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.
As I prepare for my wedding, my husband-to-be and I have had many conversations about babies and future children. He's adamant about the fact that I won't be a single mom in any aspect with my next child, emphasizing that he'll be incredibly involved. He's brought up everything from taking care of diaper changes and getting up in the night to feeding a child with pumped bottles of breast milk. "You could just pump and I'll feed the baby so you can sleep at night."
I know, incredibly sweet, right? But the thing he's not entirely certain of is how much work it takes to pump, bottle feed, pump during bottle feeding sessions, and still get some sleep. I love his enthusiasm and I seriously can not wait to start the next chapter of parenthood with him, but I'm also thinking we'll have more talks about breastfeeding, how easy and hard it can be, and a million other questions.
Because I'm pretty sure he's not the only one with questions, I took your real breastfeeding questions to International Board Certified Lactation Consultant (IBCLC) and Registered Nurse Rachael Anastasio-Collins to get some real, expert answers. Put down the Google and read what Anastasio-Collins has to say — she knows her stuff.
Pumping In Bottles For 9 Month Old
How do I get a 9 month old to take a bottle or sippy cup? I tried breast milk, formula, and water, but nothing works. Nobody's willing to watch him while he's hungry, so I've been trying to wean him into a bottle. I'm worried he's not getting enough milk or that I'm starving. It's been a week of him not eating from 8 a.m. to 12 p.m. and soon I'll be away from 8 a.m. to 4 p.m. How can I get him to eat and how many ounces should he eat? Do I pump during my time away from him, too?
"It sounds like your baby just really prefers his meals right from the tap. It’s sweet, but definitely not convenient," Anastasio-Collins says. She notes that this is a pretty common problem, even with her own child, and can happen if a child is older when you introduce a bottle. Try a variety of bottles to see if your little one prefers one brand over the other and continue trying to have someone else offer a bottle instead of you. "Babies know that you are the keeper of the breasts and they don’t want that other thing you are offering," Anastasio-Collins says. "One option is to have your partner offer the bottle around bedtime when baby is sleepy, but another great option is just feeding the baby your milk from a cup. There are resources available online and a local IBCLC can help, too."
"As far as how much you should offer him, you can do a quick calculation for a starting point of what to offer with each feeding," Anastasio-Collins says. "On average, from 1 to 6 months old, babies eat 26 ounces of breast milk every 24 hours. After 6 months, as babies increase the amount of solid foods they eat, that number starts to decrease." She suggests using 26 ounces as an estimate and divide it by the number of times a day your baby typically nurses to see how many ounces you should leave. If your baby seems to still be hungry, then you can offer more milk in small increments, like half an ounce at a time. If they leave milk in the bottle or cup, then decrease your offering. Be sure to use the paced bottle feeding method, as well. As far as pumping, absolutely. You don't want to ruin your supply and Anastasio-Collins says you have to pump for each feeding you are missing while you are separated from the baby.
Getting Baby Back To Breast
My baby wasn't gaining due to his inability to suck and effectively transfer milk. My supply dropped because he wasn't transferring milk, so now I'm pumping and supplementing. My supply is back up thanks to pumping, but I find that baby refuses the breast and I'm thinking it's due to supplementing with bottles. I still put him to the breast after supplementing and that's okay, but he will not go on the breast before. Any advice?
If you were able to discover that your baby couldn't effectively transfer milk, it's assumed that you worked with an IBCLC to have a solution. That problem has to be resolved to get your baby back to the breast so they can effectively nurse, Anastasio-Collins points out. It may take a little while to fully transfer back to breast, but she notes that you have to be patient with your baby and yourself. You're already doing everything you can, mama.
Anastasio-Collins does have some suggestions though. First, make sure you're following the paced bottle feeding method when using bottles, especially if your little one is used to a fast flow from a bottle. You should also make sure you're getting as much skin to skin as possible. "Over a weekend, just lay around all day skin to skin with your boobs out and take all the opportunities you have to offer the breast," she says. "Pay attention to your baby’s feeding routine and try and catch him before he is actively showing hunger cues. Get him skin to skin and hand express some milk from your breast to see if you can get him to accept the breast when he is calm/sleepy and not super hungry."
You can also try what Anastasio-Collins calls bait and switch. "Offer him some milk from a bottle to satisfy a bit of his hunger, then remove the bottle and offer your breast," she says. "Hand expressing prior to offering the breast will start your milk flowing and be more rewarding for him," she says.
