17 Real Breastfeeding Questions On Lumps, Pumping Laws, & More, Answered By An Expert
Breastfeeding can be a hard, isolating, and emotional journey, which is why it's so important to have a community of supporters. Romper has launched a new Facebook breastfeeding community, Breastfeeding TBH, in an effort 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. Each week, Romper will be speaking with a lactation consultant to answer as many of these questions as possible.
I've said "I feel like a cow" more times than I can count in my life, but that phrase was mostly said when I was hooked up to a breast pump. There's just something so bizarre about a contraption hooked to your breasts for the sole purpose of retrieving your breast milk, isn't there?
Breastfeeding in general can be pretty crazy, but that's what lactation consultants are there for. They help talk you off the edge, give you tips, and remind you that even if you feel like a cow, you're doing the best possible thing for your baby.
I reached out to a private practice lactation consultant Sarah Lester to get the answers you need to your breastfeeding questions. Lester provides breastfeeding care and assistance home visits in Fayetteville, North Carolina and the surrounding areas with a special interest in preterm infants and babies with oral restrictions. (She even helped create the only three pronged approach to tongue tie treatment in her area.) As the mom of two girls, both born early and both breastfed, she definitely knows her stuff. You can check out her practice, Naturally the Best Lactation Services, for even more information.
1. Preparing For Breastfeeding Before Baby Comes
So I am getting ready to have another baby. I already have two kids and had horrible luck with breastfeeding. Is there anything I can do to help it not hurt when my milk comes in?
"Part of the initial engorgement is actually tissue swelling," Lester says. "Treat it just like a swollen ankle, by using ice or cold compresses. This will reduce the swelling and allow milk to pass more freely." She also recommends massaging your breasts in a reverse pressure softening manner to soften the nipple and areola areas enough for your baby to latch. If you don't have one already, Lester suggests getting the contact information for a local IBCLC just in case you need assistance.
2. Pumping Output Has Decreased
I have been pumping since going back to work in August. I exclusively breastfeed at night and on the weekends, but my supply is dropping. I was getting 4 ounces per session at work and now it's down to 2.5 ounces, maybe 3. I am taking every supplement possible and drinking over 100 ounces of water a day. What else can I do?
Sounds like you're doing pretty well, mama. "If you’re pumping every three hours, as recommended, 3 ounces is the perfect amount," Lester says. "A good goal is one ounce per hour and your baby should be taking about one ounce per hour as well. Ensure that your child's caregiver is pace feeding all bottles and be sure to do hands on pumping to help encourage more milk." Lester also says you should consider adding a power pumping session to your day, like once in the evening, for a couple of days. "Pick a favorite hour long show, and pump during the commercial breaks, leaving the pump on in between," she says. "Also remember to relax, and trust that your body is doing as it should."
3. Baby Nurses To Sleep
My baby is 5 months old and we are currently exclusively breastfeeding. I also pump at work. My baby loves to nurse, she even nurses to sleep, but it’s a big problem for her babysitter. Any advice on getting her to sleep without me?
Lester suggests discussing with your baby's caregiver how they introduce naps as your baby should have a consistent routine for sleep. Once your baby is comfortable with the routine, they may find it easier to relax and take a nap. "Consistency is key, but babies aren’t robots, so they should expect the routine to vary slightly from time to time," she says. "Consider allowing baby’s care taker to wear a shirt or article of clothing that smells like you and if your baby has a “lovey” of some sort, let them cuddle with it when you aren’t there."
4. Local Laws For Pumping At Work
Where can I find the Michigan laws for pumping in the workplace? I know I am going to be talked to about it soon and I'd like to know what my rights are to the fullest extent, but I don't know where to look.
Lester did a little bit of research and found that there doesn't appear to be any law protecting mothers who need to pump at work in the state of Michigan. "Fortunately, you can approach this situation by utilizing some of the provisions of the Affordable Care Act, which states that an employer is required to provide a reasonable break time for an employee to express breast milk each time they have a need," she says. Your employer doesn't have to compensate you for the break, but they must provide a place other than the bathroom for you to pump according to the Affordable Care Act. However, the act also states that if these requirements impose undue hardship, an employer that employs fewer than 50 employees is not subject to these requirements.
5. Starting A Freezer Supply
My 2-week-old is exclusively breastfed, but I'd like to start pumping to have a freezer supply for when she's a little older. How do I start? I'm afraid to pump and not have enough for her next feeding.
"If you aren’t planning to return to work anytime soon, I would likely wait until after baby’s sixth week growth spurt to begin pumping," Lester says. "You can then begin pumping once a day for about five to ten minutes immediately following a nursing session. I would try to stick with the same time frame each day so you train your body to make more at that time." Lester says you shouldn't expect to see much, if any milk, the first couple of times, but consistency is key so stick with it.
