22 Real Breastfeeding Questions On PCOS, IUDs, & 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.
When you're just starting your breastfeeding journey, you encounter plenty of obstacles. But I believe breastfeeding can be even more difficult in the later months. Whether it's because you're trying to introduce a bottle, figure out birth control, or simply take a weekend break from your kid, it seems like everything has an affect on nursing your child. That doesn't mean breastfeeding isn't worth it, by any means, but it does suggest that everything pretty much revolves around breastfeeding.
And what does that mean? It means you have a lot of questions. I spoke with International Board Certified Lactation Consultant Kristin Gourley to get her expert advice on common problems like deciding on a birth control, finding the perfect nursing position, and even dealing with family members who think you should use a bottle so they can feed the baby. Gourley works with Lactation Link which offers in-home consultations in the greater Utah Valley area, but she also teaches online, on-demand, comprehensive video classes, so follow Lactation Link's Facebook or Instagram to join her community.
1. Moldy Pump Parts
I just noticed that one of the tubes on my Medela pump has some mold in it. It’s a little spot, I have boiled the tube, and no milk touches the tube. I am wondering if it’s safe to feed my son all of the milk I have pumped prior to noticing this mold. I don’t know how long it has been there.
"Breast milk, even just sitting in a cup, is really great at fighting against bacteria and other pathogens," Gourley says. "If your baby is healthy and was full-term, the milk is probably OK." Gourley notes that Medela does ask you to contact them if mold develops in your tubes.
2. Baby On Nursing Strike
My 2-month-old son was breastfeeding like a champ, but then this morning he wouldn't latch at all. I tried for 15 minutes to get him to eat, but he just screamed. We had a rough start to breastfeeding because he wouldn’t latch in the beginning so they gave me a shield. I later found out he was tongue-tied, so they stopped trying to latch him to me without the shield. He has been great until I had to travel. I gave him a bottle from 3:00 p.m. to 12:00 a.m. every two hours. He has had a bottle before with no issues, but this morning he wouldn’t even try to eat.
Babies like to do their thing and Gourley says that this may be his version of a nursing strike. "They are usually short-lived — most babies will go back to the breast with time," she says. "If he’s upset, take a break from trying. We want the breast to be a comforting place." Gourley also has a few tricks for nursing strikes including nursing when he’s very sleepy or already asleep, nursing in a dark room, trying a new position, or offering the breast while wearing him in a baby carrier. "If he also has a tongue tie and you generally use a nipple shield, you may need some more personalized support from an IBCLC if he doesn’t go back to the breast fairly soon," Gourley says.
3. Finding A Nursing Position
I find it really frustrating nursing in any other position except laying on my side on our futon. Now that we're about to have guests coming and going, I have been trying to figure out a hassle free way of nursing without an abundance of pillows to support me and my son but it feels pretty awkward. Is there a hassle free way to nurse in an upright position rather than always laying on our sides?
"It’s hard to say what position you might like without knowing why you find other positions frustrating, but at 4 months old, I wonder if you might find success with having your baby sit up your lap while breastfeeding," Gourley says. "You’ll have to support him some since he’s probably not sitting unassisted yet, but he probably has good head and trunk control." She also notes that it might be more comfortable in a standard cradle position if you didn’t focus on lots of pillows so you don’t hunch over, but rather you reclined slightly and had him lay on you, either in cradle position or vertical to you. "As he gets stronger and better able to support himself, positioning will become easier," Gourley says.
4. Breastfeeding Is Painful After 4 Months
Sitting here after almost month four of exclusively breastfeeding, and it has never hurt before. Now it is starting to be painful. I’m using lanolin occasionally, but it’s not doing much good. There’s no redness, I only have tenderness when she nurses.
Gourley says that there are a lot of possibilities as to why you're experiencing nipple pain. "They may be sucking harder to get the milk out faster and your nipple is sore as it gets used to the change, or they may be slightly biting at the beginning or end of each feed as they begin to teethe," she says. Gourley also notes that your baby may be nursing differently so their gums rub on your breast to help relieve teething pains, or one of you may be breaking suction at the end of a feed by just pulling your nipple out, which causes friction, instead of releasing suction first.
"Or it could be hormones for you," Gourley says. "Has your period returned or could you be pregnant? Those changes in your body are notorious for causing nipple pain without redness or other visual signs of pain." Gourley suggests going back to the basics and make sure your baby has a good latch. Rule out any hormonal changes like pregnancy or your period and if you're still experiencing pain, reach out to an IBCLC.
5. Pumping Discreetly
I'm returning to work soon and my baby is 7 weeks old and exclusively breastfed. I work for a small law firm of less than 50 employees as a legal assistant. I share an office and the office is open to the public, but the only option for me to pump is at my desk; I will not be allowed breaks for pumping. I'm overwhelmed by how to do this discreetly.
