Breastfeeding is supposed to be a natural thing. While it is the most natural thing in the world, it does not necessarily come naturally to new mothers and their babies. There are so many questions that face Mums on their breastfeeding journey, read on to learn the answers to 5 of the most common questions that new mothers have from an expert.
Sioned is Medela’s in house Lactation Consultant and Education Manager. She is an expert in her field and has been working with breastfeeding mums for more than 20 years. There’s not much Sioned doesn’t know about breastfeeding!
I had the opportunity to ask Sioned the 5 most common questions that mothers want to know, here’s what she had to say.
What is the most common issue that mothers seek help with when it comes to breastfeeding?
Perception of low supply. Many breastfeeding mums are unsure about what to expect and tend to compare themselves to peers and the online web of mum forums.
At times when baby has lost more than 10% of birth weight within the first 2 weeks, the health professionals rightly intervene to ensure that feeding is going well, baby is latching on, feeding with active bursts of sucking and swallowing milk, not jaundiced, nappies are wet and soiled with mustard coloured stools. As well as asking about the frequency and duration of feeds.
However, this early intervention can set the scene for a mum who will then always be apprehensive about her supply, does she have enough, her baby was big at birth, why is her baby feeding every 2 hours and her friend every 3-4 hours, and her baby only feeds for 10 minutes, takes only one breast and her friend feeds for 30 minutes or more.
What we know is that the early few weeks are key to building a good supply – sometimes when labour is challenged mums are given additional IV fluids during delivery and this is passed over to baby in-utero. If baby is weighed soon after delivery and hasn’t ‘peed’ it can give a false birth weight. Hence the potential for that % to deviate.
What is important is for mum and midwife to chat about feeding, are there any difficulties such as sore and cracked nipples? Mastitis? Sleepy baby? Is baby latching on and feeding? How frequent are feeds etc. This way the midwife and health visitor can make a feeding plan to support mum to breastfeed and also give her the confidence to help her build supply if there are difficulties, and help with latching.
By reassuring mum that every baby is different, and giving realistic expectations to what is expected as the ‘norm’ in these early weeks, it may help mums to feel confident that they are capable of building and sustaining a supply for their breastfeeding journey. For example, a word of guidance around the 3 week / 3 month growth spurt expectations where babies tend to cluster feed and softer breasts around 6 weeks as a sign that you are now in tune with your baby’s needs.
The range of normal is huge and every baby and sibling is different: different feeding, sleep patterns, temperament and mum’s own confidence. For more information on ‘What is Normal’ – Jaqueline Kent has published a great study to inform and reassure mums just how varied each breastfeeding journey can be.
Breastfeeding and alcohol – how much really crosses over to breast milk? Is pumping and dumping the answer?
Alcohol is a taboo subject – and under a lot of debate. “Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby’s exposure.” (BfN 2017) – The Breastfeeding Network have a great reputation for independent reviews and pharmacist excellence in their drugs and breastmilk fact sheets. They have recently published a great information sheet on ‘Alcohol and Breastfeeding’ to help mums to decide for themselves.
Things to consider when having an alcoholic drink is the strength of the drink. For example, a small glass of wine is 1 unit, a large glass of wine is 3. Alternatively, there may be several spirit units within a cocktail.
The age of your baby and if there are any other complications are other factors to weigh up.
Alcohol does transfer over the blood milk barrier, but can affect babies differently – it can make the milk taste different, can delay or disrupt the milk let-down reflex, it can make baby a little more restless or sleepy, it can also help mum relax just a little if she is anxious.
You can breastfeed a baby after a small amount of alcohol, but if you plan on more, remember your tolerance is lower, you will get tipsier so you may choose to pump in advance, store milk and your partner give baby expressed milk for a few hours whilst you are out and on your return. There is no need to ‘pump and dump’ but it is advisable not to breastfeed for 2-3 hours after drinking to avoid exposure to alcohol. You must also bear in mind your comfort too; missed / delayed feeds can leave you feeling fuller, engorged and more likely to get mastitis.
Many new mothers are keen to get back to their pre-pregnancy weight, how can this be balanced with making sure they are producing enough Breastmilk for their baby?
This is a common question from many pregnant, new and established breastfeeding mothers.
Nature is very clever and helps to support breastfeeding during the last months of pregnancy as it does require a lot of energy to make milk and this begins by laying down fat stores in pregnancy.
After birth, milk production takes more energy than the brain so not only do you burn up those fat stores, it also helps to return your uterus to a pre-pregnancy size within the first weeks following birth. Frequent breastfeeds of 6-13 per day will help return mum back to her pre-pregnancy figure. Some other tips:
Gentle exercise of walking; building up the pace after birth can help. Following C/S, you must wait until your review with your GP before undertaking any activity such as the gym, running, swimming etc. All mums should ensure they take care of their ligaments with a gentle warm up.