"Alternatively, you could also do a 'power pump' session a few days a week and have extra milk that way. Choose your favorite hour long show, and turn the pump on during every commercial break (I know, the one time you don't want Netflix) and then back off when the show is on," she says. Do this one session for three days in a row, and you’ll likely score a few bottles’ worth that way, too.
6. Breastfeeding In Cold Weather Clothing
Any cold weather hacks for breastfeeding? I specifically need clothing ideas. I can't imagine layers to stay warm help with trying to feed baby.
"Wear an over-shirt that you can lift up (it can be long sleeve) with a camisole you can pull down, and only a small part of the breast will be exposed," Lester says, noting that usually nurses in a carrier when it's cold. "We both have body heat transferring, and I can keep my hands in my pockets, or gloved, or I can wrap a jacket around us," she says. "Basically, using a carrier frees up your hands so you can keep them warm."
7. Boosting Supply To Pump For A Sick Baby
My 6-week-old daughter was rushed into emergency surgery last night because her stomach was flipped upside down. Up until Wednesday, she had never had a bottle and she was exclusively breastfed. I had never pumped before. With everything going on and the stressful impact of dealing with her surgery, I barely had time to pump and now I am only getting half an ounce to an ounce from each breast.Is there anything I can do to boost my supply back up and if so how long does it take?
It can be extremely scary and stressful to have a child in the ICU, but you can still manage to get your supply up. "You can take a piece of her clothing or a blanket and cover your pump while you’re pumping, so you’re not looking at the output. Pump when you’re by her bedside, as that will help output as well," Lester says. She also suggests maintaining a good routine of every two to three hours during the day and once or twice at night, not going longer than about five hours. "You’ll want to aim for eight to 12 sessions in a day, about 15 to 20 minutes per session. You can also utilize hands-on pumping, which has also been shown to increase output," Lester says.
She also adds that you need to take care of yourself. " Get enough to eat and drink, and take your vitamins," she says. "Baby is going to get what baby needs nutritionally, so you are needing to take care of yourself for you so you can maintain your nourishment levels while simultaneously nourishing your baby."
8. Baby Only Takes Bottle From Mom
I have to go back to work from maternity leave in three weeks, and my exclusively breastfed, almost 3-month-old, refuses to take a bottle from anyone. She might suck for a second or so, but almost every time she will stop, cry and scream, and refuse to take any more of it. During one of these episodes when my mom was trying to feed her, I took over and she took the bottle fine. I'm panicking because I won't be able to feed her during the day when I go back to work. Any advice?
"There are many factors that come into play when giving baby a bottle," Lester says. "Many babies put up a fuss taking a bottle from someone when Mom is around — they’re smart and want to be fed by Mom. Start with a slow flow nipple, many buy the preemie ones, and do what’s called paced feeding." If that method doesn't work, along with a slow flow nipple, Lester suggests using an open cup, syringe, or finger to feed your baby. She also notes that your baby could reverse their cycle and sleep while you're at work and then nurse throughout the night. "It works for many families that sleep close to their babies," Lester says.
9. Giving Baby Milk That May Cause Reflux
My 3-month-old son was recently diagnosed with silent reflux, and as we work through this, I have found that he struggles when I eat tomato sauce and garlic. My concern is breast milk I have frozen. Since I am not sure when I may have consumed these foods, should I risk giving him the milk?
Lester suggests mixing the old milk with some of your newer milk so it's less of an issue for baby, but don't throw it away. "You could use it for a variety of ailments or even a milk bath," she says. "Also, consider working with an IBCLC to help possibly alleviate baby's symptoms with some latch and/or positioning tweaking."
10. Baby Won't Take Bottles
My baby has been exclusively breastfed, and she is 3 months old. We recently have been trying to get her to take a bottle for various reasons and we've tried a variety of bottles but she won't take any. Suggestions or tips?
Lester's big tip is to definitely try a slow flow nipple, even one catered to premature babies. "I would also use paced feeding for the baby baby so she isn’t feeling waterlogged by the flow and volume," she says. "You can even consider other feeding methods, such as open cup, syringe, or finger feeding. If none of this works, please see your IBCLC for further assessment."
11. Breast Lump After Pumping
I am pumping constantly for my NICU baby. Today while washing, I noticed a huge lump in my breast that kind of hurts. Is this normal? Will it go away?
Lester knows the stress of being a NICU mama and constantly pumping. "Sometimes we can get clogged ducts from improper or inefficient drainage," she says. "Check your nipple faces to make sure there are no blisters covering an opening and if there are, consider a saline soak of the nipple. Once the opening is unblocked, or if there aren’t any blisters, massage the breast in a circular manner towards the chest wall. Stop every couple of minutes to hand express, and “clear the traffic jam” as we like to say." Lester notes that depending on the age of your baby, your clogged ducts may either need to be treated with cold or hot compresses. "If you are in the early engorgement phase, the time frame when people say their milk “comes in” — it is already there, it just increases in volume — cold compresses will help to reduce the tissue swelling. If supply is established, hot will help," she says.
