Breastfeeding Your Baby: Establishing Your Breast Milk
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RACHELLE MARKHAM: Establishing your breast milk supply is one of the new moms’ most important concerns. How often should I nurse? Is my baby getting enough? I feel like my baby is always on the breast. Today we’re talking about: “Tips and encouragement for the breastfeeding mom.” I’m Rachelle Markham, Internationally Board Certified Lactation Consultant and this is Newbies.
KRISTEN STRATTON: Welcome to Newbies, broadcasting from the Birth Education Center of San Diego. Newbies is your online, on the go support group guiding new mothers through their baby’s first year. I'm your host, Kristen Stratton. I’m also a certified birth Doula, postpartum Doula and owner of In Due Season Doula Services.
If you haven’t already, be sure to visit our website at www.NewMommyMedia.com and subscribe to our weekly newsletter. You can also subscribe through iTunes so you automatically get new episodes when they’re released. Sunny is here to tell us all about other ways you can participate in our new show.
SUNNY GAULT: All right, hi everybody. There are a couple of different ways you can participate in the show. First is through social media. So Newbies has a Facebook Page. We also have a Twitter account. So if you are on social media, please like us, follow us, we are going to be posting different questions that are relatable to new mamas and new babies on both of these platforms so that you can participate on the conversation that way.
Also, if you want to be a part of The Newbies Podcast, we have a couple of different segments that you can actually participate in right now. First is our: “Ask the Experts Segment.” So if you guys have questions not just related to breastfeeding but anything regarding being a new mom, any questions that you have, we have a whole list of experts on our site that are happy to answer your questions. So you can send us an e-mail through the website which is www.NewMommyMedia.com.
We will read your question on the air on one of our shows. That way everyone can benefit from the answer that the expert gives. So that’s one way you can do it. Also we have a new segment that is our Mama Oops Segment. It is a fun segment where new moms can submit all the funny stories that they’ve experienced: "The Oops” when you’ve got your newborn, the funny things that happened that you’re willing to admit at least. You can do the same thing. You can visit our website and submit through the website. We’ll include all those stories on our future episode.
KRISTEN STRATTON: Let’s go ahead and meet our panelists.
JENNIFER: I’m Jennifer. I’m almost 31. I have two boys at home – one is four and the other one is now 13 months. I’m lucky enough to stay home with them.
TURIANA HAMEL-SMITH: My name is Turiana Hamel-Smith. I am 27. I’m a stay-at-home mom of two. My daughter is 3 ½ and my son is 4 months.
NICOLE: My name is Nicole and I’m an early childhood educator currently staying home with my boys who are 2 ½ and 7 months. While I’m staying home, I am looking into going to school to be a certified lactation educator.
KRISTEN STRATTON: Great. Well thank you so much and welcome to the show.
KRISTEN STRATTON: So today on Newbies, we’re going to be discussing a new headline that just was published today with the Tribune. The headline reads: “Breastfeeding may expose babies to toxic chemicals.” It’s talking about the different chemicals that moms are exposed to and how some of that being wind up in the breast milk therefore the babies are exposed to it. So we’re really glad to have Rachelle here so she can kind of speak to this new report, discuss its validity and what mom should know.
RACHELLE MARKHAM: I had a little chance to look at it last night. I think one of the things we need to always remember is that: “Breast milk and breastfeeding is the biological norm for babies regardless of things we may hear in the media particularly.” Because things often get twisted a little bit and aren’t always exactly what the science is said behind it. I didn’t actually get a chance to look at in detail of the science of this.
A few things that I found interesting where the population they did the study on – their diet consists of a lot of seafood. That’s where a lot of these chemicals are coming from because that’s their normal diet. They live on a small island up in the North Atlantic Ocean. Predominantly, seafood is their main diet. So they are experiencing a lot higher intake of chemicals that are found in the ocean than probably we are on our normal diet.
Our body does a pretty good job of giving baby exactly what baby needs when baby needs it and that’s what we need to remember overall.
