Mama and Baby Blog Series: Breastfeeding

How are you guys enjoying this series? Are you getting all of the information you need? If you’re just joining in, I’m helping Mamas navigate the world of motherhood. It can be an overwhelming journey, so we’re going to cover everything from birth recovery to first foods for babe. So far we’ve covered:

Mama and Baby Blog Series : Recovery from Birth
Mama and Baby Blog Series : Maternal and Postpartum Depression

Today I’m digging deep into the world of Breastfeeding, which tends to be one of the most under discussed, and yet hardest, part of welcoming a new babe into the world. One way or another, that babe is going to make it’s debut earth-side … but breastfeeding isn’t as black and white as that.

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A quick note: FED IS BEST. Not all women can or want to breastfeed. And you know what? That’s ok! I’ve said it before, and I’ll say it again, everyone experiences the journey of Mamahood differently – and whatever works for you is what’s best for you and babe.

Don’t forget – if there is anything that you’d like to see in this series – burning questions that you may have, experiences that you’ve learned from, whatever it may be – please leave a comment and I’ll be sure to address it!

To get a better grasp of breastfeeding, it might help to understand the anatomy of the breast and how milk is produced in the body.

Pregnancy and Lactation

The hormones of pregnancy – including estrogen, progesterone, prolactin, and others – cause complex changes to occur in the breast. The various hormones each play a specific part in preparing the body for breastfeeding; however, the biggest change that women notice? Enlargement!

During the first trimester of pregnancy, the ducts and alveoli in the breast multiply rapidly. Your breasts may be tender, and their size increases in preparation for breastfeeding. Lactogenesis is the term denoting the origin, or the beginning, of lactation, and it occurs in three stages:

• Lactogenesis I
• Lactogenesis II
• Lactogenesis III

Lactogenesis I starts about 12 weeks before delivery, as the mammary glands begin to secrete colostrum. Breast size increases further as the alveoli become filled with colostrum, but the presence of high levels of the hormone progesterone in the mother’s blood inhibits the full production of milk until after birth.

Lactogenesis II begins after birth when the placenta is delivered. Progesterone levels fall while prolactin levels remain high. Prolactin is the main hormone in charge of lactation, and it, in turn, is controlled by hormones secreted by the pituitary, the thyroid, the adrenal glands, the ovaries, and the pancreas. More blood flows to the breasts, carrying more oxygen. Anywhere between two to five days postpartum, the “milk comes in.” The amount of milk produced increases rapidly, and its consistency gradually changes from colostrum to mature milk. Sodium, chloride, and protein levels in the milk decrease, and levels of lactose and other nutrients increase. The color gradually changes from the golden yellow, typical of colostrum, to a bluish white. Since this process is controlled by hormones, the breasts begin to produce milk whether a mother is breastfeeding or not. At this stage of lactogenesis, it is important to breastfeed often (and/or pump, if the baby is not feeding well), because frequent breastfeeding in the first week after birth seems to increase the number of prolactin receptors in the breast. A receptor’s job is to recognize and respond to a specific hormone. Having more prolactin receptors makes the breast more sensitive to prolactin, which researchers believe affects how much milk a mother produces in the next stage of lactogenesis.

Lactogenesis III is also referred to as galactopoiesis. This is when the mature milk supply is established. During this time, milk production switches from endocrine (hormonal) control to autocrine control, meaning that continued milk production depends more on the ongoing removal of milk from the breasts than on the hormones circulating in the blood. The “supply and demand” principle takes over at this point. The more a mother nurses, the more milk she will produce. If a mama nurses less, her milk production will slow down.

Breastmilk Supply and Demand

Understanding how milk production works can help a Mama ensure that her baby is getting enough milk at the breast. For example, sometimes mothers feel that their baby has completely emptied their breast and that there is no more milk available, even though the baby wants to nurse. Knowing that new milk is constantly being produced in the alveoli will give a new Mama the confidence she needs to put her baby to the breast, even when it feels “empty.”

Emptying the breasts is what keeps milk production going. A baby’s sucking sends messages to the brain, which then releases the hormone oxytocin. Oxytocin causes the muscle cells around the alveoli to contract, pushing milk down through the ducts to the nipple. This movement of milk down the ducts is called the milk-ejection reflex. Mamas may experience it as a tingling feeling or a sense of release in the breast, which is why it is also called the “let-down.” The let-down empties the alveoli and makes the milk available to the baby at the nipple. When the alveoli are empty, they respond by making more milk.

