are critical in establishing your milk supply and helping your baby become a successful breastfeeder.   When the entire family and neighborhood are camping out in your hospital room, it might be difficult to feel entirely comfortable taking your top off and letting your baby find his/her way to your breast.  This is YOUR time to figure out breastfeeding, not to practice breastfeeding in front of an audience.  So, decide on a policy with your partner and stick to it.  Remember, your friends should understand that this is your time to get to know your baby and that they can all come and see you once you get home.

7. Choose a breastfeeding-friendly pediatrician.  The is most likely a physician you will see more in these next few year than any other you have ever seen before.  Make sure that the pediatrician is supportive and knowledgeable about breastfeeding.   Ask to interview him/her BEFORE your baby is born so that you can make an informed decision.

8. Create a hospital-plan that will optimize your breastfeeding success.  Items to include are: rooming in, no pacifier or bottles, no formula unless medically necessary, limiting visitors, delaying your baby’s bath, and keeping your baby skin to skin as much as possible.

9. Ask for assistance from a certified lactation consultant, or a well-trained postpartum nurse, while at the hospital.  Have her check positioning and your baby’s latch.  You are paying for these services, so  take advantage of them!

10. Look for a local lactation consultant while you are still pregnant.  Spend time perusing the Internet to find a local IBCLC that seems like a good fit for you.  Attach her name and contact information to your fridge, so you can find it quickly if you need it.  This way you aren’t calling the first person you find, out of desperation, after the baby is born.

*** I know I said Top 10, but I couldn't forget to include this tip.... Hire a birth doula.  The easier your birth is and the fewer birth interventions you encounter can definitely get breastfeeding off to a great start.  Doulas can make this happen:)

Thanks for your question, Jenny!  Hope this helps!

Warmly,

SDBFC

Breastfeeding Expectations for the First Month

Do you remember what breastfeeding was like during those first few weeks after your baby was born? 

I personally remember feeling somewhat clumsy and awkward, as if my son and I were trying to master a new dance without stepping on each other’s toes.  Our rhythm was slightly off.   I constantly relied on my breastfeeding pillow and there was absolutely no dependable schedule.  I was forced to switch off my Type-A brain and learn to go with the flow, which was quite a challenge for me, to say the least!

Yet, as the months went by our breastfeeding relationship changed.  In most ways, it improved immensely, as I became a more confident mother and caregiver.  In other ways, different nuances surfaced, which taught me that breastfeeding, like parenting, is constantly in a state of motion and sometimes in need of modifications.

Listening to other breastfeeding mothers, I realized that my experience was super common.  We all found that our breastfeeding relationships with our children changed dramatically from the time our babies were born to the time they eventually weaned.  Breastfeeding a 6-week old was drastically different than breastfeeding a 9-month old or toddler, and all of the months in between.  And, what helped make these transitions manageable was knowing now common and normal these experiences truly were.

Today, on The Boob Group online radio show, I am excited to announce a NEW SERIES called Breastfeeding Expectations! 

For the next 12 months, we will be following three new mothers along their breastfeeding journeys, learning how they cope with breastfeeding challenges and settle into a breastfeeding rhythm with their babies.  Jenn, Anney, and Cherri have graciously offered to share their stories, including both their successes and their struggles, as we document what it has been like for them to breastfeed their babies.

Please click here for the first episode of Breastfeeding Expectations: The First Month

For additional resources about breastfeeding during the first month of your baby’s life, check out Breastfeeding Expectations: The First Month on The Boob Group web site.  Also, join The Boob Group Facebook Page and sign up for The Boob Group Newsletter to stay informed about upcoming episodes, blog articles, and giveaways!

What did breastfeeding look like for you and your baby during that first month?

What challenges did you face and how did you overcome them?

What did you enjoy the most during that first month of breastfeeding?

Partner Support: Can It Make or Break Your Breastfeeding Experience?