KRISTEN STRATTON: Yes, I thought it was really interesting. I mean we should always be mindful of what we’re putting into our bodies regardless of our breastfeeding
RACHELLE MARKHAM: Absolutely
KRISTEN STRATTON: We just need to take good care of ourselves. But I don’t think that we should run and clear the shelves about the formula and immediately stop breastfeeding. I don’t think that is a solution here.
RACHELLE MARKHAM: No, definitely not. Well, absolutely watching what we expose ourselves to, what we exposed our children to and minimizing in ways we can minimize and where we can minimize.
TURIANA HAMEL-SMITH: I think it’s silly that they chose such a small population size and then said like: “This is it. This is the study.” Not everybody rely so heavily on seafood on the mercury that’s in deep sea fish or even just regular seafood. Most people have a very diverse diet that can then counteract with the amount of maybe the chemicals that they are getting that then bouncing it out with something else.
So the fact that they’ve been read the study and then published it with such a headline like that I feel is a little irresponsible which isn’t surprising. It’s really irresponsible for them to say since so many women worked so hard to breastfeed and to continue. They have a lot of hurdles and struggles that they have to go through and it’s not easy. So it feels like saying something so inflammatory like that is a little rude.
JENNIFER: That can be really discouraging to mothers that are thinking about breastfeeding and trying to weigh if it’s going to be the right thing for them versus formula and this could sway mothers that haven’t had their babies yet
TURIANA HAMEL-SMITH: Have another chance to
JENNIFER: I’m going to be dangerous to my child so formula would be so much better.
TURIANA HAMEL-SMITH: It’s balanced.
TURIANA HAMEL-SMITH: It’s good but I don’t think that’s a good headline.
KRISTEN STRATTON: Yes.
NICOLE: I think it’s a good point.
KRISTEN STRATTON: Today on Newbies we’re discussing how to establish your breast milk supply as a new mom. Our expert is Rachelle Markham, an Internationally Board Certified Lactation Consultant. Welcome to the show.
RACHELLE MARKHAM: Thank you.
KRISTEN STRATTON: What are some of the things mom can do prenatally to prepare for a good breastfeeding relationship with her newborn?
RACHELLE MARKHAM: In my experience, what I find the most important is education. If a mom is educated herself on what life is like with a newborn, what to expect from a newborn, what to expect from breastfeeding – that is often the best way a mom can prepare prenatally is to know what life is going to look like with a newborn.
KRISTEN STRATTON: Let’s talk about when baby is here; what is the importance of skin-to-skin time with mom and baby for the breastfeeding relationship?
RACHELLE MARKHAM: Skin-to-skin time is awesome. Baby has been inside you for the last nine months. You’ve been holding baby, rocking baby, cuddling baby and now baby is been born and baby really doesn’t know anything more than that. Baby wants to be on you skin-to-skin because that is baby’s environment. It helps babies respirations normalize. It helps heart rate. It helps keep baby warm – the area between your breast actually heats up or cools down depending on baby needs and responds accordingly to keep baby at exactly the right temperature which then in turn helps stabilize blood sugars.
So we’ve got a baby who is functioning at their best when they’re skin-to-skin. Not only then does baby is baby’s heart rate good, blood sugars are good, temperature is good – baby then is ready to feed much more frequently and because baby’s skin-to-skin much more accessible. Baby wakes up and is ready to nurse more frequently that way.
KRISTEN STRATTON: I would imagine that would help mom know notice baby’s hunger cues pretty easily.
RACHELLE MARKHAM: Exactly.
KRISTEN STRATTON: Because baby is right there.
RACHELLE MARKHAM: Exactly.
KRISTEN STRATTON: It’s hard to miss.
RACHELLE MARKHAM: Yes, baby’s wrapped up like a burrito in the basinet. It’s often easy to miss some of those early feeding cues where baby’s skin-to-skin, you don’t miss those.
