Breastfeeding

From experience over a number of years, I have found that I can assist with the majority of breastfeeding problems by working with you to adjust fit and hold (attachment and positioning). If breastfeeding is not working for you as you had hoped, please be in touch so that I can see you as soon as possible. It is important to get issues sorted quickly so that you are able to continue breastfeeding. The longer that issues continue, the more complex they can be to assist with.

The following Facebook groups are also helpful places to find support:

Breastfeeding Mums Support Group (Australia)

The Australian Breastfeeding Project

Latch and positioning, also referred to as "fit and hold", is the way that you and your baby fit together. Having a good fit and hold is vital, as this allows you to enjoy pain free breastfeeding, where both you and your baby are comfortable, and where your baby is able to suck effectively to gain adequate amounts of milk.

Early, frequent and effective milk removal is key to establishing and maintaining your breastmilk supply. This can only be done if breastfeeding is comfortable for both mother and baby.

If you have poor positioning or latch, you may be experiencing the following problems:

• Nipple damage or pain
• Difficulty latching onto the breast
• Fussing and pulling off the breast
• Back-arching at the breast
• Marathon feeds
• Excessively frequent breastfeeds
• ‘Windy’ behaviour during or after breastfeeds
• Poor weight gain

Positioning and latch is something that IBCLC Lactation Consultants can help you with , as it is a bit different for every mother-baby team.

I also recommend the videos from Nancy Mohrbacher, an IBCLC in America, which can be found on YouTube here.

This video demonstrates how to hand express. This includes when you are expressing colostrum before your baby is born.

This video demonstrates alternate feeding methods for a newborn baby including syringe feeding, cup feeding, spoon feeding, finger feeding and supplemental nursing systems. 

Nipple pain during breastfeeding is a common, but abnormal experience. Breastfeeding should be comfortable and painfree, and if it is not, that generally means that there is something wrong. The most common cause is suboptimal fit and hold. 

During a consultation with me, I will assess your nipples and also your baby's mouth to exclude any medical causes. If there is a medical reason, I can organise treatment for this straightaway. We can also work on positioning and latch.

Many Mums worry that they do not have enough milk for their baby. This is stressful and scary and a common reason for women to stop breastfeeding. 

How do I know if I have enough milk?

• At least 6 very wet cloth nappies or at least 5 very wet disposable nappies in 24 hours. The urine should be odourless and clear/very pale in colour. A very young baby will usually have 3 or more soft or runny bowel movements each day for several weeks. An older baby is likely to have fewer bowel movements than this. Strong, dark urine or formed bowel motions suggest that the baby needs more breastmilk and you should seek medical advice.
• Good skin colour and muscle tone. Does she look like she fits her skin? If you gently ‘pinch’ her skin, it should spring back into place.
• Your baby is alert and reasonably contented and does not want to feed constantly. It is however normal for babies to have times when they feed more frequently. It is also normal for babies to wake for night feeds. Some babies sleep through the night at an early age while others wake during the night for some time.
• Some weight gain and growth in length and head circumference.

Don’t be alarmed if your baby brings up milk-coloured vomit after a feed, this is to be expected. However, seek medical advice if the vomit has orange, red, green, brown or black in it, or he/she is projectile vomiting, has a high temperature, blood in his poo, a sunken fontanelle (the soft spot on his head), or is not back to his birth weight by two weeks of age.

What causes low milk supply? 

• Poor positioning and attachment
• Baby is not being fed enough times in the day
• Previous breast surgery such as breast reduction surgery
• Recent mastitis or other illness
• Some medications, for example the oral contraceptive pill and pseudoephedrine 
• Smoking or alcohol
• Insufficient glandular tissue, a rare condition where a mother doesn't have enough of the "milk making" glands in the breast. This is not at all related to the size of a woman's breasts.

How can I ensure that I have enough milk supply? 

Breastmilk is produced on a “supply and demand” basis and so the more milk that a baby drinks (or is pumped), the more milk will be produced. In order to make milk, you must take milk. The baby must have good fit and hold in order to be able to drain the breast well. Your baby must also feed regularly, and it is very common and normal for a baby to need to feed 10-12 times in a 24 hour period, especially in the early days whilst supply is being established. 

It is important to feed babies on demand as opposed to scheduled times. After all, even we as adults eat and drink according to hunger and thirst, not according to the clock on the wall! Use the breast as a tool to soothe or dial down your baby to increase the number of feeds. You can also offer another “top up” breastfeed if your baby seems unsettled soon after a feed (this is sometimes called cluster feeding and it is fairly common to have a block of several hours each day where your baby may want to cluster feed in the early weeks). Try to avoid giving your baby "top ups" of formula as this can further reduce your own milk supply, as your body thinks that it is making enough milk. Putting the baby to the breast, even if your breasts feel empty, will help to increase your supply as it tells your body how much milk your baby needs. Your baby is the best pump after all! You may find it helpful to switch breasts frequently during a feed to encourage further “let downs” or ejection of milk. 

