23 Questions On Donating Blood, Hand Expression, & More, Answered By Experts
by Kelly Mullen-McWilliams

Breastfeeding can be a hard, isolating, and emotional journey, which is why it's so important to have support. That's why Romper launched a Facebook breastfeeding community, Breastfeeding TBH — to help make feeding another human being with your own body a little easier. Every day readers ask questions because, let's face it, breastfeeding is complicated, and each week in Rack Facts, Romper speaks with a lactation consultant to answer as many of those questions as possible. After all, everyone can use a little expert help, especially when it comes to feeding your kid.

Supply issues, nipple pain, latch trouble — today Romper answers a host of common questions, and a series of not-so-common ones, too, with a superhero team of lactation consultants and specialists who always have your back. Can you donate blood while breastfeeding? After a miscarriage, can you nurse a 17-month old with the milk coming in, even if he's already been weaned? Breastfeeding is such an individual journey, and reader questions never cease to amaze me in the caring, dedication, and love they display.

I promised you a superhero team, and here they are:

Carley Mendes, expert at The Tot and founder of Oh Baby Nutrition shares wise words about unexplained breast pain, nursing after a loss, and more. Tania Archbold, B.Sc, International Board Certified Lactation Consultant (IBCLC), of Mothers Nectar Lactation Consultant Services, comes to the rescue with advice on left-side problems, slow-flow nipples, and her favorite breastfeeding literature for expectant mothers. Angie Natero, RN, IBCLC, talks pumping for a baby with a congenital heart defect and donating blood while nursing. Kristin Gourley of Lactation Link swoops in with critical information about pumping with small nipples, among other gems. Finally, Andie B. Schwartz, M.Ed., RD, LD, CLC, of Happy Family's Happy Mama Milk Mentor program, lends her expertise on cracked nipples, leaking during pregnancy, and so much more.

While many of our experts recommend visiting an LC or IBCLC for an in-person consult, it's a brave new world out there, and specialists are increasingly offering consultantions online. While an in-person consult may still be best for you, it's good to know that getting advice from The Happy Mama Milk Mentor program is as easy as clicking a chat box on their infant feeding site — the service is completely free — and that Lactation Link offers online consultations as well as in-person breastfeeding classes.

There's never been so much help available for breastfeeding mamas, and I, for one, am so grateful. Keep nursing, pumping, and of course, keeping on.


Unexplained Breast Pain

I exclusively pump for my 3-week-old daughter. Yesterday afternoon, I noticed that my left breast was a lot more sore and tender, and I could barely raise my arm above my head without pain. Still getting the same amount of milk — about 2.5 to 3 ounces every three hours. No hot or warm areas and no bumps, but it hurts ... not sure what is going on or what to do. Any advice would be appreciated.

Ouch. I'm so glad you wrote in. Breastfeeding should never be painful. "It sounds like it could be a blocked duct," Mendes tells Romper, and suggests a warm compress, and massaging the area with hands or a wide-tooth comb. "Most importantly, continue pumping on the affected side as frequently as you can." Mendes further recommends calling your provider if you feel a lump, the breast feels warm, or if you develop chills, because these are all symptoms of the advanced stages of mastitis.


Nursing After A Loss

Hi. Hoping to find some help. I miscarried at 18 weeks, two days ago. My 17-month-old stopped nursing a month ago and completely weaned himself. I am now wondering, if my body starts producing milk again, will he drink it? I'm only asking because he still refuses milk at 17 months and now that he's not breastfeeding at all, I'm worried. My plan was to pump when the milk came in and try to give him at least one bottle a day.

First of all, I'm sorry for you loss. My thoughts are with you and your family. According to Mendes, each child is different. You'll have to see how your little one responds.

"If you begin to produce breast milk again, he may continue consuming it again," she writes. "Once weaned, some children forget how to latch on and others are able to without complications. If you’re OK with it and he shows an interest, then you can try it out. However, if your son prefers not to drink cow’s milk as a replacement to breast milk, rest assured it’s not a requirement. At 17 months, milk from an alternate source is not mandatory and there are plenty of other sources of calcium, vitamin D, protein, and fats. It's very possible for toddlers to meet their dietary needs through a variety of healthy foods rather than cow’s milk."