When Ben was born almost 7 years ago, I had no idea how much I would rely on my husband to be my pillar of support.  When I was gliding along my roller coaster of postpartum hormones, it was my husband who gave me space, as well as made sure I stayed somewhat sane.  He brought me water while I was nursing, ordered in dinner when we were too tired to cook, and made me laugh when I thought all I could do was cry.  He was also the person who got on the phone to call the lactation consultant when I had no idea why breastfeeding wasn’t going the way I have envisioned it. 

Breastfeeding was important to US and we knew we could make it work.

In all of my prenatal breastfeeding classes, I discuss with my students how to create a team of support, for both birth and breastfeeding.  The first and most important person on this team is mom’s partner, or as I fondly call my hubby - My Partner in Crime!  My students’ homework for the night is to discuss how THEY can get breastfeeding off to a great start. 

I recommend discussing the following questions:

• What are your breastfeeding goals (i.e., how long would you like your baby to breastfeed, will you exclusively breastfeed, etc.)?

• Will your baby receive bottles during this time?

• How would you like your partner to be involved with breastfeeding?

• What support do you need from your partner?

The last question tends to be the most difficult to answer prenatally, as it is sometimes hard to envision what breastfeeding support you will need after the baby arrives.  Also, it is hard to explain to a partner what it feels like to be the sole person in charge of meeting your baby’s nutritional needs.  Yet, I feel like it is the most important question of them all. 

In our society, when so many of us are not meeting our breastfeeding goals, our main cheerleader (often our partner) can truly make or break our breastfeeding experiences.  When a mom calls me up, with desperation in her voice, yet is unable to book an appointment with me because her partner doesn’t see the benefit of meeting with a lactation consultant, I can sense that her breastfeeding journey is going to be an uphill battle that she is fighting alone.  On the flip side, when I have a partner asking to hold the tube and syringe so that mom can supplement their baby at breast, I am confident that this mom will continue to try to overcome her breastfeeding challenges.

So, how can your partner help you to meet your breastfeeding goals?

In last week’s article, Why Aren’t Moms Meeting their Breastfeeding Goals, we talked about several different ways that society members could offer support to breastfeeding mothers.  This week, I have collected advice from a few wise mamas about ways in which their partners helped them to meet their breastfeeding goals. 

“While we were dealing with some initial breastfeeding challenges, I asked my husband to tell anyone who came over that they could only say positive things about breastfeeding.  Rather than saying that it would be ok if we gave our baby a bottle, our guests mentioned what a great job I was doing trying to breastfeed and that they were sure things would get easier soon.  I truly believe that the positive vibes in our home really helped to turn around our breastfeeding challenges.” - Sarah

“Up until my son was a few weeks old, he liked to sleep all day and party all night.  After the 11pm nursing session, I really wanted to have a few hours of sleep before we started all over again.  My partner would take our son out to the living room, watch John Stewart, and let our baby sleep on his chest until the next feeding session.  After those few hours of uninterrupted sleep, I felt like a million bucks!  It made all the difference!” – Michelle

“When our son was 6 weeks old, my sister in law got married.  The dress I was wearing required that I had to take the whole thing off to nurse my son. …probably poor planning on my part, but I LOVED the dress!   Whenever I went into the bridal suite to nurse, my partner joined me and hung out for those 30 minute intervals.  I so appreciated her company and support!” – Jessica

Here are a few other ways that partners can support breastfeeding, as well as support a new mom’s well-being, that I have stumbled upon over the years:

• Call a lactation consultant if mom is having breastfeeding challenges.  Don’t expect her to solve this all on her own.

• Bottle feed the baby in a ‘breastfeeding-friendly’ manner so that your baby will be willing to go back and forth between bottle and breast

• Set up the pump when mom is pumping often.  This just removes some added stress.

• Document your new baby’s life with photos and videos and share with family/friends through email, Facebook, and Kodak Gallery

• Soothe the baby when the baby is not hungry and doesn’t need a diaper change

• Wear the baby.  There’s nothing sexier than a baby-wearing partner!

