The most frequently asked questions about breastfeeding

As an obstetrician, my patients ask me as many questions about breastfeeding as they do about the pregnancy itself. I don’t care at all because it is a very important topic. Over the years, I have scribbled many of these questions in my notebook so that I can research the most current information for new mothers eager to learn how to feed their babies naturally.

Now these questions are the basis of this week’s article which is written just for you, with a completely different mindset and format than all my previous articles. However, before writing, I decided to interview the lead lactation consultant, Ms. Renate Abstoss at Stamford Hospital in Connecticut, to get a second opinion and collect her responses. Ms. Abstoss took the first International Board for Lactation Consultants Exam in 1985 and has worked continuously in the field since then in California, New York, Germany, Austria, Switzerland, and Connecticut. She was the first lactation consultant to be appointed a State Certified Teacher for the Bavarian schools of obstetrics.

There are probably many variations in the answers to these questions, so please consider this information useful, but not absolute. I welcome any additional “pearls” from other lactation consultants or seasoned moms so that we can share knowledge and promote the best nutritional health for babies everywhere.

What are the most common problems women encounter when expressing milk?

Decreased milk supply is probably the main problem women face when expressing milk. This can be attributed to many different factors.

Infrequent pumping

A working woman should try to express her milk every 3 hours for 10 to 15 minutes or at least every time she does not breastfeed.

Inefficient pumping

The pump being used may have inadequate pressure or not have enough cycles per minute, causing a decrease in milk supply.

Lack of breastfeeding

Even when mom is home from work, she should try breastfeeding to stimulate milk production. For convenience, babies can be bottle-fed too often.

Sore nipples

This may be due to poor pumping due to excessive suction pressure, pumping for too long a period of time, or poor latch on when the baby is breastfeeding.

Fatigue and exhaustion

The stress of caring for a newborn coupled with the pressure of work and home can result in exhaustion and fatigue that can decrease your milk supply.

How do I increase my milk supply?

There are several medicines and herbal products available to help increase your milk supply. To increase your existing milk supply, two herbal supplements can be taken in combination with fenugreek and blessed thistle, both of which are available in health food stores and have no known contraindications.

The two most commonly used prescription drugs are metoclopramide and domperidone, both designed as stomach drugs but found to increase prolactin production in the brain. The drug Domperidone, (Motlium) is not approved for use in the United States and the FDA has issued warnings against using this drug as a galactagogue because at higher doses, when given intravenously, Domperidooe was associated with cardiac arrhythmias and cardiac arrest. . However, the small doses used when administered orally to increase lactation (30-40 mg / day) and for the short period of three to six weeks do not appear to be of great concern. Patients generally obtain this drug in Canadian pharmacies or in Mexico and Europe, where it is sold without a prescription. The ILCA (International Lactation Consultants Association) is conducting studies on the safety of domperidone.

Metoclopramide (commonly known as Reglan), used to treat severe nausea during pregnancy, is known to have a side effect of depression, so its use should be carefully monitored in the mother postpartum. The drug can be detected in breast milk, and long-term side effects in babies are unknown.

How do I treat clogged milk ducts?

Milk ducts that don’t drain can cause the milk to back up and lead to a clogged milk duct. Often the surrounding breast tissue becomes hard and inflamed. This area can eventually become infected resulting in mastitis that requires antibiotic therapy. Clogged ducts often occur when:

Mom does not breastfeed

Mom doesn’t express milk often

The chest does not empty

Nursing more often

Positioning change

Improving the latch of the baby (sometimes a shield is necessary). A lactation consultant would be very instructive in this situation.

This can be the result of improper positioning, improper pressure from a pump, or restriction of milk flow due to poorly fitting bras or any type of trauma to the breasts that damages the duct. Fatigue, stress, or the baby’s inability to latch on properly can also contribute to this problem.

