Top 6 Tips for Protecting Your Milk Supply While Traveling for Work

We had this terrific question posted on our Facebook page:

“Dear Robin,

I leave tomorrow for a four day work trip and I can't take my baby with me. She has 6 feedings a day (one of those at night) so I'll be doing a good amount of pumping while I'm gone. Do you have any tips, specifically for pumping at airports and/or on planes? I'll be on a red eye there and a direct flight on the way back.”

Absolutely!  Just because you have to travel for work doesn’t mean that you can’t protect your milk supply while you are gone.  

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Here are my top 6 tips for protecting your milk supply while traveling for work

Freemie Collection Cups

1. Pick up a few insulated cooler bags with a zipper, like this one from Trader Joe's, with several blue ice packs, from Rubbermaid, to bring with you in your check-on luggage.  When traveling for more than a day or so, you may have a lot of pumped milk to bring home with you.  Using insulated cooler bags with ice packs will allow you to bring all of that liquid gold home with you, without having to lug it through security.
2. Call your hotel before you leave home to ask if there is a fridge in your room.  If not, you can request one and that is where you will place all of your pumped milk while on the trip.  Store your milk in breast milk storage bags so that you can fit a lot of them in the insulated cooler bags on the way home.  Also bring a small cooler with ice packs to store pumped milk when you are away from your hotel room.
3. Depending on the length of your flight, you could either skip the pumping session and just make sure to pump extra long when you arrive in at your destination.  Or, you could bring a nursing cover, your pump pieces, and a battery pack and pump while on the flight.  On the red eye, this should be easy, since it will be dark.  On the daytime flight you might ask the flight attendants if you could sit in the back in one of their seats so that you have a bit more privacy.  If you are going to pump on the flight, bring a small cooler with you with blue ice so you can save your pumped milk.  You could also just pump right before you get on the plane and then completely forget about pumping while on the flight.
4.  Invest in some Freemie collection cups.  These cups are amazing!  You can pump with your shirt on and no one will know what you are doing!  They are incredibly discreet and hold up to 8oz per cup.  These are great for on the plane, in the cab, and in between meetings.  
5. Try to pump every few hours, and once at night if your baby is still breastfeeding in the middle of the night, to keep up your milk supply for when you get home.  If your meetings are in a conference center or hotel, ask the concierge if there is an open room that you can use (NOT A BATHROOM) to have some privacy while pumping.  Aim for pumping for about 15 minutes, which is about as long as it will take your co-workers to enjoy a coffee break.
6. Do some research ahead of time to see if the airport you are spending time in has a Mother’s Room, Nursing Room, or Pumping Room.  Download the Mamava app to find publicly placed Mamava Lactation Suite in United States airports.  

Mamava Lactation Suite

Support Group or IBCLC: What's the Difference?

When a mom is looking for breastfeeding assistance, it can often be difficult to know where to get this help and from whom.  There are so many options…. Facebook, breastfeeding support groups, lactation consultants… where to go can be confusing, especially if she feels like she needs to get help immediately!

So, what is the difference between the breastfeeding help you will get at a support group and at a private lactation consultant visit?

What you can expect at a breastfeeding support group:

Let me preface this by saying that not all groups are the same and it really depends on the level of expertise of the person running the group and how busy the group is.  There are different levels of experience and training in the field of lactation, depending on how many hours a person has spent in class and in an internship.  The level of expertise are demonstrated by the letters that follow the person’s name (IBCLC, CLC, CLE, etc), which is all explained in this fantastic article, What’s the Difference Between LC, IBCLC, CLE, etc?

At a breastfeeding support group, you will find a leader who is there to offer general breastfeeding assistance and support.  This leader can assist with positioning and latch (although often times this leader will not be able to actually touch you or the baby), basic information about normal breastfeeding/pumping strategies, normal baby feeding patterns, normal baby weight gain, breast and nipple care, and ways to maintain and protect your milk supply.  Often times there is a scale where you can weigh your baby before and after a feeding to see how much your baby is taking in (which is AWESOME!)  Attendance at the support group can range from a few moms to over 20, depending on how big the space is and how well attended the group is.  Support groups are often free, depending on where you live.  Support groups are fantastic for getting basic breastfeeding support, getting help while you wait for an appointment with an IBCLC, meeting other breastfeeding moms in your community, and practicing breastfeeding outside of your home.  

What you will not receive at most breastfeeding support groups is a personalized plan of care for difficult breastfeeding situations.  To create a personalized plan of care, a mother and baby’s medical history need to be discussed, as well as mom and baby both need to be assessed, which requires a consent form.  Therefore, most advice given at a breastfeeding support group is general, not specific for mom and baby’s personal situation.  

What you can expect at a private lactation consultant visit:

If you are meeting with an International Board Certified Lactation Consultant (IBCLC), you are now moving from general advice to a personalized assessment and plan of care.  The IBCLC should conduct a suck assessment on your baby, collect medical histories of both you and your baby, assess a feeding session, and offer guidance on how to improve your personal breastfeeding experience.  

