 Today our expert owner Dr. Kathleen F. McCue is sharing her thoughts on low milk supply and some of the underlying reasons.
Dr. McCue: It’s fair to say that I make a living regulating milk supply. The number one complaint we hear from clients is, “I don’t have enough milk!” Sometimes I’m in agreement and other times, expectations are totally unrealistic. There are so many things that come into play; storage capacity of the breasts (meaning amount of glandular tissue and milk-making alveoli within the breast itself); adequate nipple stimulation to help produce prolactin (a hormone that promotes milk production); suckling ability of the baby (big strong baby or jaundiced baby with a low birth weight); frequency of stimulation by either baby or breastpump. Here are some of the issues I look for, and as always, a consultation with an International Board Certified Lactation Consultant (IBCLC) will help determine what’s happening and how to assist:
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 Traveling with Milk
It’s summer and that can mean vacations and traveling! For the pumping mom, the question of how to get breastmilk from one destination to another can be a difficult one. We usually recommend packing breastmilk in a cooler with lots of ice, taping it up, and checking it to your destination. But what about times when that method won’t work (or the flight is too long?) Recently, the Milk Stork service gave us a great overview of their services. We’ve included this information below. Tell us, how have you gotten your milk from one place to another? Milk Stork Services, Here is an overview of our services: Milk Stork provides the following breastfeeding travel solutions: Pump & Ships Pre-addressed and pre-labeled with FedEx Priority Overnight Shipping labels (for delivery anywhere in the US), Pump & Ships provide at least 72 hours of refrigeration and enable moms to overnight milk home as needed. Pump & Ships are available in two sizes: * 34 oz (a day’s supply of breast milk) at $139/delivery plus shipping and handling to the destination. This is a great option for moms with newborns who need to send home a daily supply of milk. * 72 oz (over two days’ supply) at $159/delivery, plus shipping and handling to the destination. This is a great option for moms who want to send more milk home less often, nurse more than one baby or who have a larger milk supplies. Pump & Totes Compliant with domestic TSA carry-on regulations and complete with an easy-to-activate, push-button cooler and free tote—Pump & Totes provide 60 hours of refrigeration and offer moms a convenient way to carry their milk home with them on a long flight or road trip. They’re also great for weekend and Sunday travel, when a mom might otherwise arrive home before a cooler shipped separately. Pump & Totes are available in two sizes: * 34 oz (a day’s supply of breast milk) at $79/tote plus shipping and handling to the destination. * 72 oz (over two days’ supply) at $89/tote plus shipping and handling to the destination. There is shipping and handling charge to cover the cost of getting the kit(s) to your travel destination which varies based on order lead-time, quantity, and destination. You will have visibility to the shipping and handling cost before you complete your order. How do you get your breastmilk from one place to the other? Share your tips and tricks with us on Facebook! (photo courtesy: http://www.freedomforgepress.com/2012/12/30/udderly-ridiculous/)  What is it?
Have you ever had someone recommend you use a nipple shield? It’s exactly what it sounds like: a thin, flexible silicone shield that fits over your nipple and some of your areola. Nipple shields are one tool in a lactation consultant’s toolbox for a baby with latching issues, among other things! Mary Unangst wrote a great post discussing the use of nipple shields. Why would you use them? Nipple shields are helpful for the baby with a tongue or lip tie (until revision) as they allow the baby to grasp the breast and actively remove milk. They are also helpful for the late preterm infant. These early babies have difficulty coordinating their suck, swallow, breathe reflexes and the shield can allow for an easier latch and therefore removal of milk. In conjunction with adjusting holds and maturation of the breastfeeding relationship while following your lactation support’s guidance, the shield can bridge the gap between challenging feed scenarios and a normalized breastfeeding process. An IBCLC might also recommend the use of a nipple shield when an improper latch has painfully damaged the nipple(s). When I hear a mom say “I just can’t imagine putting her on the breast one more time, it hurts so bad”, then (following a comprehensive assessment) I may very well pull out a shield. Nipple shields can allow just enough relief for mom to go on breastfeeding as she simultaneously works on correcting her baby’s latch. It’s also important to note that you should definitely consult a lactation consultant if you are using a nipple shield. Making sure that you are followed is key: An IBCLC (local or virtual) can also follow up frequently to monitor your baby’s weight gain while using the shield. Most importantly, an IBCLC will work with you to resolve the underlying issue so you can eventually (and hopefully quickly) go on to breastfeeding without it! Have you ever used a nipple shield? What was your experience? Tell us in the comment section below! And thank you Mary for sharing your great words of wisdom!  Most mothers have been stressed when they have a new baby. I DO, absolutely remember how tiring it is to be a mother and especially when you’re a breastfeeding mother. I decided to write about time this week because in the midst of working with a new breastfeeding mother of a six day old, she flat-out told me that this “breastfeeding thing is taking way too much of my time.” I was left flabbergasted and flap-jawed. What I wanted to say and what I did say were two very different things.