• Massage moms’ sore neck and shoulders, or make an appointment for mom to get a massage

• Help baby to latch on to the breast, as mom sometimes can’t even see her own nipples :-)

• Make sure mom is eating healthy foods and drinking plenty of water.  Sometimes new moms forget to take care of themselves, which can really make her exhausted and lower her milk supply (i.e., cranky!)

When Should I Introduce Solids While Breastfeeding?

Dear SDBFC,

Thanks for responding to this question on Facebook the other day, but I would love to hear more on this topic: does breast milk start losing its nutritional value after 6 months? If the pediatrician states solids (in particular enriched rice cereal) twice a day are needed, are there any alternate opinions? I'm curious if the WHO or LLL have any alternate evidence.

Sincerely,

Abby

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Dear Abby,

Thank you for your excellent questions.  Solids are a huge topic of discussion in our weekly breastfeeding support group and pretty much every pediatrician in town has a different philosophy.  Here’s what the official organizations recommend:

The World Health Organization: “Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development, and health.  Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to two years or beyond.

The American Academy of Pediatrics: “Introduction of complementary feedings before six months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.”

Based on these recommendations, it is not that the breast milk is losing nutritional value at 6 months, or even a year!  It is that your baby is beginning to need additional nutrition, which is supplied by complementary foods.  Plus, complementary foods start out as little bites, not full bowls of food.  It is a very slow process.

So why do these organizations recommend delaying solid foods until your baby is at least 6 months? 

Here’s what the research says.....

1. Your baby’s digestive tract is not fully ready to accept anything other than breast milk until she/he is at least 6 months old.  This is when your baby’s intestinal tract is finally sealed against allergens and will be able to digest a greater variety of foods.

2. As stated on Kellymom.com, the pancreatic enzyme amylase does not reach adequate levels for digestion of starches until around 6 months, and carbohydrate enzymes such as maltase, isomaltase, and sucrase do not reach adult levels until around 7 months. Young infants also have low levels of lipase and bile salts, so fat digestion does not reach adult levels until 6-9 months.  When foods aren’t digested well, babies can have negative reactions (eczema, gas, constipation, etc.) 

3. Most babies don’t need iron supplementation (see our article Do All Exclusively Breastfed Babies Really Need Iron Supplementation to see if your baby is one who is at risk for anemia), so the excess iron given through iron-fortified foods (cereals) actually DECREASES a baby’s efficiency in iron absorption when given before 6 months of age.  Most exclusively breastfed babies have enough iron stored in their bodies to last for at least 6-9 months.

4. Delaying solids helps to protect a mom’s milk supply and decreases her risk of early weaning.

So, do you have to start with iron-fortified rice cereal when your baby is ready for solids?  NO!  Iron-fortified white rice cereal is almost completely void of nutritional value.  I am completely guilty of starting this with my oldest child, as I didn’t know any better, yet it was such a waste. 

Go for the whole grains and foods! 

Choose REAL food! 

What are your options for those first solid foods? 

One of my favorite websites, Wholesome Baby Food, gives a fantastic list of foods to start with your infant.  La Leche League gives similar recommendations, as well.  How much better does this list sound than boring rice cereal?

Avocado

Banana

Whole grain cereal

Pear

Squash

Sweet potatoes

Lastly, do you have to start solids the minute your baby turns 6 months old?  No.  Wait until your baby is showing signs of being able to tolerate solid foods, such as sitting up unassisted, developing a ‘pincer’ grasp, and is willing to gnaw and chew food.  For a detailed article about solid food readiness, check out Kellymom.com’s article, Is My Baby Ready for Solid Foods?,  as well as The Womanly Art of Breastfeeding.

Sincerely,

SDBFC

Do you have a question you would like answered by our lactation consultant? Please post it in the comment section, on our Facebook page, or to our Twitter Account (@SanDiegoBFC). We would love to feature it in an upcoming Help A Breastfeeding Mama Out article!

