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.
Motherhood is a constant gray area, isn't it? Just when your kid is sleeping through the night, they go on a bedtime strike and you feel like you're the mother of a newborn again. You're sure you've got it all figured out discipline-wise, and then your kid throws their first public tantrum in the middle of the cereal aisle and none of your tricks work. And when you're absolutely sure that breastfeeding is going great and there are no problems, you sweet little angel bites you like you're an extra on Buffy the Vampire Slayer.
Yep, breastfeeding is full of gray areas, too, which is why I reached out to Danielle Downs Spradlin, a certified lactation counselor accredited by the Academy of Lactation Policy and Practice to answer your questions about breastfeeding. She is a veteran nursing mother who wants mothers to meet their breastfeeding goals, and her practice, Oasis Lactation Services, focuses on science, infant-mother well being, evidence based solutions, and making breastfeeding an enjoyable and healthy time for the whole family. (And she also understands how awful it is to be bitten by a child you're trying to provide sustenance for with your own body. Ungrateful little heathens.)
1. Self Weaning
My little boy is 7 months old and we have nursed and given formula since he was 3 months old. My breasts aren't getting as full and he's drinking more ounces of formula in the bottle. Do you think he is self weaning?
Not exactly. "Babies under 12 months who refuse the breast are having a nursing strike, a short term behavior feeding issue usually related to approaching developmental leaps," Spradlin says. "Milk production naturally decreases as a baby transitions to solid foods and/or human milk replacements." She also notes that just because your breasts no longer feel full doesn't mean you're not producing milk. "If you are interested in increasing your breast milk production, nurse more frequently when you are together, even if the baby isn't cueing for feeds. Increased nursing is the number one way to increase milk production."
My baby is 4 months old and has no teeth yet, but is biting me when he nurses. He does it toward the end of his nursing session, when he lets out this whiny little growl, then bites down. What works to get him to stop?
"Biting is awful, and many children do it before teeth erupt," Spradlin says. But don't worry — it's just a phase. "Babies can't bite and actively nurse. They would bite their own tongues. When the feed slows, you can try unlatching and switching sides. The change in position and milk flow is distracting. When the feed slows on the other side, switch back. The baby will be more interested in the switch game than the biting game. The switch game can end on your terms."
3. Increasing Production With Domperidone
My son is 6 months old now. I had such a hard time nursing in the beginning and had to give my son formula and pump. I can not for the life of me pump more then 2 ounces the whole day. I've tried pumping every two to three hours, fenugreek, mother's love, mother's tea, oatmeal, cream of wheat, Gatorade, and beer and still nothing. I've been thinking about asking about domperidone. Is there anything else I can do to help before doing that?
"Your ability to pump milk is a separate issue from milk production," Spradlin says. "If your nursing production is normal and your pump output is low, taking medications will not remedy the problem. Low milk production always has a cause. Rather than trying tons of supposed lactogenic foods, herbs, and medicines, find the cause of the low production and treat it directly." Spradlin recommends making sure your pump is working and that it fits correctly.
4. Using Opened Breast Milk
If I take breast milk out of the fridge for supplementing and my baby doesn't take it after breastfeeding, can I put it back in the fridge?
All of the storage and handling tips for breast milk can be confusing, so Spradlin recommends trying the milk yourself. "When in doubt, throw it out. Your breasts will make more," Spradlin says. She also recommends checking out this collection of storage guidelines from the Centers for Disease Control and Prevention and La Leche League International.
5. Increasing Milk Production With Food
What are some good choices of food to help produce more milk?
There's a lot of misleading information out there about food affecting breast milk, but Spradlin suggests forgetting about it. "Despite the cultural beliefs, there is little evidence that foods improve milk production in humans," she says., suggesting that the best way to ensure full milk production is to breastfeed frequently or pump. "The law of supply and demand stands. The more comes out, the more is made. Breasts contain glands, not bladders, and they won't fill up to a large capacity. If you feel full, your breasts actually signal your body to slow down production." Spradlin also recommends lots of skin to skin contact with your baby as it has also shown an increase in the hormones that make milk.
6. Extreme Bleeding While Breastfeeding.
Ever since my C-section in December, I've been struggling with an extreme amount of bleeding. I exclusively breastfeed, and during my bleeding episodes, when my son feeds, it makes the bleeding worse and the cramps and back pain can be almost unbearable. My son just turned 6 months old and I'm struggling with the will to keep going. Do other women struggle with this problem? Is there anything at all I can do besides quitting breastfeeding and taking the hormones?
