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Breastfeeding Q + A with Lactation Consultant, Amey Fields

Breastfeeding is a lot of work.  A lot of mamas struggle with it and it really can put an emotional toll on us!  I’ve fortunately had a pretty good experience with breastfeeding thus far, but I’ve had a great lactation consultant that has helped me every step of the way and that’s my lactation consultant, Amey Fields of AZ Breastfed Babies.  So many of you guys DM me with questions about breastfeeding all the time, so I figured why not have the expert answer it instead of me!

I will be sharing my personal breastfeeding Q+A and system soon!  I’ll let Amey take it over from here!

 

Is it possible for every mom to breastfeed?

  • I do think that if a mom doesn’t want to breastfeed or if she has tried so many things and finds that the struggle is interfering with her enjoyment of her new baby or babies, and she decides to not breastfeed, that is the best choice she can make for herself and her family.
    I do find that if a mom wants to breastfeed, it is possible, but it may take time and it may look different than what she expected. She may not have a full milk supply, low supply issues are real. I have some clients that supplement with formula and still put the baby to the breast for some feeds. I have clients that hardly make any milk and feed their baby at the breast with a supplemental nursing system. This is a small flexible tube that fits into the corner of the baby’s mouth and delivers milk from a bottle.
    I have clients that have never given birth and have breastfed an adopted child or a child that they have with a same-sex spouse or partner. Sometimes they are able to stimulate milk supply and some need to supplement some or all of the milk at the breast. 

Is there an age where it’s not ok that they fall asleep while nursing?

  • It is almost impossible to keep a newborn baby awake while breastfeeding. Everything that they could hear, smell and feel in the womb, they experience when they were held and fed, so it is very comforting. After a certain age, you may notice that your baby is staying awake during some or most feeds. At this point, I believe that it is a parenting decision whether or not you want to breastfeed your child to sleep. I do not think there is a right or wrong answer here.
    Breastfeeding is more than nutrition, it is very comforting, some babies and moms find this to be truer than others. My personal decision and what worked with my 3 kids was that breastfeeding was my superpower and I used it. I offered the breast when they were hungry, when they were thirsty, when they were tired, or if they were fussy. Sometimes I offered the breast when I was tired so I could cuddle and relax with them. They were all great sleepers and their dad and I never had an issue with bedtime routines and sleep with them.
    Some mothers do find that separating sleep and breastfeeding works for them.
    You get to do what works best for you.

When baby uses a boob as a paci 

  • Well, the boob has been around a lot longer than a paci so it could be that babies are using a paci as a boob.  This goes along with my answer above, if that is working for you, go with it. If it is not, once your milk supply is well established and breastfeeding is going well, you can start to gently offer the baby a pacifier. I really love how Malai loves her “bun bun”. Any thing that a baby can snuggle and use as a lovey is sweet and not a bad habit. 

How to establish a good milk supply and how to increase low milk supply

  • This is one of the most common questions asked. Breastmilk production is mostly about supply and demand. If you don’t let the baby “put the order in” and nurse frequently your body won’t know you need that milk. I am going to refer back to the first two questions because I think that the cultural beliefs that we have that newborns shouldn’t nurse to sleep and shouldn’t use the breast to pacify are two big reasons why women struggle with their milk supply. In the first 2-4 weeks, we should be offering the breast as much as possible. It really helps to establish a good milk supply. Our hormone prolactin receptors in the breasts can only be stimulated in those first few weeks. So, if a baby isn’t given unlimited access to the breast, or if the baby isn’t latching well and mom isn’t pumping to make up for that lack of stimulation, the supply can be suppressed.
    Once the supply is established, after 4-8 weeks postpartum, if a mom feels like her supply is low she can try adding in extra feeds or pumping. I always want to know if mom is taking care of herself with rest, hydration, frequent snacking and regular meals. Many moms find that supplements like Majka work well to boost supply. I also want to explore the possibility of thyroid or hormonal abnormalities that can lower milk supply. A consultation with an IBCLC would be a great idea to address any low milk supply concerns right away. 

Breastfeeding a newborn with sore nipples, what should I do?