If you're grieving your loss, it might be a good idea to check out Pregnancy After Loss (PALS), an excellent support site for women who have experienced miscarriage or stillbirth.


Uncomfortable Comfort Zone

My son is 17-months-old and has been exclusively breastfed up until about three weeks ago. We've been working on weaning down on feedings and I cut out all nursing, with bedtime feeding as the last to go. It was a challenge. Since then, he reaches down my shirt and plays with my nipples multiple times during the day. Usually when we are sitting down together and always when he's tired and before bed. It's associated with times he would previously nurse. I understand that's his comfort zone, but it's not very comfortable for me. When I tell him no, and take his arm out repeatedly, he gets SO mad and cries and just does it again no matter how many times I remove it. Has anyone else's child done this? Think it's just a phase he will stop?

"This can be a hard habit to change once established," explains Mendes. "Try using phrases such as, 'Pinching hurts mommy,' while gently but firmly removing his hands. Even though you may have to repeat this action multiple times, consistency is key. It can be confusing if you accept this behavior sometimes, but try to prevent it other times. As an alternative, try offering a special stuffed animal or blanket to comfort him. Try holding his hand with your own while looking into his eyes and singing to him as a distraction. It can also be helpful to wear shirts with higher necklines that offer less access to your breasts until this habit subsides."

I know moms put up with a lot, but the good news is that at 17 months, your toddler may understand more than you think. Sweetly telling your son what hurts, even if he doesn't understand the exact words, can help get your point across. As Mendes noted, however, "consistency is key."


One Breast Lagging Behind

Hello! I'm new to breastfeeding/pumping and I have noticed that my one breast isn't producing much milk anymore? I was wondering if you had any suggestions on why? My little one and I have had a rough go with breastfeeding so we are taking a break from it so I can heal. I am also supplementing with formula at times throughout the day because his demand is higher than what I can produce. He is only 4 weeks old.

Thanks for bring this question to Romper. Mendes explains the rules of breastfeeding supply and demand so well here:

"Breasts produce milk on a supply-and-demand basis, so the less often you breastfeed, the less milk you will produce. Therefore, offering formula can actually lower your supply ... It may also be that you favor one side more than the other, so the breast used less often begins producing less milk. Using a pump to extract milk more often than breastfeeding your baby can lead to a lowered supply in one or both breasts as well, even when the frequency of pumping sessions matches the previous regularity of breastfeeding.

Mendes notes that pumps aren't as effective as babies when it comes to emptying breasts or stimulating your supply, for hormonal reasons. (Your body knows that a pump isn't a baby.) Whenever you have pain, it's a good idea to see an IBCLC in person, so they can check your latch. Breastfeeding should never be painful — really and truly. Mendes agrees. Get thee to an LC as soon as you can.


Bleeding & Breastfeeding

I have a huge question. I have been exclusively breastfeeding for a little over nine months and I'm a first-time mom. Last week, I started spotting light pink-to-brown blood and it would come and go for about three days. I had slight cramping, nothing like a period. I was just wondering if this is normal for breastfeeding, or if my period is trying to come back, or could I be pregnant?

"A breastfeeding mother can definitely experience some spotting as a result of fluctuating hormones," explains Mendes. "There are so many variations of normal when it comes to the return of menstruation after having a baby and it really varies from mother to mother. There are some women who experience a lighter flow with less cramping and others who experience more difficult periods postpartum. It may take quite some time for your cycle to regulate and for you to settle into your new normal."

I love that Mendes emphasizes the variance between women after they give birth. Every mother truly is unique.

Generally speaking, however, a little spotting is nothing to worry about. Your vaginal walls are also drier and thinner when you're breastfeeding because of the hormones you produce. If you're concerned, pay a visit to your OB-GYN. Most likely, the spotting will pass.


Left-Side Aversion

My little one is 7 weeks old and has been breastfeeding just fine for several weeks. After she was born, we used the nipple shield for a couple weeks but had successfully weaned from it. For the last couple of days, she has been refusing the left side. She gives hunger cues (sucking on hands) and the minute I try to put her near my left side, she just screams and arches her back. I have had a little luck with attaching her after I put the nipple shield on that side, but even then she'll only eat for a minute and then start screaming again. Any ideas of what the problem could be? Or any solutions? It's extremely frustrating and upsetting.