There will be some situations where your baby does need some formula feeds in addition to breastfeeds, in order to meet your baby's needs. This should be discussed with your doctor or IBCLC, and I am more than happy to help you work out a system that works for both you and your baby. 

In some situations it is worth considering medication to improve your milk supply. Domperidone (Motilium) is a prescription medication that can be used to increase the milk making hormone in order to increase your supply. It is usually well tolerated and has few side effects; however a medical review is very important to make sure that this medication is right for you. 

The following references provide more information:

The Royal Women's Hospital: Low Milk Supply

Australian Breastfeeding Association: Increasing Supply

Adelaide Mums and Babies Clinic: Domperidone

Medela: Supplemental Nursing System

Australian Breastfeeding Association: Insufficient Glandular Tissue (breast hypoplasia)

This website also has lots of useful information:

Low Milk Supply

Sometimes when the Mum has a generous supply of breastmilk, the baby can make a lot of explosive, frothy stools and appear quite windy, fussy and unsettled. These babies usually also have excellent weight gain. The Mum can experience very full breasts, sometimes with blocked ducts or mastitis (see below). 

These are usually signs that the baby is getting too much breastmilk, and this can be easily corrected with a few simple strategies that we can discuss in a consultation. 

Breast refusal is probably the most upsetting of all breastfeeding problems. The following link has some excellent information. If your baby is refusing the breast, please ring for an urgent appointment and we can discuss and trial strategies to bring your baby back to the breast.

The following references provide more information:

Australian Breastfeeding Association: Breast Refusal

Blocked ducts and mastitis can happen when milk sits "stagnant" in the breast. The milk builds up and causes inflammation, pain and sometimes infection in the breast. It is important for breasts to be continually emptied to prevent this from happening. This can happen because of a generous supply, abrupt weaning, dropping a feed/s or as a result of suboptimal fit and hold. 

You may notice flu like symptoms, rigors, aches of reasonably sudden onset, as well as painful, red, swollen, hot areas of the breast, often in a wedge shape. Sometimes you may notice a "milk bleb" which is a white area on the nipple that connects to a duct that is blocked.

To manage mastitis, the aim is to prevent milk sitting for too long in the breasts, and this is done by regularly emptying the breasts. Ideally, this is done by the baby breastfeeding, and you should offer the breast that has mastitis first to promote movement of breastmilk. You should offer the breast flexibly and frequently to your baby, and you can also try different feeding positions such as side-lying feeding. Most importantly though, you don't want to spend time breastfeeding or pumping more than you would normally, as this can send signals to your brain to make more milk, which can worsen the problem. 

If your baby is not interested in the milk, this may be due to a change in the taste of the milk as a result of the infection, and in this case you can hand express or use a pump to express. If you are not comfortable with this, please book an appointment as soon as possible so that we can get the milk moving before the problem worsens. Rest, cold-packs, Panadol and anti-inflammatories such as Nurofen (Ibuprofen) will help with the pain. Restrictive clothing and tight bras should be avoided during time. If these measures don't improve things within 12-24 hours, please see a doctor as you may need antibiotics. 

This handout provides a great summary: Mastitis Spectrum

Paced bottle feeding is a style of bottle feeding that is useful for all bottle fed babies, but especially those who are also breastfeeding. It slows down the volume that the baby can swallow, which helps to avoid gulping and an upset tummy. As the baby has to actively suck the milk from the bottle, as opposed to just drinking it, it is much more like being breastfed. It should reduce the chance of “flow confusion” which is usually the underlying cause of a baby starting to prefer the bottle over the breast.

Here is a video about how to do paced bottle feeding here.

Breast milk can be pumped by hand, by a suction device such as a silicone milk collector, or by an electric pump. If you need help with any of these methods, this can certainly be discussed further during a consultation.

Once pumped, it needs to be stored in a way that is safe for your baby to drink. There is no need to be alarmed, breastmilk is extremely hardy - after all it is a living substance that has special organisms in it that kill bacteria!

The University of Rochester in America an excellent table and an article that summarises how to store breastmilk and can be found here.

This website has a great article on how to choose a breast pump here.

There will be some occasions where a non-gestational mother may wish to breastfeed, such as in the case of adoption or surrogacy. There are ways that breastfeeding can be induced without ever giving birth. If you would like to discuss this further, please book in for a consultation, ideally, six months prior to the time that breastfeeding will be initiated.

I have helped several Mums with this very precious aspect of parenting, and if you are the intended parents of a baby being born overseas, we can continue to consult over Zoom after your baby's birth.

See the Induced Lactation page for more information.

There are occasions where breastfeeding and mental health can significantly impact one another, and this is an area that I have a special interest in. 

Sometimes breastfeeding is just plain difficult. I love this link with breastfeeding affirmations which may be useful to read through.

Sometimes it is so much more than that, and if you feel that your mental health is not good, please do not hesitate to reach out. There is nothing so scary that you cannot share it with somebody.

If you are neurodiverse, or think you might be, this is a great podcast by Dr Sophie Mace on ADHD and parenting.