To ensure that you are properly “emptying” your breasts and promoting further milk production:

• Make sure baby is nursing efficiently (we’ll go into complications that can affect this next!)
• Use breast massage and compression
• Offer both sides at each nursing – wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.
• Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible).

Breastfeeding Complications

Here’s the thing – breastfeeding doesn’t always come easy to new Mamas. IT’S NOT YOUR FAULT. There are all sorts of issues that can come up when you’re new to breastfeeding, and figuring out what’s complicating your breastfeeding journey may not be easy, but there are a few common occurrences that many mamas and babies tend to experience.

Tongue and Lip Ties
Tongue ties – also known as ‘Ankyloglossia’ or ‘anchored tongue’ – is a common but often overlooked condition. Tongue ties occur when the thin piece of skin under your baby’s tongue (the lingual frenulum) restricts the movement of the tongue. We are all born with some of this tissue that causes tongue ties, but for some babies it is so tight that they cannot move their tongues properly. In a similar way, a baby’s lips can be attached to his gums, making it difficult to get a good grasp on a nipple. Babies who have lip ties almost always also have tongue ties, and in both situations, breastfeeding is usually affected.

Your babe needs to be able to cup your breast with his tongue to be able to remove milk from your breast. If the tongue is anchored to the floor of the mouth, your baby cannot do this as well. He may not be able to open his mouth wide enough to take in a full mouthful of breast tissue. This can result in ‘nipple-feeding’ because the nipple is not drawn far enough back in the baby’s mouth and constantly rubs against the baby’s hard palate as he feeds. As a result, you, Mama, are likely to suffer nipple trauma.

There are many signs that a baby’s tongue or lip tie may be causing problems with breastfeeding, but you don’t have to have all of them:

• nipple pain and damage
• the nipple looks flattened after breastfeeding
• you can see a compression/stripe mark on the nipple at the end of a breastfeed
• the baby keeps losing suction while feeding
• the baby makes a clicking sound when feeding
• the baby fails to gain weight well

It is important to note that all of the above symptoms can also be related to other breastfeeding problems and are not necessarily related to tongue and lip ties.

Here’s the good news: tongue and lip ties are easily fixed, once properly diagnosed!

If you suspect your baby has a tongue or lip tie that is causing breastfeeding problems, you should see either a lactation consultant or your pediatrician. Once diagnosed, the tongue or lip tie can usually be released in the office on the same day. Tongue and lip ties can be released either with a scalpel or scissors, or by laser. Lasers do not require anesthesia, and *seal* the revision instantaneously, so there is minimal bleeding and no risk of infection. The baby usually breastfeeds straight after the procedure.

Mastitis and Blocked Ducts
Mastitis is what they call it when tissue in your breast becomes painfully inflamed. With mastitis, signs and symptoms can appear suddenly and may include:

• Breast tenderness or warmth to the touch
• Generally feeling ill
• Breast swelling
• Pain or a burning sensation continuously or while breastfeeding
• Skin redness, often in a wedge-shaped pattern
• Fever of 101F or greater

Although mastitis usually occurs in the first several weeks of breastfeeding, it can happen anytime during breast-feeding. Lactation mastitis tends to affect only one breast.

Mastitis that’s not due to an infection may be caused by milk staying in the breast (this is called “milk stasis”), engorgement, or plugged milk ducts. A breast infection may be caused by any of these as well as cracked or damaged nipples, which allow germs to enter the breast. Stress, fatigue, and being a first-time mom can increase your risk of mastitis. I’ve heard lactation consultants say that mastitis can be a sign that you are pushing it too hard and need to rest or that you’ve gone too long without nursing.

Here’s the good news: if you have an infection and it’s diagnosed early, it’s easy and quick to treat, ideally without the need for antibiotics.