KRISTEN STRATTON: How often should a mom be breastfeeding her newborn to encourage her milk to come in?
RACHELLE MARKHAM: The bare minimum is eight times per 24 hours. Ideally, it’s 10, 15 – 20 times an hour. There are cultures where babies in the first few days typically nurse about 20 times a day – very short feeds. But they are breast nursing about 20 times a day. In those cultures, they see far fewer issues with weight gain and far fewer issues with jaundice. So bare minimum is eight, a lot more is better.
KRISTEN STRATTON: What is the average time frame for a woman’s milk to come in?
RACHELLE MARKHAM: Typically we see it around 72 hours but there are a lot of variations with that. If mom is been nursing a baby through pregnancy, show off and notice an increase in the supply much sooner than that 72 hour mark. If mom has had a really long hard labor maybe a C section or complications then we often see a delay in that.
KRISTEN STRATTON: What can woman do once her milk come in and we all know that tell-tale rock hard boob, engorgement phase, what can they do to provide themselves with some comfort but still maintain their supply?
RACHELLE MARKHAM: Yes that can be a fun time frame, an uncomfortable time frame.
KRISTEN STRATTON: Just a little.
RACHELLE MARKHAM: One thing that does actually help prevent engorgement not entirely but it can certainly help is nursing at your 10 plus times a day – Moms who have baby skin-to-skin and nursing real frequently in that first couple of days often don’t notice as dramatic engorgement. That’s a great way to start off well as nursing 10 plus times a day.
If you do get rock hard and experience the painful engorgement period, there’s a technique called: “Reverse Pressure Softening” that works really well and helping baby then latch. If your breast is so swollen, the baby can’t latch effectively then you create a whole another series of problems and you can’t empty the breast and get comfortable. So the Reverse Pressure Softening really helps move the fluid that is accumulated on the breast that is not necessarily milk. But move the fluid away from the nipple and areola area and then allows baby to latch on to a softer breast and be able to drain the excess milk that you do have.
You can also use cold compresses, warm showers can also help. Pumping typically makes the engorgement worse in the first little bit. So pumping is not going to be helpful like many moms think it would be helpful. So that’s something to avoid in the first couple of days.
KRISTEN STRATTON: How about our panelists? I’m sure this is a memorable time for you to remember those. It looks like you’ve got a boob job but you didn’t. Probably hurt just as much. So why do we open at that? Maybe Nicole can start herself with her experience?
NICOLE: Well with my first, he was premature and I had a C Section. So it was probably five or six days before the milk fully came in because he was in the NICU for a while. I was inclusively pumping. In hind sight, I realize that I was too engorge for him to latch which created nipple trauma which then lead to thrush, clogs and mastitis.
I exclusively pump for the first five months before we are finally able to latch and then inclusive pumping created a massive over supply for me. I didn’t realize it until afterwards with the constant clogging and mastitis. By the time we got everything cleared up, my supply had gone from an oversupply to no supply. So I was lucky to get five ounces every couple of days when I pump.
But I was able to by six months and increase my supply and we went onto a nurse for a year and a half until I was half way through my second pregnancy.
KRISTEN STRATTON: That’s amazing
RACHELLE MARKHAM: That’s great.
KRISTEN STRATTON: You’re a breastfeeding warrior.
NICOLE: Yes, definitely difficult something so natural shouldn’t seem they would be so difficult. I don’t think that a lot of people understand that and they don’t think that a lot of woman are educated enough to be able to push through it.
RACHELLE MARKHAM: Yes, I feel like that’s the thing with breastfeeding though. People assume that you just pop the baby on and boom you’re done. There’s pain and then there’s engorgement which is horrible.
NICOLE: My second one, I figured I went through all of it with my first and this would give me a breeze. It wasn’t until three months, we were actually able to because initially, he had a great latch. He was a full term baby but I didn’t notice that later through the feeding, he was tucking his bottom lip in which created even more nipple trauma than my first had and it took seven weeks for my nipples to fully heal.
