Breastfeeding support

Hi, mamas! I’m Lacey Parr, a lactation educator and blog manager here at Lactation Link. I’m also a birth advocate and have birthed my 3 children in all different scenarios and am excited to discuss a few tips for labor and delivery to make breastfeeding easier!

We know that prenatal breastfeeding education is a big factor in breastfeeding success (1). We are thrilled to help moms get the information they need prior to birth to have a successful breastfeeding experience. In addition to prenatal education, there are a few ways to help breastfeeding get off to a good start. Labor and delivery is one place to look.

When all the focus is on helping mom and baby have a safe delivery, we might forget about a few things during labor and delivery that can help make breastfeeding easier. Here are a few things about labor and delivery that not only help you have a more enjoyable experience, they can also help get breastfeeding started well. Be sure to discuss any of these options with your healthcare provider and place of birth.

Tips for labor & delivery to make breastfeeding easier:

1. Have a doula present. A doula is a trained professional who is hired by the mother to give emotional and physical support during labor and birth. She does not perform exams or monitor the the baby like a midwife or a doctor. Doulas often help mothers achieve unmedicated birth and aim to support the mother initiate breastfeeding. The mother and doula have a relationship prior to the birth and having peer and community support is helpful to breastfeeding success. Doulas also help mom find resources prior to birth like breastfeeding education. Also, doulas care for one mother at a time. For mothers giving birth in the hospital, they are being cared for by a nurse and healthcare provider that are often caring for several other patients simultaneously. This is when doulas and hospitals can work really well together to help moms. A doula usually stays with mom continuously until 2-3 hours after the birth and is there to assist in the first feeding, if needed. If a mom has more breastfeeding concerns, help from an IBCLC is best. We now have 4 IBCLCs on staff and can help with your breastfeeding concerns in an e-Consult or in-person.              
2. Consider alternative pain management options. More than two-thirds of moms in the U.S. use an epidural for pain management during labor (3). But did you know that unmedicated births can have more positive breastfeeding outcomes (4)?  Keep in mind that many, many women are able to breastfeed successfully after an epidural. However, I recommend taking a quality childbirth class even if you plan to get an epidural because it will prepare you to handle labor before you arrive at the hospital and while you are waiting for the anesthesiologist (something I missed with my first birth!). Pain management options such as movement, counter pressure, hypnotherapy, breathing techniques and more will be helpful during labor. Using alternative pain management tools will allow you to be more in control of your birth and can help you get started breastfeeding. A quality, in-depth childbirth class from a trained childbirth educator will give you and your partner lots of tools for pain management during birth.        
3. Immediate skin to skin. Immediate skin to skin means that as soon as baby is born, they are put directly on your chest, before measurements, before swaddling. The benefits of immediate skin to skin are numerous (5). Immediate skin to skin after birth allows for a beautiful surge in oxytocin (the love hormone!) to flood mom and baby.  Your chest is your baby’s home and the best way to start breastfeeding. In healthy, full-term infants, all necessary immediate measures can be done on your chest. Height and weight measurements can wait and can be done at the bedside. The largest organization of obstetricians and gynecologists in the U.S. (American College of Obstetricians and Gynecologists) now even recommend waiting to cut the cord, which can help facilitate immediate skin to skin time (6). Skin to skin can even occur in the operating room. Be sure to discuss these options with your healthcare team.

Luckily, moms and babies are incredibly resilient and many are able to meet their breastfeeding goals without a doula, immediate skin to skin or after a medicated or surgical birth. There is no right or perfect way to birth or feed your baby. I only wish you an experience that makes you feel informed, confident, strong, supported and loved. Did anything you do during labor and delivery help set you up for breastfeeding success? How did your birth attendants help you start breastfeeding well?

More on preparing to breastfeed from Lactation Link:

What is skin-to-skin?

What is SIDS and how can breastfeeding reduce my baby’s risk?

