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’s a very important topic. Over the years, I have jotted down many of these questions in my notebook so that I can find the most up-to-date 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 of 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 gather her responses. Ms. Abstoss sat for the first International Board for Lactation Consultant examination in 1985 and has worked continuously in the field since that time in California, New York, Germany, Austria, Switzerland, and Connecticut. She was the first lactation consultant appointed as a State Certified Teacher for Bavarian Midwifery Schools.

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

What are the most common problems women encounter when pumping?

Decreased milk supply is probably the number one problem women face when pumping. This can be attributed to many different factors.

infrequent pumping

A working woman should try to express milk every 3 hours for 10 to 15 minutes or at least for each missed feeding.

inefficient pumping

The pump being used may have inadequate pressure or insufficient cycles per minute, causing a decrease in milk supply.

Lack of lactation

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

painful nipples

This may be due to a poor pump due to excessive suction pressure, too long a pumping period, or poor latch-on when the baby is nursing.

fatigue and exhaustion

The stress of caring for a newborn along with the pressure of work and home can lead to exhaustion and fatigue that can decrease your milk supply.

How can I increase my milk supply?

There are various medicines and herbal products available to help increase milk supply. To increase the existing milk supply, one can take two herbal supplements 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 medications 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 the use of this drug as a galactagogue because at higher doses, when given intravenously, Domperidooe was associated with cardiac arrhythmias and heart attack. . However, the small doses that are used when administered orally to increase lactation (30-40 mg/day) and for a short period of three to six weeks do not appear to be of great concern. Patients usually get this drug from Canadian pharmacies or from Mexico and Europe, where it is sold without a prescription. The ILCA (International Association of Lactation Consultants) is currently conducting studies on the safety of domperidone.

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

How do I treat clogged milk ducts?

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

Mom misses the shots

Mom doesn’t pump often

The breast is unable to empty

Breastfeed more often

Change of positioning

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

This can be the result of incorrect positioning, inadequate pressure from a pump, or restricted milk flow due to ill-fitting bras or any type of breast trauma that damages the duct. Fatigue, stress, or the baby’s inability to latch on correctly can also contribute to this problem.

Standard treatment consists of moist heat beforehand for about 5 minutes, emptying the breast as much as possible, cooling the packs afterwards, and reducing swelling between feedings. It may also be helpful to massage the duct toward the nipple. If the plug comes out, it may look like powdered milk on a string. One must continue nursing to fully clear the plug. Apply cold compresses through an ice pack or plastic bag of frozen peas for about 15 to 20 minutes. Putting fresh cabbage leaves on 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?

Shutdown 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 that the baby is well supported with the mouth wide open to remove all of the breast tissue. The baby should latch on well beyond the tip of the nipple. Often, latch-on problems 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 may be used to prevent engorgement when expressing milk. This will prevent your milk supply from diminishing or disappearing. Different lactation specialists and hospitals may prefer one modality over another, however, all agree that care must be taken when using any device so that trauma or serious damage to the nipple does not occur.

Once the baby is “educated” that the breast is his “food supply”, the baby will usually suck well. It is helpful 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 start.

Is the baby not hungry right now?

Is there a nurses strike?

A “nursing strike” can occur if a baby who is nursing well, beyond the newborn period, suddenly refuses to breastfeed. This can often occur after 4 months of age when a mother says “my seven month old weaned suddenly”. These babies are not weaning themselves, 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 nursing pattern with more skin-to-skin contact, trying to nurse in a quiet, calm environment without distractions, such as nursing 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 nursing pattern.

Is the baby getting sick?

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

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

If the baby does not latch, it is important to stimulate the establishment of milk production by using 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 weaning pump and stop nursing altogether. One option for weaning would be to reduce the time per pump, 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, ie from every 3 hours to every 4, 6 or even 8 hours. If you want, you can use ice packs after pumping for added comfort. Additionally, Motrin can be used for anti-inflammatory pain relief. A snug, comfortable bra can also help with support and relief. Nursing pads can be used to prevent excess 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, astringent taste, so adding honey makes it more palatable. Do not use this if you are currently pregnant as it is abortifacient.

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

Three days of Sudafed can help dry up milk production. Milk supply decreases as you feed less. The quality of the milk also changes and becomes more salty and colostrum-like, which many babies do not like. Consequently, this also helps to decrease nursing.