"Your son deserves a healthy mom. The way you care for yourself will help him learn how to care for himself and others," Spradlin says. But she notes that it never hurts to get a second opinion when you are uncomfortable with your medical options. "You deserve to feel confident in your diagnosis and treatment plan. Many women take hormonal medications during breastfeeding and meet their breastfeeding goals. An ideal care situation for a mother in need of medication during breastfeeding is to have a lactation specialist and the prescribing doctor follow the patient together to check progress and side effects." Spradlin also recommends checking out The Infant Risk Center, a free resource for mothers and health care providers to discuss medication studies in breastfeeding mothers.
7. Reflux & Breastfeeding
My son is 2 months old, exclusively breastfed, and growing very well, but he has reflux and awful, painful gas. We tried Zantac for reflux and just switched to Prilosec to see if it works better.
"Reflux is tricky," Spradlin says. "Babies are on a liquid diet and have poor core strength, so they kind of slosh around all the time. Reflux is inevitable, but how it's managed can save your sanity." She recommends trying out a new nursing position to help with the symptoms. "Tummy-down nursing helps compress gas and elongate the esophagus so baby can nurse more comfortably." Spradlin's YouTube channel also has a video about a nursing position that can help ease your baby's reflux symptoms.
8. Preventing Mastitis
My daughter is 4 months old and exclusively breastfed. She usually nurses every two hours during the day, and goes about four hours at night. She also only nurses from one side at a time. Last night she slept six hours and I woke up feeling only a little engorged and didn't notice any pain until she latched on. I felt a small but painful bump. I've never had a clogged duct before so I'm not sure what to do. From what I could find on Google it says to nurse often, but since she only nurses from one side at a time, how do I do this and not cause my other breast to get a clog also?
"Mastitis sneak attacks and knocks you down for two to four days," Spradlin says. To keep yourself protected from mastitis, she recommends checking out her first aid on clog care and preventing mastitis.
9. Getting Baby Back On The Breast
My baby is almost 7 weeks old and has been great at breastfeeding until two weeks ago. She has suddenly stopped wanting to nurse during the day. She will latch and nurse for two or three minutes, pull off and cry, and continue this for the whole afternoon and early evening. I eventually had to start pumping and giving her bottles during the day because I didn't want her going hours and hours without eating. As a result, I have now had two clogged ducts because of the constant stopping and starting with the nursing. I have tried nursing in different positions and I know my let down comes pretty quickly because when I pump it usually takes less than a minute to come out. Do you have any suggestions or ideas as to why this might be happening?
It might be your pump that's the issue. "Check the fit of your pump flanges. Too small flanges can compress milk ducts and risk clogs," Spradlin says. She also suggests considering co-bathing to get her back on the breast. Spradlin's Oasis Lactation Services has an instructional video on a back-to-breast technique called "re-birthing" that you can do in your tub at home.
10. Pumping & Breastfeeding As A Working Mom
I am a first time mom and my daughter is almost 5 months old. I work full time and am away from her from 6 a.m. to 6 p.m. each day. I was only allowed six weeks leave, but we have struggled with breastfeeding since day one. We had to use the shield for the first month, almost two, and I have very low yields. She was put on formula after her first week, but we haven't given up breastfeeding. However, even with pumping three times a day at work, breastfeeding in the evenings, and through the night, I am lucky to pump two ounce max per sitting total, but I average one ounce. I am wondering if I can dramatically increase my milk supply past this point or am I just wasting my money on supplements?
You need to find out why your milk supply is low and treat that issue specifically. "Low milk production always has a cause. Find the cause and then a targeted treatment," Spradlin says. "Supplements don't work because they aren't targeting the cause and most are not evidence based." She also notes that a normal pump output is two to four ounces total from both breasts combined in a 20 minute pumpping session, so make sure you are pumping correctly. "There are a lot more broken and ill-fitting pumps than broken mommies," Spradlin says. She also recommends her list of pumping tips for working moms.
11. Failure To Thrive
I've been slowly getting mildly depressed. My 3 month old has had a weight issue according to the pediatricians we go to. "Failure to thrive" is what they called it. I was trying to exclusively breastfeed her and apparently she wasn't gaining enough weight so they've had me formula feed. I'm terribly unhappy about it. Now when I do try to nurse she will take it just fine, but she's not getting full. I still have to formula feed. Any advice?
"Failure to thrive is a frightening diagnosis. It can leave moms feeling defeated, disappointed, and inadequate," Spradlin says. But she notes that often it's the result of a latch issue. "Some babies don't pull milk out of the breast efficiently, even though the milk is there. A skilled lactation consultant can help you determine if your baby is latching well and getting adequate milk at feeds. If not, there are treatments to correct this." Spradlin also recommends pumping milk in addition to breastfeeding. Not only will you boost your milk production, but then you can give your baby pumped milk in her bottles.