What I wanted to say was “Well, what were you expecting?……Did you think you were going to drop the baby in the umbrella stand in the way in and out of your front door?” What I actually said is “Tell me how I can help you.” She went on to explain that this every two hour hunger thing was beginning to grate on her nerves. I went on to explain that babies had tummies the size of golf balls and that breastmilk was a “perfect food” that made it digest and move through the stomach very rapidly. I quoted how each DROP of colostrum had 3 million cells (the majority being immune cells). Breastfeeding is as much nurturing as nourishing (hoping the old adage would help). I also described cluster feeding as being analogous to a camel getting ready to cross the desert…….feed, feed, feed and then you get the big sleep (maybe 4-5 hours max). In my first book “Start Here; Breastfeeding and Infant Care with Humor and Common Sense” I tried to call the hours between 6-10PM the “arsenic hours,” but the publisher opted for something safer. I guess that “every hour on the hour” cluster thing is what put this new mother “over the edge.” So, here are some suggestions I’ve come up with to help you save time during your busy breastfeeding days. If you have an exceptionally sleepy baby (or just have need to get the show on the road once in awhile), I find that you can feed on one side while you simultaneously pump on the other…..Tarzan Pumping (at least that’s what I call it). That trick alone can save you up to a half hour per feeding and maximize your milk supply. Your body will react as it you’re feeding twins (because both sides are going at the same time) and perhaps even increase supply a bit. It will also expedite your feeding and have your baby feel as though a bigger, stronger twin was on the other breast helping him or her out. Now you’ll want to feed that milk to your baby at some point (perhaps during cluster feeding time), as when I previously instructed another mom to do this, she was giddy with her new frozen stash; problem was the baby hadn’t gained any weight in a week …… duhhhh; I should have been more clear with my instructions but thought is was pretty self-evident. To accomplish this TARZAN PUMPING , I like the hands free pumping bra by Simple Wishes because it has a zipper that unzips from the bottom up (in fact, you can add the panel and make it have two zippers), giving lots of flexibility (can get one breast out for baby while the other is snug in the bra. If you’ve already purchased the “other” less flexible hands free bra (that zips from the top down), then you can try turning it upside down so the zipper goes the opposite way. Anyone who tells you to sleep when the baby sleeps probably doesn’t shower, do laundry, use the bathroom, open the mail or eat; I never understood that suggestion. I mean, that’s the only time you have to do ANYTING, isn’t it? Also, ALLOWING others to do things for you will help put time back in your day. You shouldn’t feel as though you’re not a good mother if you don’t do everything and do it well (do as I say, not as I do/did). I remember 28 years ago how I came creeping out of my house to get the mail and was spotted by my neighbor. She promptly sent her “nanny” over to my house with instructions to “help that poor woman out.” Problem is that I wouldn’t let the well-meaning nanny in. As I look back on it, I was afraid that I’d be found out; that I’d be “exposed” and my neighbor would know how I wasn’t really holding things together as a mother “should.” In my experience, many mothers feel that same way. They’re overwhelmed but think that they’re the only mother experiencing that. I’m here to tell you that MOST mothers feel overwhelmed in the beginning and if they tell you otherwise, I’d be wary. So when I heard this mother complaining about time, as I think more about it, I’m suspicious there might be something else going on. Is she depressed? Is she lonely and needs to get out of the house for companionship, does she simply have cabin-fever, or are her expectations that “out-of-whack” with reality and how much time infants take out of a mothers day? What do you think?  Sometimes it’s clear-cut and other times, well…..it takes us a little longer to figure out exactly what’s causing the chronically sore nipples mom is experiencing with breastfeeding. With an anterior tongue time, a rooky could spot it. You can see the tongue tethered to the bottom of the FRONT of the tie. Some are so tight, that the tongue actually comes into a “heart-shape” when the baby cries. One quick, clean clip, one drop of blood, and the fear of nursing disappears. Additionally, the high risk of speech-language problems down the road, may also be erased.
Parents often show me their own tongues when I ask “who else in the family is tongue-tied?” Some of these moms and dads had been through speech-language therapy and others tell me that they never found it a problem at all. One mom told me her own mother wasn’t able to breastfeed her as a baby and never knew why, until I pointed out that she couldn’t even stick her tongue out. Isn’t that a prerequisite to being a little kid? I mean, what are you going to do when another kid is mean to you……hello? I admit that, before I understood the difference between an anterior and posterior tongue -tie, I worked more with moms latching than babies sucking. Then I realized, after attending a conference, how to detect and diagnose this phenomenon. You have to place your index fingers (pointing in) on either side of the underneath part of the tongue and……low and behold……a little string-like frenulum may just pop up. That little string is called a posterior tongue-tie and can cause just as many problems as the more obvious anterior tongue-ties. When you sweep your finger under the tongue from one side to the other, you actually feel a little speed bump. Last week, I was told by one of my moms, that her husband had taken care of her tight frenulum….I then asked if he was a dentist or ENT surgeon….but NOOOOOO, it turns out that he’s just a really, really “passionate” kisser!!!! Yup, he broke her frenulum with his own tongue….YIKES! My final problem is called a tight labial frenulum and it’s located in the middle, under the upper lip. Many kids break them during toddlerhood when they fall and hit their mouths on a coffee table or some other lovely item in the home. When left unclipped, they can result in a gap-toothed smile (ala David Letterman). Dentists usually discover them and sometimes want them clipped before the permanent teeth erupt. With babies, it can prevent them from curling up their upper lip to help latch at the breast. One key to solving tongue-tie problems, as described above, is to find an experienced lactation consultant and ENT surgeon, who specialize in diagnosing and understanding how tongue-ties can negatively impact a nursing relationship and milk supply. |