First off, congratulations on your new baby. At only 7 weeks you're still in the thick of it, but it sounds like you're managing beautifully.

Archbold explains to Romper that your problem could be caused by muscle strain in your baby's neck, an ear infection, or another issue that makes it painful to lie in that position.

"You could try keeping her in the same position that she feeds well on your right side (e.g., in the cradle hold) and then instead of flipping her over to feed on your left, just slide her over into the football hold on the left," explains Archbold. "You may find she latches better this way. As there are many different reasons why your baby could be having issues latching on your left side, it would be a good idea to have the situation assessed by an IBCLC."

Make sure your IBCLC watches a full feed for the best assessment. Good luck.


Third Time's The Charm

Hi! Need some help. I'm due with my third child in February, and I nursed my first two for a few weeks but was ultimately unsuccessful. Could you please direct me to some literature or post something on breastfeeding basics? I need a little guidance.

I just want to say that it's amazing that you're committed to trying again. I know it's easy to give up on nursing when trouble strikes, but it's so true what they say — every baby, and every breastfeeding relationship, is different. So here's to your third try. It just might be the charm.

For breastfeeding guidance, Archbold recommends The Womanly Art Of Breastfeeding, produced by La Leche League. (The League itself has compiled an admirable website bursting with great information, as has Archbold also recommends Preparing to Breastfeed: A Pregnant Woman’s Guide by Teresa Pitan, and Dr. Jack Newman’s Guide To Breastfeeding. These are all gems.

Also check out Romper's article on creating a breastfeeding plan. Setting your wishes, goals, and intentions down in writing can work wonders, and help get everyone in the family on board.

Happy upcoming birthday to you and your new baby. I'll certainly have you in my thoughts come February.


Evening Supply Boosters

I have been back to work for four weeks now. I am only in the office part-time, so I am away from my little one for three full days. I pump once for every bottle she takes while in daycare. Every time I pump at work, I am getting at least 3 to 4 ounces, sometimes even up to 7 or 8 ounces total. I have never had supply issues — if anything I have had an oversupply, especially in the morning. For the past few days, I have not had enough supply for my evening and afternoon feedings. My little one struggles at the nipple, latches, and gets frustrated that nothing comes out, so she detaches and cries. As soon as I present a bottle, she guzzles it down. Any suggestions on how to keep my supply high enough to be able to nurse my baby in the evenings? I am staying very hydrated, eating relatively healthfully, and trying to rest (as much as possible with an infant).

According to Archbold, supply might not be the problem here — the trouble might be the bottle. Babies are associative creatures, and it could be that your little one has learned to expect the quick, immediate flow of the bottle at all times. "Ensure that your baby’s caregiver is using a slow flow bottle for feeds," Archbold suggests. She continues with instructions for properly paced bottle feeding while you're away:

"Paced bottle feeding can help limit a baby’s preference [for the bottle]. Your caregiver should have your baby sit as upright as possible so that your baby has better control over the flow of milk ... Encourage your caregiver to have the end of bottle tipped down at first so that your baby has to work to get a 'letdown' from the bottle. After 10-to-15 seconds, they can tip the bottle level to start the feed. This will encourage your baby to have patience and work for the milk. A full bottle feed should take 15-to-20 minutes. Your baby should be relaxed and breathing normally during the bottle feed. If she is finishing the bottle in five minutes, breathing heavily, gulping, etc. ... then the bottle flow is too fast."

Additionally, keep up with your skin-to-skin time, and breastfeed as much as possible at night. Combining bottle feeds with nursing can be difficult, but the proper technique can absolutely help you now.


Uneven Milk Production

I have a question. Currently I am exclusively pumping due to my 7-week-old daughter not latching well (once a day we try to latch and usually are successful for a few minutes). My production is extremely uneven. I get between 4 and 8 ounces from my left and approximately 2 ounces from my right each time I pump (every four hours). Is there any way to even this out?

With supply issues, I find that more variance is normal than people might think. That applies to quantities of milk, and to differences between your breasts. Here's what Archbold has to say:

"It is normal for someone to have a dominant breast during lactation. Typically most people breastfeed/chestfeed/pump from both breasts, so it doesn’t matter if one produces more than the other. It might be helpful to seek the opinion of an IBCLC to work out why your daughter is having difficulty latching."