In most cases, you’ll feel ill with flu-like symptoms for several hours before you recognize that your breast has an area of tenderness and redness. First thing to do is nurse your baby frequently to keep the affected breast empty (this may also help clear up any infection more quickly.) Try applying moist heat for 15-30 minutes before nursing to help loosen the blockage in the duct and make nursing easier, then apply ice after nursing for 15-30 minutes to bring the swelling down. Taking hot baths with Epsom salts can also be helpful. Try massaging the clogged duct to help release the blockage. Massage the duct in small circles while your baby is nursing. Drink extra water. Drinking water is extremely important when fighting mastitis to keep your milk supply up and help your body fight the infection. You can also try using extra vitamin C, vitamin D and probiotics to boost your immune function.

If your symptoms get worse or don’t go away, see a medical professional. Really bad cases of mastitis can definitely warrant antibiotics (which are a better option than developing an abscess).

Low Milk Supply
Low milk supply can be caused by a huge variety of reasons:

• Insufficient glandular tissue: some women’s breasts don’t develop normally (for various reasons) and may not have enough “milk-making” ducts to meet their baby’s needs.
• Hormonal or endocrine problems: hormonal disorders like polycystic ovary syndrome (PCOS), a low or high thyroid, diabetes, hypertension (high blood pressure) or other hormonal problems that may have made it difficult to conceive in the first place. Any of these issues may also contribute to low milk supply because making milk relies on these same hormonal signals being sent to the breasts.
• Using hormonal birth control: many mothers who breastfeed and take birth control pills find their milk production doesn’t change, but for some, any form of hormonal birth control (the pill, patch or injections) can cause a significant drop in their milk. This is more likely to happen if you start using these contraceptives before your baby is four months old, but it can happen later as well.
• Taking certain medications or herbs: pseudoephredine (the active ingredient in Sudafed and similar cold medications), methergine, bromocriptine or large amounts of sage, parsley or peppermint can affect your milk. If you find your milk supply has dropped and realize you have taken one of the medications listed here, ask your doctor about an alternative treatment for your cold or health ailment.
• Sucking difficulties or anatomical issues: this is where tongue and lip ties can be an issue!
• Birth medications or jaundice: mamas don’t always realize that medications used in labour, such as epidural anaesthetic or Demerol, can affect the baby’s ability to latch on and breastfeed effectively. Some studies show these effects last as long as a month, depending on the medication used in the epidural and the length of time the mother received it. Jaundice, a common condition in newborns, can also make your baby sleepier than usual, so that he doesn’t wake up to nurse as often as he would otherwise.
• Supplementation: especially in the first couple of weeks, supplementing with formula tricks your breasts into producing less milk. When your baby is given formula supplements, she naturally eats less at the breast, and the breasts respond by making less milk.

If your baby is showing signs of not getting enough milk, don’t throw away your nursing bra just yet. Talk to your midwife, a lactation consultant or other breastfeeding expert who can help you figure out and treat the cause of your low milk supply.

A huge proponent in low milk supply comes down to nutrition. Here are a few recommendations to boost your milk supply naturally:

• Make time to eat. Eat meals and snacks regularly throughout the day. If you are nourished, you’re better able to increase your milk supply.
• Eat until you’re full! Consume at least one large, satisfying, nourishing meal per day. It’ll help your brain produce oxytocin, which helps in the production of milk.
• Eat warming foods. Cooked, warm foods should form the basis of a nursing Mama’s diet.
• Choose organic – fat is an important component of breast milk, and therefore the quality of fats you eat is extremely important. Remember that fats attract and store fat-soluble chemicals so stay away from non-organic animal products, trans-fats and vegetable oils.
• Consume a rainbow variety of fruits and vegetables. Many are potent mother foods that provide antioxidants, vitamins, minerals, enzymes, folic acid, and beta carotene.

In a Nutshell

1. Breastfeeding can be a difficult journey, but know that you aren’t alone!

2. Breastfeeding problems can be as a result of a variety of health issues, nutrition and diet, and even anatomy issues in both Mama and baby … but all can be fixed when properly diagnosed :).

3. Talking to your healthcare provider, pediatrician, lactation consultant, and/or breastfeeding support groups can make this journey a lot easier. Don’t be afraid to ask for help Mama!

Let’s Talk!

I’d love to use this space as a forum of sorts, providing inspiration and community among my readers, so … I want to hear from you!

What’s your breastfeeding journey been like?

Do you have any tips and tricks to share with new Mamas that helped in your breastfeeding journey?

Spread some Breastfeeding lovin’! Sharing is caring, and I bet you have some friends who would love to read this too :).

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