Finally, you can try nursing while both of you are relaxing in the tub and you can also dream feed at night. "He will be sleepy and less likely to notice that you’ve slipped a boob in his mouth and not a bottle," Anastasio-Collins says. If none of these things work, contact an IBCLC to work out a plan.
Keeping Nipple Piercings
I'm pregnant with my second child and plan on breastfeeding. However with my first, I didn't have nipple jewelry — I expect some minor obstacles with keeping them in. Any advice?
"Pierced nipples do not usually cause any issues with breastfeeding success," Anastasio-Collins says. "There are some cases where scar tissue develops at the piercing site and can interfere with milk flow from the nipple. Many moms with pierced nipples report leaking from the site of the piercing, but that won’t impact your ability to breastfeed." She notes that the general recommendation is to remove your jewelry during feedings to make sure your baby doesn't loosen the jewelry sucking and accidentally ingest it or choke on it. Keeping them in could also interfere with your baby's ability to latch to the breast.
Breastfeeding & Circumcision
I went to my breastfeeding class last week and the teacher told me that getting the baby circumcised can cause problems with breastfeeding. She said that the baby might not latch and that the baby will sleep a lot. Will it interfere with breastfeeding?
Anastasio-Collins agrees with your instructor's warnings. "It is important to remember that a circumcision is a surgical procedure," she says. "The procedure itself can be stressful and babies will feel discomfort following the procedure. Both of these things can cause babies to sleep for long periods and be difficult to wake for feedings." If baby is in pain, Anastasio-Collins notes that it can be hard to get them to calm down and latch to the breast.
"You should plan to be skin-to-skin with your baby following the procedure and if he doesn’t wake to feed on his own, try and gently rouse him and get him to latch," she says. "You can hand express drops of milk onto his lips to help get his interest in nursing, but if he doesn’t nurse, it would not be a bad idea to hand express your milk into a spoon or cup and feed him that way until he decides that he feels well enough to nurse on his own." Nobody can predict how your baby will react (he may be totally fine), but it's not a bad idea to be prepared. Anastasio-Collins suggests asking your OB or midwife what is usually done during a circumcision. If you feel like your baby is experiencing discomfort, discuss pain relief options with your doctor.
Black Dots On Nipple
I get black dots at the tip of my nipple and then my nipple is very sore to the touch. How do you get rid of it? I've tried a bath, but nothing happened.
It’s difficult to answer this question without being able to look at your nipple and see exactly what the dots look like, but Anastasio-Collins thinks it sounds like a blood blister on your nipple, which is usually caused by a poor latch. "I would suggest contacting an IBCLC in your area to have them evaluated," she says. In the meantime, you can express some breast milk onto the nipple, rub it in, and let it air dry to aid in healing if it is a little blister.
Adjusting Milk Supply For Baby's Sleep
My 3 month old has just started sleeping longer at night, but my boobs are still on the old schedule waking up every two hours to feed. I'm finally getting a chance to sleep more, but I get woken up by engorged breasts. Do I need to wake up and pump or do I need to just wait and see if my body regulates to the new schedule?
"Your body will regulate to the new schedule," Anastasio-Collins says. "If you like, keep a bottle on your beside table and hand express into it if you wake up feeling uncomfortable and your baby isn't ready to nurse yet."
Eczema & Breastfeeding
I am exclusively breastfeeding my 2-month-old daughter. She has developed eczema, but we haven't found out what triggers it. It has gotten so bad that her cheeks started oozing. We went to the doctor and she was diagnosed with staph infection. Currently she's on antibiotics and I'm applying antibiotic cream, so it's getting better. But I'm worried that there is something I'm eating that's causing this allergic reaction. Can you please tell me what I should and shouldn't eat to prevent eczema?
As awful as this is, there isn't an easy answer to your question. "It's not clear if your child is having an allergy to something in her environment or something that you are ingesting that is passing through the breast milk," Anastasio-Collins says. "True food sensitivities are actually not very common in breastfed babies, but if it is a food sensitivity, the most common culprits are cow’s milk protein, soy, wheat, corn, eggs, and peanuts." She notes that you can start by eliminating any or all of those from your diet for at least two to three weeks as it can take that long for them to clear both your and your baby’s system.