  • Getting breastfeeding off to a great start is one of my favorite things to do. Breastfeeding a newborn is a lot of work. If you have sore nipples, this can be overwhelming. Breastfeeding should not be painful, there might be tenderness with the initial latch but pain and damaged nipples are never normal. We breastfeed, we do not nipple feed. If your nipples looked flat, pinched, creased, or blanched white after a feed, reach out to an IBCLC right away. We can help get to a root cause.

How to know if your baby is getting enough

  • This is also one of the most common questions that I get asked. Your baby’s weight will be monitored by your pediatrician and your IBCLC if you have one. On a day to day basis, especially in the beginning, you will be asked to track diapers. If your new baby is having 6-8 wet diapers a day and several yellow seedy stools after day 5, that is very reassuring.
    I have my clients listen for swallowing at the breast, feel for their breasts to soften during the feed, and to watch the baby’s behavior after a feed.

Latch issues, baby crying at the breast, choking, forceful letdowns

  • If there is a problem, there is a solution. There are so many reasons as to why a baby may struggle at the breast that I cannot easily give an answer to this. Breastfeeding has a learning curve for you and your baby. If you feel like breastfeeding isn’t progressing and getting easier over the first couple of weeks, please reach out for help. Check with your insurance and see what your benefits cover for lactation support. We have amazing lactation consultants here in the valley and many of them are in-network with some insurance plans.  I am not in-network with any insurance companies but I do take HAS/FSA cards and I do offer a superbill which is a receipt with diagnostic codes, your insurance may reimburse you. 
  • If you are not in the Phoenix area you can search for an IBCLC near you by going to www.ILCA.org.

How many times you need to breastfeed or pump to maintain your supply

  • The textbook answer for how many times you need to breastfeed and/or pump is 10-12 times in 24 hours to establish a supply and 8-10 times in 24 hours to maintain a supply. We call this the “magic number” and it can vary from mom to mom. I have some clients that only need 6-7 breastfeeding sessions in a 24 hour period and their baby sleeps 10-12 hours at night and they have plenty of milk. I have some clients that need the 8-10 sessions and if their baby is sleeping 10-12 hours, we have to add in pumping sessions. Maybe a pumping session right before mom goes to bed and then one in the early morning hours.
  • Some babies don’t sleep 10-12 hours at night for 1-2 years, and that is ok and still in the realm of normal. 

Snacking and breastfeeding often

  • I would want to know if the baby has a good, efficient latch and is the baby gaining well. Each mom’s definition of “breastfeeding often” can vary. How often a baby needs to each can have a lot to do with their personality as well as mom’s breast capacity. How much milk can a women’s breast hold? This has nothing to do with breast size. Some women can hold 1.5-2 ounces before their breasts are full and their body takes that as a signal to make less, so it’s important for her to breastfeed every 2 hours during the day. Some women can hold 3, 4, or even more ounces before their breasts get that full signal and start making less milk. Their babies might be able to go 3-4 hours between feeds. Trying to stretch out time between feeds can lead to low milk supply. If you have concerns, an IBCLC can help you by going over your baby’s weight gain, eating schedule and even doing a weight check before and after they breastfeed.

Using a nipple shield- good, bad?  Why would someone need one and how to stop using one?

  • Nipple shields can be used too often and many of the moms I work with have been given the wrong size. I personally purchase a special shape of nipple shield that I find works best for most babies when needed.
    Nipple shields can be used if mom has a lot of nipple damage and it is too painful to put the baby to the breast. They can be useful if the baby has a tongue and/or lip tie and the baby cannot maintain a latch and transfer milk. They help with flat or inverted nipples and even fast let downs. They are like training wheels, they are meant to be temporary. The reason a mom needed one is often unclear to them, they feel like they were just given one without any reason or instructions. I often have to figure out why mom and baby were struggling, address that and then help mom wean off of the shield.  Sometimes this is easy and happens right away, sometimes we have to be patient and let the baby breastfeed with the shield, get some milk in their belly, then remove it quickly. I call it the “bait and switch.”
    If you have been given a nipple shield you need to watch your baby’s weight closely to make sure they can transfer milk with the shield and have a plan to wean off of the shield. Again, this is exactly what an IBCLC can help you with. 

