Avoiding Common Breastfeeding Pitfalls

Guest Post By Summer J Friedmann, IBCLC

Awaiting this precious baby’s entry into your world, you sit with a mind full of stories from friends and family about their struggles with breastfeeding, pumping and milk supply. “My nipples hurt so bad," “I couldn’t make enough milk," “My baby never latched," “They told me my milk was low calorie and didn’t have enough fat," “My postpartum depression and anxiety was unreal and I couldn’t enjoy my baby so they suggested weaning," “I was told the medication I needed was contraindicated with breastfeeding." Do those sound familiar?

These stories are heartbreakingly real and common among moms I work with to get them on track. I’m going to discuss ways to avoid common pitfalls so these stories don’t become your own.

I don’t know what I don’t know…

Get the education you need while pregnant. Make sure this information is provided by a qualified lactation professional like an International Board Certified Lactation Consultant (IBCLC) or Accredited La Leche League Leader (LLLL). Enroll in a prenatal breastfeeding class and go to a breastfeeding support group. Sit in the group, listen to the conversations, listen to the Lactation Consultant or Leader and hear how these women overcame obstacles. Set up a prenatal session with an IBCLC to discuss your goals, your questions and what to expect in the first week postpartum. Essentially, build your support network WHILE you are pregnant!

Retaining information is easier now than in the postpartum period. Online groups that are run well by an IBCLC or LLLL, moderated very closely, don’t allow for any drama or judgment, and only allow evidenced based information, these are the ones to JOIN! Ahem… I have one. These gems can be a great place to lurk, learn and feel supported any hour of the day or night.

I’m worried I won’t be able to make enough milk.

Less than 1% of the entire female population are physically unable to make a full milk supply. That means that most women who think they “don’t make enough milk” actually have the ability to make plenty of milk for their baby. We call this PIMMS; Perceived Insufficient Milk Supply Syndrome:

So what does this mean for you? It means you are extremely likely to make ample milk for your baby. What about the women in these stories? How does this happen? Anyone, even a medical professional who isn’t well informed, can easily mislead a mom down the wrong path which then creates low milk supply. Or the mom may have unintentionally mismanaged her early postpartum period just from lack of knowledge, creating a low supply.

Of course there are times when a mother has a condition that puts her at risk for low supply and this makes it even more vital that she connect with an IBCLC to make sure she does everything right in order to get the most success out of her experience.

Breast surgeries, insufficient glandular tissue (IGT), PCOS, insulin dependent diabetes or even thyroid dysfunction are all risk factors that are considered primary, which simply put, means ‘born’ in the mother and out of her control. Secondary risk factors are things that happen after delivery that could be social, mismanagement of the postpartum period, PIMMS, complications during the labor and delivery, or baby driven factors. This doesn’t mean these people can’t optimize their success, they absolutely can!

Bodies are incredible and surprise me all the time. I’ve worked with so many of these women with risk factors and against all odds and expectations, they make plenty of milk for their babies.

So how can we avoid PIMMS?

We need to understand how milk making works to get off to the best start. Who is in charge of determining milk supply? The baby! Their job is to tell the breasts how much milk to make. The babies are THE BOSS! They are instinctual, very smart and it is our responsibility to trust them.

Any time milk is removed from the breast, more milk will be made to replace what was taken out. I like to describe it like the cans of soup in a grocery store. Some stores have these soup cans, laying horizontally, in a container that when you grab a can, the next can comes rolling down into position. This is what happens inside the breast. So the more frequently the baby breastfeeds, the more milk a mother will make. Doubting a baby’s need to nurse is a quick road to low milk supply. “They can’t be hungry yet, they just ate 15 minutes ago," “Can you just hold them and use a pacifier, I need a break."

Lemme break this down for you: babies are never wrong; they are the customer that is always right! Any time they cue, smack their lips, root around, put their fingers in their mouth, or stick out their tongue - they are communicating to you they need to breastfeed. It doesn’t matter what time it is, how long ago they last nursed, or how long they nursed at the last session. Trust the baby to do the work they need to do and they will create a bountiful milk supply. They are building the foundation of your milk supply. Something that has a short window of time to accomplish.