Reasons you would want to see an IBCLC rather than just attend a support group:

• Cracked, bleeding nipples

• Painful latching that isn’t improved with positional changes

• Baby not gaining weight well

• Mom’s milk has not come in by day 3-5

• You suspect your baby has a tongue tie and/or lip tie

• Baby has signs of colic or reflux

• Mom has a low milk supply/supplementing baby

• Mom has an oversupply

• Premature baby

• Challenges with breastfeeding multiples

Each of these situations requires that someone provides a medical assessment and advice beyond what’s normal or typical with breastfeeding, therefore, it goes beyond what a mom can seek help for at a support group.  These private visits can take place in mom’s home, in the IBCLC’s office, at an outpatient clinic, at a medical practitioner’s office, or similar places.  Most of the time these visits have a fee associated and sometimes insurance will pay for these visits.

Where you can find an IBCLC in your area:

• Ask your friends

• Ask your baby’s pediatrician

• Search for a local breastfeeding coalition

• Call the breastfeeding warm line at the hospital or ask your midwife/OBGYN

• Ask your WIC Peer Counselor

• Search for an IBCLC in your area on the ILCA website

• Google “IBCLC” and the name of your town or city

• Ask for a recommendation on Facebook

• Attend a support group led by an IBCLC

Where have you found breastfeeding support in your neighborhood?  

Was it easy to find this support?

Positive Breastfeeding in Public Stories

Written by Ashley Treadwell, IBCLC

So much of what we hear about feeding our babies in public is negative - stories from women being harassed and shamed for breastfeeding in public.  While we believe that it is so important to respond to these incidents and educate people on the importance of normalizing breastfeeding, we also think that one of the best ways we can empower women is to share our positive experiences as well.  Below is one of many examples of wonderful responses women receive while feeding their babies in public - meet Briana!

"So I'm at Ross today with the toddler and baby when baby gets fussy and hungry. I let the kiddo try on big girl shoes in the ladies dept while I nursed baby. But a woman and her 'tween came down our aisle and hovered. I wasn't covered up and panicked for a second thinking that this may be my first altercation regarding NIP.

NOPE. The super sweet lady said I was doing a great job--and the most important one. She breastfed all 3 of her babies. I felt such a sense of connection and gratitude. I had a hard time not crying and hugging her.

I've never had anything but support from family, friends and strangers, but this was really touching today.

Just wanted to share a happy story, and write a little blessing to the wonderful woman who made my day. May she feel the love that I felt from her today, every day."

Do you have a positive breastfeeding in public experience to share?  Please send it to us at ashleytreadwell@sdbfc.com

Breastfeeding at 3-4 Months - It Can Look Very Different!

Written by Ashley Treadwell, IBCLC

Running two support groups every week, I get all sorts of questions from moms with concerns about their breastfeeding babies.  One of the questions/concerns I hear the most often is this: “My baby is suddenly not feeding for nearly as long as they used to and they aren’t interested in feeding as often.  They get fussy easily at the breast and pull off after just a few minutes.  I’m concerned that they aren’t getting enough milk from me!”  I can almost always predict the age of these babies - somewhere around 12-16 weeks.  And here’s why.

Many moms know that babies feed frequently in the early weeks.  They expect feedings around the clock that can last quite a while.  What many moms don’t realize is that this *can* change dramatically around the 3-4 month mark.  Babies who used to feed every 1 to 3 hours, for 30 minutes or more, babies who were always happy to breastfeed when offered - suddenly start refusing the breast at times, and when they do accept, may only feed for a few minutes before pulling off.  This can be a frustrating time for moms as they are often concerned that the baby may not be getting enough and are worried about this significant change in baby’s feeding patterns.  In this article, we’ll discuss why this happens, how to know if there is reason for concern, as well as how to manage this new behavior.

Why is this happening?

While it’s great to know that this behavior is normal, many moms want to know why their baby’s breastfeeding behavior has changed so much.  Much of it has to do with developmental changes that occur as baby grows and matures.  One reason the length of a baby’s feeding may shorten significantly is simply that baby is becoming more efficient at the breast - meaning she/he can get more milk out in less time.  This can be hard for moms to believe, so visiting a support group where you can do a weighted feed to see how much baby is taking is a great way to confirm this!  I can’t tell you how many moms come to my groups and are amazed at how much their baby can take in only 5-10 minutes.  Another factor is baby is experiencing a huge developmental leap at this time...  awareness of his/her surroundings is exploding.  Suddenly, your baby will notice the plant in the corner, the dog chasing it’s tail, the freckles on mom’s nose!  Everything is so new and exciting, babies are often too distracted to breastfeed.  They may go hours between feedings, and when they do go to breast, they will often pop off frequently to look around and interact with their surroundings.  