Pumping To Increase Supply

I have a question. My son is turning 3 months old this week. I was breastfeeding him and also supplementing with formula since he was born. About three weeks ago, I stopped pumping and randomly breastfed him on and off since then. Do I still have hope if I try pumping to get a milk supply back? Please help, thank you.

Congratulations on officially surviving the grueling fourth trimester. I so hope the sailing is smoother from here on out — it certainly was for me.

Archbold explains that your milk supply is absolutely likely to increase with pumping, though you might not be able to get to full supply. "A thorough exam with an IBCLC should be able to work out the likely causes of your low milk supply and then you can see if there are specific steps that can be taken to maximize the milk supply you can make," she notes.


Pumping For A Congenital Heart Problem

I HAVE to pump for my little man as he has a congenital heart defect and is tube fed. How do I get my milk supply to increase? I have tried Reglan [the breastfeeding medication] — horrible, horrible experience. Then I got Emergency Brownies from Milky Mama, and they did nothing, absolutely nothing. I don't know what to do. I get 31 milliliters out of pumping now. I pump every three hours. I am at a loss. Please, please give me ideas.

"First of all, great job working to give your baby the gift and amazing benefits of breast milk," Natero says. "I'd recommend working one-on-one closely with an IBCLC to help troubleshoot the output deficit in your individual circumstances. My general recommendations for this instance would be using a good electric double pump at least nine times every 24 hours, or around every two-and-a-half to three hours. Also, utilize hands-on pumping techniques, and assure the flanges are the correct size. The key to supply in almost all cases is frequent effective milk removal."

Gourley concurs:

"Pump more often! That's the best first step to making more milk — demand that your body make more! Try power pumping: put the pump up somewhere you pass by frequently in the house and pump for about five minutes every time you pass by for an hour or so. Shoot for at least five times during this hour. This is in addition to your regular pumping schedule. You may want to consider pumping every two hours during the day when you're able as well. Are you pumping at night? It's hard to miss out on sleep but nighttime removal of milk can really help milk supply for some moms. Try to pump at least every four hours at night."

While it's understandable that you're trying whatever you can to increase supply, Natero recommends avoiding medications, herbals, teas, and lactation treats like Emergency Brownies, unless your baby's pediatrician has given them the OK. "Many moms are unaware that often these things carry risks," she notes. They also might not be particularly effective.

Because your situation is so individual, I second working closely with your doctor and an IBCLC until you get your supply up to where you want it. If your current IBCLC isn't working for you, try someone else in your area, or reach out to an online service, like Lactation Link. I know it's a lot of work, and that you have a lot on your plate. Hopefully, you'll be pumping plenty very soon.


Breastfeeding Through A Cold

Hi, I’m breastfeeding my 11-week-old and I got a really bad cold yesterday. I know continuing to feed her will give her antibodies against this cold, but will I make her sick, too? I don’t plan on stopping. I just want to know what to look out for.

"Breastfeeding doesn't guarantee protection against colds, but it is generally advised to continue nursing during minor illnesses to offer the nursling the continued benefits of breast milk," explains Natero. She suggests practicing good hand hygiene, and calling your pediatrician at any hint of fever in your baby. While illness and colds are par for the course in parenting, my heart always goes out to moms carrying for sniffly little ones.

Gourley offers even more reassurance. If your daughter does get sick, she notes that breastfed baby's illnesses are "less severe and shorter lived than [in] adults and older kids." Why? Because breast milk is amazing.

Learn more about expert hand-washing (it's more involved than you'd think) at the Centers for Disease Control and Prevention (CDC) website, and don't count on hand sanitizers or antibacterial soaps. There's really no replacing scrubbing with good old soap and water.


Breastfeeding & Blood Donation

A family member of mine is holding a blood drive. I am a universal donor and try to give when I can. Is it OK to donate blood while breastfeeding?

"Generally speaking, breastfeeding isn't a contraindication to donating blood in and of itself," explains Natero, and according to KellyMom, The American Red Cross says nursing mothers can safely donate blood at six weeks postpartum. Because donation involves losing blood volume, however, it could theoretically negatively affect your supply — so you might want to hold off if you're having any issues there.

Gourley also wants to make sure you didn't have a blood transfusion after your birth. If you did, the American Red Cross recommends waiting a full year after transfusions before giving blood again.

