 What fish should I eat? What’s for dinner tonight? Oh, I need to go to target and make a baby registry! Am I going to be a good mother? Does breastfeeding hurt? Should I get an epidural or not? Is bread bad for me?
There are endless questions flooding through a women’s brain while she is pregnant. Nutrition and nourishing her body should not be adding to that stress. The goal is to simplify nutrition into an attainable and sustainable menu for success. Whole foods first and foremost. I will say this once, a colorful plate is your best friend. The more variety of foods you consume the better! For example, a red bell pepper is high in vitamin C, carrots are high in Vitamin A, and chicken is high in Vitamin B12 and protein of course. Every food serves a purpose in your diet, therefore the more diverse your plate looks at every meal ensures you are meeting all your and your babies’ nutrient needs. On the other hand, you are growing a tiny human which is hard work! And I completely understand that no one has the perfect diet. That is why it is recommended to take a prenatal vitamin during pregnancy as well. This vitamin is a supplement, simply a catch all for the nutrients you are missing or not getting enough in your diet. Prenatal vitamins, however, are not a substitute for a well-balanced diet. They work harmoniously to provide mothers with the optimal nutrition needed to grow a healthy baby. Additionally, your prenatal vitamin should include approximately 27mg-45 mg of iron and 400 mcg of folate (folic acid) as well as the other vitamins/minerals. The overall goal is to keep nutrition and food simple. Especially when there are a variety of different things grabbing at your attention. Food should bring you joy, not more stress. Important tips to remember:
Limitations to remember:
By Dr. Kathleen McCue  Woohoo your baby has reached the starting solids milestone! Congrats to your hard work and endless love to your infant these past four to six months. Now is when the real fun, and mess begins!
First steps first, is recognizing the signs indicating that your baby is ready to start eating solid foods. Some key signs to look for is an interest in food or what you are eating, as well as physical signs of readiness. Is your baby able to sit up on their own and control their head? Is your baby turning their head side to side? Did they lose the tongue thrust? Which essentially means that when offered food, they thrust the food out of their mouth with their tongue. Another recommendation is your baby should be 4-6 months in age and/or has doubled their birth weight (weighing approximately 13 pounds or more). Great, if you answered yes to all or majority of those questions your baby may be ready to try solid foods! Now, let’s get into first foods! Babies have iron stores that will last them approximately the first 6 months of life, however around the six months mark it is appropriate to start adding outside sources of iron to a baby’s diet. Unfortunately, breastmilk contains little iron and is not an adequate source of this nutrient after six months. Therefore, for exclusively breastmilk babies it is recommended that their first foods are ample in iron. Sources of iron rich foods include beef, pork, lamb, beans, legumes, chicken, poultry, iron-fortified infant cereal, tofu etc. Additionally, animal sources of iron are more readily absorbed by the body. Therefore, it may be beneficial to pair plant-based sources like legumes or beans with a high Vitamin C food such as broccoli or bell peppers. Okay now it’s time to introduce these foods to your baby! There are a variety of feeding approaches to choose from whether it is baby-led weaning, spoon-feeding, or combo feeding. Whatever approach you choose it is important to wait approximately 3-5 days after introducing a new food to note any symptoms or allergic reactions. Once cleared for a reaction, you may introduce another new food! Reminder this time is about exploration and exposure. Therefore, your baby is not going to start gulping down oatmeal the first day they start solids and that’s okay. This time is for introducing a variety of foods and allowing your baby to enjoy the journey of exploring new foods, flavors, textures, and smells at their own pace. Try not to stress too much about the amount of solid foods your baby is taking in at this phase because breastmilk or formula will remain to be their primary source of nutrition. By Dr. Kathleen McCue  Feed your baby what you would want to eat….