So we used a shield until three months when I was able to finally kick it and I mean three months isn’t five or six months but still.
JENNIFER: I don’t remember really with my first either. But our nursing relationship was kind of sabotaged in the hospital. I wasn’t as educated with my first as I was with my second. But with my second, I was engorged the day they leave me in the hospital which was three days after my C Section. So my milk came in ridiculously fast.
Luckily with him, I was much more educated than pretty much in every opportunity; I latch him and it really only lasted a couple of days. I was very thankful for just the difference that a few years make in education. Even though I wasn’t very young, I just didn’t know. So this time, it wasn’t horrible. It was very painful and I have large breasts anyway so it was so much worse.
But luckily, I was able to stay home and I had helped so he would latch on all the time. It helps so much just to have him on the breast to deal with the engorgement.
RACHELLE MARKHAM: Yes, babies are good at that, if you can get them latched.
KRISTEN STRATTON: Well thank you for sharing so much. A lot of mothers worry about their baby not eating enough when they’re sleeping or whether or not they should let their babies sleep at night through feedings. There’s a lot of debate as to whether or not you should wake your baby up. So maybe we can speak tomorrow about what mom should do.
RACHELLE MARKHAM: I tend to follow the three rules that I have created. If baby has regained birth weight. Baby is showing that they’re gaining well. We’re not dealing with a baby who’s struggling to gain weight. So baby’s regain birth weight, gaining well has the right number of pees and poops every 24 hours so that we are not worried about intake and mom is comfortable. If mom is comfortable, nipples and breasts are comfortable and all of three of those things have been met then you do not wake up that baby. Let baby tell you when baby is ready to eat.
If you’re struggling with weight gain, if you’re very painful either from engorgement or from really sore nipples then we wake baby up to nurse more frequently and evaluate what’s causing those problems.
KRISTEN STRATTON: What about a mom who’s maybe been told that her baby has a high bilirubin count, jaundice? But baby is really sleepy?
RACHELLE MARKHAM: Yes, those are hard babies to wake up to feed because the bilirubin makes them so sleepy. But getting more calories in them is the fix for that which means we don’t let them sleep unfortunately. Once you get passed that then you can let them sleep. But keeping them well-fed, meaning that we’re awaking them to feed at least every two hours in the beginning is important.
KRISTEN STRATTON: If a mom in a previous breastfeeding relationship didn’t have enough milk or felt that she didn’t and was worried that she let her baby sleep that would affect her.
RACHELLE MARKHAM: That will affect the supply
KRISTEN STRATTON: Yes so what would be your advice be?
RACHELLE MARKHAM: Once we’ve met those three things with the three rules meaning baby’s gaining well, mom’s comfortable, pees and poops are okay then really letting baby dictate exactly how much baby needs. Typically it takes care of all problems and milk supply is not usually a problem when you’re letting baby. Because babies innately know exactly what they need and they’re good at that. They’re good at telling us exactly what they need.
So by following those cues, we don’t typically see some milk supply problems. If we do have a past history then we watch a little bit closer and mom can keep track a little bit closer to make sure that’s she’s producing enough.
KRISTEN STRATTON: Wonderful. Thank you so much. When we come back, we will continue our discussion about establishing milk supply for new moms. We’ll be right back.
KRISTEN STRATTON: Welcome back to the show. We’re talking with Rachelle Markham IBCLC about how to establish your breast milk supply. Rachelle when a mother is returning to work at six weeks postpartum, when should she begin to pump in and how can this affect her milk supply?
RACHELLE MARKHAM: I usually like to encourage moms to wait until they’ve passed the two to three week grow spurt. But two to three week growth spurt can be quite drying and to add pumping in on top of that can really be exhausting. So once baby has passed the two week grow spurt – sometimes happens at three weeks then mom can start pumping either after feeds and combine the milk she’s pumped during the day to store. She could add in a special pumping time during baby if baby has a longer sleep stretch, pump in the middle of that sleep stretch.