Standard treatment consists of moist heat beforehand for about 5 minutes, emptying the chest as much as possible, cooling compresses afterward, and reducing swelling between feedings. Massaging the duct to the nipple may also be helpful. If the plug comes off, it may look like powdered milk on a string. You should continue breastfeeding to fully clear the plug. Apply cold compresses through an ice pack or plastic bag with frozen peas for about 15 to 20 minutes. Fresh cabbage leaves in the area is another herbal remedy that can be used between meals to help with congestion. Cabbage leaves can be left in the bra for about an hour until they wilt. It is important to avoid the nipple area when applying cabbage leaf because cabbage is caustic and can cause irritation.

What do I do if the baby does not latch on?

Blocking problems can depend on the situation that causes them:

It may be due to a newborn who is just learning to latch on.

The assistance of a lactation consultant can be very helpful in making sure the baby is latched on with a very wide mouth to obtain all of the breast tissue. The baby should be latched on well beyond the tip of the nipple. Attachment problems often occur because the baby is unable to widen the lower lip.

Is it due to flat or inverted nipples?

If the problem is due to flat or inverted nipples, a suction device, pump, or nipple shield can be used to prevent engorgement when expressing milk. This will prevent your milk supply from decreasing or disappearing. Different lactation consultants and hospitals may prefer one modality over another, however, all agree that care should be taken when using any device so that serious trauma or damage to the nipple does not occur.

Once the baby is “informed” that the breast is his “food supply”, the baby will generally breastfeed well. It helps to try to go beyond the first few days when only colostrum is present, until the milk comes in. Try to avoid artificial nipples from the beginning.

Is the baby not hungry at this time?

Is there a nursing strike?

A “breastfeeding strike” can occur if a baby who breastfeeds well beyond the newborn period suddenly refuses to breastfeed. This can often occur after 4 months of age, when a mother will say “my seven month old baby was suddenly weaned.” These babies are not being weaned, but are actually facing a situation where breastfeeding has become unpleasant, boring, or painful. Often these babies need to be taught to return to a functional breastfeeding pattern with increased skin-to-skin contact, trying to breastfeed in a calm and calm environment without distractions, such as breastfeeding at night in bed. Bottles should be avoided, but spoon or cup feeding with expressed milk is acceptable. If the underlying cause is treated, most babies will happily return to their normal breastfeeding pattern.

Is the baby getting sick?

Causes of poor grip can be an undiagnosed ear infection, a urinary tract infection, or an upper respiratory infection. Check with your pediatrician to make sure an illness is not being overlooked. Maternal stress can also cause this problem.

Regardless of the problem, it is important to eliminate milk as efficiently as possible if there is an established supply to avoid engorgement that will decrease or cause the milk supply to disappear.

If the baby does not latch on, it is important to stimulate the establishment of milk production through the use of a pump.

How do I wean the baby when I have decided to go to the bottle?

Weaning is the time when the baby moves away from the breast. Weaning times can vary from weeks to months.

Slow weaning is always more optimal. Some mothers will use the breast pump for weaning and will stop breastfeeding completely. An option for weaning would be to reduce the time per extraction, that is, instead of pumping for 15 minutes, reduce it to 10 minutes. This can be gradually reduced to 2-3 minutes per session. An alternative way of weaning is to increase the interval between pumping sessions, that is, from every 3 hours to every 4, 6 or even 8 hours. If desired, you can use ice packs after pumping for convenience. Additionally, Motrin can be used to relieve anti-inflammatory pain. A snug, comfortable bra can also help with support and relief. Nursing pads can be used to prevent excessive leakage. A recommended herbal remedy may be to drink 3 cups of sage tea that is available in health food stores. It has a strong and astringent flavor, so adding honey makes it more palatable. Do not use it if you are pregnant, as it has an abortive action.

Sometimes a sudden weaning is necessary. The discomfort is generally greater as the breast continues to produce milk and the breast remains engorged. Breastfeeding can be replaced with pumping, but only pump the breast to allow for comfort and not to drain completely. Increase the period of time between pumps.

Three days of Sudafed can help dry up your milk supply. Your milk supply decreases as you breastfeed less. The quality of the milk also changes and it becomes more salty and colostrum-like, which many babies don’t like. Consequently, this also helps decrease lactation.