Should you be concerned?

If your baby has breastfed well up to this new stage, if weight gain has been within normal limits (4-7oz per week), and they are having the appropriate amount of wet and dirty diapers, you can rest assured that this is all normal behavior and your baby will not go hungry.  It is very uncommon for a baby who has gained weight well to suddenly start to have difficulties.  Yes, your baby may take in less during the day if they’re distracted by all that goes on around them, but they will make up for it in other ways.  Baby may start to wake more at night, asking to feed, to make up for the milk he/she missed during the day. This is one of the reasons that we don’t recommend night weaning at this time - your baby might need those middle of the night feedings! But don’t worry, tired mama, this won’t go on forever.  

• The signs to look for that will tell you that all is fine are as follows:

• Baby is having the appropriate number of wet and dirty diapers

• Baby is meeting the age-appropriate milestones

• Baby is gaining at least 4oz per week.  

While you may not know what your baby’s weight gain looks like in between doctors’ appts, you can visit a weekly breastfeeding support group to monitor baby’s weight on a weekly or monthly basis and be sure that he/she is gaining appropriately.  

What can you do?

• Offer your baby the breast when he/she shows signs of wanting it, but don’t worry too much if he/she don’t take it, or doesn’t feed for as long as she/he used to.  

• A couple of times a day, try to feed your baby in a dark, quiet place with fewer distractions.  

• Consider purchasing a nursing necklace so that your baby has something to play with while breastfeeding.  It will help keep your baby’s attention on you rather than the ceiling fan above your head.

• Try nursing in a carrier, which provides a nice, quiet, distraction-less space on the go.

• When your baby wakes at night, respond to him/her and breastfeed, as he/she may need these feedings now more than ever.  

• But mostly, relax!  Enjoy the shorter feeding periods and longer stretches between them.  Have fun with your baby as he/she explores his/her surroundings and learn about the world. Trust that your baby will let you know when he/she is really hungry and follow his/her lead!

 Here are a few more resources about breastfeeding a 3-4 month old:

Help a Mama Out: Tips for Breastfeeding the Distracted Baby

I've Had My Baby - Now What? Breastfeeding During Months 2-6

The Boob Group: New Mom Breastfeeding Manual 2-6 Months

Breastfeeding... It has to get easier, right???

When I started working with Galit 10 1/2 months ago, I knew immediately that she would be one of the most dedicated, hard-working, and comedic mothers I would ever encounter.  Her breastfeeding journey has been wrought with painful nipples, engorged breasts, and twins who had difficulties transferring milk.  It has also been blessed with sweet moments of tandem nursing, gaining an abundance of milk, and confidence to overcome any challenge that lay in her path.  Happy 1st birthday to your adorable boys, Galit, and happy 1st nursiversary to you!  You continually inspire me!  

Here is Galit’s story, in her own words!

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I had twins at 37 weeks 3 days who were 5.5 and almost 6 lbs (FRIGGING AMAZING) after preterm labor at 23 weeks and 4 months of bed rest!  I wanted nothing more than to provide for them and ensure their health. Breastfeeding started out pretty rough.  My colostrum was hard to obtain and milk took forever to come in.  We were told to supplement with formula to keep them out of the NICU (they lost weight after birth, as all babies do), so we obliged. We went home with two healthy boys after 4 days and they were with me the entire time!

For several weeks, we used a gloved finger-straw-tube thing to help the boys practice sucking.  Then, out of desperation and exhaustion, we switched to a bottle and for several months (yes, months), we had to pull their chins down to help them open their mouths wider and also tilt the bottle up and down to simulate the natural flow of breast milk. No one was really capable of helping my hubby and I because there was just too much to remember.

My schedule was: nurse one baby, nurse the other, supplement both with bottles with as much breast milk as I could pump, then another separate bottle with formula (we were told not to mix breast milk with formula.  We tried several organic versions before finding one that worked for us), then pump. Between pumping 8+ times a day and nursing 10-12 times a day, I had between 10 and 25 minutes to eat OR to sleep at a time, around the clock, for almost two months. Ugh. I was always hungry and tired. If someone didn’t put food in front of my face, I didn’t eat. Great diet plan, aside from the feeling of extreme hunger, lack of energy, and need to consume extra calories to help my body make milk! 

After a couple months of serious struggles with nursing, we were desperate. The boys both had extremely tight frenulums (tongue ties), hampering their sucking abilities and leaving them very inefficient (45 minute feeds to take in less than an ounce), and me in incredible pain due to their pinching. We were told to have them clipped to allow their tongues to work better (ouch, but not too bad). This didn’t do enough (the frenulums were posterior and thick), so several of our doctors recommended we have them lasered (under their tongues and under their upper lips). Holy hell, this sucked so hard!  Then, worse, for a month and a half after the laser (until they healed), we had to stretch their wounds every time they ate. They cried. I cried. It was a very hard decision and experience, but we did what we thought would be best for our babies, for nursing, and for other reasons. So we resorted to these “drastic” measures. They eventually healed and can do all sorts of things with their tongues now! Oh the trouble they will get into some day. 

