Breastfeeding Checkups

As an IBCLC, I see many parents looking for help AFTER trouble with breastfeeding has led them to my services. This is very helpful, and in the process of working with families to meet their goals, we can usually overcome the difficulties that they encounter.

However, all parents - even those for whom breastfeeding is going well - have questions!
That means it’s time for:

The Breastfeeding Checkup….

And, so much more!

Have a personalized visit in the comfort of your home - lengthy enough to check latch, know how much milk your baby is drinking, work with various positions, answer many of your questions, AND have follow-up time by text, email, or phone to continue refining your plan. Initial and follow-up visits are coverable by most insurance policies as preventative care. And, even if your policy doesn’t fully cover your visit, consider paying out of pocket for this valuable information.

Evidence-Based Resources for Breastfeeding and More

Combat Misinformation and learn more info by referring to our favorite evidenced-based resources:

• Kelly Mom (extensive list of parenting and breastfeeding resources)

• MOBI Motherhood International (extensive list of breastfeeding resources - low supply, tongue/lip ties, sensory issues, dealing with fast flow, dealing with slow flow, baby's oral-motor skills, and so much more)

• Low Milk Supply (lots of information on building supply and more)

• Bobby Ghaheri's Website - a Tongue and Lip Tie expert.  Informative articles on all aspects of this important topic can be found on his blog page.  Also look at his "Aftercare" page for all aspects of what to do after any tongue or lip tie procedures.

• Podcasts!  So informative on many topics - parenting, breastfeeding, working and pumping, and so so much more.  All of them are available through their websites (linked here) or you can find them on most podcast apps.

  • The Boob Group

  • The Badass Breastfeeder

  • All Things Breastfeeding

  • Breastfeeding Outside the Box

  • The Double Shift

  • The Longest Shortest Time

Nipple Shields

Many women are given nipple shields in the early days of breastfeeding. They can be incredibly helpful when used for the right reasons, however they are unfortunately provided with little instruction. It’s very important that a nipple shield:

• Fits the nipple properly

• Helps the baby to achieve a better latch

• Helps ease mother’s pain during latch

• Is used as a “bridge” toward breastfeeding, and not a permanent solution. Families need a plan to determine how to use a nipple shield and also figure out why it’s hard to latch without it. Work with an IBCLC to figure this out!

Here's a excellent video on nipple shield use from DIY Breastfeeding to get you started. Then, make sure to get help to determine what to do next! 

Bottle Feeding

Many babies receive supplementary bottles during their breastfeeding journey.  It has become a very common practice to hold a baby laying on their back while feeding, and also to provide a consistent and fast flow to the baby. However - we are finding that babies fed this way are eating too rapidly - leading to gulping, air intake, tummy upsets and also overfeeding!

Breastfeeding has a natural pace, one that supports the most comfortable method of feeding and also providing the amount of milk that the baby wants at any particular feeding. Paced bottle feeding is a method of feeding that mimics many of these aspects of breastfeeding - providing baby with milk at a slower pace, and also only the amount that they want. This type of feeding is good for all babies, no matter how they are ultimately fed. And, for the baby who is having trouble latching, paced feeding allows for an easier return to the breast once the source of the difficulty is determined.

For paced bottle feeding, we recommend:

• A soft, gently tapered, slow flow nipple (one that adopts to the shape of the babies mouth an promotes a deeper “latch”). The newer (and often more expensive!) nipples with wide bases and short nipples often promote a shallow “latch”. This excellent blog post by Rachel O’Brien, IBCLC explains more about this very important topic.

• Sit the baby upright, and hold the bottle horizontally. This allows for slower and calmer milk, and encourages baby to use their breastfeeding muscles - promoting oral development eve while a baby cannot breastfeed.

• Here are excellent resoureces relating to paced bottle feeding:

  • Video demo with an infant

  • Video demo with a doll

  • And two informative articles to learn more!

    •  Article by Kelly Mom

    • Article by Rachel O’Brien, IBCLC

Paced bottle feeding and bottle refusal are two more excellent reasons make an appointment with an IBCLC for help!