How to breastfeed in public

Thanks for stopping by,

Lacey Parr, BS, CLE

Sources

(1) Rosen, IM., Krueger, MV., Carney, LM., Graham, JA. (2008) Prenatal Breastfeeding Education and Breastfeeding Outcomes. The American Journal of Maternal and Child Nursing. 33 (5). 315-19.  Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/18758336

(2) Gruber, KJ., Cupito, S.H., Dobson, C.F. (2013) Impact of Doulas on Healthy Birth Outcomes. The Journal of Perinatal Education. 22(1) 49-58. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/

(3) National Vital Statistics Report. (2011) 59(11). Retrieved from: https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf

(4) Montgomery, A., Hale, T. and the Academy of Breastfeeding Medicine. (2012). Academy of Breastfeeding Medicine Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother. 7 (6).  Retrieved from: http://online.liebertpub.com/doi/pdf/10.1089/bfm.2012.9977

(5) Vila-Candel, R., Duke, K., Soriano-Vidal, J., Castro-Sanchez, E. (2017). Effect of early skin-to-skin mother-infant contact in the maintenance of exclusive breastfeeding. Journal of Human Lactation. Retrieved from journals.sagepub.com/doi/pdf/10.1177/0890334416676469.

(6) ACOG News Release 2016. Retrieved from: https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Delayed-Umbilical-Cord-Clamping-for-All-Healthy-Infants

Hello, mamas! I’m Stephanie Weight Hadfield, BS, IBCLC. I’m a mom of 4 and a lactation consultant with Lactation Link. Today I’m talking about some of the most common breastfeeding concerns I see when I’m consulting with moms and babies.

Pain and Nipple Tenderness

Pain is one of the most common reasons mothers give for early weaning. While some nipple tenderness is normal at the beginning of feeds in the early postpartum period, severe pain and skin damage is NOT normal and should be seen as a sign that help is needed. How can you tell when you should be concerned? Use the “30 second” rule. If your pain disappears within 30 seconds after latching, you can safely ignore it. If your pain lasts longer than that, gently insert your finger into the corner of your baby’s mouth to break the suction and unlatch baby, then try again. If you’re not able to get a latch that is comfortable for the majority of feeding session, your pain is severe, and/or you notice any damage to the nipple, you should seek help right away.

Milk Supply

Concerns over milk supply are right up there with nipple pain as a top cause of early weaning. Neither babies nor breasts come with full/empty gauges, so you might feel like it’s hard to know how much you’re making and how much baby is getting. However, there are some reliable signs that can clue you in if you know what to look for. You can be confident that your baby is getting just the right amount of your milk if he or she is growing and gaining well, and having plenty of wet and poopy diapers each day. After the first week, and for the first month or so, expect 5-6+ light colored and mild smelling wet diapers and 3-4+ poopy diapers. If your baby is gaining poorly and/or not having enough wet and dirty diapers, help from an IBCLC is a very good idea.

The best way to ensure that you’ll have an ample supply is to start breastfeeding within the first hour after birth and then whenever your baby shows feeding cues after that—generally 8-10 or more times per day. Milk volume works on a supply and demand principle—the more you demand it (by feeding or pumping), the more you’ll supply. Your breasts are always making milk. They’re never truly empty, so you don’t need to wait for them to feel full before you feed your baby. In fact, if you do, you might be telling your body to make less milk.

Medications While Breastfeeding

Breastfeeding mothers might worry that prescribed medications will pass through their milk and possibly hurt their babies. The Infant Risk Center at Texas Tech University Health Sciences Center is an excellent resource for information on the safety of medications in breastfeeding mothers.  If you’re worried about a medication, or have been told that you can’t breastfeed while taking a medication, you can call their hotline 806-352-2519 or visit www.infantrisk.com for the most up-to-date information. If you have an ongoing medical issue requires medication and you have concerns about it and breastfeeding, we would love to talk with you on an eConsult or an in-person consultation if you are in our area. Making a personalized plan with one of our IBCLCs is a great way to bring some confidence into what could be a challenging situation.