When they were about a month old, I got mastitis. I thought I was dying. The pain, all over my body, was horrible. I cried all the way to the hospital (and I’m not a crier when it comes to physical pain) and got antibiotics.  It took about four days before I felt okay enough to try breastfeeding again. I was in so much pain I couldn’t handle the babies biting/pinching, so I was only pumping. So much pumping. My parents (and in-laws) came to help care for the boys, as I couldn’t even hold them. 

Then, thanks to the antibiotics, I think got thrush (a yeast infection in the nipples. I had never had a yeast infection before, thus I am conjecturing that antibiotics was the cause).  I didn’t show any symptoms, aside from what I called “fire needle nipples.” The pain went all the way up to my armpits.  This lasted for 3.5 months. AAACK!  We had to sterilize everything, including pump parts, bottles, bras, and even my boobs(!) all the time.  My attempt to destroy thrush was energy and time consuming, to put it simply. I continued to sterilize everything after each use until I stopped pumping (at over 9 months). I still change nipple pads several times a day.  I’m so very thankful the boys never showed any signs of thrush, as I probably would have gone cuckoo! 

I ended up getting mastitis again a few weeks later (OMG!).  Thankfully, Robin came to my rescue with her “mastitis protocol.”  I healed within 1.5 days, with NATURAL supplements, pumping, massage, heating pads, hot showers, etc. without antibiotics! YIPPEE!  In total, I’ve had mastitis 10 times (WTH?), 5 of them pretty bad, leaving me mostly dysfunctional. Damn you, Plugged Ducts!  I know how to deal with it now (phew!). I worked for months to restore my milk production to the level it was before infections and scar tissue hampered my supply. I still produce less on the left side, as compared to my right; however, I still made enough to feed both my boys! 

In addition to dealing with mastitis and thrush, I had severe breast (and surrounding area) pain, for several weeks.  I was mostly pumping and wasn’t nursing more than once or twice a day due to the intense discomfort (So. Many. Bottles.). I discovered I have vasospasms but, thanks to Robin’s protocol, the pain is now gone! Thank goodness for Robin.  Phew!  My daily supplements can fill an aisle at Sprouts, but at least they are all actually helping, homeopathic, and aimed at health rather than disease. 

Big milestone: at about 3 months, I realized the boys were only being bottle supplemented with MY milk. I was finally producing enough to feed two growing boys and we were off formula! HOORAY!  From 3 – 5 months, I was weighing the boys before and after each breastfeeding session to see how much they were taking in (as if I wasn’t doing enough already).  We rented a scale from a local hospital to make sure the boys were eating enough.  Then one day, at about 5 months, I looked at their thighs and BAM!  I noticed they were chunky monkeys!  We immediately returned the scale! SCORE!  

At 8.5 months, we were meeting and overcoming new “opportunities for growth.”  These “opportunities” have slowed greatly, but they still come.  With 4 new teeth, one of my boys bit me. Hard.  I instinctually yelped, so he cried. I soothed for 5 minutes and we tried again.  He bit again. Hard. I yelped (no self control) and he cried harder, longer.  15 minutes later we tried again. Guess what happened? He bit. Again. I yelped (OMG control yourself, Mama!) and he was hysterical, hungry, and absolutely refusing to nurse, for 45 minutes. I gave him a little bottle of my pumped milk to calm him and his belly and put him down for a nap.  I was sure he would never want to breastfeed again.  Thank the heavens, as my hubby suspected, when he awoke, our baby had forgotten the morning ordeal and all was normal again. PHEW!  

So, was all this craziness, horrible frustration, and extreme pain worth it? HECK YES!!! So far, my boys have always been healthy!  In their whole first year, they’ve never even had a sniffle! Holy cows!  I’ve had two colds and my hubby had three! Was it the breastfeeding?  I’d like to think so. In addition to their health being friggin amazing, we get some great bonding time. I pet their heads, they give me smiles, hold each others’ hands, and sometimes giggle while nursing. They eat 3 solid food meals a day now, and I nurse them 5 times a day as well. The enzymes, antibodies, and good stuff my milk provides for them is so important.  Breastfeeding is just the BEST and I’m SO grateful my body has provided. 

We’re learning, growing, and laughing so much every day. We’ve hit the latest “golden age” of our babies and are enjoying each moment.  It’s just amazing. 

Do's and Don’ts of Using the Nipple Shield

Written by Robin Kaplan, M.Ed, IBCLC

Is your baby having a difficult time latching?  Is breastfeeding incredibly painful?  Do you have a cracked nipple that just won’t heal?  Then most likely you have been recommended to try a nipple shield.  While the nipple shield can often be a terrific temporary tool to help with these situations, it is important to know how to use them correctly, as well as have an exit strategy for how to discontinue usage as soon as possible.