Have you talked to your employer? Gourley suggests doing that first. "Even if you have less than 50 employees in the company, which means you’re not protected by federal law, your employer may be willing to work with you on when and where you can pump privately." But make sure to check your states' laws as some have laws in place that supercede the federal law. "If you can find no other way to pump, you can consider using a nursing cover while pumping, or pumping in your car. Some moms also find they can pump less at work if they feed baby more overnight or wake to pump at night, too," Gourley says.
6. Dealing With Skin Conditions Without Medication Due To Breastfeeding
My son is almost 7 months old and is breastfed almost exclusively. My second trimester of pregnancy I developed perioral dermatitis and rosacea. I've been offered several prescriptions, ointments, and creams for it from my dermatologist and family doctor, but none of them are 100 percent safe for breastfeeding. Breastfeeding has been going amazing for us with supply and latching and taking a bottle, so I don't want to ruin any of that with a prescription or put my son potentially in danger. Has anyone else had these conditions and how did you handle them or get rid of them?
"No drug is going to be absolutely 100 percent safe for breastfeeding because most drugs do transfer, even if just in minute amounts, into breast milk," Gourley says. "That said, most medications, especially topical ones, are quite safe for breastfeeding and cause no adverse effects or long-term problems for babies. I’d encourage you to call the Infant Risk Center or look the medication up on LactMed to learn all you can and to offer yourself some relief."
7. Baby Nurses For Only A Few Minutes
My daughter will only eat for a couple minutes on each side. How do I get her to eat longer?
"Some babies are very efficient so she may not need any more time," Gourley says. "If she is growing well, developing normally, and having at least five to six wet diapers and at least one to three poopy diapers (depending on age) per day, she is probably getting enough even in that short amount of time." Gourley suggests using breast compressions while feeding to keep her interested if she's not growing well. These compressions will give her a stronger milk flow. Or, you can nurse more often to make up for those shorter sessions. Switching back and forth between sides can also encourage a reluctant nurser, Gourley notes. "If she’s having trouble gaining weight, I’d encourage you to see an IBCLC to rule out other problems and get personalized support," she says.
8. Baby Prefers Bottle
I have a 3 month old baby who is strictly breastfed. She has not wanted to feed and the only way she will feed is through bottle. I'm concerned she won't want to take my breast anymore.
"It could be a nursing strike, in which case most babies will come back to the breast after a short period of time," Gourley says. "I find that some babies who prefer the bottle aren’t confused about the nipple difference, but are instead preferring the constant flow of the bottle. Milk directly from the breast comes in waves (letdowns), so babies have to continue sucking through a slow milk flow to be rewarded with an abundance of milk when letdown happens. This pattern happens multiple times throughout one feeding while the bottle offers a constant steady stream of milk." Gourley suggests taking frequent breaks and paced bottle feeding to help get baby used to different flow rates during a feed and help her get back on the breast.
9. Storing Pumped Milk In Bottles
I'm trying to mentally and physically prepare myself for when I have to go to work and pumping. I'm exclusively pumping only during the day and pretty much pumping for the next day and just a tad bit more. Is it OK if I pump and pour what I pump into one bottle for the next day so her caregiver during the next day is able to pour out just what she needs for each feeding? Or do I need to store it in separate bottles/bags?
"You could store it in one big bottle for the next day that is then broken into the individual bottles she needs throughout the day, as long as you keep it handled properly in the fridge," Gourley says. "Make sure that your day care provider does pour it in a separate bottle when it’s time for a feeding and doesn’t feed directly from the big bottle all day long though."
10. Digestive Enzymes While Breastfeeding
I was wondering if anyone had any experience with digestive enzymes while breastfeeding?
"These have been taken by both mothers and babies while breastfeeding before," Gourley says. "Sometimes mothers find that taking them themselves can help their babies with poop issues, like not pooping often or unexplained (allergies and anal fissures ruled out) blood in poop." In general, Gourley says that these are OK while breastfeeding, but it’s always a good idea to talk to your and baby’s doctor about it.
11. Breastfeeding With PCOS
I suffer from PCOS and I'm really hoping to be able to breastfeed my son who is due at the end of November. Did anyone else have successful breastfeeding with PCOS? Should I take anything to make my supply stronger?
Although it is true that the reasons behind PCOS and symptoms caused by it can also affect lactation, many women with PCOS have no issues breastfeeding according to Gourley. "My advice is to take a breastfeeding class and get off on the right foot, then nurse very often in the beginning and don’t hesitate to see an IBCLC if any issues at all arise," she says. PCOS can also affect how some supplements or herbs work in your body, so talk to an IBCLC before trying any to help your supply.