Do not overthink it. You like food with spices and herbs, they will too! I have sessions with so many parents who stress and stress over what their child is eating… I am here to tell you to take a deep breath and trust your instincts. There is no right or wrong way to feed your baby. Embrace the foods you enjoy eating and share them with your baby, simple as that. The overall goal here is to encourage a healthy and happy relationship with food. Not a relationship filled with stress, structure, and unattainable routines. Listen to your body. And allow your baby to do the same. Your child will eat when they are hungry. I know this is a hard truth to accept, yet they are the ones experiencing their bodily needs and will instinctually listen to that. Therefore, they will eat when they are hungry, they will decide how much to eat, they will decide when to eat, and they will decide what they want to eat. A parent’s job when starting solids is to emphasize support and patience during the process. A big no no is force feeding your child as this will foster an unhealthy relationship with food. The parents who role model healthy eating habits and wholesome relationships with food tend to pass these onto their children as well. Exposure is key when starting solids with a baby. Reminder that this is their first time trying everything, so it is vital to be patient and allow them to explore the foods with all their senses. Release control and expectations of how the experience is supposed to happen. Stop obsessing over the mommy blogs portraying this perfect image of starting solids. It will get messy, like many things in life, so please don’t fret and embrace the beautiful journey of watching your baby try new foods and learn to love nourishing their bodies. By Dr. Kathleen McCue  By Dr. Kathleen F. McCue, FNP, IBCLC and Katie Ralls
As the customer service rep for Simple Wishes and Pumping Essentials, I wanted to share my story, in hopes of helping other mothers out there who might face similar challenges. My story begins with being diagnosed with Vasa-Previa (overlapping blood vessels next to the inside of the cervix) when I was 22 weeks pregnant, I was placed on hospital-based bedrest for the rest of my pregnancy. This story, however, has a happy ending. Baby Harper was born at 33-weeks gestation via C- Section when my liver function tests sky-rocked and I felt really sick. I intrinsically knew there was something wrong and am thankful my nurse listened to me and acted quickly. We have a voice within us that tells us what to do, but listening to that voice can be an art form, especially when we’re pregnant and everything is new. While on bedrest, I was given non-stress-tests twice a day with the plan of an eventual C- section. All in all, I spent a total of nine weeks in bed and was only able to get up twice a day for walks and brief trips to the bathroom. This was one of the most difficult times I ever could have imagined. Thankfully, with enough advanced planning, I had been given two rounds of injected steroids at 24 and 32 weeks; this helped mature my baby’s lungs in anticipation of her early delivery. I had no “Golden Hour,” where I could breastfeed my baby and be skin-to-skin, as she was whisked away to the Neonatal Intensive Care Unit so she could be given the best chance possible of survival outside of my womb. Harper was born weighting 3 lbs., 2oz. and was only 15.25 inches long. She spent her days in a NICU isolette being monitored 24 hours a day. My husband and I spent our days watching and worrying. On day three post-partum, I literally thought my breasts were going to explode. I woke up with breasts that were twice their normal size, tender and rock hard. Thanks to a class I had taken prior to delivering, I learned and remembered the method of hand-expression to relieve engorgement. Although I had access to a hospital grade pump, at this moment in time, this is what felt right to me. Hand expression. How could a hand be better than this super expensive breast pump? Am I a cow? I feel like I could fill a swimming pool but I only have little drops my first day. I think hand expression is the best thing to use, second only to the baby itself. Breast massage. Pull back, compress, release, repeat. You can use it anywhere at any time. You do not need a plug, battery, clean flanges. You always have your hands with you. It’s really interesting to know that my first experience performing hand expression involved two breasts that were NOT my own. Yep, I milked another woman. I had learned all about it in my classes with Evergreen Perinatal and at WIC where I worked for five years. How hard could it be? I had all the confidence on the outside and all the nervous shakes on the inside. My friend was in pain. She had forgotten her pump at home and we had just walked out of the Raider’s Stadium in Oakland, CA. We were making our way to the parking lot when she looked like she might cry. Can I help her?!?! Ok what did they say to do again? Massage around. Feel for lumps. Made a “C” hold. Why weren’t my hands bigger?! Ok now push back….. And compress. And again…. Push back and compress. Oh my gosh it is working! After spraying milk everywhere there was a sigh of relief. I had done it! Again, not too long after the previous incident another friend had forgotten her pump at a family party. Welp… looks like I am going to attempt this again. This time in a bathroom sink. Once again, It worked! Having said that, learning to hand express, hand expressing your friend and hand expressing yourself are not the same. When my own daughter was born at 34 weeks, I knew I needed to get my milk flowing right away. I was so hopped up on Magnesium, pain meds and morphine… … I was all thumbs…. So this is what it supposed to feel like? I was amazed that it worked. 