What is a nipple shield and why is it used?

A nipple shield is a thin piece of silicone that is placed on your nipple so that your baby can feed at the breast.  For the baby who cannot latch on easily (due to prematurity, difficult birth, tongue tie, etc) the nipple shield provides a definitive shape for mom’s nipple, making it easy to latch onto.....all baby has to do is open his/her mouth and start sucking.  For the baby who is compressing mom’s nipples while breastfeeding (due to a tongue tie, lip tie, torticollis, receded chin, difficult birth, etc.) causing pain and cracked nipples, the nipple shield provides a temporary barrier so that the baby can still breastfeed while allowing mom’s nipples some relief and time to heal.  Sometimes the nipple shield is offered to a mom just because she has flat nipples.  In most cases, this isn’t really necessary, since a baby who latches on deeply doesn’t care whether mom has flat or erect nipples.

Is there a correct way to use the nipple shield?

YES!  Just as with the baby who latches on to the bare breast, when a baby is latched on with the nipple shield, he/she will only be able to stimulate mom’s milk, keep up her milk supply, and effectively transfer milk if he/she has the entire nipple shield in his/her mouth.  If the baby is sliding off and on the nipple shield while feeding, the baby will not be able to transfer milk well and can also cause mom a lot of nipple pain.  

Depending on how long your nipple is, you might have to invert the shield before putting it on, so that your nipple goes further into the shield before latching your baby.  Our DIY Breastfeeding YouTube Video, Latching: Using a Nipple Shield, demonstrates how to do this.

What are the pros and cons of using the nipple shield?

Pros:

• Mom’s nipple has an opportunity to heal without having to introduce a bottle too early to her baby.
• Premature babies who have not yet become super coordinated at latching on to mom’s bare breast and who tire quickly are able to breastfeed more easily.
• Babies who are unable to latch onto mom’s bare breast, for a variety of reasons, are able to breastfeed while the underlying challenges are addressed.

Cons:

• Babies may not be able to effectively transfer milk using the nipple shield, so baby might need supplementation even if mom’s milk supply is able to meet his/her need.
• Mom’s milk supply could potentially decrease if baby isn’t effectively stimulating her milk supply.
• Mom might get recurrent plugged ducts and/pr mastitis due to ineffective milk drainage.
• Babies can become very dependent on the nipple shield, which can make it difficult to wean from.  This can make breastfeeding in public a bit of a challenge.

How can I wean my baby from the nipple shield?

Babies can become very obsessed with the nipple shield, so sometimes it can be challenging to wean them from it.  This is why you always want to have an exit strategy.  

• If you are using the nipple shield as a temporary band-aid while your nipples heal, try to use it for only a few days and maybe not for every feeding.  If one side is less damaged than the other, only use the shield on the more damaged nipple.  
• If you are using the nipple shield to help with latching difficulties, attempt each day to latch your baby without it.  You never know when he/she is going to figure out how to latch without it and the daily practice should help speed up that process.  Sometimes moms find it helpful to latch the baby with the nipple shield at the beginning of the feeding and then try the ‘bait and switch’ move to encourage the baby to latch back on without it once he/she has a little milk in the belly.
• If you are using the nipple shield due to baby’s inability to breastfeed well because of a tongue tie, lip tie, general chompiness, torticollis, etc., you absolutely want to schedule an appointment with a lactation consultant to help remedy these underlying issues.  The use of the nipple shield might help temporarily, but it may increase your risk for breastfeeding challenges later on, which can be more difficult to fix as the baby gets older.  A great IBCLC should be able to assess what is causing these breastfeeding challenges, as well as provide you with other practitioners who can help remedy the situation, such as an ENT, pediatric dentist, chiropractor, craniosacral therapist, etc.

American Airlines: Please change your policy about checked pumped breastmilk!

A few weeks ago, the San Diego Nursing in Public Task Force was contacted by Theresa Morawski Pulickal about an incident she needed help resolving with America Airlines.  Theresa has already done an amazing job advocating for herself and almost completely resolved the situation she had with the airlines, but she needs your help to change American Airline's policy regarding transporting breast milk.  She doesn’t want another mother to have to deal with the challenges she dealt with a few weeks ago. 

Here is her story.  