I really commend you for wanting to give blood while nursing and caring for an infant, too. That is truly the stuff of superheroes.


Sudden Refusal

I have a 3-month-old who is breastfed and takes bottles when I'm not around. He has never had any problems with nursing. Today he has been refusing to nurse, but will take a bottle. Has this happened to anyone else? Any advice?

Negotiating bottles while breastfeeding can be tricky, and Natero notes that this sudden refusal is also, unfortunately, an all-too common problem. She suggests pacing feedings with a slow-flow nipple, and trying not to overfeed your little one.

"Baby should not have more than 3-to-4 ounces each bottle, and that should last three hours," she explains. "If baby is overfed and/or fed too quickly, baby can have their tummy stretched out and become frustrated with the breast ... If this has been happening, you will want to gradually decrease baby's volume in bottles and implement pace feeding ASAP. I'd visit a local IBCLC to troubleshoot and get things back on track. Make sure when you are together, you breastfeed on-demand, unrestricted."

Gourley also notes that offering the breast when baby's "very sleepy or even already asleep can help his natural breastfeeding instincts to kick in before he thinks too much about it."

Natero adds that you shouldn't feel defeated. You're doing a fine job feeding your baby, and you're certainly not alone in this problem. Thanks for writing in.


Hand Expressing

Hello, I have recently discovered that my nipples are too small to comfortably use a breast pump. The smallest flange I could find is still too large. I would like to try hand expressing milk as I have heard some people have great success with it, but I am wondering how to collect the milk. I tried expressing over a sterilized metal pot, but I feel like as much milk got on my hands and the underside of my breasts as actually got collected in the pot. Any advice would be greatly appreciated!

"You may have to use some trial-and-error for what works best for you, but some moms hand express into a regular cup or right into the baby bottle they'll be using," explains Gourley. "Sometimes a bigger target is easier, so a mom will like a big bowl. It's not always quite as comfortable, but leaning over can help you make it into the cup you're trying to catch the milk in. If you can hand express with one hand and hold the cup with the other, you can get your nipple almost in the cup while you're aiming, which reduces overspray and lost milk. You may also want to reach out to an IBCLC if you haven't yet to size you for a pump flange ... Many moms only hand express with lots of success so you definitely don't have to [get sized for a pump flange], though."


After Weaning, Startling Behavior

I weaned my daughter about a week before her first birthday. She started around that time sucking her arms bad. She leaves bruises, welts, and sores. She won't take a binky or her thumb, isn't interested in a lovey blanket or special toy. This has been going on about eight weeks now with no signs of stopping. I've tried socks over her arms with the fingers cut out and it works OK, but any open skin she finds, and as soon as they are off, she is right back at it. Her doctor said it will just stop eventually, but the sores all over her arms make me feel bad.

"Some babies have a really strong sucking urge, especially after breastfeeding for so long, so it can be really hard for them when the breast is no longer available," says Andie B. Schwartz, M.Ed., RD, LD, CLC, of Happy Family's Happy Mama Milk Mentor program. "I know you wanted to wean, but since you’ve tried everything else and this has been going on for months now, you could consider putting baby to the breast once per night or in the morning. Choose whatever time works best for the two of you to see if that provides her with some comfort she’s looking for. Rest assured that you will not be building up a full supply again by limiting the nursing to once or so a day."

Schwartz notes that the behavior should stop over time. Meanwhile, a little extra comfort might help with the sores and bruising. Schwartz continues:

"For other moms considering weaning, it’s typically best to let the baby decide when nursing is done. I know as mamas it’s sometimes one more thing on the list, and sometimes we just want to be done. But for our little ones it is a very strong bond and level of comfort that only the breast can provide."


Waking A Baby To Nurse

I have an almost 7-week-old who last night randomly slept for nearly seven hours (normally she does four to five hours) and now she is sleeping for another three hours. Typically during the day she wakes to eat about every two hours. I've been told to let her sleep, especially at night. Should I keep letting her sleep or wake her to eat?