The foundation of a mother’s supply is built within the first 2-4 weeks postpartum. With every single nursing session, the baby lays down prolactin receptors in the breast that keep stacking up like bricks do in the foundation of a house. Those receptors later allow the milk supply to grow, similar to planting a garden. We plant the seeds, the prolactin receptors, and later the garden will bloom just like a healthy milk supply. If we don’t plant enough seeds, our garden will be sparse and likely to fail.

I must not make enough milk because my 2-day-old wants to eat so often and must not be getting full.

Newborns are NOT supposed to be full or sleeping for long stretches. A sleeping baby is not stimulating a milk supply. Wakeful, energetic, vigorous, feeding-frenzied babies are a Lactation Consultant’s dream. These babies create a fantastic milk supply. A full-term and healthy newborn that is allowed to stimulate a healthy milk supply will be nursing or held nearly all hours of the day.

Is that a lot of work? Absolutely! Am I serious? I am. “My baby is just very oral." I hear so many new families tell me this in their explanation of why the baby is probably not hungry while cue-ing. Newsflash! Every baby is very oral by design to create the milk they need. Will they always be nursing so frequently? No. They will eventually shift to feeding about every 2-3 hours and feedings will last about 10-30 minutes. But this initial time period of the first few weeks is what I call “Building The House of Milk."

Babies' tummies are teensy. Their stomach holds 1 teaspoon of milk in the first couple days of life! The mother’s colostrum is that same perfect small volume: isn’t nature so smart?! By day 2 and 3 of life the baby’s tummy is about the size of 2-3 teaspoons. So why do babies nurse so often if they have small stomachs? Shouldn’t they be full quickly? Well, no. Guess what? Small stomachs fill up, of course, but they empty even faster. So by the time a feeding has finished, they have likely digested the milk already and need to fill up their tummy again.

 

Remember when I said the more milk removed, the more milk is made. Frequent feedings are our friends. In these first few days babies may nurse for 45 minutes, take a 15 minute break, then start nursing again. This is NORMAL and if we have appropriate expectations, we won't be concerned as to why they are nursing often. Basically, it comes down to allowing the baby unrestricted access to the breast, trusting the baby and trusting the body to respond the way they are both designed to do.

What about the pacifier?

Pacifiers aren’t terrible, but when and how they are used is critical. During the initial “House of Milk” phase, the pacifier can be the most problematic. Babies have a very high need for sucking, as it is quite vital to life.

 

If the baby is spending time sucking on the pacifier, they are basically telling the pacifier to make milk. It won’t of course, but that is what the baby is doing instinctively. Worse, the mom is missing out on essential milk removal and therefore missing vital stimulation of her supply. Pacifier use in these early days leads to more infant weight loss, less diaper output, a lethargic baby, higher incidence of jaundice, low milk supply for mother and early cessation to breastfeeding.

The use of a pacifier needs to be judicious. It should not be used as a way to control when the baby feeds or doesn’t. It should not be used to postpone feeding the baby or to give mom a break. Can it be used during a photoshoot, while the mom is in the bathroom, while the baby is in the car, or as a way to calm the baby down in order to get the baby to the breast? Yes. Any other use risks the mother having a low milk supply especially when used in the first several weeks.

I can’t see how much the baby is getting, so I never know if they are getting enough.

You are right; we can’t see through the breasts to visualize how much milk they actually drank at any given feeding. I know some of you are wishing you could! What we CAN see is what comes out…in the diaper! So you will have visual confirmation of getting enough milk, it will just be on the way out instead of on the way in. For some moms this is quite a struggle. Especially those that are more analytical, in the medical field, an ICU RN, a certain personality type, or a person who just loves all the data. I completely get that. My job, as their Lactation Consultant, is to switch their brains to rely on the output data instead of intake. Many have heard me say, ‘the proof is in the pants’. It truly is. Even from the first day of life, counting how many wet and poopy diapers a baby is having tells us so much. The color of the poop in the first week of life also tells us what we need to know. If enough is coming out, enough has to be going in.