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I am trying to change an American Airlines policy after an experience I had traveling from Puerto Vallarta to Phoenix to San Diego a few weeks ago. While in Puerto Vallarta, I pumped breast milk for my child home in San Diego. He was not traveling with me. At the Puerto Vallarta airport I was told by the TSA agents that I could not carry my breast milk on the plane. I tried to tell them that the rules in the US state that it's okay to carry pumped milk onboard the plane and it could be tested, but they gave me a firm ‘NO’. I took my breast milk coolers to America Airlines (AA). I told them I was told to check my breast milk by the TSA agents. The American Airlines ticket agent generated a check bag tag and said it would cost $499MXN pesos. I asked if the could be waived, as it is breast milk. I told them I was not expecting a fee. They said, no, because the baby was not with me and that it was company policy to charge a fee and that he (the AA Agent) didn't agree with it either, but had to charge me.  I paid the fee, as it was very important to me to bring home my milk. I checked the bag to Phoenix. In Phoenix, I spoke to the AA customer service representative. The agent told me that they should not have charged me for the bag in Puerto Vallarta, but he was unable to reimburse at his location. He told me there is no one to call and I would have to make a claim online through the comment/compliant website. I picked up my bag and went through TSA in Phoenix to San Diego with no problem. They looked at my milk and tested the cooler bag. I was allowed to carry on. 

When I got home, I submitted a complaint on the AA website and I posted my experience on Facebook, Twitter, and Yelp. 

The next day I received a call from Jana at AA’s customer relations explaining she was contacting me due to my social media posts.  She reiterated that AA’s policy is that you only get a free bag only if the child is along with you for travel and that milk is not considered a medical necessity so it does not qualify to be free. I asked how I could get the policy changed and she said I had already voiced my concern and it was now being handling internally.  I was offered a $50 voucher (that I did not want) and instead asked her to follow up with the policy change. 

I posted my updated status on Facebook.  Later I received a message through Facebook saying that AA will reimburse me for the bag in 7-10 days.   I wrote back thanking them for the reimbursement, but asked if this could lead to a policy change. I received a generic message saying they appreciated my feedback. 

Last week, I received a formal letter from American Airlines’s customer relations stating that they had done a thorough investigation of my incident.  The letter included this paragraph: “We apologize for the inconvenience caused when you were unable to carry-on your breast milk with you from Puerto Vallarta to Phoenix. Our customer service personnel are expected to be knowledgeable of our baggage policies including information about exempted articles such as medication and other assistive devices. Please accept our sincere apology for our service failure as well as any resulting anxiety or inconvenience this may have caused you.”  I was then offered a full refund for my checked breast milk bag. 

After I received this formal email, I called back to clarify American Airline’s policy and was told by the agent that a fee would still be charged if breast milk is checked because it was not considered a medical necessity.

While I am very appreciative that American Airlines worked so quickly to resolve my incident, I would like to take this opportunity to ask American Airlines to change their baggage policy with regards to checking pumped breast milk.  I am reaching out to other mothers and advocates of breast feeding/pumping/nursing to get this policy changed. I feel that even though my child wasn't with me and TSA wouldn't allow my breast milk to be carried on that American Airlines shouldn't be charging a fee to check pumped breast milk.  I think it should be free, just like a cane, a diabetic’s insulin, or an oxygen tank. To some babies, pumped breast milk is a medical necessity and a mom shouldn’t have to pay to bring it home to her baby. That is what I want to see changed.

Call to action: How you can help!

Let’s see if we can get American Airlines to change their policy on checked breast milk!  Here are some easy ways to have your voice heard:

Post the following message on American Airlines’ Facebook page:

Thank you for refunding a mom’s baggage fee when she had to check her pumped breastmilk due to a TSA mistake.  How about instating a policy update where all moms are exempt from paying a baggage fee if TSA requires them to check their pumped milk with your airlines?  What a great way to support your passengers and their families!

Copy this email and send it to American Airlines’ Customer Relations Department

(Make sure to use these parameters: Topic (Customer Relations), Subject (Complaint), Reason (Other), and when it asks 'Is your comment or concern related to your flight', choose 'No')

Dear American Airlines,

As a breastfeeding advocate, I am asking that you consider updating your policy so that breastfeeding/pumping moms may check their pumped milk on your flights, at no charge.  Whether a mom is traveling with or without her child, she depends on bringing home her pumped breastmilk safely so that she can provide nourishment to her child at the end of her travels.  The benefits of breastmilk are vast and beyond any other substitute, which is why a mom works so diligently to pump and bring home her milk to her child.  While TSA is supposed to allow a mother to carry her pumped milk on board, sometimes TSA agents make a mistake, which require a mother to check her pumped milk.  I am asking you to consider adding pumped breastmilk to your list of items that are exempt from baggage charges, such as a cane, booster seat, or stroller.  Breastmilk is DEFINITELY a medical necessity! This would help your airlines stand out among the others as being supportive of all families and their needs.

Thank you for your time and consideration.

Breastfeeding After Breast Reduction - It IS Possible!

Written by Ashley Treadwell, IBCLC

Many women wonder if they will have a full supply after having a breast reduction.  While the basic answer to this question is “we don’t know yet” - there are many factors, as well as things she can actively do, that can affect her ability to breastfeed successfully.  In this article, we will discuss what those activities are and how a mom can maximize her supply when breastfeeding after a breast reduction. We will also look at what long-term supplementation can look like, if it is necessary.