"You’ll want to keep a food diary to help find patterns in what you eat and reactions in the baby," Anastasio-Collins says. "In addition, you can ask your pediatrician to have a stool sample tested for blood. Blood in the stool can point more solidly to a food intolerance causing her allergy instead of something in her environment." She also suggests working closely with an IBCLC and your pediatrician to figure out your little one's allergies.
Nursing Bras For Larger Sizes
Where can I find bigger nursing bras?
You actually have a few options here. According to Anastasio-Collins, Nordstrom offers a service to convert their regular bras into nursing bras, so you can always go and get fitted for a great bra and then have them convert it. "If you are handy with a sewing machine, you can find the right pieces online and do it yourself," she says. "But Motherhood Maternity also carries bras up to size F and they have a lot of locations nationwide." Anastasio-Collins also recommends contacting your local La Leche League International meetups, breastfeeding support groups, and even Facebook breastfeeding groups to get recommendations from other moms.
Loving The Smell Of Breast Milk
I am breastfeeding my second child, and I have always wondered if I am the only one who absolutely loves the smell of breast milk. My husband says it just smells like spoiled milk after a couple hours when I don’t change clothes, but it smells different to me. It reminds me of the smell my little ones had when they were born.
"Just reading this question brought back memories of my little girls as newborns and their sweet milky smell," Anastasio-Collins says. "Oxytocin is a hormone heavily active in the breastfeeding process and one of its jobs is to promote feelings of love and bonding. It makes sense that the smell of breast milk would bring on the warm fuzzies and why your husband might not have the same reaction."
Pumping At Work In New York
I am looking for my rights for pumping at work in New York.
You definitely have rights. Anastasio-Collins notes that your best resource is the New York Statewide Breastfeeding Coalition webpage. According to the website, your employer has to provide you a safe place to pump other than a bathroom as well as give you adequate break times to pump.
Baby Fussy With Bottle
I am unable to nurse my 6 week old, but I pump milk, then feed it to him in a bottle. I've been doing this for about four weeks now with no problems until this last week. When I feed him, he fusses during the feeding, but when I stop and burp him, he screams bloody murder. Sometimes the screaming stops when he burps, but not always. Any idea what the problem might be?
You're doing so great, mama and this kind of scenario can be really frustrating. "His behavior could be so many things, so it will take some investigating and patience to nail down the exact cause," Anastasio-Collins says. She notes that if it is every feeding, there may be something your baby doesn't like about the bottle and nipple. The flow could be too fast or too slow or your baby might want to be held a different way while he's eating (try the paced bottle feeding method to help).
But if you notice a difference between the times he eats freshly pumped milk versus stored milk, it could be high lipase. "Breast milk contains an enzyme called lipase that helps break down fats for easy digestion," Anastasio-Collins says. "Some moms produce higher amounts that can cause stored milk to have a different taste. The milk is safe to eat and nutritious, but the different taste can be bothersome to some babies while others have no issue at all. If your stored milk smells soapy once thawed, this might be your culprit, but there are ways to work around this."
But if your baby screams all the time and isn't comforted by being held or being rocked, has mucus or blood in his stool, and/or seems to be in pain, it might be reflux. Anastasio-Collins suggests contacting your IBCLC and pediatrician to help figure out the exact cause of your baby's fussiness.
Psoriasis On Nipples
My son is almost 2 years old and has no intentions of weaning. My problem is that I have developed psoriasis on my nipples. It’s horrible — they peel and crack and my left nipple has a crack running all the way around it. It’s so painful to even wear a shirt, let alone have my son nurse. I don't know what to do. My doctor wants to prescribe me a steroid cream, but I’d have to give up breastfeeding. I have a hard enough time trying to limit nursing to just before bed, it makes me want to cry sometimes because he wants to nurse when we are at home during the day, but it hurts so bad.
You are a total warrior, mama — never forget that. "The good news is that according to Dr. Hale from the Infant Risk Center, low to moderate potency topical steroids can be used even while continuing to breastfeed," Anastasio-Collins says. "I would suggest finding out the name of the specific steroid cream your doctor wants you to use and then contact the Infant Risk Center to see if it is one that is considered safe for breastfeeding. They can provide guidance on any precautions you might need to take, such as washing the cream off prior to feeding, or suggest alternative medications to try that are compatible."