Wear a Supportive Bra
Feed before activity to minimise milk leakage and wear a comfortable supportive bra, not a sports bra as this could compress the delicate breast tissue.
Adopt a Healthy Diet
Cut out the treats, have lots of vegetables and protein. You may prefer to switch to full fat dairy/ more protein to help keep you full for longer and reduce the carbohydrates such as refined sugars, white bread. Look for fortified cereals / bread to give you some of the extra micro-nutrients you need and it is advisable to have 2 omega rich foods such as oily fish/ salmon twice a week. You only need an extra 2 digestive biscuits per day in terms of extra calories.
Drink to your thirst. Making milk is thirsty work, make sure you have a glass of water or alternative at hand whilst you feed.
Avoid Crash Dieting
Restricted trend diets such as low calorie as this can impact upon your milk supply, your well-being and energy levels. There are slimming organisations that do have plans for breastfeeding mothers so chat with the group leader to tailor a plan to you with increased activity, sensible healthy eating that you can sustain, gently shifting the baby weight whilst supporting you and your baby to continue to breastfeed.
Beyond the basics of eating well, being rested & keeping hydrated, are there any secret ways to boost breast milk production that you can share?
The mantra of the more you feed the more milk you make is true. In the early weeks after birth your breast milk cells – alveoli are given the recipe – the how to use, instructions for the production of milk. This will then be the same for the whole duration of your breastfeeding journey and this is what determines the breast storage capacity and effectiveness of each milk sac. The more your baby feeds and drains the breast the more milk is synthesised by the milk cells.
Having an extended duration between feeds can shift the balance and increase the presence of an enzyme that regulates milk production – feedback inhibitor of lactation. this is responsible for protecting the milk cells and ducts. The less milk that is taken from the breast the level of FIL increases and starts to switch off those cells from making milk and they then shrink and become dormant.
Therefore, the more mum feeds or expresses and drains the available milk the greater her milk 24 hour volumes will be.
Remember the volume per feed varies during the day and between mums. An excellent blog by Emma Pickett – the dangerous game of the feeding interval obsession is really food for thought and discusses the limitations and detrimental consequences of how trying to schedule feeds, stretch feeding intervals has on milk production
Night feeds are a great way of boosting supply, these are essential in the early months to help build and maintain supply, suppress the enzyme FIL and as we sleep our bodies experience surges in hormones to help replenish, cells, tissue and function in preparation for next day.
There are some herbal remedies and medication as well as foods such as oats, that can assist. There should always be caution in taking additional vitamins and nutrients, and explore if maternal diet provides everything you need. Some cultures support fenugreek tea, soups etc. as it has properties that help boost prolactin but it does have contradictions, and strength and quality varies.
If milk supply is suppressed and both mum and health professional are concerned, a full history and consultation with a specialist lactation consultant / counsellor is advisable. At this time other medication, as well as a feeding and expressing plan can be discussed.
Can you explain exactly why double pumping is so effective?
When mum breastfeeds both her breasts will have milk ejection reflex– let-down at the same time. The breastfeeding mum on average has around 3-4 milk ejections (ranging from 2-11) and these patterns vary between each mum. Danielle Prime a researcher at Hartman Lactation Institute UWA and Medela identified during her PhD research and subsequent publications that mum has the exact peaks of let-down and frequency with every single feed a blueprint.
When mum breastfeeds her baby, the ‘feeding breast ‘has milk ejection (MER) but the resting breast also experiences the MER and has some milk leakage, but as baby isn’t nursing at that time on that breast, the milk isn’t removed. When baby then comes to nursing on that breast, it is known to have already utilised some energy and is ‘tired.’ However, when babies breastfeed they have pauses and this compensates, resulting in babies feeding from both breasts, removing milk effectively, babies are satisfied and regulate their own needs.
When it comes to expressing double pumping it is proven to get 18% more milk because both breasts are stimulated at the same time. Not only do mums get more milk compared to single pumping, the fat energy rich cells also increase, resulting in higher energy content in the milk. Last but not least, high energy content indicates increased breast drainage, thereby it is assisting in the maintenance of lactation.
Double pumping is twice as fast as single pumping so not only do mums benefit from:
- 18% more milk in a 15minute pumping session compared to single pumping
- An additional milk let-down reflex
- Higher energy content in her milk
- And better and more effective drainage of the breast
They also save time cutting an average single pumping session from approx. 30 – 40 minutes to 15-20 minutes, dependent on the storage capacity of the breast and milk flow.
A huge thanks to Sioned for answering these questions. You can ready more about everything you need to know about breastfeeding by visiting Mummy Of Four’s Breastfeeding Resources.