Going back to work- pumping and milk storage

  • I do offer a pumping consult both in my office at The Motherhood Co. in Phoenix and virtually. If you are interested in a customized plan, you can go to AZ Breast Feed Babies and schedule online.
    Some moms never need to pump. If you are not returning to work outside of the home and don’t plan on needing your baby to take a bottle, you can just nurse, nurse, nurse. Some stay at home moms I work with use a haaka style silicone pump and store some extra milk that way so their baby can get an occasional bottle.
    Unless there is a medical reason or breastfeeding struggles, it is best to wait until the baby is about 3-4 weeks old to start pumping. A Haaka style, silicone pump can be used right away.
    If you are returning to work, I recommend pumping once a day, after a morning feed. Don’t pay attention to how much milk you get. Just put in the order every day, and get used to your pump.
    You can start saving that milk and at around 4-6 weeks postpartum, have your partner or another family member start giving the baby a bottle every 1-3 days. If you wait too long, or don’t offer a bottle several times a week, your baby may refuse a bottle. I even do consults to help a baby take a bottle.
    When your baby gets a bottle, use a slow flow nipple and paced bottle feeding. I have included a link below, of a handout by Ameda that shows the amount of breastmilk a baby needs, family members and daycare workers often overfeed a breastfed baby. Breastfeeding is very different from formula feeding when it comes to how much a baby needs. The regular formula is 19 calories per ounce, so as your child grows, they need more volume. By 1-2 months a formula-fed baby may be taking 4-5 oz and by 6 months they may need 7-8 oz. Breastmilk composition changes as the child grow so the volume the baby needs doesn’t change as drastically as it does with formula. With breastmilk, the volume of milk between 4 weeks and 6 months is usually 3-5 oz a feed. This makes sense because our breasts do not get bigger and bigger as we breastfeed. That 3-5 oz of milk has different fat content, etc., as the child grows. 
  • Know how much a baby needs when you go back to work. Click here

Breastmilk storage and milk rotation guidelines:

  • Breastmilk storage guidelines vary but the AAP and CDC state that breastmilk is good at room temp for 4-8 hours, in the fridge for 4-8 days, in a regular freezer for up to 9 months and in a deep freezer for up to 12 months. Once defrosted it should be used within 24 hours. Freeze your breastmilk in small increments, like 2-4 ounces. It is easier to defrost in smaller batches and there is less risk of waste. 
  • I have my moms try to use at least 50% recently pumped breastmilk and rotate some of their freezer stashes once they are back at work. Don’t rotate your stock of milk by always freezing the fresh milk and using the oldest frozen milk. Fresh milk has the most recent antibodies that your baby needs.
  • If you want to go over this more and want to discuss how to make pumping and bottle-feeding work for you, I offer pumping/ back to work consults at The Motherhood co. in Phoenix and I have a virtual option too.

Implants

  • Women with implants can still breastfeed. The incisions for implants are either under the breast, in the armpit area or around the areola. The incision around the areola can increase the incidence of a lower milk supply because milk ducts and glands are cut. This decreases the sensation to the breast. This is especially true if there was a breast lift done because the incision is usually around the entire areola. If you have had implants and/or a breast lift with the incision around the areola, I recommended working with an IBCLC right after birth to monitor and maximize your milk supply. 

Nipple piercing. 

  • I have not seen any issues with breastfeeding if a mom has had her nipples pierced in the past. The milk ducts are further back in the breast, not in the nipple. It’s just an extra hole that milk often comes out of. 

Blebs and nipple blisters:

  • Blebs and nipple blisters can be so very painful. They are often caused by friction of a poor latch and/or a badly fitted pump flange.
  • I will have my moms put warm water with 2 tablespoons of regular table salt, or Epsom salt in a silicone pump and attach it and let it soak for 5-10 minutes, 4 times a day. I have her stop using the thick lanolin cream and switch to olive oil.
    Once the skin on top of the bleb or blister softens you may be able to gently scrape the “roof” off.
    Address the cause of the bleb or blister, if you are unsure… call me or another IBCLC, we can help!