I’m scared of the pain and broken nipples.

Pain is not normal with breastfeeding, ever. Proper latch is the key to having healthy nipples and babies extracting good amounts of milk.

Nipple tenderness can be normal in between feedings as hormones shift from pregnancy to non-pregnancy hormones. Typically this tenderness subsides after a couple of weeks. During a feeding with optimal latch, one should feel tugging, pulling, stretching or pressure. Mom should be able to talk, breathe and do normal things while feeding.

Feeling sharp, stinging, stabbing, knife-like or pinching sensations are not ok and indicative of something being incorrect.

A trained IBCLC has many skills to demonstrate positioning, latching and perform oral exams to assist in getting you pain free.

I did have someone look at the latch and they said it looked good…even though it hurt so bad I couldn’t breathe and my toes were curling.

My suggestion; find someone else. What a latch looks like while feeding is less important than what YOU are feeling. The difference between a good and a poor latch is extremely noticeable by any woman, even a beginner. As I said above, she should be able to breathe normally and talk normally while feeding. And regardless of what it may appear like, if the mom is in pain, there needs to be further investigation as to why and steps for how to correct it, period.

I was told my medication wasn’t compatible with breastfeeding.

I hear far too many stories of mothers being told to ‘pump and dump’ or wean when it is completely unnecessary. It is so sad, actually angering, women are getting inaccurate information from medical professionals. Even more angering is some of these same professionals do not refer her to an IBCLC. More often than not, lactation management and medications while lactating is entirely outside their scope of practice and knowledge base. Most medications are quite safe while breastfeeding. It is extremely rare for medications to be contraindicated, to warrant recommending weaning, discarding or being unsafe for the baby. Some medications are even prescribed in pediatrics, given directly to a baby themselves, so of course it would be safe for a breastfeeding mother to take. Medications that are taken during pregnancy are also safe during breastfeeding for once a baby is born.

The science is clear; there are many risks to a baby not getting breastmilk and risks involved with formula exposure. Generally speaking, those risks are higher than the mother continuing to medicate as directed while continuing to breastfeed as normal. If anyone tells you to discard, to wean, to delay breastfeeding, or avoid feeding, please let an internal alarm go off in your head. Pause any changes or action and get a hold of an IBCLC asap. She will reference the gold standard resources for you; LactMed from NIH and Hale’s Medications and Mother’s Milk, aka InfantRisk Center. Women with ailments, illness, diseases and other struggles that require medications are better off breastfeeding, as are their babies, while she medicates as directed by her physician.

I’ve heard that postpartum depression and postpartum anxiety are more common if a woman breastfeeds.

Any woman, regardless of feeding method, in the year after birth, is at risk for PPD and/or PPA. This is not exclusive to breastfeeding or pumping. There are many medications available for treating PPD and PPA that are safe for using while breastfeeding and pumping. In fact this family of medications, antidepressants, anti-anxietals, and mood stabilizers are medications that have THE most research in lactation.

Taking care of yourself is paramount and the sooner it is addressed the sooner you’ll feel better. Does breastfeeding or pumping cause PPD or PPA? No. In fact, women who do not breastfeed (pump) are at a much higher risk of experiencing PPD and PPA. Kathleen Kendall-Tackett, PhD, IBCLC is a psychologist, researcher and Lactation Consultant who has done extensive research on this topic. It has been proven without any doubt that breastfeeding and pumping are protective against PPD and PPA. Her work is easily accessible at https://kathleenkendall-tackett.com/ and she is considered THE expert on this topic.