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Teething & Breastfeeding

Yes, you can continue to breastfeed through teething and beyond! Many teething babies will nurse better if they get to chew on something cold first. You can also talk to your doctor about pain relief options for your teething baby. If you’re worried about those new little teeth being right next to your nipples, relax. Most babies’ teeth cause no problems at all for their mamas. When a baby is actively drinking, the tongue comes forward over the lower gumline and gets in the way of biting. If your baby does bite though, he or she is usually trying to resolve the discomfort of teething, or simply experimenting with new ways to use his or her mouth. Your baby doesn’t realize that it hurts you. You can teach your baby that biting mama isn’t ok by ending the feeding session and calmly, but firmly saying “No, no, no.”

Concerns with breastfeeding older babies

Sometimes, breastfeeding problems can pop up with older babies after breastfeeding has been going really well for a while. This can be especially worrying if you don’t know other moms who have breastfed past early infancy and worked through these common bumps in the breastfeeding journey. Joining a local breastfeeding support group is a great way to help you gain confidence in nursing your older baby, and maybe even make some new friends at the same time.

Nursing Strikes

Sometimes older babies will start to refuse to feed at the breast. It is unlikely that a baby younger than a year old is actually self-weaning from the breast. If you can protect your milk supply and be patient, you can be confident that the refusal is almost certainly temporary. Most nursing strikes only last a day or two, but some can last up to a week or more. If your baby starts to refuse the breast, keep offering gently. The trick is to act like you don’t care whether or not baby latches, even though you probably care very much! Lots of skin to skin cuddle time can be very helpful in these situations. You could try nursing baby when he or she is very sleepy, or in a new position– maybe even standing up and walking around.

If the refusal goes on more than a few hours, you’ll need to express your milk. You can give this milk to baby by cup, spoon, or bottle. Older babies who have never taken a bottle may do better with a straw sippy, or even frozen breastmilk cubes in a mesh feeder. Don’t be afraid to reach out for help from an IBCLC when having issues breastfeeding an older baby. We don’t just help newborns, we love helping moms breastfeed babies of all ages.

I hope these breastfeeding concerns and solutions have created some more confidence in yourself! What was the biggest snag you hit in breastfeeding? How did you overcome it? Share in the comments.

Thanks for stopping by,

Stephanie Weight Hadfield, BS, IBCLC

Have you signed up for our free email breastfeeding course?

I think you’ll find it really helpful. Click the image below for more info.

Sources:

Mohrbacher, N. (2010). Breastfeeding answers made simple: a guide for helping mothers. Amarillo, TX: Hale Publishing, L.P.

Hi mamas, I’m Stephanie Weight Hadfield, an International Board Certified Lactation Consultant (IBCLC) and mom of 4. I’m here today to share a guide to caring for your nipples before and during breastfeeding. This nipple care guide will help prepare you for breastfeeding with confidence!

At Lactation Link, we get lots of questions from mamas wondering if they need to do anything special during pregnancy to prep their nipples for breastfeeding, or if nipples need special care or cleaning once baby is here. The quick answer is no. The nipple and areola (pronounced air-e-O-la, it’s the darker pigmented area that surrounds your nipple) can do a pretty good job taking care of themselves.Because of this, our nipples do not need any special nipple care during pregnancy. You don’t need to do anything to disinfect your nipples and you definitely don’t need to “toughen them up”. 

You may have noticed small bumps around your areola that became more prominent during your pregnancy and might be especially noticeable when you’re cold. These are called Montgomery glands and they secrete a substance that is anti-bacterial and naturally moisturizing. This substance also smells similar to your amniotic fluid, so it can help babies find the nipple and latch right after birth (1). Isn’t that amazing?! As long as you don’t have any cracking or damage to your nipples, they don’t need any special nipple care through washing or disinfecting beyond your normal bathing routine.