There’s a lot of different ways that mom can get in a pumping session to store some milk for returning to work; although you don’t need a whole lot. A lot of moms love to have hundreds of ounces in their freezer and that’s not always something you need. Because you’ll be pumping at work to feed the milk or pumping at work to get the milk baby needs for the following day. So you really don’t need a huge stock pile in your freezer. So you don’t need to spend your entire six weeks at home with baby pumping. Spend that time with baby.
KRISTEN STRATTON: For moms who maybe have to pump exclusively from Day One, what’s the best way to ensure they meet their baby’s needs?
RACHELLE MARKHAM: Lots of skin-to-skin. Baby helps trigger milk supply that way by lots of skin-to-skin and frequent pumping just as if you were nursing baby at breast.
KRISTEN STRATTON: Any mom who needs to use syringe feeding or a supplemental nursing system, what’s helpful to facilitate bonding while that milk supply gets established?
RACHELLE MARKHAM: Those are some great tools but there are also some stressful tools. So having help at home definitely helps with those tools because really you need an extra set of hands. So it does help keep baby at breast which is a great thing which helps stimulate milk supply and bonding.
They are great tools to use but they can also be a little stressful. So having an extra pair of hands in that even if that means you have to ask someone to come help you, those are great ways to help with an SNS.
KRISTEN STRATTON: How would a mom know if her baby is receiving enough milk? You mentioned weight gain but what about output? How do we know if baby is getting enough in?
RACHELLE MARKHAM: That’s easy. If nothing goes in, nothing comes out. If plenty goes in, plenty comes out. So all you have to do is watch the pees and poops. They will tell us exactly whether or not baby is getting enough. Six wet diapers or more and per 24 hours and three or more poopy diapers in the beginning and you know babies getting plenty. So if you’re ever concerned, just watch those diapers and they’ll tell you exactly what baby’s getting.
KRISTEN STRATTON: Maybe some of our panelists can share the progression of poops and pees throughout that first week – that’s always a fun experience.
JENNIFER: With my first like I had mentioned before, I was concerned about whether or not he was getting enough because he was my first. I didn’t really know. One of the nurses says like: “Well if you’re concerned, just give him formula.” They did. They had me keep a log of how many wet, how many poopy diapers throughout the day but not mentioning any correlation between breastfeeding or his consumption versus what was coming out.
One thing I did know was that: “His first few days of poop were that very Meconium – that very black sticky mess.” The nurse that was – she was actually quite rude unfortunately. She comes in just change his diaper apparently because she felt she needed to and she had taken his diaper off. Right then, he poops and it’s this big black bubble and it’s still sticking to him.
I tried to laugh because her hand was right there. I tried not to laugh because I thought it was just the funniest thing. My kid doesn’t like you so much. But getting home and everything and it turns this kind of soupy, mustardy yellow, weird with specs in it and it’s kind of a slow change but it’s really interesting to see that from that very black, very sticky to much less solid.
RACHELLE MARKHAM: Yes. That normal transition from the Meconium to the green to the yellow – it also tells us that they baby’s getting enough. If we’re still seeing Meconium on Day Five, Six, Seven; we know that baby’s not getting enough. As a new mom, you will probably spend more time discussing poop and thinking about poop than you ever thought you would.
NICOLE: It’s my first year ago probably several times the feeding and I was every feeding through the day so that might be 10 feedings a day, three bowel movements per feeding. Probably at four months, he’s finally slowed down to four bowel movements a day which he held consistent until now at 2 ½.
My second was completely opposite. He would just go couple of times a day and now he’ll go three or four days without one. Then have a whole day of nothing but bowel movements. I think a lot of moms start to get concern when their digestive system changes and they go from heavy 18 poops a day to maybe one or waiting four days in between. But that’s again back to the education factor where you have to kind of research work into that. So you don’t have to stress yourself out in those early days because it was already a lot of things you have to focus on.
