FREQUENT ASKED QUESTIONS

NEED TO KNOW INFORMATION

FOR PRENATALS/POSTPARTUMS:

Q. When should a mom contact a Lactation Consultant?
It is highly recommended to contact an LC as soon as Mom arrives home from the hospital, if mom is having difficulties. A mom should see a LC before day 3 at home, as a first resort to solve the issues and/or to prevent any concerns. A mom should not wait for weeks or a month to contact a LC as a last resort or when the issue has soared and when it has affected mom emotionally.

Q. Why do I have sore nipples?
There are various reasons for sore nipples:

1. Perhaps, the baby is only latching-on to the nipple: sore nipples.

2. By chance the baby is receiving a bottle or a pacifier when the baby is learning to breastfeed. When these are given to an infant while the baby is learning to breastfeed, the baby only opens up their mouth a tad, unlike breastfeeding. Therefore, your infant only latches on to the nipple: sore nipples.

3. Possibly, the baby is not held tummy to tummy. Consequently the nipple may not be in position aimed at roof of the baby's mouth and the baby may be slipping off of the breast: sore nipples.

4. May be one hand is holding one breast and the other is holding the baby. Therefore, the baby could be dangling and the weight of the babe is pulling the babe off of the breast and the baby is only latching on your nipple: sore nipples.

5. Also, waiting to nurse when the baby is crying is not good as the babe is so hungry, the baby sucks so hard: sore nipples.

6. Possibly, you could be engorged and hence, the babe only latches on to your nipple: sore nipples.

7. Perchance, your baby's frenulum is short: sore nipples.

8. Remember, nursing is not suppose to hurt and if it does it would be best to contact a IBCLC. When you are in the hospital, always as for the LACTATION CONSULTANT.

Q. What is one of your biggest problems with your moms?
The biggest problem is that they come in with sore nipples. This is any where from day three to two weeks after discharge from the hospital. The majority of these Mom's are having problems because they are introducing the bottle. So it is suggested that they eliminate the bottle totally. Once the babe knows how to breastfeed a cup is introduced.

Q. What is the difference between bottle feeding and breastfeeding?
When a baby is bottle fed, the baby only opens up their mouth a tad. With breastfeeding the baby's head needs to go back: when the head goes back the mouth opens up wide. Then the Mom needs to bring the baby to the breast "quick and gentle" (with the nipple aiming at the roof of the babe's mouth) to form a vacuum. The entire breast goes into into the baby's mouth not just the nipple. This is why we call it "Breastfeeding" not "nipple" feeding.

Q. How long does it take for a baby to learn to breastfeed?
Every baby is different. It may take any where from one month to six weeks for a baby to learn the art of breastfeeding.

Q. Why is a bottle not recommended?
Bottles are against the International Code of Marketing Breast Milk Substitutes and therefore the bottle is not recommended. Even a new born is able to drink from a cup, if the infant is having difficulty latching on.

Q. What if the infant is having difficulty latching-on?
It is best to offer breast milk in a cup, in a spoon or a dropper. After Mom pumps her breast milk, even Dad would be able to feed the baby from a cup if he is available. After offering one or two ounces in a cup, then Mom may want to try to attempt to offer the breast at this time. Once the baby is more relaxed/in a groggy state, the baby may take the breast.

Q. How does Mom produce more milk?
Mom produces more milk by by emptying out her breast more frequently and more thoroughly. The amount of milk she removes from her breast is the same amount of milk that she will produce. If Mom does not put the baby to breast or pump she is not producing any milk. the milk will stay in the breast and dry up. It is a matter of supply and demand.

Q. Is a pacifier recommended?
A pacifier provides zero or no calories to the baby and it interferes with adequate intake. Sucking is designed to bring calories to the baby. A qualified Oral Motor Therapist may recommend a pacifier for a therapeutic purpose.

Q. How long should I breastfeed for?
UNICEFand WHO recommend to "exclusively" breastfeed for 6 months ( with no pacifiers, bottles or supplemental foods) and to continue to breastfeed for two years and beyond. The average length of time to breastfeed globally is five years, unlike the USA and yet Michael Jordan was breastfeed for three years and his Mother feels this is why he is one of the finest athletes on the basket ball court.

Q. May I take any medication while I am breastfeeding?
Most medications are safe and yet some are not safe. The best reference is Thomas Hale's book MEDICATION AND MOTHER'S MILK or just ask your local Pharmacist: they will know best on what medication will be "breastfeeding compatible".

Q. Is it OK for babies to cry?
Do you like to cry? There you go. Remember, the baby gives Mom subtle "hungry cues" (i.e. mouth is opened - hands in mouth) and yet if Mom waits to feed the baby when the baby cries: the babe doesn't have the energy to suck (Ludington-Hoe et al 2002), the infants heart rate elevates and this elevates their blood pressure (DInwiddie et al 1979) and possible hemorrhage of the brain could occur (Hayden 1985), the baby is stressed out and so is everyone else in the house when a baby cries. I know of babies who developed a hernia because of prolonged crying. No it is not good for any infant to cry.