Why Aren’t Moms Meeting Their Breastfeeding Goals?

In the Pediatrics research article, Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention, scheduled for publication in July 2012, the authors conclude that most moms will not meet their personal breastfeeding goals.  According to the Pediatrics study, more than 85% of the new moms in the study said they intended to breastfeed for three months or longer, but just 32.4% met their mark.

The study found that moms who were most likely to meet their goals:

• Were married
• Had given birth to other children
• Started to breastfeed within an hour of birth
• Had babies who were less likely to be given formula or pacifiers during the hospital stay

 Of these findings, breastfeeding exclusively while in the hospital, without giving supplemental formula, was the most significant factor in reaching breastfeeding goals.

So, what were the indicators that correlated with a mother to be less likely to meet her breastfeeding goals? 

• Obesity
• Smoking
• Planning to breastfeed for longer durations

Still 32.4% of the moms in the study didn’t meet their goals of exclusively breastfeeding for 3 or more months.  The American Academy of Pediatric recommends exclusive breastfeeding for the first 6 months. 

We are failing our moms!  

Why is this happening?

Study after study has shown that new moms need breastfeeding support to be able to meet their personal breastfeeding goals.  (Cochrane meta-analysis)

So what does this breastfeedingsupport look like?

• We need peer to peer support (like a support group) where we can learn from our friends and teach one another about the lost art of breastfeeding.
• We need access to affordable and effective prenatal breastfeeding classes that are routinely promoted by our OBGYNs and midwives, so that we can increase our breastfeeding initiation rates. 
• We need capable, caring lactation support in the hospital that can assist us when we need help and guidance, and recommend local breastfeeding support for when we leave.
• We need hospital practices that support breastfeeding, like skin to skin in the first hour, even after a cesarean birth, and limited visiting hours.
• We need access to affordable, on-going lactation support, from a trained certified lactation consultant (IBCLC) starting from day one until we decide to wean our baby.
• We need our health insurance to cover the cost of qualified lactation services, just as they do with routine well-baby check-ups.
• We need pediatricians to value breastfeeding and recognize that breastfeeding will protect their patients from so many preventable chronic illnesses.  So, when a concern arises about breastfeeding, we need them to immediately share with us breastfeeding resources in the community, both free and for payment.
• Ideally, we need lactation consultants (IBCLCs) in our pediatricians’ offices so that when issues are brought to our attention at our appointments we can receive immediate and ongoing breastfeeding support and assistance.
• Lastly, we need formula companies to stop sending free formula to every new mom.  If a mom needs or wants to use formula, she can get it at any local grocery store… no judgment!  Yet, let’s not make it so easy for new moms to succumb to self-doubt.  Do you know that the WebMD article, Most Moms Don't Meet Own Breastfeeding Goals, that first shared these findings from the Pediatrics' study happens to be placed RIGHT NEXT to a HUGE Similac formula advertisement.  Seriously???

Why do I think breastfeeding support for all moms is imperative?

As a married, breastfeeding in the first hour, and ‘no formula supplementation’ mama, it was the lack of community breastfeeding support that led to me not meeting my personal breastfeeding goals and that is something I will always regret.  When my milk was dwindling as my son turned 4 months old, it was never recommended by a health professional to see a lactation consultant to increase my supply.  Why was formula an acceptable substitute for my son in their eyes?  It doesn’t make sense to me.  Why didn't this doctor recommend that I see a lactation consultant?  

My story is not unique.  I meet women every day who feel guilty for not meeting their personal breastfeeding goals.  This doesn't have to continue!

Support, support, support!  It’s what we all deserve for ourselves and our babies!  We need to make this happen NOW!

How Can I Keep Up My Milk Supply While on a Business Trip?

Dear SDBFC,

Do you have tips on your first (business) trip without the baby when you're breastfeeding and have to pump (in my case, baby will be 9 mo.)? 

Thank you!