KRISTEN STRATTON: That’s when we know the weight gain is going out then that’s reassuring at that point too.
RACHELLE MARKHAM: Absolutely.
KRISTEN STRATTON: When should a mother contact an IBCLC?
RACHELLE MARKHAM: If you were having sore nipples and soreness past, I have never done this before. I’m uncomfortable if it’s passed that where you are dreading, feeding, your toes are curling up, the thought of having to latch baby definitely call a lactation consultant. If baby is not getting enough pees and poops in 24 hours or in a super sleepy and you’re having a really hard time waking baby, call a lactation consultant.
If you have any concerns about feeding a baby, pick up the phone and give us a call. We’ll be happy to answer those questions because a lot of times we can answer those questions over the phone and give you the information that you need. If not then you can go in and see a lactation consultant who can help you one-on-one get baby latching well or evaluate their suck.
There are lots of things that we can do to make mom comfortable and make sure that she’s comfortable and make sure baby is getting what baby needs.
KRISTEN STRATTON: I know sometimes you can do a weight feeding to see how much milk is actually transferring.
RACHELLE MARKHAM: For moms who are still a little nervous about how much baby is doing, we can do a pre-impost weight feed where we weigh baby before nursing, let baby nurse, weigh baby afterwards. It gives us a good clue as to how well baby is feeding. It’s not the only tool to use because it’s not a 100% accurate but it definitely can give reassure a mom who thinks maybe she’s not making enough milk and then baby gain five ounces in the less 15 minutes. That is a good tool.
KRISTEN STRATTON: That’s a good confidence builder right there.
RACHELLE MARKHAM: Yes, exactly.
KRISTEN STRATTON: Thank you so much Rachelle and our lovely panelists for chatting with us today about breastfeeding tips for the new mom.
SUNNY GAULT: Keep in mind that we do have The Boob Group which is a separate podcast, it’s all about breastfeeding and we have like 125 plus episodes that are just geared towards breastfeeding. So if you guys are listening to this and go: “I need more breastfeeding information.” Head on over to www.NewMommyMedia.com and you can listen to the episodes there.
KRISTEN STRATTON: For our Newbies Club Members, our conversation will continue after the end of the show as Rachelle will share her favorite resources for breastfeeding when your baby is in the NICU. For more information about the Newbies Club, please visit our website at www.NewMommyMedia.com.
JENNIFER: Hi. This is Jennifer in some San Diego and California. I have a six month old daughter and she is breastfed right now but my pediatrician keeps wondering about whether or not I need to give her iron supplements. So my questions for you are: “What are the signs that a baby is iron deficient? Is it difficult to test for iron deficiency? I’d really love to stay away from unnecessary supplements, so your advice would be greatly appreciated.” Okay, thank you.
FREDERICK JOHNSON: Hi. This is Dr. Johnson. Luckily Jennifer, we really don’t need those any longer. There are infant food, the formula, mom’s prenatal vitamins – we do normally at least in our office check at nine months of age to see if our child is anemic. There are other simple tests involves their fingers and you can instantly know what their blood count is.
Most of the time I would say maybe once or twice a year now, if you ever need to use iron – so it’s sort of a thing over the pass but we still check for it anyway. So the other supplements probably number one right now in the list is: “Vitamin D” before breastfeeding infants, breastfeeding infants yourself not to get enough Vitamin D, so you usually supplement that.
Vitamin D is a substitute and helps us to build strong bones and to really become more prominent as far as the nutritional needs. So I hope that answers your question. Have a good day. Thank you.
KRISTEN STRATTON: That wraps up our show for today. We appreciate you listening to Newbies.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Parent Savers for moms and dads with infants and toddlers
• The Boob Group for moms who breastfeed
• Twin Talks for parents of multiples.
Thanks for listening to Newbies: “Your go-to source for new moms and new babies.”
This has been a New Mommy Media production. The Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Well such information and materials are believe to be accurate, it is not intended to replace or substitute for professional, medical or advise or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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