It is important to remind you that breastfeeding does not have to be an “all or nothing” endeavor!  We need to re-define what “success” means when it comes to breastfeeding after a breast reduction. Anytime a woman has a physiological factor that can affect milk supply, we always want her to understand that ANY amount of breastmilk is amazing. Whether she is able to provide 10% or 100% of what her baby needs, she is doing a fantastic job.

What Factors Will Affect My Ability to Breastfeed Exclusively?

An initial factor is how the surgery was performed.  Fortunately, surgeons are currently performing breast reduction procedures in a manner that protects as much of the lactation function as possible - increasing a woman’s chance for breastfeeding later in life.  If a large amount of breast tissue has been removed, or the ducts that deliver the milk to the nipple openings are severed, breastfeeding may be negatively affected. There are many different types of procedures and it isn’t always possible to tell which type was performed by simply noting the shape and placement of a woman’s scars.  If you have had a breast reduction surgery and don’t know the specific type that was performed, the best way to gather this information is to contact the surgeon who performed the procedure.  The most popular surgery performed in the United States is one that is also known to have the best implications for breastfeeding later in life. In this procedure, the areola isn’t completely removed and, therefore, connection between the nipple and breast tissue/ducts is partially protected.  If the procedure involves removing the nipple completely and then surgically reattaching it, your chances of exclusively breastfeeding can be decreased.

Another factor that will affect your milk production is when the procedure was performed.  The longer the time between the birth of your baby and the procedure, the better your chances will be to develop a full milk supply.  Also, your milk supply is likely to increase with each subsequent birth - so if you are not able to exclusively breastfeed a first baby, there is still a good possibility you will be able to with a second or third child!  These factors are each important because with both time and breast stimulation, breast tissue can actually re-grow and re-connect.  This can be very encouraging for first-time moms to hear - that even if they are not able to provide their first baby with 100% of their breastmilk needs, all the hard work they are putting in is likely to pave the way for a larger milk supply with later children.

What Can I do to Maximize my Milk Supply - Before and After my Baby Arrives?

Something ALL moms can do to best prepare to breastfeed a baby (those who have had reduction procedures and those who haven’t!) is to educate themselves prior to the baby’s arrival.  Take a breastfeeding class taught by an International Board Certified Lactation Consultant (IBCLC) and find out which resources are available in your area.  Free support groups are a wonderful place to get help and support, as well as connect with other moms who are currently breastfeeding.  We encourage women to attend our breastfeeding support groups while still pregnant - it’s a great way to familiarize yourself with breastfeeding women. A breastfeeding class will teach you what normal breastfeeding looks like in the first few weeks - this knowledge can help to reduce a lot of stress and anxiety.

Find an IBCLC who is knowledgeable about helping women breastfeeding after a breast reduction.  Most offer prenatal consults that will specifically address what you can do to maximize your milk production, including different herbs available to help with supply.  And even if you don’t meet with one prior to birthing your baby, she can be there as soon as baby arrives to help, if needed.

Once your baby arrives, the very best thing you can do is to breastfeed that baby constantly!  The more stimulation your breasts receive in the early days, the better your milk supply will be.  Babies feed frequently in the early days - knowing the signs that baby is getting enough are important.  We have great information in a blog post about how to know baby is getting enough in the first week - I’ve Had My Baby, Now What? Breastfeeding During the First Week.

Some signs that baby isn’t getting enough are: baby not gaining weight after the 5th day of life, baby not having the recommended number of pee and poop diapers per day, or baby is well under birth-weight by 2 weeks of age.  If you are experiencing any of these issues, it is important to seek out the help of an IBCLC.

If Long-Term Supplementation is Necessary - What are My Options?

It may be the case that some amount of supplementation is necessary for a woman breastfeeding after a reduction, especially for her first baby.  If this is true - there are many options available.  Whether mom has little to no supply, or close to a full supply, the best way to supplement a baby to establish a wonderful breastfeeding relationship is to feed the baby the additional milk at the breast.  There are supplemental nursing systems (SNS) available that are made for this specific situation - an IBCLC can help a mom learn how to use this.  If mom doesn’t want to supplement baby this way, but does want baby to have time at the breast, she can still feed the baby at the breast and then follow up with another feeding method - like a slow-flow bottle.  If having baby at breast is important to mom, we do recommend that a bottle isn’t introduced until baby is latching well at the breast - some time after week 3.  Prior to then, mom can supplement using a SNS, and then move to some combination of that and a bottle after the baby is 3-4 weeks of age.  Supplementation can either be with mom's pumped milk, donor milk from another breastfeeding mother, or commercial formula. Here is our YouTube video showing one way a mom can supplement her baby at the breast: Supplementation: SNS at Breast

What Resources are Out There to Help Women Who Want to Breastfeed After a Breast Reduction?