Kristi

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Dear Kristi,

Absolutely!  Taking a business trip, when you have a breastfeeding baby at home, doesn't have to be as daunting as it sounds.

Here are a few tricks to maintain your milk supply and keep your baby comfortable while you are away from him.

1. If you have the opportunity, pump a few extra times a day for a good two weeks before your leave on your business trip.  An extra pumping session in the morning and right before bed can help to build a surplus in your freezer for when you are away.

2. Make sure your little one is used to taking the bottle several weeks before you leave on your trip.  There is nothing more frustrating for a partner or caregiver if the baby is refusing the bottle when mom is gone.  Plus, you won't have to worry about what your baby is going to eat while you're travelling.

3. Bring a double, electric pump AND a hand pump with you on your trip.  The double electric will hang out in your hotel room or accompany you to work.  This will insure that you are truly DRAINING your breasts several times a day.  Try pumping 15-20 minutes at a time, with some breast massage.  

The hand pump is great for the inconvenient times where you only have a few minutes to pump, but you want to relieve the fullness.... like on the plane or during a business dinner that went a lot longer than you anticipated.  This will help so your aren't leaking through your snazzy business blouse or exploding any shirt buttons:)

4. Create a pumping schedule that allows you to pump several times a day while you are away.  Kristi, since your baby will be 9 months old, my guess is he is probably nursing (about) 5 times in a 24 hr period.  If that's the case, try to pump 5 times in 24 hours while you are away from him.  This may mean you have to wake up once in the middle of the night to get in that extra pumping session, but it will be worth it to help maintain your supply.  Plus, this separation is only temporary!

5. Bring a small cooler with blue ice to keep your pumped milk fresh during those work hours.  Transfer it to the hotel fridge when you get back to your room.  Your milk will stay fresh for 24 hours in the cooler with the ice packs and 5-7 days in the hotel fridge.  No need to pump and dump!

Large freezer bag6. Pack a larger freezer bag that zips (think Trader Joe's freezer bags) and some extra ice packs.  This is for the ride home.  You can take all of your pumped milk back home with you.  Just store it in breastmilk storage bags, place it in the freezer bag with ice packs, and pack it in your checked bag.  No need to even have a discussion with TSA about your breastmilk:) 

7. When you get back home, my guess is that you and your little guy will want to take a mini nursing honeymoon, which means just nurse and nurse whenever either one of you wants to.  Reconnect and enjoy one another!

Warmly,

Robin

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What tricks have worked for YOU when you went on a business trip away from your breastfeeding little one?

If you have a question you would like to submit for our series Help a Breastfeeding Mama Out!, please add them to the comment section of this article, share them on our Facebook page wall, or send it through the contact link on our website.

Newborn Hands: Why are they always in the way while breastfeeding?

Oh, those sweet little newborn hands.  Such a love/hate relationship we breastfeeding mothers have with those hands.  We love to hold and kiss those sweet-smelling hands, yet when it’s time to breastfeed, those annoying little clawing paws won’t get out of the way!  The minute our breast is out and ready to feed, those newborn hands are like defensive linemen, blocking any entry into our baby’s pecking mouth.

So, what’s the deal with those hands? 

Why is it that immediately when our baby realizes he is starving, his hands get in the way?

 Fun fact #1: Did you know that your baby has been using his hands in this fashion while in utero?  Ultrasounds show babies bringing their hands to their faces before swallowing amniotic fluid.  This is actually a process in the feeding pattern, which explains why babies bring their hands to their mouths when they are hungry. 

Fun fact #2: Did you know that if your baby’s face is not touching your breast as you initiate a breastfeeding session, he will use his hands to find your nipple?  Newborns have incredibly poor eyesight and use all five senses to locate and latch on to the breast.  Those little hands are searching for your breast to help bring it closer to his mouth.

So, what’s a mom to do when her baby is crying to eat, yet his hands are blocking every chance she has to put her breast in the baby’s mouth?