Oversupply, block feeding, foremilk, and hindmilk imbalance

  • Oversupply is when a woman is making too much milk, sometimes more than twice as much.
    This can be a struggle, especially with a new baby that can’t manage a fast flow.
    An oversupply can increase a women’s risk of plugged ducts and mastitis, which is why we don’t recommend pumping too soon after birth unless it’s medically necessary.
    I rarely recommend block feeding, especially in the first 3-6 weeks because breastmilk supply will naturally down-regulate. I work with a lot of moms that were told by another lactation consultant, a family member or friend, or their pediatrician to block feed and it decreased their supply so much that we have a lot of work to do to try to backtrack and increase their supply.
    There is a lot of new research that is finding that foremilk and hindmilk isn’t really a common thing. There is no skim milk at the beginning of a feed and fatty milk towards the end. There was a time that women were taught this and the idea still comes up. There is fat throughout the entire feed, especially if you are doing breast massage and compression before and during a feed.
    I see about 400 new moms a year and I have been an IBCLC since 2012. I have seen true hindmilk/foremilk imbalance in 3 women. They all had a significant oversupply, they all made over 100 ounces of milk extra a day and their babies all had green, frothy stools. An occasional green stool isn’t concerning, especially if the stool isn’t bubbly and frothy. 

Can you breastfeed when sick?

  • Yes! Please do, in fact, breastfeed as much as you can. Your baby needs the antibodies that your body is making so there is less of a chance that your baby will get sick.
    If ever you need to take medication and are unsure if it is safe to breastfeed, please call Infant Risk at 1-806-352-2519
    If your doctor, dentist, or radiologist tells you that you have to delay or stop breastfeeding because of a medication, test, procedure, or surgery, please call Infant Risk.  More often than not, moms are given incorrect information. 

History of low milk supply or health issues that are making you worry that breastfeeding will be a struggle

  • This is exactly why I offer a prenatal lactation consult. I do a full history so I can find out why the supply was low before and we can address it before the birth and in those first few weeks. For moms that have PCOS, thyroid issues, insufficient glandular tissue (IGT)- there are things that we can do and monitor during the pregnancy. 
  • Was the low supply because of birth practices, like delayed skin to skin, or just plain poor lactation support? Was baby in the NICU with jaundice, low blood sugars or other issues and breastfeeding didn’t get off to a good start?

Slacker boob

  • Super boob/slacker boob. Shitty titty/show off. The Stud/The dud.
    It is normal to have one breast that makes more milk than the other. Sometimes it is a subtle difference. Sometimes the breasts switch it up and the left is the slacker boob one week and the next week it is the right. This is rarely an issue. Sometimes adding some extra nursing sessions or pumping on the slacker side can help.

Distracted baby

  • A distracted baby is a challenge. This often starts happening at around 3-4 months of age. Babies are also more efficient, so they can get more milk faster. The 15-30 minute feeding sessions can turn into 5-minute feeding sessions. If a baby gets distracted by a sibling, a pet or another parent, they may need to come back to the breast more often to get what they need. Some moms find that going into another room where it is quiet can help. It won’t always be this way, those milestones and developmental stages change. The Wonder Weeks app is one of my favorite resources. It really helps parents understand what is going on in a baby’s brain and how it can affect their behavior. 

Bottle and or sippy cup recommendation for a 9-month-old EBF baby

  • Skip the bottle and sippy cup, go right to a cup with a straw or a 360 cup. Feeding littles has a great post on this. Check out their post here.

 

Thank you for letting me talk about breastfeeding!  There were a lot of great questions. You can always reach out to me on my Instagram @azbreastfedbabies if I didn’t answer your question. 

Check out my website to see the information about the support I offer. I teach breastfeeding classes, facilitate free postpartum support groups twice a week at the Motherhood Co. and I am certified in Breast Massage Therapy for plugged ducts, engorgement and mastitis. I am also available for lactation consults in the Phoenix area or virtually. I offer prenatal consults, if you feel like you have a lot of questions or if you had struggles breastfeeding a baby in the past, we can spend time going over all of your questions and concerns. I offer the pumping/back to work consults to go over pump settings, flange sizes, milk supply and a pumping plan that will work for you.

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