Literally, the most consistent advice I received as a pregnant person was this: never wake a sleeping baby. Turns out, that's not true for all sorts of reasons. Helping baby to sleep on a schedule is one, and according to Schwartz, it might be a little early for baby to be sleeping through the night, in this case. Here's her take on your good sleeper:

"Although this may appear like a godsend, I wouldn’t necessarily let your little one or you snooze the day and night away just yet. This is such a tough question because all mommies need their sleep, especially during the newborn phase, but the first few weeks and months are such a critical period [for] establishing a robust milk supply ... The key is to maintain your supply through 10 to 12 feedings per 24 hour period and also provide the proper amount of hydration and nutrition for her growth."

However, Schwartz thinks it might be all right to let your little one sleep through the night (amazing!), so long as she's been gaining weight, is wetting six-to-seven diapers in 24 hours, and soiling two to four. If those conditions are met, and you're squeezing in 10 to 12 nursing sessions during the day (which will help with your supply), you have some truly enviable options. All babies are individuals, and you may well have hit the sleeper jackpot.


Plus-Size Nursing Bras & Breastfeeding While Diabetic

I need help with plus-size nursing bras on where to find them? Also any good tips on being diabetic and nursing?

I firmly believe that every woman deserves a properly-fitting bra, and Schwartz agrees. She recommends getting your fit checked in person at a store like Motherhood Maternity or A Pea in the Pod. She also notes that lactation boutiques at some birthing hospitals can help you out with sizing. (It's also very likely that your friendly neighborhood IBCLC has a tape measure and chart stashed away somewhere.) For Schwartz, a great bra isn't just about comfort, either — tight-fitting bras can actually affect your milk supply.

As for managing nursing with diabetes, Schwartz notes that you might have more challenges with your supply than other moms. Fortunately, she has lots of recommendations for moms managing the condition:

"Nursing mamas need extra snacks and calories to maintain an adequate milk supply, but a mom with diabetes really needs to pay extra attention and be sure to add extra calories and snacks spaced out throughout the day to stabilize blood sugar. I would recommend working with your diabetes educator to come up with an appropriate meal plan. In case of a drop in blood sugar, have 15 grams of fast-acting carbohydrates around in case of hypoglycemia. Babies born to DM mamas are more likely to have issues with hypoglycemia after birth, so while you’re pregnant, you could consider expressing colostrum ... to give as a supplement if baby has low sugar at delivery. Discuss this with your doctor, diabetes educator, and/or lactation consultant."

Thank you so much for asking this question. Over 11 million American women have diabetes, according to Diabetes Sisters, and many of them are nursing or planning to nurse, just like you.


Nursing Through The Witching Hour

My daughter is 2.5 months old. Every evening from around 6:00 to 10:00, she wants to nurse for almost that entire time. If I take her off, she screams her head off. I thought my milk was low, so we tried topping her off with a bottle of pumped milk. That lead to projectile spit-ups. My husband works during the day and literally never gets any time with her because of this. This would come in as my time to shower and exercise and I feel like I can't do anything. I've switched my schedule around and even make dinner in the mornings when she is happy as a clam. She is fine all day, until the witching hour arrives. She really hates the binky, too. Anyone experiencing this? And how did you cope with it, and how long did it last? Why does she want to nurse for hours at a time? We have a doctors appointment in two days, so I am waiting to discuss it there as well.

"Congratulations on your newborn and breastfeeding! I know it can feel very overwhelming with a newborn and a constant breastfeeding schedule with such little time for you; trust me I’ve been there," says Schwartz. "I felt like I nursed my first born around the clock the first couple of months, but it did slow down. Your little one’s behavior is totally normal and doesn’t have to do with your breast milk supply.

"Fussy time or 'witching hour' is when little ones engage in cluster feeding, also called bunch feeding, that might consist of nursing for a few minutes, pulling off, then nursing again, etc. Many professionals think it’s their need to fill up before a longer sleep. For most babies, this happens to be between 6:00 p.m. and 10:00 p.m., before they go to sleep for the night. I know this behavior is very frustrating and at times you might feel helpless and insecure that you’re not soothing your baby. But I do not recommend you give your baby a bottle as this can lead to a lower supply, since bottles correspond with less time on the breast.

"It’s hard to quantify accurately how long it will last, but the reality is, this is only temporary. Most newborns are the 'neediest' during what many professionals term the fourth trimester, or until 3-to-4 months of age, when they’re better acclimated outside of the womb."

Besides nursing on demand, Schwartz recommends baby wearing — a great way to get a bit of exercise, though you should be sure to be safe and wear correctly. She also recommends bouncy time: "I swear by this one — you know those gym exercise balls? Yes those. I bounced both of my kids to sleep or to soothe them during witching hour. It worked like a charm."