"If you have been prescribed something like Metformin in the past and it was helpful, you may find that taking it while breastfeeding can help regulate your hormones and help you to have a better breastfeeding experience," Gourley says. "Talk to your doctor and work in conjunction with an IBCLC if issues arise, but remember that it’s very possible that you’ll experience no problems, too."
12. Biting While Nursing
I have a 6-month-old that’s exclusively breastfed. My question is now that he has his two bottom teeth, how can I get him to stop biting while nursing? Going for a bottle only is out of the question. When he is tired and in the middle of the night, he nurses just great, but if he is not almost passed out, he bites.
"Many babies bite when they’re done feeding and beginning to play around so it can help to anticipate this, but it’s impossible to bite if latched on correctly," Gourley says. "So, if baby loosens or lets go of their latch, remove them from the breast and give them something else to bite. Also, sometimes babies bite for attention so putting down your phone (I know it’s hard) and looking at him during the feeding may help." Gourley also suggests wearing a necklace or something around your neck for your baby to play with as he nurses or you can try reading a small book to them for a distraction from biting.
13. Pain In Breast
My 1-month-old is exclusively breastfed and we both prefer the right side, but I try to pump and nurse with left once or twice a day. It's been a couple of days, but I feel a shooting pain in my left breast when I nurse on right. Is that normal?
"It can be common to feel letdown in both breasts even though you’re only nursing or pumping on one side," Gourley says. "If it’s painful, it could be that you’ve developed a clogged duct in your left breast. Nursing or pumping more on that side, massaging the breast before and during feeding, and applying heat before feeding may help release it."
14. IUD Effects On Breastfeeding
I was wondering if there are any negative effects of an IUD on milk supply?
According to Gourley, there can be some negative effects, especially if your IUD is placed before you're six to eight weeks postpartum. "If you are looking into the Mirena or Skyla IUDs (they have low-dose hormones), you may want to try a trial of the progesterone-only birth control mini pill first," she says. "There are similar hormones in those pills so you can monitor your supply while on them and stop them easily if your supply suffers. If it doesn’t, which is what happens for a lot of moms, then you could choose to proceed with the IUD placement." Gourley notes that if your supply is affected, you may want to talk to your doctor about your birth control options.
15. Baby Fusses At Left Breast
I exclusively breastfeed and sometimes, like once a day, when I start my baby out on the left side, he nurses for five to eight minutes and then stops, cries, and won't take that side anymore, but he'll gladly take the right. Why is this? And why does it happen randomly?
"It probably happens randomly because babies are fickle beings," Gourley says. "But, it could be that he wants a faster milk flow than is currently coming out, and he’s happier after nursing on the other side triggers an immediate letdown. It could be that he can see what he wants to see better on your right side at that time, too." Gourley notes that following baby’s lead on how often to feed, but also on what side, is good practice.
16. No Period After Introducing Solids To Baby
My son who is 6 months old was exclusively breastfed until four months old when we introduced solids. He is now still breastfed and eating solids three times a day. He sleeps through the night, sometimes up to 10 hours. But I have not gotten my period yet. Is that weird? He is my third child and this is the longest I’ve gone without it.
More proof that your body is weird. "When your period returns can vary greatly from woman to woman but also from baby to baby," Gourley says. "Things like age, hormone levels, nutrition and fitness status, and more can all play into when it returns." As he's only six months old, there's probably no need to worry, even if he's eating solids and sleeping through the night. According to Gourley, some moms find they have to wean completely to see their period again. "If other things feel off or you wean completely and still don’t have a return of your cycle, then it’s time to see your gynecologist," she says.
17. Introducing Sippy Cup Without Weaning
My 6-month-old has been reaching out for and drinking water from glasses when we have them. She does pretty well so I wanted to try out a transitional sippy cup with her. Is one indicative of the other or will she maintain a healthy nursing pattern and still be able to move from bottle to sippy (when we're apart)?
"At six months old, it’s unlikely that she’ll have a problem with nipple confusion, and getting water from a sippy cup is very different than getting milk from a breast," Gourley says. She notes that in most of the world, weaning actually begins whenever anything other than breast milk is introduced, but in America, the word isn't used until you're ready to be completely done with breastfeeding. "You can certainly have your nursing relationship continue while introducing solids and liquids in cups, even though it’s actually beginning the (sometimes very long, if you want) process of weaning," Gourley says.