Lester also recommends meeting with the IBCLC at the hospital to ensure your pump flanges fit correctly, too. "If you start to feel flu-like, have a fever, or chills, please see a doctor immediately," she says.
12. Left Breast Not Producing Milk
My son is almost a month old and has refused the left breast since birth and only eats off the right side. I pump the left side, but I got lazy and missed a couple pumping sessions. Now my left side only pumps a drop or two, and when I was done I noticed a groupy stringy thing hanging off. What is that? What do I do? Or what can I do to get to pump more?
Lester says that your first plan should be to get your baby loosened up and feeding better on both sides. "Call around to find a local body worker who specializes in babies," she says. "Body workers encompass many modalities, such as chiropractic, massage therapy (myofascial release), and cranio sacral therapy. But ensure before using the provider that they do work with infants." Lester notes that once your baby is taking both sides, your supply will increase. In the meantime, she suggests utilizing hands on pumping on that side or pump that side while baby nurses on the other.
13. Not Pumping Enough To Meet Baby's Needs
I am starting my third week back at work. I am pumping every two hours, and I'm getting roughly between nine to 12 ounces a day, but, it seems my baby loves to suck down the bottle all day at the babysitter's. I'm worried I won't be able to pump enough for her. Is this normal?
"This is a common concern for many moms," Lester says. "Ensure that your babysitter is feeding baby via the paced feeding method. Baby should take about an ounce an hour and that’s also the volume you should focus on pumping. If you pump every three hours and baby feeds every three hours, you should both expect around three ounces." She notes that many caregivers unknowingly overfeed baby and leave moms thinking their supply has dropped. It's OK to plan for spills, leaks, and to send a little extra milk, but make sure your babysitter knows and understands bottle feeding for a breastfed baby.
14. Baby Is Only Soothed By Nursing
It seems like sometimes the only thing to soothe my son is hooking him up to my boob even though I know he's not hungry, and then he throws everything up making him more uncomfortable. He's only 3 weeks old and won't take a pacifier. What do I do?
Lester says that it sounds like you definitely need to speak to an IBCLC. "I would definitely reach out to someone to perform full oral, structural, and functional assessments on baby. Babies don’t really do non-nutritive sucking in the first six weeks; he is doing exactly how Mother Nature intended. Babies are born with a very high suck need and as their suck need decreases, our supply increase," she says. Lester suggests that you allow baby to nurse as he pleases the first six weeks so you really establish supply, but ensure that transfer is sufficient by his four to six wet and four to six dirty diapers per day.
15. Giving A Toddler Breast Milk
I am 36 weeks pregnant with baby number two and I plan on exclusively breastfeeding for a good long time. My first child only made it to a month of being breastfed due to me simply not having any idea what I was doing or was in for. He is almost 3 years old and he's been bottle weaned for over a year. I want to give him some of my breast milk in his cup. Will my body meet supply & demand of a newborn & the extra gallon for toddler? Will my body make its breast milk cater to the needs of the toddler the same way it will the newborn? Would it be more beneficial for the toddler to drink breast milk even if it's not tailored to his own body’s needs rather than the whole milk?
"Your body will make more milk if you demand it," Lester says. "Establish breastfeeding with your newborn first and then slowly add in a couple of pump sessions per day. Any amount is better than none." As you demand more milk by pumping after nursing around the same times each day, your body learns to make more. "Don’t expect to see a ton, if any, the first couple of sessions. Just establish breastfeeding with your newest babe first and consider the pumping sessions after baby’s sixth week growth spurt," she says.
16. Am I Overfeeding My Baby?
I've been exclusively breastfeeding and my baby is now 2 months old. She had breast milk in a bottle a few times when I was away and at her two month check up, she had doubled her birth weight. Is this OK? Am I over feeding her? How many times a day should she eat at two months? The pediatrician told me to try and give her an extra 30 to 60 minutes between feedings.
Don't worry, mama. Your baby sounds perfect. "Breastfed babies don’t really overeat at the breast; they typically know when they’re full," Lester says. "Babies her age typically nurse every two to three hours."
17. When Should You Pump?
I have to go back to work next month and am trying to get some milk ready for when I do, but I don't really know how. My baby feeds every three hours. So when should I pump? I've heard of doing the opposite side while she is nursing, but should I be doing that every time or just a certain time of day? I will be pumping when I go back to work so I'm not too worried, but I'm new to all of this and trying to not get stressed out.
"Consider pumping for about five to ten minutes immediately following a couple of daytime (or nighttime if you’ll be working night shift) feedings for the next few weeks," Lester says. "The average person only has enough milk saved up for a day or two, so there’s really no need for a huge freezer stash." She says that the biggest thing to remember is to relax and make sure baby’s caregiver is utilizing paced feeding so you are providing the perfect amount for her.