And of course, you can always pass the baby to dad for some bonding. Schwartz suggests that dad sing songs, hum to baby, dance (on a side note, my husband has a very funny dance he developed just for our baby's fussy days), listen to calming music, or bouncing with her on the above-mentioned exercise ball.

She also recommends a change of scenery. Head to the park or take a ride in the car. Cluster feeding is difficult, and it's so crucial that you keep taking care of yourself. While you're feeding, dad can also bring you lots of high-protein snacks, or read to you both from a book or newspaper.


Diminishing Supply After Returning To Work

When I was home on maternity leave, I used to produce SO much milk. I have been been back to work for two weeks and pumping every four to five hours, but in my left breast the supply is VERY slow and I am scared I am not producing as much milk as I was. It seems to be enough milk for the next day, but I am just very worried that my supply is slowly diminishing... is there any advice to up my milk supply? Especially in my left breast? Thanks so much!

If I could wave my magic wand and make a wish come true, it would be for this — a year of maternity or paternity leave for every new parents that wants it. Unfortunately, my magic wand seems to be broken right now. I'll keep you posted on how that turns out.

In the meantime, Schwartz wants you to know that what you're going through is completely normal, and that there's a physiological reason you're producing less milk while pumping. "When you’re home with your baby and when baby is feeding from you, more milk is produced from direct stimulation: we smell, feel, and see our baby," Schwartz explains. "When pumping, the body receives less direct stimulation, which for many moms, makes it more difficult to make as much milk."

But don't worry. There are plenty of things you can try.

First, check your pump and flanges for fit on both breasts. Second, up your pump game, if possible. According to Schwartz, "A robust breast milk supply is a supply-and-demand relationship as well as an emptying relationship." So the more you nurse, and the more you "empty," the more milk you'll make.

Schwartz further recommends pumping more frequently on the less productive side, pumping on the less productive side after feeding from the more productive side, beginning all feedings on the less productive side, and massaging your breast on the weaker side while pumping to increase flow. She explains:

"It may take up to five days to see an increase in milk supply, so be consistent and hang tight for a bit longer. If you've been focusing on the other side for at least five days and aren't seeing an improvement, come chat with myself or another Happy Mama Milk Mentor. We’re available to answer any infant feeding question you may have."


Dry, Cracked Nipples

I have been exclusively breastfeeding my 7-month-old from day one and it has been relatively smooth sailing. I have had no trouble with latching or getting him to eat. However, I did have mastitis once and occasionally I get dry and cracked nipples. They usually heal after a day or so with me remembering to put cream on, but this time, it's not healing. It is only on one side, but it feel like needles are being stabbed into me when he tries to latch. A friend of mine gave me one of her shields that she wasn't going to use and that worked for a day until he started thinking it was fun to bite it, which made things way worse. So I have just been pumping for the past day and feeding on my left, but it still seems to be tender and I still have a crack which turns very red and almost looks like it is going to bleed after I pump sometimes. I also get very itchy and it burns at times. I thought thrush, but my LO doesn't have anything in his mouth at all and I don't have the other signs of it either. Could it still be thrush? Help. I love breastfeeding and would very much like to get back to not having to pump all day.

"Congratulations on exclusively breastfeeding for seven months and being such a trooper to work through this recent road block," says Schwartz. "Cracked, dry, and painful nipples are all uncomfortable for mama, so let’s first work on soothing and healing ... Here are some remedies that will help:

  1. Saline soak: Make ‘normal saline’ (a very low concentration of salt in water, which is not painful). Mix together ½ teaspoon salt in 8 ounces warm water and soak nipples for about a minute after breastfeeding (or squirt on with a bottle). Pat dry. Gently wipe off with fresh water before breastfeeding again.
  2. Lanolin: Use this cream (medical grade) on your breasts between feedings to help with nipple soreness and ‘moist’ wound healing. It's absolutely safe for you and baby, so don't worry about wiping it off before feeding again.
  3. Olive oil or coconut oil can help. And the breast milk itself has healing properties.
  4. APNO cream (also known as Newman’s Nipple Cream) is a prescription compounded ointment that can be very effective.
  5. Gel pads: can be used for pain relief. You can also put these in the refrigerator for a cooling effect.