18. Breasts Engorged, But No Letdown
I am three days postpartum and my breast milk just came in. However, I am not experiencing a letdown so I remain engorged. My baby isn't really having that many wet diapers and when I pump after nursing, I get a very small amount. I had this same issue (delayed letdown) with my other two kids and it took weeks for me to establish breastfeeding and many many tears. I have tried warm wet compresses, massages, relaxation techniques, and more and still can't get the letdown reflex. Any tricks or advice?
"Are you sure you’re not experiencing letdown? It can still happen if you don’t feel it. Many women don’t feel their letdown, but notice that baby begins to swallow bigger gulps in more of a rhythm," Gourley says. She notes that if you’re sure it’s not happening, which the few wet diapers might indicate, there’s a few things to think about.
According to Gourley, the hormone oxytocin is responsible for your letdown and it is produced by the hypothalamus and pituitary gland. She notes that if this has been an ongoing issue for you, you might want to see your doctor about your pituitary and other hormone levels in your body. "An oxytocin nose spray used to be used to aid in letdown, but that’s not really prescribed anymore. I suggest also seeing an IBCLC to go through your full history and situation to give you some personalized tips," Gourley says. She also suggests having skin to skin contact with your baby very often, especially when nursing, to help raise your oxytocin levels.
19. Baby's Bowel Movements Changed After Supplementing
My little one is six weeks old and breastfed, but I have been supplementing with formula because of a medicine I was taking that doctors said wasn't OK while breastfeeding. Three days and over 15 ounces of breast milk pumped and dumped later, I was told by her pediatrician that I could in fact nurse and to return doing so. Since then my little one’s gas is horrible and very foul smelling. When she has a bowel movement, it's dark green and seems very hard for her. Before formula, she went every time after she ate, but now it's every couple days. Should I be worried?
"Are you still using the formula? Even only partially using formula can sometimes lead to constipation in babies," Gourley says. "That, combined with the fact that some healthy breastfed babies can begin to go a few days in between poops after a month old could be the culprit of infrequent pooping in your little one. The green could possibly be related to the formula and/or the medication you took (that doesn’t mean it was bad to take, so don’t worry)." Gourley suggests talking to your pediatrician or IBCLC if you want to improve your baby's bowel habits. An IBCLC can also help you with your milk supply if you want to get rid of formula completely.
20. Baby Has Foul Smelling Gas & No Bowel Movement
I know exclusively breastfed babies can go days without pooping, but my little one has gone every day since birth. She's four months old and hasn't had a bowel movement in two days. I'm not really worried, but when she passes gas, it stinks. Could it be what I'm eating or is it because she hasn't pooped the reason it smells?
"It’s not uncommon for moms to say that their baby’s gas stinks when they go a few days in between bowel movements," Gourley says. "As long as when it does come, the poop is soft and normal-colored and there’s a lot of it, the gas and gaps between stooling aren’t usually cause for alarm."
21. Family Members Want To Feed Baby
My SO's mother constantly makes me feel bad that I don't leave the baby with her to watch for an extended period of time. She doesn't seem to respect my decision to only offer my baby a bottle only when necessary. Most recently, she took it upon herself to book us a weekend away on the condition that we leave the baby with her. My baby is only seven months old and I am not comfortable leaving her for more than a couple of hours, let alone overnight. I would really appreciate some advice and insight.
This is a really tough situation as it's always hard to defend your parenting decisions, especially to your partner's family. But, Gourley notes that standing firm for what you want for your child and your family is going to be the best thing long term. "Write out what you want to say and practice with your SO (give him a line or two to say to support you, if possible) and then firmly but kindly request that she respect your wishes," Gourley says. "Some moms find that having their partner run interference or do all the talking can be beneficial, too. The bottom line is that she is your baby and while you may want the support and love of her grandparents in her life, you’re the mom and get to decide when it’s right to leave her for certain periods of time."
22. Birth Control That Won't Affect Milk Supply
I am currently five months postpartum and breastfeeding. I have an appointment to look at birth control, but I'm scared it may mess with my supply. Depo shot is not an option; I've had it before and didn’t do well. What are some good ones that haven't messed with a milk supply?
"This can vary woman to woman," Gourley says. "The good news for you is that hormonal birth control is less likely to affect supply after at least six weeks postpartum when your milk supply is well established." She notes that some moms notice no change in supply at all when they take the mini progesterone-only pill, Mirena or Skyla IUD, or the Norplant arm implant (all of which use similar hormones), but some moms do notice a dip in supply.
"Since the mini pill can be easily discontinued if you do notice a dip, moms who are worried can do a trial run with the mini pill. If all goes well, they choose a longer-lasting option like the IUD if they want," Gourley says. There are also non-hormonal options available such as the Paraguard copper IUD, condoms, or diaphragm. "The one thing we know for certain is that regular birth control pills with estrogen generally have a negative impact on your supply."