Decongestants While Breastfeeding
I have a 5-month-old baby boy. He is exclusively breastfed. I have the worst cold/sinus infection and my nose is so stuffed up. I know some decongestants dry up your milk but is there any that don't? I'm dying to take something so I can sleep.
Anastasio-Collins says her first suggestions are always hot, steamy showers and getting yourself a neti pot, which is used to flush your nasal passages and sinuses of mucus that causes all that pressure and your runny nose. She also notes that there are many over-the-counter options that are considered safe for breastfeeding moms. "The most common ones would be the non-sedating antihistamines like Zyrtec, Claritin, and Allegra," she says. "Sudafed (Pseudroephedrine) is the one medicine that most moms worry about drying up their milk supply although, according to the research, it seems that effect is a higher risk for moms breastfeeding babies over 8 months old." She recommends the Infant Risk Center website for more information on specific medications and their effects on breastfeeding.
Baby Constantly Gassy
My baby is incredibly gassy, to the point of discomfort for him. He seems to be constantly passing gas and his tummy is distended. He is exclusively breastfed and I have tried eliminating dairy from my diet. I've tried gas drops, gripe water, and we are currently seeing a chiropractor. I burp him during and after feedings. Any suggestions?
"Lots of things can cause gassiness in babies," Anastasio-Collins says. "Sometimes it really is just because they have immature digestive systems and make lots of gas, grunting sounds, and fart and burp a lot, especially in the younger ones." But because you've already done some work to ease your baby's symptoms, Anastasio-Collins suggests contacting an IBCLC to help pinpoint exactly what's going on — an in-person consultation can be extremely helpful.
She also notes that an improper latch can impact the amount of air that is taken in when feeding, which can lead to gassiness and another thing that is often overlooked is a tongue tie or lip tie. "These can be tricky to identify so I would suggest having an IBCLC well versed in ties check out his mouth and see if he has one," Anastasio-Collins says. "Sometimes, a fast let-down can cause the baby to take in more air during a feed, so you could try nursing him in a reclined position in an effort to slow down the flow of breast milk and see if that helps"
According to Anastasio-Collins, it can take two to three weeks for food to completely clear both your system and your baby's system. She adds that the most common causes of food intolerances are cow milk proteins, soy, wheat, corn, eggs, and peanuts. If you believe this is your culprit, you can keep a food diary and try elimination diets to determine the cause.
Weaning Twins From Nighttime Breastfeeding
I have 14-month-old twin girls. I have exclusively breastfed since birth, but now I only breastfeed them at bedtime. I am planning on taking that away soon but how/when do I replace that milk? They don't take the bottle at all, they only drink from sippy cup. They also eat dinner at 6 p.m. and I nurse them for bedtime at 8 p.m.
An obvious round of applause for 14 months of breastfeeding twins, mama. That's incredible. If you're trying to figure out an alternative milk in place of breast milk for dietary reasons, Anastasio-Collins suggests talking to your pediatrician for specifics on how much milk to feed them and the best type of alternative milk to feed them as they continue to grow. She notes that some parents skip alternative milks entirely and just feed their children foods high in good fats and calcium, but this is still a discussion worth having with your doctor.
If you're trying to replace that bedtime nursing with something else or simply trying to prepare them for the end of nursing, Anastasio-Collins has a few suggestions. "If you haven’t already, you can start coming up with a bedtime routine to replace nursing — cuddling, reading books, singing songs — that way when you stop nursing, there is a familiar and comforting routine already in place," she says. "There are a lot of ways to let them know that nursing is not an option any more and it might take some trial and error to find the one that works the best with the least tears."
Some other ideas include talking to your babies about weaning and setting a timeline of when the milk will be gone to prepare them, having your partner do the night time routine for awhile, putting band-aids on the nipples and telling the girls that they are not working anymore, and simply distracting them from the fact that they didn’t get to nurse before bed. "There is also the option of just continuing with your current bedtime routine and nursing them," Anastasio-Collins says. "I only mention it because some mamas aren’t aware that it is okay and still very beneficial to continue if it is something that you all enjoy and find comfort in. If you are ready to be done, then I want to offer my congratulations on 14 wonderful months. That is really something to be proud of."