2, maybe 3 droplets came out. Breakfast, lunch and dinner! Haha! I am joking. It didn’t feel great, to be honest as I had bruises all over my breasts which my husband got the stink eye for from a nurse later that day. Sorry about that. I knew the facts about hand expression. When using hand expression correctly you could express more milk than you could with any pump. You did not need a magic bra or a magic breast pump to express milk. My baby was too small and premature to latch and have milk transferred. It was up to me to get it going. The lactation staff at the hospital where I was admitted for observation had a video about what to expect in the first few weeks. How you could potentially go from syringe feeding (another technique rather than a bottle) to possibly breastfeeding directly when the baby was “ready”. Unfortunately, my baby was not cleared to breastfeed until she was 6 months old due to silent reflux (a danger for aspiration). Her epiglottis was under-developed which caused her to inhale thinner liquids. This was heartbreaking. As the months went on I used hand expression in many different circumstances. If I forgot my pump, if an outlet was not available, in the shower for comfort, to release plugged ducts, to express milk into my baby’s eye if it had discharge (it happens). I will be forever grateful for the knowledge I had and the confidence that was built by my experiences and training. I believe every mother should learn how to hand express for these very reasons. I remember using a video clip that was on the Standford.edu website to encourage many moms to use this technique over the breast pump. The method is to start with clean hands and sit down in a place where you can relax and get comfortable. By the way, this should be the case whether you’re nursing, pumping, hand- expressing, or simply holding your baby. You need to build a nest of sorts. Gather a container to catch your milk, then gently massage the breast your expressing in a circular motion from chest wall down to the nipple. Heat can also be an added benefit. In order to stimulate your let-down (a reflex that starts the milk squirting out of the nipples), you’re going to need some rolling of the nipple between your thumb and index finger. You will then place your thumb on the top of the areola (the edge where the darker color ends and your breast begins) and your index finger at the bottom (same placement). Spread the skin back toward the chest wall, squeeze in and gently but firmly pull, aiming the nipple into the collection container. There is a sweet spot that you will have to find. Some moms find that the area needing compression is either closer to the nipple or further back on the areola. It will take practice. Remember, they’re not faucets! You will get faster with practice and yield more milk as you gain confidence.  By Dr. Kathleen F. McCue, FNP, IBCLC
It’s fair to say that I spend most of my clinical days regulating maternal milk supply. The number one complaint is “I don’t have enough milk,” Sometimes, I’m in agreement but other times, I find maternal expectations, for how much milk one is supposed to produce is pretty unrealistic. Although we don’t want to be living paycheck to paycheck (milk-wise), we also don’t want to open a Dairy Queen. I’ve discovered slow gaining babies with what we call “inadequate weight gain,” can be a result of moms who are “feeding the freezer.” They need a stash. There are so many things that come into play when helping women regulate supply: Storage capacity of the breasts (meaning amount of glandular tissue and milk-making alveoli within the breast itself); adequate nipple stimulation to help moms produce prolactin (a hormone that promotes milk production); suckling ability of the baby (big strong baby or small jaundiced baby with a low birth weight); frequency of stimulation by either baby or breastpump (moms with less storage capacity (smaller breasts) will most likely be feeding more frequently and sometimes for longer sessions. This is not an exact science. Trouble usually starts when moms either start on any type of hormonal contraception or return to work outside the home. Keep in mind that empty breasts make milk, so if you don’t have any significant reason for a decreased supply, you basically need to keep emptying the breasts. Here’s the checklist that I give my consultants to work with moms with this complaint.
Keep in mind that some moms will fall outside the bell-curve and do just fine with their insurance pumps but, since this article is about low milk supply, those moms aren’t even reading this blog. Insurance pumps that you own are sometimes called “hospital grade” but in the world of lactation consultants, we mean pumps that you rent from your lactation consultant or hospital. My favorite is the Medela Symphony because it’s only seven pounds and has a soft stimulation phase that helps moms produce prolactin. Again, you will need to trial different pumps to see what works best for you.
If you’ve ticked through this entire list and are still unable to increase your milk supply, visit your local IBCLC or schedule a telehealth at Metropolitan Breastfeeding. Our website is and there’s no doubt we can help you. |
