Ask A Lactation Consultant

We learned after speaking with several expecting mothers that they had a lot of questions about breastfeeding, just like you! Here is a list of frequently asked questions by mothers like you. If you have questions you don’t see here, email us at askconsultant@rumbletuff.com.

Before the Baby Comes

Most women prefer to wear a nursing bra to make it easier for frequent feedings. You will want to purchase one that you can undo with one hand because you will mostly likely be holding the baby. It is best to avoid underwire bras unless they are fitted well and do not impede on your milk producing tissue. Some women have milk producing tissue that extends up into their underarms.

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It is possible that your breasts may leak if it has been a while since your baby last fed. Also, letdown (the release of milk in a lactating mother) can occur with instinctual triggers, such as when you hear a baby cry or smell the soap you use to wash your baby's clothes.

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When your transitional milk comes in (about 3 to 4 days after birth), your breasts generally increase one cup size and one girth size. You may want to invest in a bra or tank top that will accommodate your new cup size.

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Tenderness is normal for the first few weeks of breastfeeding. If you are experiencing pain, you should consult your local IBCLC-certified lactation consultant.

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Breastfeeding

Yes. A baby will instinctively crawl from Mom's abdomen up to the breast and attach, due to the reflexes gained at birth.

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Some babies will be full after feeding on one breast only. Your breasts should adjust to your baby's feeding routine so that you can wait and feed him on the other side during the next feeding. If you become too full of milk, you can pump out enough milk until you are comfortable.

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This would depend on the age and feeding habits of your baby. When your milk comes in, a baby will average 8 to 12 feedings (20 to 40 minutes each) in a 24-hour period. As the baby gets older, he will become much faster and feed less frequently, around 7 times in a 24-hour period.

When pumping milk, a mother first has to pump and store the milk, then feed it to the baby later. You will need to use your pump as frequently as you would have breastfed your baby. In the beginning, it may seem easier to use a bottle; but after you and your baby get better as a couple, it takes much less time and effort to breastfeed then to pump and bottle-feed.

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Keep the baby feeding on one breast until he slows down or comes unattached from the breast. After burping or changing, he may still have signs of hunger. If so, then you can attach him to the second breast. If he looks like he is in a milk coma (a phase where he can barely keep his eyes open and his hands lay open and relaxed), he is most likely finished.

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Generally, you can eat the same foods you did while pregnant. The baby in utero (in the womb) swallows a great amount of amniotic fluid which has flavors of the foods you consume while pregnant. When you eat those same foods while breastfeeding, your baby will recognize the flavors.

If your baby experiences symptoms such as diarrhea, rash, fussiness, gas, constant spitting up or vomiting, hard stools, bloody or mucous stools, runny nose, cough, or congestion, it's possible that your baby may be allergic or intolerant to that food. Ask your lactation consultant if this occurs.

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Try to avoid any medication that can dry you up, such as decongestants, antihistamines, or medications containing estrogen. Check with your lactation consultant on which medications to avoid.

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Feeding with a Bottle

The latch on the breast and the bottle should be similar. The baby should be able to have a complete seal on his lips. A narrow nipple often creates a latch most like breastfeeding. If you notice that your baby is leaking from the corners of his mouth, you hear clicking sounds, your baby is swallowing air, or the nipple is collapsing, you should try a nipple of a different shape.

Bottles that flow too fast: Worried, shallow latch, pulling away, spilling, or gulping

Bottles that flow too slow: Lack of rhythmic swallowing, more rest periods, less feeding

The rhythm of feeding: Suck - swallow - breathe 1:1:1 or 2:1:1 is an ideal pattern 3:1:1 is the breaking point; anything higher than 3 indicates baby may be burning more calories than they are consuming.

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It is best if you can wait to introduce a bottle when your milk is established, when your baby is about 3 to 4 weeks of age.

In the beginning, you may want someone else to introduce the bottle so that the baby will associate you with the breast and someone else with the bottle. You may want to try to give the baby a bottle once or twice a week to avoid refusing him.

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There are conflicting reports on the dangers of BPA, or bisphenol A. BPA is an endocrin disruptor, which means that it changes the way a body's hormones function. BPA specifically mimics the hormone estrogen, which affects cell growth and development, fetal development, and the onset of puberty. Studies have shown that BPA does have a negative impact on the health of mice; however, the effects, or potential harm, of BPA on a human system are hard to determine as it requires long-term scientific study.

While some people are convinced of the danger of BPA, others believe that the amounts we are exposed to are so negligible as to pose no real risk. In response to growing public awareness and concern, the FDA announced in July of 2012 that plastics containing BPA cannot be used in baby bottles and cups.

Our bodies usually clear BPA out of the system through a detoxification process in the liver. However, the livers of infants and children may not be fully developed and may be unable to perform such a function. It is important to limit their exposure to BPA.

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Producing Milk

Always label the milk with the date that it was expressed.

Try to store milk in the amounts that your baby is drinking to help reduce waste.

Storage
Milk should be stored in glass or hard-sided plastic containers with lids that fit well. Clean your containers well before use and allow them to air dry. If you are freezing your milk, leave an inch of space at the top of the container to allow room for expansion.