• Let your baby suck on his fingers to calm himself at the breast.  When he moves his hands, he is already at the ‘restaurant’ and will be ready to breastfeed.
• Try not to tuck your baby’s hands under his body or swaddle him while breastfeeding.  Tucking his hands can disorient him.  Think about if you were trying to eat with your hands tied behind your back.  You would most likely feel off-centered and clumsy.  Babies need their hands to keep them stable, just like we need our arms to our side or in front of us when we eat.
• If you have sore nipples and the thought of your baby clawing them makes you yelp just thinking about it, then keep your baby’s face touching your breast.  Try laid-back breastfeeding to assist with this.  In this position, you can wrap your baby’s hands AROUND your breast and he will come in with his face instead.
• Catherine Watson Genna, one of the most amazing lactation consultants I have ever met (and also the head researcher in an infant hand-use while latching study) recommends this technique in the Lactation Matters article, An Interview with Catherine Watson Genna, “Sometimes babies do get caught in a ‘reflex loop’ of sucking their hand, moving away, and then sucking their hands again. Moving the baby slightly so his face touches mom’s breast can interrupt this loop and get the baby to move his hands away and look for the breast with his mouth again.”  More information can be found in her article, Facilitating Autonomous Infant Hand Use During Breastfeeding

So, maybe those roaming little hands are actually helping our babies to become better breastfeeders.  Who knew?

Why Does My Milk Smell Sour?

Dear SDBFC,

This weekend my hubby wanted to give our son a bottle, so I thawed some milk that was pumped mid-February (2 months ago). When I was putting it in the bottle it smelled sour like spit-up. Why is that? He still ate it and it didn't make him sick. Is my milk bad? That was the oldest milk I have so I thought it would be fine still.

Thank you!

Natalie

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Dear Natalie,

There are many reasons why your milk may smell sour.  

Storage

What are you storing your milk in?  Sometimes the breastmilk storage bags can let in smells from the freezer, which may make your milk smell less than desirable.  Try storing in air-tight glass containers to see if this helps.  Also, store your milk in the back of the freezer, rather than the door, so that the milk doesn't defrost as the freezer door stays open.  For terrific information about milk storage guidelines, check out Mother and Child Health's article: Storage and Handling of Breastmilk.  

Excess Lipase

Your milk may have excess lipase in it, which can cause stored breastmilk to smell sour or soapy.  Lipase is a beneficial enzyme found in breast milk that helps break down milk fat.  If your breastmilk has excess lipase, the longer the milk is stored, the stronger the smell becomes.  The milk is totally safe for the baby to consume, but some babies may reject the milk because of its strong scent and change in flavor.  To break the cycle of the excess lipase, you can scald your milk after you express it, so that you can store it and use it at a later date.  Here are two great resources, one by Christina Williams and one by Simply Rebekah,  about scalding breastmilk to get rid of excess lipase.

For a more detailed explanation of excess lipase, check out Kellymom's article: My Expressed Breastmilk Doesn't Smell Fresh.

Natalie, as long as you are following proper breastmilk storage guidelines, sour milk doesn't always equal spoiled milk.  Hope these resources help!

Warmly,

SDBFC

What Can I Do About My Fast Let-Down?

Dear SDBFC,

What are some good nursing positions if you have a fast let-down?

Sincerely,

Alanna

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Dear Alanna,

When moms have a very fast let-down, babies often have difficulties tolerating the fast and furious flow.  Some choke and sputter at the breast.  Some pull off and get sprayed in the face.  Others pinch down on the nipple, as if trying to put a kink in the water hose.  All of these can cause somewhat uncomfortable feedings for mom and baby.

So this is what you want to do.... Work with gravity!

Recline and lean back

When you lean back, it can slow down the flow a bit, making it more comfortable for your baby to feed. Place a pillow behind your back on the couch or your diaper bag behind you while nursing in public.  Then slide your bottom to the edge of your seat and you are now reclined.  