Q. What causes elevated bilirubin levels in the newborn?
When the infant is given supplementation (i.e. formula or water) rather than breast milk, this slows down the stooling process and therefore the baby looks jaundice. (Bertini et al 2001, Nicoll, Ginsbur & Tripp 1982). Mom's first milk is colostrum, known as "Liquid Gold". Colostrum is yellow, thick and sticky (like honey). It is full of protein that contains all the antigens and immunoglobulins to fight off the bacteria, infections, viruses, etc. The colostrum acts as a laxative and aids the baby in excreting the meconium and excreting the bilirubin into the stools. Since breastfeeding expedites the stooling process, it prevents the bilirubin from being reabsorbed into the blood stream which creates the jaundice color in the infant. Therefore, it is best to breastfeed as frequently as possible especially in the hospital to maintain normal bilirubin levels.
I would like to add that when labor is induced (i.e. Oxytocin, Pitocin) (Omigbodun et al 1993) and/or an epidural (Kuhnert, Kuhnert & Gross 1982) is administered for pain, it delays the normal process of the baby's liver to excrete the bilirubin and therefore these drugs promote and increase the risk of jaundice in the newborn.
All of these drugs pass through the placenta and effect the baby. These drugs also inhibit the normal hormonal process which will produce and release Mom's milk. Moreover, Mom's milk will be delayed until these drugs are out of her system.
It is best for Mom's to go through a natural delivery and allow her hormonal hormones release naturally which promotes milk let-down after the placenta is delivered. The natural hormone oxytocin aids in the contracting of the uterus and then when Mom focuses on relaxing ... her beta-endorphins will be released to help deal with the pain.
When drugs are administered during labor, it certainly compromises the baby in sucking, swallowing and latching-on to the breast (Righard & Alade 1992) after delivery and it also impedes the let-down of Mom's milk after delivery.

Q. Why may a baby cry during the nursing session?
What I see most of the time in my office is that the Mom brings the breast to the baby. When a Mom does this, the baby is unable to hold the heavy breast into the mouth and so the baby lets go and cries. Also, if the nipple is brought or placed in the baby's mouth with the mother's hand, the nipple will not be positioned correctly as it is sitting on the baby's tongue and therefore the nipple will not stretch properly. When the nipple doesn't stretch, the baby doesn't receive any or very little milk: the baby gets frustrated, lets go and cries. When the nipple stretches properly the transfer of milk occurs. The nipple is suppose to stretch two to three times its length. When the nipple is stretched at this length and compressed along the roof of the mouth, it acts as a valve or a faucet and it releases the milk. Therefore the nipple must be aimed at the roof of the baby's mouth when the mouth is opened. I have seen babies cry and refuse Mom's breast because the Mom has the baby sitting up on their lap. By doing this, their breast falls about 4 to 8 inches below the babies mouth and then the Mom lifts up their breast and places it in the babies mouth. The baby refuses the breast every time as they know they will not get any milk in this position. I have a baby who is so traumatized by the Mom's persistence that he will only breastfeed when the Mom is laying down. Therefore, if you were blessed with breasts you may need to roll up a diaper and place it under your breast to elevate your breast. If you are really heavy, perhaps, a baby's blanket will do or even a towel rolled up will work. Once your breast is elevated, it doesn't matter how your nipple falls, as long as it doesn't hit your abdomen. Now no matter where your nipple falls, you do not touch your breast with your hand at all ( as you are holding the baby with both hands), you just have to make sure your nipple is aimed for the ROOF of your baby's opened mouth when you draw the baby quick and gentle on to the breast. By doing this, the baby will be more comfortable (rather than holding the heavy breast in it's mouth) and the baby will be receiving more milk (as the nipple will stretch the proper length and compress against the roof of their mouth with their tongue to release the milk).

Q. What is a good latch?
A good latch is when the Mom brings the baby's nose to her nipple and then moves the baby at least two inches away which allows the baby to lean the head backward: as this happens the baby opens the mouth wide. As the baby opens its mouth wide and the head is back, Mom is to bring the baby quick and gentle on to the breast (with the nipple aiming at the roof of the mouth - not in the middle of the opened mouth) having the baby's chin touch the breast first. The baby's nose should not touch the breast.

Q. How soon should I breastfeed after delivery?
There should be no separation of Mom and baby after delivery. It is best that Mom and baby are skin-to-skin directly after delivery without interruption (Yamauchi, Yamauchi 1990). The cord care, the weighing and measuring, the vitamin K injection, the eye drops, the heel pricks etc all can be delayed until the Mom and baby have had their first breastfeeding session (Step 4 from the BFHI). During their first skin-to-skin session the baby will go directly to the breast when the baby is ready to breastfeed.