Having support and help both before and after the birth of your baby is crucial and can have a lasting effect on your breastfeeding experience.  We encourage all moms, whether they’ve had breast surgery or not, to look for breastfeeding support in their communities.  Women who are breastfeeding after a breast surgery may need additional support and information specific to their unique situation.  One of our favorite places for support is the website Breastfeeding After Breast and Nipple Procedures.  Here you can find links to health care providers in your area who specialize in helping women post breast surgery, as well as a community of women who are in your same situation.  Robin also interviewed Diana West for The Boob Group podcast episode: Breastfeeding After Breast Reduction Surgery.  

Additional Resources:

Defining Your Own Success. Breastfeeding after Breast Reduction Surgery by Diana West.

Using YouTube to Help Achieve Comfortable Breastfeeding Positions

Written by Ashley Treadwell, IBCLC

In the beginning, breastfeeding can feel somewhat awkward and uncomfortable as new moms learn how to get their baby properly latched on.  As an IBCLC, I see a lot of new moms breastfeeding their babies sitting straight up or hunched over, looking very uncomfortable.  Heck, I did this as a new mom myself!  I remember the constant aches in my neck and shoulders from sitting in contorted positions for long periods of time.  Breastfeeding is something moms do very frequently in the early weeks and months - it should be comfortable.

Out of all of the breastfeeding positions, there are two that happen to be our favorite - the side-lying and laid-back breastfeeding positions.  We like these positions for so many reasons - the laid-back position often helps a baby achieve a deeper latch, and both positions are extremely comfortable for both mom and baby and promote lots of rest and relaxation.  This is great for moms as their bodies need good rest to recover from delivery and is great for babies as the best milk transfer often happens during sleepy, calm times.  Sometimes a mom may find that she is having a difficult time replicating these positions on her own - so we decided to provide a video demonstration!  Here are two videos showing the laid back breastfeeding position and the side lying position.  For mom breastfeeding videos, check out our YouTube channel: DIY Breastfeeding!

Breastfeeding Positions: Laid Back Breastfeeding

 

Breastfeeding Positions: Side Lying Breastfeeding

 

What is YOUR favorite breastfeeding position?

Our New Low-Cost Breastfeeding Clinic

Written by Robin Kaplan, M.Ed, IBCLC

My background is in social justice and urban education.  For the years before I started the San Diego Breastfeeding Center, I worked in inner-city elementary schools and for non-profits, including AmeriCorps, to help bring well-deserved resources and education to underserved communities who needed it the most.  Because of this, one of the biggest challenges I have faced since I started SDBFC was trying to figure out how I could make my expertise and support accessible to ALL breastfeeding mothers... not just the ones who could afford my services.  I have seen over and over again local moms posting on Facebook about how desperate they are for breastfeeding help, yet cannot afford to see a qualified IBCLC and this absolutely breaks my heart!  

Not being able to help these mothers goes against everything I have been taught and everything I stand for.  

No one should be denied qualified breastfeeding assistance and support because of their financial situation.  While I have loved offering community-based breastfeeding support groups, when a mom is faced with a complicated breastfeeding situation, it is almost impossible to receive the necessary attention and follow-up when there are 10-20 other moms in the room, who happen to also be looking for their own support.  

When I founded SDBFC, my 5-year plan was to be able to offer reduced-fee consultations to mothers who needed low-cost options.  Well, we just celebrated our 5-year anniversary and I am thrilled to announce our new low-cost breastfeeding clinic!

Here are the clinic details:

At our 90-minute low cost breastfeeding clinic, up to three moms/babies will meet with a lactation consultant (IBCLC) and receive assistance with their breastfeeding challenges.  

 What takes place at the clinic:

• Baby is evaluated for tongue tie and lip tie
• Breastfeeding position and latch are assessed
• Baby is weighed before and after the feeding to see how much breastmilk was transferred
• Mom is given a personalized Plan of Care

Reasons why a mom would want to attend the clinic:

• Baby not latching or nursing well within 24 hours of birth
• Tongue tie or lip tie
• Nipple pain/damage
• Baby is gaining weight too slowly
• Mom feels like she doesn’t have enough milk
• Nursing multiples
• Nursing a preemie
• Recurrent plugged ducts/mastitis

Requirements: Mom qualifies for WIC, baby has MediCal, or mom or dad must be active duty military.

Cost: $25 

Registration: Mandatory, as space is limited to 3 moms per clinic (www.sdbfc.com/consultations)

My sincere hope is that this is just the beginning of SDBFC making connections with more local communities by providing judgment-free, affordable breastfeeding support for any mom who needs it!  We have many more plans in the works and we are excited to get started!

If you have any local connections to organizations that work with low-income pregnant or new moms, please send me an email (robinkaplan@sdbfc.com) so that I can send them information about our new clinic!