Does that mean no one will get postpartum depression or anxiety while breastfeeding? Of course not. But the hormones involved in lactation are highly protective. Oxytocin is the hormone responsible for let-down, for falling in love, for orgasm and nicknamed the ‘feel good hormone’. During breastfeeding this hormone surges and is a protector from depression and anxiety. Some other large contributors to PPD/PPA are short maternity leave, lack of support in the workplace, lack of postpartum care, and lack of loving lactation support; all of which can lead to trouble, trauma, lactation failure and then put any woman at risk. But to be clear, it is not the act of lactating that puts one at risk. The poor maternity and postpartum system are larger players and I think we all agree they need much improvement.

My milk was inadequate. They told me my milk was skim milk (or low calorie) and that infant formula would provide my baby with what they needed.

I think I’m going to blow your mind here. Human milk has the lowest fat content of all mammal milks and for good reason. Other mammals need fat to stay warm in the elements. These mammals also need more protein in their milk for building muscles quickly. Realize most other land mammals walk immediately after birth and humans don’t typically walk until near 1 year of age.

This next fact is one of my favorites. Human milk has the most milk sugar of all mammal milks! Why? Because milk sugar is what grows a brain and humans have the most sophisticated brain of all mammals. This is what is called species specific milk. Did you know that human milk is specially designed for each baby and changes in content as the baby grows and has new needs? Each woman’s milk will be different and for very specific reasons that match that particular baby at that specific age. A mother’s milk at 2 weeks will be greatly different at 3 months because a 2 week old has needs that differ from a 3 month olds.

Caloric content and the amount of fat in milk also vary between mother to mother. They each also vary throughout the day and throughout a single feeding. No one single feeding is the same. Pretty cool if you ask me. If a baby is not gaining weight and there is reason for concern, we need not blame the contents or quality of her milk. Her milk is perfect. The baby needs MORE volume of milk and it has nothing to do with the quality of the mother’s milk, despite what many hear or have been told. This can and should be evaluated by an IBCLC.

Human milk is never insufficient or inadequate by design. What words and language we choose when we talk to mothers can make all the difference in how she feels about her journey. So choose your words wisely and handle her with care.

I couldn’t keep up with how much the baby drinks at daycare; I had to supplement with formula and that lead to eventual weaning before I’d hoped.

If you haven’t heard of “The Magic Number” then hurry up and watch!

When we are separated from our baby, knowing how often to pump is very important to maintaining your milk supply. Essentially, we want our body to think we are home nursing our baby instead of away from them. The frequency of nursing sessions when home with the baby needs to match the frequency of pumping sessions when you are away. Also, how the baby is bottle-fed is critical and the daycare provider plays an important role in protecting breastfeeding.

Paced bottle-feeding is the best way to protect breastfeeding. It allows the baby to manage their own intake, keeps the baby actively sucking and engaged with the bottle as opposed to passively laying and allowing milk to just pour into their mouth. This pacing then translates back to breastfeeding so the baby still is actively suckling milk out of the breast. Pacing the bottle means milk will only flow when they suck. Tada! This is just like the breast. Breasts don’t just pour milk out, it requires effort on the baby’s part. Doing pacing of bottles prevents what people call “nipple confusion." Although the baby is not confused at all. The baby has become “flow preferenced”. They learn they don’t have to work when the bottle is tilted upside down, where the milk just drips out. Then when they return to the breast, they expect the milk to just flow out without effort on their part, leading to breast refusal and bottle preference.

Another key to keeping up with daycare bottles is having proper fit pumping flanges. This can shorten pump sessions, collect more milk, have no pain and make pumping more enjoyable. So you need to actually measure the diameter of your nipples and ideally try on several sized flanges, usually not the ones provided with the pump and have pumping observed by an IBCLC.

 

Please also make sure you are using a new, never-used-before breastpump. Breast Pumps are not meant to be used by multiple users.

They are designed for one mom and one baby and built to last about 1 year of pumping for a full-time 40-hour/week job.

Lastly, know what normal bottle-feeding volumes are and how much is normal to collect in a pumping session. All too many moms get all flustered and feel inadequate comparing themselves to others. Don’t get stuck in that situation. Breastfed babies rarely need more than 4-5 ounces at a feeding, no matter how old they are.

Older babies, between 6-12 months, actually take less milk than when they were 0-6 months.