Basic Nipple Care

• Make sure your baby is latching well. A deep, comfortable latch is your first defense against nipple pain and damage, and will also help your baby get more of your milk. Lactation Link’s online breastfeeding courses include in-depth information on how to position baby for the most comfortable and effective latch. You nipple care routine will be rather short if baby is latching well!
• Pain is not normal. Nipple pain is your body’s way of telling you that something needs to change with the latch. Some tenderness is normal during the first couple of weeks. However, pain that lasts longer than the first 30 seconds of a latch or is severe, is a sign that you need to unlatch baby and try again. If you’re not able to get your baby to latch comfortably, get help. Continuing to nurse through pain can cause nipple damage like cracking, bleeding, blistering and infection. With qualified lactation help, breastfeeding will get better!
• Change your breast pads often to keep your nipples from sitting in an over-wet environment. Think of what happens to your fingers and toes when you take a long bath– they get wrinkly as they absorb extra water. The same thing can happen to your nipples if they are exposed to soggy breast pads for long periods of time: it leads to chapping and skin breakdown.

Caring for Tender or Damaged Skin

If you already have painful skin damage like cracking, blistering and bleeding, get qualified, in-person help, preferably from an IBCLC. We would love to help, with either an eConsult or an in-person consultation if you are in our area. Tips to healing and nipple care will not do any good if the latch is still causing damage every time baby feeds. In the meantime, here are some quick tips to help you find some relief:

• Offer the uninjured or less injured side first until the milk releases. Once you see your baby swallowing actively, then gently move your baby to feed on the more painful side. This can help because babies tend to have a stronger suck at the beginning of a feeding session when they’re trying to stimulate the flow of milk. If both sides are painful and sore, you can stimulate a letdown by expressing a small amount of milk before putting your baby to the breast (2).

• Talk to your healthcare provider about taking an over-the-counter pain reliever. Ibuprofen (Motrin, Advil) is a good choice because it relieves inflammation in addition to pain and is generally considered compatible with breastfeeding.
• Wash your hands carefully before every feeding (singing the alphabet song in your head can help get the timing right). If you have any cracks or breaks in your skin, gently wash your nipples and areolae twice each day with a mild, non-perfumed, non-antibacterial soap until the broken skin is healed. Breaks in your skin are an entry point for germs to enter the breast and cause infection. Careful hygiene is one of the best ways to reduce the increased risk of mastitis that comes from having damaged nipples (3).

• Provide a moist healing environment. This is different than the soggy surface wetness I mentioned above. Wound care experts have found that wounds heal faster and with less pain when the natural internal moisture of the skin is protected (4). Moist wound healing techniques have also been found to reduce pain because they protect exposed nerve endings (5). There are many products on the market designed to provide moist healing for breastfeeding mothers, like hypoallergenic purified lanolin ointments or hydrogel pads. Apply these products after every feeding session to maintain consistent protection until your skin is healed.
• Contact your healthcare provider if you have any signs of infection: inflammation/redness, swelling, oozing or pus. A variety of rashes can also cause nipple pain, so see your healthcare provider if you have flaky, red, itchy, shiny and/or irritated skin that extends to your areola.

Remember, nipple pain and/or damage is not normal: it’s a big red flag that you need competent and compassionate clinical breastfeeding support. If you live in Utah between Payson and Ogden, one of Lactation Link’s International Board Certified Lactation Consultants (IBCLCs) can come to your home to assess your baby’s latch and the cause of your pain. If you live outside of our area, you can find an IBCLC in your area, by clicking here.

More articles on nipple & breast care from Lactation Link:

Reasons & Solutions for Nipple Pain

Which Nursing Pad is Right for Me?

How to Relieve Breast Pain While Breastfeeding

Have you signed up for our free email breastfeeding course?

I think you’ll find it really helpful. Click the image below for more info.