Preparing For Surgery While Breastfeeding
My son is going to be 7 months old soon. He takes a little bit of baby food, but he's almost exclusively breastfed still. I'm having some pretty horrible medical issues right now and within a month, I think I'll be getting either an endoscopy or a colonoscopy — both require IV sedation drugs. I don't know how long they stay in your system or if you can breastfeed with them in your system. I also don’t think I can pump enough if it's going to be more than a few days because he refuses bottles. I don't know what to do.
Try not to panic, mama. There's good news. "Most likely, the medications you will be given are compatible with breastfeeding (most medications are) or only require a short time to clear from your system before you can return to nursing," Anastasio-Collins says. "The first thing to do is to contact your doctors and be given a list of medications they would plan to use for your procedures. Then call your local IBCLC who should have the proper medication book or contact the Infant Risk Hotline. They will be able to advise you on if the medication is considered safe and any precautions you might need to take."
She also notes that if there is a small time frame where you will need to use pumped breast milk and your son refuses to drink from a bottle, your son can be fed with an open cup or a sippy cup. A consult with an IBCLC can walk you through this plan.
Breasts Leaking After Weaning
I breastfed my son for almost five months, but stopped four months ago due to a bad latch. My son and I never quite got the hang of it, but we sure tried. I have still been able to produce very small amounts of milk, but nothing of note. This afternoon I sat down with my son and gave him a formula bottle and noticed that my shirt was very wet and that my breast was leaking. The fluid all looks normal, but I was very alarmed to see this spontaneous leaking. I wouldn't mind at all pumping to produce breast milk for him again, though I know getting him back to the breast at this point is unlikely. Otherwise, is there any advice to get it to stop or should I be concerned?
"It can take a long time for breast milk to fully dry up and chances are if it looks and smells like breast milk, you’ve had breast milk in there, and you have no other concerning symptoms, it is most likely just breast milk," Anastasio-Collins says. "It is worth a call to your OB-GYN to let them know and see if they want to see you and rule out anything else. Some medications and other medical conditions can cause nipple discharge."
But according to Anastasio-Collins, if it is breast milk and you're interested in relactating, go for it. "All you would have to do is start pumping again. If you want to try and get back to a full milk supply, you should pump at least eight times a day, including overnight, taking up to a five hour break at night," she says. "You might also consider renting a clinical grade pump for the first few weeks as they are designed to build breast milk supplies. If you don’t want a full supply, but would like to offer some breast milk in addition to his formula, then just remember that the more often you pump, the more milk you will make."
Breasts Haven't Grown During Pregnancy
I'm 26 weeks pregnant and my boobs haven’t grown at all. Does it mean I can't breastfeed?
"There are lots of different changes that happen with our breasts when we become pregnant as the breasts prepare to feed our babies," Anastasio-Collins says. "Common changes include more visible veins on the breasts, darker and larger areolas, enlarged and more firm nipples, stretch marks on the breasts, breasts feeling more firm, the appearance of little bumps on your areola called Montgomery’s glands, nipple and/or breast tenderness, and growth of the breasts themselves."
But a lack of breast growth alone isn’t really concerning if you are having some of those other breast changes. According to Anastasio-Collins, some women have all the changes and some only have one or two — it really depends on the mama. "There are some mamas who have certain circumstances that can lead to difficulty producing a full milk supply," she says. "One of the red flags is the lack of any breast changes during pregnancy. If you are having none of the symptoms listed above, the best thing to do is to contact an IBCLC to evaluate your specific health history and your breasts. In the event that your specific situation makes you more likely to have difficulty making a full milk supply, they will be able to provide support and assistance to help you be successful and have a satisfying breastfeeding experience."
Sling For Breastfeeding
Any recommendations on a breastfeeding sling? I don't want to spend the money on one and not like it. I have a carrier, but it's hard to breastfeed my 3 month old in.
"Pretty much all ring slings work the same way, although there are a huge variety of materials, weave structures of the material, and shoulder styles," Anastasio-Collins says. "None of these would really impact your ability to breastfeed in it, but would impact your comfort in wearing it. My advice is to find your local Babywearing International chapter. They will usually have a lending library where you can 'check out' different carrier types to try out and they have experts who can show you the correct way to use all the different types."
Check out Romper's new video series, Bearing The Motherload, where disagreeing parents from different sides of an issue sit down with a mediator and talk about how to support (and not judge) each other’s parenting perspectives. New episodes air Mondays on Facebook.