So if your daycare is telling you they need more milk than before, or that you aren’t sending enough, get in touch with an IBCLC. Unfortunately, daycares sabotaging breastfeeding is quite common and can be easily avoided.

They aren’t intentionally sabotaging at all, but they are mis-informed and if mom is not armed with education and support, her journey may come to halt long before she wanted.

I just can’t keep up the lifestyle that is needed to breastfeed. I need to be able to be me.

I have news for you! There is no specific lifestyle required to breastfeed. Breastfeeding happens all across the world and think how different each culture and the women in it are. We aren’t the same and aren’t supposed to be the same and all babies are born to be breastfed. Breastfeeding is designed to be accessible to all regardless of status, culture, income, society and living conditions. Something I say a lot is:

Don’t be a breastfeeding mom. Be a mom who happens to be breastfeeding.

Do you want to exercise? Do it!

Do you want to have a cocktail or two? Go for it! Alcohol and breastfeeding are compatible and ‘pump and dump’ is an old myth.

Do you smoke cigarettes? Please breastfeed! It is safer for a baby to breastfeed with a smoking mother than that same smoking mother feeding her child infant formula.

Do you want to go out on dates and spend weekends away and hang out with your girlfriends? Have at it ladies! Separating from your baby is doable!

You should and can eat the entire world of foods while breastfeeding; no special diet exists.

You can eat anything you want and it doesn’t have to mean you have to eat healthy. The food you eat impacts YOU only. The quality of your milk is not dependent on the quality of food you eat.

A woman in a 3rd world country, who has very little access to food and water herself, will make perfect milk for her breastfeeding child. Would SHE be better off with access to foods available in developed countries? Of course. Have you thought you’d have to avoid certain foods because they will make the baby fussy, give them gas or create an allergy?

None of these are substantiated with evidence. A mother’s milk is a blood product. What a mother eats runs through her own digestive tract and she may experience gas from cruciferous foods or beans, but that DOES NOT transfer to the baby via your milk. Only if the baby was eating said foods directly, would the baby experience those gastro-intestinal issues.

What about spicy foods? Eat ‘em! They absolutely will not make your milk spicy. That is a preposterous idea! Again, your milk is blood (called white blood) and is completely separate from your digestive system. So eat what you want without bothering yourself that it is creating unwanted behavior in your baby.

The fact is this: babies have gas, just like we do, and babies have fussy periods because they are babies. It is NOT a mother’s fault nor her milk’s fault. The baby is LUCKY mom is breastfeeding. And guess what else? Babies who are fed infant formula, are also gassy, fussy and have unwanted behaviors just like breastfed babies. The difference is, for some reason, breastfeeding mothers tend to blame themselves or their milk any time something is wrong with the baby. And this needs to stop. Breastmilk does NOT cause illness or disease, it cures them!

Another favorite fact of mine:

One single drop of human milk has 1 MILLION white blood cells in it. ONE MILLION in one drop! What do white blood cells do? They build an immune system and fight disease and infections. Guess how many white blood cells are in formula. Zero.

Human milk is a living fluid, alive with millions upon billions of cells and is THE ideal food for our babies. Breastfeeding doesn’t mean you need to stop living the life you have always lived. You get to be you AND breastfeed. So don’t be a breastfeeding mom, be a mom who just happens to be breastfeeding and live your life!

Learn about Summer Friedmann

After experiencing poor lactation care from an IBCLC with my first baby, I immediately knew I wanted to change my career path by becoming an IBCLC. I knew then I could help make a difference and change it so more families could have GREAT lactation care! That path started by my being "raised" by La Leche League, going to support groups and becoming an Accredited Leader and then sitting for my IBCLC Boards.

Additionally, I have a YouTube channel that is my way of continuing community outreach in a relevant way for the fast paced, social world.

I really love creating videos that are short, bite-sized and easily digestible so that families can watch any hour of the day, many tell me, even while breastfeeding and pumping!

- Summer Friedmann, IBCLC