Thanks for stopping by,

Stephanie Weight Hadfield, BS, IBCLC

Sources:

1. Doucet, S., Soussignan, R., Sagot, P., & Schaal, B. (2009). The secretion of areolar (Montgomery’s) glands from lactating women elicits selective, unconditional responses in neonates. PLoS One, 4(10), e7579.
2. Mohrbacher, N. (2010). Breastfeeding answers made simple: a guide for helping mothers. Amarillo, TX: Hale Pub.
3. Genna, C. W. (2009). Selecting and using breastfeeding tools: improving care and outcomes. Amarillo, TX: Hale Pub.
4. Hinman, C. D., & Maibach, H. (1963). Effect of Air Exposure and Occlusion on Experimental Human Skin Wounds. Nature, 200, 377-378.
5. Mertz, P.M. (1990). Intervention: Dressing effects on wound healing. In: W.H. Eaglstein (Ed.), Wound care manual: New directions in wound healing (pp. 83-96).

Hi mamas! I’m Kristin Gourley, IBCLC. I’m a mom to 5 and lactation consultant with Lactation Link. I’m here today to talk about newborn hunger cues. Enjoy!

Soon after you’re holding your fresh bundle of joy the reality can set in: you are responsible for keeping this little one alive and thriving!  So how do you know when your baby is hungry if he can’t tell you?  Well, baby not be able to use words and tell you, but he sure can let you know when he’s ready to eat! Read on to learn about newborn hunger cues!

{Savi Mom Nursing Gown}

Babies have great survival instincts and consistent behaviors to show when they are hungry (and then when they’re full!).  Sometimes it can take some time to learn your baby’s cues to eat, but it’s important to remember that nursing is about more than just the food. You can offer the breast to your baby even if it hasn’t been the standard 2-3 hours that the hospital said would be in between feeds.  You can’t nurse too much!  

Common hunger cues in infants

• Quiet alert state (check out our Breastfeeding Basics class for a great video showing this behavior!).  If baby is turning his head from side to side or turning his head and opening his mouth while looking content, put him to breast!  He may be content now, but he’s trying to tell you he’s hungry before he gets hangry!
• Sucking on hands, lips, clothes, toys, etc.  Babies do put everything in their mouths, but hand sucking in the first few weeks is a big sign of hunger, and frantic sucking on anything else is a dependable sign of hunger in babies once they’re a couple months old.

• Trying to lay down in typical nursing position.  If you normally breastfeed in the cradle position, baby might try and throw his head back to get into that position.  It’s a not-so-subtle way to say, “Hey, mom!  Help me do this!”

• Squirming around is another sign of potential hunger, especially in newborns and very young infants.  Little babies with full tummies are generally very relaxed and content.

• Mild fussiness.  This is pretty self-explanatory, but babies can be intermittently fussy before they get to the too-hungry stage.  Sometimes moms will think that baby is just fussy or having a “witching hour,” when really he is trying to let you know that he’s getting hungry (and on his way to getting overly worked up!).

If you’ve spent any time with a baby you are probably wondering why crying is not on this list!  It’s true that babies will cry when they get hungry, but it’s generally once they are so hungry that they’ve gotten angry they haven’t been fed yet! (1)  Once it gets to this point, you often need to calm baby down so he can focus enough to latch on and breastfeed.  

It can seem like a crash course in learning baby language when you become a parent, but rest assured that you will learn your baby’s unique signs and become fluent before you know it!  To feel as prepared and confident as possible once baby arrives, be sure to take our Confident Breastfeeding Course video classes.  Our classes are also great once baby arrives!  Don’t feel like you’re flailing in parenthood; knowledge brings confidence!  Are you still unsure about what baby is trying to tell you?  Schedule an e-consult and we would love to help you figure it out.

Thanks for stopping by,

Kristin Gourley, BS, IBCLC

Have you signed up for our free email breastfeeding course?

I think you’ll find it really helpful. Click the image below for more info.

Sources

(1) Riordan, J. & Wambach, K. (2010). Perinatal and intrapartum care in Breastfeeding and human lactation, 4th ed. Sudbury, MA: Jones & Bartlett Publishers, p. 221.