Position your baby in a diagonal or upright position

When your baby is laying on his side, it is hard for him to coordinate his suck, swallow, breath when the milk is pouring into his mouth.  Think about it... have you ever tried to drink a glass of water laying down on your back?  I'm choking just thinking about it!  So, sit your baby up a bit and let gravity help him as well.  This works well when the baby is facing tummy to tummy, either sitting in your lap or somewhat diagonal.

Sidelying

Now, I realize that this goes somewhat against the above two suggestions, since you are no longer reclined and baby is now on his side, but check this out.  When you feed in the sidelying position, any milk that cannot be swallowed by your baby can just slide out of his mouth, while he is feeding.  Sure, your bed or couch might get a little wet, but just place a towel under the two of you and nurse away!

For more information about this topic, check out our recent article: Foremilk vs. Hindmilk: The Unnecessary Controversy

For other terrific photos of laid-back breastfeeding, check out the Biological Nurturing Web site.

Do All Exclusively Breastfed Babies REALLY Need Iron Supplements?

When I read a policy statement from the American Academy of Pediatrics stating that exclusively breastfed babies need to be supplemented with iron starting at 4 months, I have to wonder…

Are they saying that my perfect nutrition for my baby is no longer PERFECT? 

Are they saying that what my body produces is suddenly SUB PAR? 

This caused me to do a little research.  What IS the deal with iron in breast milk? 

Does my 4 month old really need those nasty-tasting drops?

According to my research, I found that not all exclusively breastfed babies need iron supplementation.  In general, babies are born with enough iron in their system to last at least 6 months, of not until they have tripled their birth weight. (Riordan and Wambach, Breastfeeding and Human Lactation)  According to the Womanly Art of Breastfeeding, there is not a lot of iron in breast milk, yet there is not supposed to be, as it is more completely absorbed from breast milk than in supplements or formula.   Also, breast milk contains a protein, called lactoferrin, which binds to the extra iron that the baby cannot use, keeping it from feeding harmful intestinal bacteria.  Iron supplements, for a baby who is not iron-deficient, can often overwhelm the lactoferrin, causing an overgrowth of intestinal bacteria, resulting in diarrhea and possible microscopic bleeding.  WHAT???

And, my biggest RED FLAG went off when I found a Letter to the Editor of Pediatrics, called Concerns With Early Universal Iron Supplementation of Breastfeeding Infants.  In this article, the executive committee of the Breastfeeding Section of the AAP states that they have “major concerns about universal iron supplementation at 4 months in breastfeeding infants” and that the authors of the above policy “acknowledged that this report was submitted for review to the AAP Section on Breastfeeding, but they did not mention that we disagreed and provided our additional recommendations 2 years ago.”

HMMMMM!  So, clearly my breast milk is much more perfect than the AAP was trying to make it sound and universal iron supplementation of exclusively breastfed babies over 4 months is NOT ideal.

So, how would you know if your baby actually needs iron supplements?

Which babies are more at risk for iron-deficiency anemia? (according to www.kellymom.com)

• Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
• In addition, there is evidence that babies whose birth weights are less than 3000 grams – about 6.5 pounds – (whether term or premature) tend to have reduced iron stores at birth and appear to need additional iron earlier.
• Babies born to mothers with poorly controlled diabetes.
• Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not anemic during pregnancy.
• Babies who are fed cow’s milk (instead of breast milk or iron-fortified formula) during the first year of life.

If your baby falls into one of these categories, you have the right to ask for your baby’s hemoglobin to be tested for anemia, rather than automatic iron supplementation.  And, if your baby does test positive for anemia, there are many Iron-only drops that you can give your little one.  No need for that multivitamin because your breast milk has all of those vitamins already in it!

In addition, when your little one is over 6 months and ready to start solid foods, consider those with a healthy dose of iron, like the ones listed on one of my favorite baby food sites, Wholesome Baby Food.  No need to try that boring white rice cereal, just because it is fortified with iron!