"Next, let’s get to the root of the problem. Diagnosing the symptoms of the nipple pain are less important than looking for the probable cause of the nipple pain, so we can resolve it once and for all. Of course, we don’t want to leave a condition like thrush untreated. But whenever I hear a mom complain of sore and painful nipples and nursing pain, I always take a look at the baby’s latch and sucking ability. Because breastfeeding shouldn’t be painful!

"The most common cause of nipple and shooting breast pain is a poor or shallow latch. Even though you two have been able to get along well so far with only a few hiccups ... You would really benefit from an in-person breastfeeding assessment with a Certified Lactation Consultant (LC) ... [the problem could be caused by a too-shallow latch]. Lastly, let’s address the itchy, burning sensation and stabbing pain symptoms. It could just be the skin sensitivity from the dry, cracked nipples ... but since you’ve had it before and this time it’s not going away, it leads me to believe it could possibly be thrush. Just because you or your little one doesn’t have the typical thrush symptoms doesn’t mean there isn’t a possible yeast infection ... If you don’t experience any relief from the itching doing the above treatments, I would see your provider to get properly evaluated."

If you do have thrush, your provider can help you clear it up faster. Hope one of these strategies will work for you.


IUDs & Breastfeeding

Hello. My son is 8 months old and pretty much exclusively breastfed. My OB-GYN suggested birth control options at my six-week appointment, but I was too nervous about my milk supply decreasing. I am now fairly confident in my supply as I have been overproducing. I am horrible with remembering to take pills, so I am not looking to do that. Has anyone had any experience with an intrauterine device (IUD)? She specifically recommended Kyleena for breastfeeding moms, however, I haven't been able to find much research on this specific IUD as it is a newer brand. Has anyone had experience with an IUD while breastfeeding? Are there better options than others?

Kellymom has written quite a lot on the issue of breastfeeding and contraception, so that's a great page to refer to. Your pediatrician's lactation consultant is also likely up to date, and you can always print out research you find and share it with your OB-GYN. In the meantime, Schwartz writes:

"Congratulations on going strong with breastfeeding for eight months. You’re correct that some women can experience a drop in their milk supply even with progestin-only birth control. Since you’ve identified that pills aren’t for you, the IUD seems like a reasonable alternative. Kyleena is a progestin-only IUD, so according to Kyleena’s website: 'It’s not likely to affect the quality or amount of your breast milk or the health of your nursing baby. However, isolated cases of decreased milk production have been reported among women using progestin-only birth control pills. The risk of Kyleena becoming attached to (embedded) or going through the wall of the uterus is increased when Kyleena is placed in breastfeeding women.'

"As with any prescription medication, including birth control, there are always possible unintended side effects. The advantage to the progesterone-only pill is that if you notice you are one of those women who do experience a drop in supply, you could choose to stop taking it immediately, whereas the Kyleena IUD is a multi-year commitment (up to five years); although you could always choose to have it removed. My best advice is to do what’s best for you and your family. There are natural planning birth control methods out there that many women find successful and compatible with breastfeeding."


Leaking Milk During Pregnancy

I'm 34 weeks pregnant with my first baby. I was wanting to know if it's safe to pump before giving birth? I started leaking milk around 23 weeks — is that normal also? My breasts are so engorged and swollen and leaking so much milk. Please help!

Congratulations on your first baby. I'm sure leaking milk is startling and uncomfortable, especially considering it's been going on for weeks. I do think it's a good sign for your supply, although Schwartz notes that it's impossible to say for sure.

Her advice is to practice "light hand expression," if your OB-GYN gives the OK. I'd also recommend calling an in-person lactation consultant today to teach you good technique. According to Schwartz, "Hand expression would help relieve your engorgement and leaking." She also suggests you see a lactation consultant because you may be at risk of oversupply. (I always thought oversupply didn't sound like such a terrible problem — and then I met someone who had it. Oversupply is no joke, and you definitely want to nip that in the bud.)

Be advised that vigorous hand expression or pumping isn't likely to help you control your supply. In fact, an important breastfeeding truism is that the more you pump, the more milk you make. Hopefully, you can stave off some of that production until baby arrives.

Congratulations again, and thanks for writing in to Breastfeeding TBH.

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