Milk bags may be a good alternative to bottles. Because of the compact size, you can store a lot more milk in a small space than you can with traditional bottles.

Temporary Storage
Milk can be stored at room temperature (66° – 78°) for 4 to 6 hours.

Milk can be stored in a cooler bag with ice packs for up to 24 hours.

Refrigerator
Refrigerated milk can be stored for up to 8 days. Be sure to store milk towards the back of the refrigerator where the temperature is more consistent. Refrigerated milk has more anti-infective properties than frozen milk. If it is feasible in your situation, refrigerating your milk is recommended.

Freezer
Frozen milk can be stored in a refrigerator freezer for 3 months, or in a stand-alone freezer for 6 to 12 months. Store milk towards the back of the freezer where temperature is more consistent. Never refreeze milk that has been thawed.

Preparation
Never microwave breast milk because it can create hot spots that can burn your baby's mouth.

To warm fresh milk, place the bag or container in warm water until the desired temperature is reached.

To warm refrigerated milk, place the bag or container in water and increase the temperature of the water until the milk reaches the desired temperature.

To thaw frozen milk, place the bag or container in the refrigerator overnight, then place it in cool water and increase the temperature of the water until the milk is room temperature. Used thawed milk within 24 hours, and discard what isn't used. Never refreeze milk that has been thawed.

If you are adding fresh milk to previously frozen milk, cool the fresh milk in the refrigerator prior to adding.

That's Interesting . . .
Occasionally thawed milk may smell or taste soapy due to the breakdown of the fats in milk. Most babies will still drink it and is still safe to consume. Milk with high lipase, which is an enzyme that breaks down the fat in milk, can give the milk a rancid smell. If this occurs, you can heat the milk to scalding (not boiling) after expressing, then quickly cool and freeze. This procedure deactivates the enzyme.

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This often depends on how old the baby is and the capacity of the milk-producing cells in the breast. Generally your breasts will adjust to make the amount of milk your baby consumes.

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Using a Breast Pump

The best way to know is by their output of stools. On day 3 to 4, your baby should be stooling 3 to 4 good-sized stools which should be changing color from meconium to transitional stool greenish brown or yellow with white curdles that look like cottage cheese. There should be 6 to 8 wet, pale yellow diapers in a 24-hour period. A reddish tint can indicate that not enough milk was consumed.

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When milk is removed from the breast, either by your baby or a pump, your brain releases a hormone called prolactin which helps to produce more milk. Try to pump after your morning feeding or after a nap when your prolactin levels are highest.

Proper nutrition will increase the quality and quantity of your milk supply. You will need a minimum of 1800 calories a day and at least 6 glasses of fluids.

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This is generic information intended to help you get started pumping; you should change and adjust your settings over time so that your pump most closely matches your baby's current nursing patterns. This applies to a typical breast pump with two speed settings.

How long you stay on each speed setting depends on the reason you are pumping.

If you are pumping to increase milk supply, the stimulation phase only needs to be about 30 or so seconds, just enough to cause your milk to letdown. The expression phase should last until the milk flow stops plus 2 minutes.

If you have a low milk supply and are trying to stimulate your breasts to make milk (no milk flowing or dripping at all), pump about 10 minutes after as many feedings as you can.

If you are pumping because you have too much milk, only pump long enough to relieve the discomfort. Pumping longer will continue to increase your milk supply.


Learn how to utilize the speed and suction settings of your pump to maximize your results. Adjustable settings help you to match your pump's patterns to that of your baby. This helps to stimulate your body and to help it keep producing the milk that your baby needs.

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Many work places set aside rooms where mothers can breastfeed in private. Current law requires large employers (companies with 50 or more employees) to provide a place, not a bathroom, where a mother can breastfeed or pump breast milk.

Here is an excerpt from the U.S. Labor Department Fact Sheet:
"Employers are required to provide reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child's birth each time such employee has need to express the milk. Employers are also required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk."

If your employer does not provide a private location, talk to them about finding a place where you can discreetly breastfeed or pump breast milk. Smaller employers are not covered by this law, but many will work with you to find a solution.

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This will depend on why you are using the pump.

If you plan on going back to work, you will want to start storing up milk about 3 weeks before returning to work. This will give you time to get comfortable using your pump and will ensure that your baby will have plenty of milk. While you are away from your baby, you should remain on the same feeding schedule and use your pump in lieu of breastfeeding your baby. This will keep your milk supply up and keep your body on schedule to match the needs of your baby, even when you're apart.

If you do not plan to work or spend significant time away from your baby, your pump can be used to relieve engorgement or create a small stockpile of milk so that your partner can assist in feeding or to prepare for short times away from your baby, such as an appointment or a date night.

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It is not as convenient as breastfeeding; but when your baby can't breastfeed, choosing the correct pump will make pumping much easier. A double pump that is easy to assemble and easy to clean saves time. Even a single pump that is easy to clean will save you time. Having a pump that will run on batteries or a pump with a car adapter may be necessary for some moms.

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With a high-quality pump and the right size flange, there should be no pain while pumping.

A lactation consultant may have suggestions or recommendations to make pumping a more comfortable experience for you.

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