Congratulations on your new baby and on your breastfeeding efforts. After delivery, many women tell us they never knew how hard breastfeeding was. One of the most important things is to know you are not alone and it is difficult for many, if not most women, especially with their first baby.
Here are some common breastfeeding issues and concerns and what you can do about them. As always, please call the office if you need additional information or things are not improving.
Breastfeeding support
The Women’s Hospital of Texas offers a breastfeeding class you can choose to take prior to delivery. You will also see a lactation consultant during your hospital stay after you have the baby. They will “round” on you a day or two after you deliver. Your postpartum nurse should be able to give you some breastfeeding guidance as well. But many women don’t have issues until they get home and their milk comes in (typically three to five days after delivery). You don't have to struggle at home with breastfeeding issues. There are many resources out there.
Below are several recommendations:
- The lactation support group at The Women’s Hospital of Texas
- SOS Lactation (a lactation consultant who offers classes, home & virtual consults)
- The Motherhood Center
Maternal nutrient requirements during breastfeeding
Infant demand is the biggest factor in milk supply, meaning your supply should increase based on the amount your baby is feeding. Your body expends approximately 500 calories/day breastfeeding in the first six months. To compensate for this, during the first six months, a breastfeeding mom needs to ensure they are eating approximately 330 extra calories/day. Your protein intake is vital to your milk production. You need approximately one more serving of protein/day (25 g) than you would while not breastfeeding.
The American Academy of Pediatrics recommends breastfeeding moms intake 200-300 mg of DHA or the equivalent of one to two servings of fish per week. As with pregnancy, it is recommended to avoid more than two servings of low mercury content fish per week. It is also best to avoid fish with high level mercury content completely, such as swordfish and tilefish.
How to increase milk supply
- Drink plenty of fluids. You should be drinking non-caffeinated beverages and using the restroom frequently and noticing clear, light colored (diluted) urine.
- Drink Mother’s Milk Tea three to five times/day. You can buy at Central Market, Whole Foods, Amazon
- Take Fenugreek three capsules three times/day. Buy at Central Market, Whole Foods, Amazon. This is an herbal supplement that has been around for many years and is used frequently by lactation specialists. You will typically notice an increase in your milk supply in 48 – 72 hours.
- Some pediatricians also suggest drinking malt. You can have this in the form of malted milk two to three times/day.
- A prescription medication we can provide is Reglan, 10mg three times per day. Many patients do very well with this medication and for some it can double their milk supply in a 48 hour period! However, if you have a history of depression or are currently experiencing symptoms of postpartum depression, this is a medication that could make those symptoms worse. It can also increase fatigue and increase gastrointestinal (GI) movement (it is a GI motility agent with a side effect of increasing milk supply). Most people do not get diarrhea but if you have a history of irritable bowel syndrome you would want to start at a low dose and increase slowly to avoid these potential side effects. All medications, whether prescription or over the counter, have potential side effects so we always want to be careful. If you have tried the other suggestions mentioned already, please call the office to schedule an appointment with a provider to discuss if Reglan may be something appropriate for you to try.
- Increased demand equals increased supply. The more you nurse or pump and demand of your breast the more your body realizes you need to make more. We call it a ’48 hour pump-athon’. Try nursing and pumping every two to two-and-a-half hours for 48 hours (this includes waking up at night) and then go back to your regular schedule).
- Remember, there are also many medications that can reduce your milk supply. For example, antihistamines like Benadryl, Zyrtec, Allegra, etc, or decongestants like Sudafed, can decrease your milk supply. So please call us if you are breastfeeding and need clarification on the safety of a medication or to see if a medication you are taking may be affecting your milk supply while breastfeeding.
- The last suggestion can be one of the most difficult for some people and that is to sleep when the baby sleeps. Stress and sleep deprivation can definitely affect your milk supply and the more sleep you get and the more continuous sleep you can get (a goal of five hours at one time when your baby will let you) will help your milk supply.
Clogged ducts
Clogged milk ducts are a common occurrence with breastfeeding. Clogged ducts are a blockage of milk that causes the area to form a tender and firm “lump." These should resolve within 24-48 hours generally. If not, or if you also develop redness of the area, fever, chills or body aches, please call the office for guidance.
These symptoms could be a sign that you are developing a breast infection called mastitis or a breast mass that is not related to breastfeeding. If you experience recurrent clogged ducts, we recommend you see a lactation consultant. Some tips to clear and prevent clogged ducts:
- Continue feeding on the breast with the clogged duct and ensure it is completely empty
- Ensure the baby is latching correctly
- Massage the clogged area while baby is breastfeeding. Some women find using an electric toothbrush to massage the area is more helpful than using your hand
- Apply a warm compress to the area, warm water in a Ziploc baggie works well
- Sunflower Lecithin powder taken orally (available on Amazon) helps to decrease the “stickiness” of the breastmilk and can help prevent clogged milk ducts
Weaning
When you are ready to stop breastfeeding, don’t stop abruptly as this can cause engorgement and potential mastitis. It is recommended to “drop a feed” every two to five days and see how your body responds. You should slowly decrease the amount of time of each breastfeeding session and slowly extend the time in between feedings at the breast.
During weaning, try to only pump enough to relieve discomfort so you don’t inadvertently increase your milk supply. Although there isn’t good medical evidence to support cabbage leaves and decongestants to help decrease your milk supply, many patients feel these aid in their weaning process.