Q. Why should I massage my breast?
Massaging and compressing the breast BEFORE the feeding aids in the letdown of the milk for the baby. After massaging, it is also good to compress the areola with your thumb and finger to allow the milk to drip on to your nipple. Then offer your breast to the baby. Moreover, in the middle of your feeding when the baby pauses for a while, gently hold your baby with only one hand and gently free up your other hand and massage your breast down towards your nipple with the free hand. If Dad is around he can also help massage. As Mom or Dad massages, the baby will start to suck and swallow more. Massaging the breast before the feeding also softens the breast and reduces engorgement.

Q. Should I offer both breasts for a feeding?
I am so glad you asked this question. Daily I deal with Mom's who say their newborn is so fussy and still hungry after the feeding. This is because the Mom takes the baby off of the first breast and then offers the second breast. By doing this, the baby is not getting the HIND MILK which is full of FAT. The fat is full of calories and gives the baby the satiety value. If the baby does not receive any fat, the baby DOES NOT FEEL FULL. Remember, the first milk is the lactose, the sweet milk which draws the baby to the breast. The second milk has the protein (and a little fat) which has all the antigens and immunoglobulins to fight off the infection, viruses, bacteria etc and the hind milk is full of fat. It is best to stay on one breast for a feeding (Smillie, Campbell, Iwinski, 2005). Also, if only one breast is offered for a feeding, the other breast will not leak. Also, It is best to let the baby come off the breast itself. When the baby comes off the breast in the middle of the feeding, in most cases the baby needs to be burped. So burp the baby and then offer the same breast again ... unless there is no more milk.

When the baby comes off the breast, look at the hands. If both hands are opened, the baby has had enough milk and their little tummy is full. If the baby comes off the breast and one hand is opened and the other closed, the baby is still hungry: When the baby comes off the breast Mom needs to either wake up the baby or burp the baby and then offer the same breast again. When the Mom offers the same breast again, this is when the baby receives most of the hind milk. (Smillie, Campbell, Iwinski, 2005). The feeding is over with when the baby falls asleep on the breast, is no longer sucking or swallowing, both hands are opened and the baby pops off itself. When the baby wakes up two to three hours later, Mom offers the other breast.

Q. Why is it best to offer one breast for a feeding?
First of all, if only one breast is offered, then the breast will drain out and empty. After this happens, first of all the breast will fill back up quickly (Daly 1995) which produces more milk.
Secondly, the baby will receive the hind milk which is full of calories and provides the satiety value of feeling full.
Lastly, if only one breast is offered for a feeding, the other breast will not leak.

I would like to add, some Mom's do not produce sufficient amount of milk in one breast and therefore may have to offer the second breast. Prior to offering the breast, it is always best for Mom's to massage their breast first and then express Mom's milk out on to the nipple before offering the breast. By doing this Mom's will know if they produce enough milk in only one breast. Continue to do this every time the baby comes off the breast (to see if there is more milk) and then offer the same breast if Mom still has milk.

Q. How long is a normal breastfeeding session?
All babies are different. A newborn may take up to half an hour, as the baby is learning to breastfeed. Remember, the baby loves to be with Mom as Mom has everything the baby needs. Babies love to be held as they love the warmth, the security and of course the smell of Mom's milk.

As the baby gets older, the baby will empty the breast within ten minutes or so. It is best not to look at the clock when breastfeeding .. Mom's need to look at their baby's hands. Remember, when the baby has both hands opened, that is the end of the feed.

If a Mom wishes to breastfeed, she needs the four P's: Practice, Patience, Perseverance and a Positive attitude to be successful.

Q. Is it true lactation prevents another birth?
When a Mom "Exclusively Breastfeeds" (no bottle, formula, water or pacifier), the lactation process prevents ovulation and menstruation 98% of the time (Kennedy, Rivera, McNeilly 1989). It is recommended to "Exclusively Breastfeed" for six months. When foods are introduced at six months, it is best to offer the breast before and after each meal or snack which will keep up Mom's milk supply and also increase the prolactin levels.

The Lactation Amenorrhea Method (LAM) effect on each Mom is different. Some mom's have their mensies return at 6 months, some at nine months, some at a year, some at one and a half years and so forth. Presently, I have a Mom who is still nursing her 3 year old and she has yet to start menstruating. Yes, it acts as birth spacing.

Q. May I breastfeed if I have inverted or flat nipples?
Yes, the majority of the Moms with inverted/flat nipples may breastfeed with an explanation. First of all, if you have flat or inverted nipples it is important to visit a Lactation Consultant as soon as you are pregnant or better yet even before you plan to get pregnant. If you are not pregnant there are two new devices on the market now to evert your nipples. Secondly, if you are already pregnant, this technique is advised to start at least at 37 weeks to stretch the lactiferous ducts. Lastly, if you wish to breastfeed without using any device to stretch the lactiferous ducts, it is important NOT to introduce a bottle if you wish to breastfeed. Many baby's have a good strong suck at birth and will suck without a problem as they can latch-on by themselves. Once a bottle is administered, it is most difficult to have the baby return back on to the breast.



Disclaimer: all material provided in Trezil Consulting LLC is provided for educational purposes only. Consult your Physician regarding the advisability of any opinions or recommendations with respect to your individual situation.