How to Start Pumping (in the early weeks & on!)

Just the most wonderful picture! This amazing mom pumped with hand pump while hiking in Maine for 3 days to keep up her supply. Nursing and pumping moms can do anything! Thank you so much @straightfromthetap_milklady (Instagram) for your adventurous spirit and for sharing this fantastic and beautiful photo! To see a few more wonderful pictures from this trip, click on the link!

If breastfeeding (supply, latch, etc) is going well, it is not necessary to pump in the early weeks - exclusive breastfeeding is all that’s needed to feed your baby and raise/maintain supply.  However, if you are having breastfeeding problems it is essential that you pump or hand express (see above) many times a day to keep your supply flowing.

Here are some helpful pumping resources to help you get started:

• In the early days, Hand Expression is more effective for collecting colostrum to feed a baby that needs supplementing - see our earlier blog post on this topic!

• If a baby is not latching, pumping is an effective way to provide stimulation for your supply. If a newborn is expected to nurse 8-12 times per day, double pumping 8 times per day is an effective way to tell your baby that your baby needs milk frequently. This will help bring your full milk supply in.

• This is very informative video from Stanford Medical Center - How to use your hands for massage while pumping. Using your hands for massage before, during and after pumping sessions is very effective.

• A handy guide on how to fit flanges properly to your breasts - properly fitted flanges allow for the most comfort and best flow of milk.

• A fantastic interview about flange fitting and pumping with Dee Kassing on the Breastfeeding Outside the Box podcast

• Finally, many people find that adding lubrication to their areola helps so much with flange fit and comfort (which can sometimes help you increase vacuum!). Non-lanolin nipple balms are a good option (lanolin is too sticky for this purpose!). Or, organic olive oil or coconut oil can also be used. All are generally regarded as safe for babies but always read ingredients and consider your own family history of allergy.

If you are having problems that require you to pump in the early days, or if you want to learn more about pumping for return to work or exclusively pumping - make an appointment to go over pump function, flange fit, ideas for increasing supply, planning for return to work, exclusive pumping planning, and all aspects of planning for any amount of pumping.

Engorgement and Hand Expression for Milk Production

Engorgement sometimes occurs in the first week following birth, usually around the time that the full milk supply starts to “come in”. While engorgement is commonly experienced by many new parents, it’s something that ideally never occurs, especially if breastfeeding is going well in the early days.

Engorgement can be exacerbated by:

• IV fluids during labor - these fluids add to the overall fluid in the body, including breast tissue, and put pressure on milk ducts - making the milk flow less easily.

• Breastfeeding challenges in the early days. If breastfeeding hurts, if latch is ineffective, or any other challenge leads to a baby removing less milk from the breast, this can cause the milk to remain in the breast and cause pain.

In addition to making sure that you have the most effective latch (see previous blog posts), here are our favorite resources for relieving engorgement:

• Excellent Engorgement Tips From KellyMom 

• Massage and Hand Expression video by Maya Bolman

• Another fantastic Hand Expression Video - by Global Health Media

In addition to helping relieve engorgement, hand expression is an incredibly valuable skill to know!  It's extremely helpful if you need to:

• Express colostrum (which is sticky and tends to get stuck on pump parts!) - you can hand express directly into a spoon or small cup, and have enough to fill your baby's tiny tummy for a feeding!

• For getting milk in general. It’s a great add-on to a pumping routine later in your parenting journey, or a great skill to know if you find yourself without power or without your pump!

Learn About Laid Back (Natural) Breastfeeding

Babies on their tummies have a lot of head control, making the laid back position comfortable for mom and baby!

We are so used to seeing babies on their backs - while being held, while feeding and while laying down to sleep. And, consistent with this position, many parents are taught positions like the cradle and football holds - both of which place a baby on their back, or below a parent - both of which make the baby feel like they are falling away from the person they most want to be next to. And, often the parent winds up uncomfortably leaning over the baby in order to hold them in place.

These positions, while commonly taught, are usually very challenging and uncomfortable, especially if you do not have supportive pillows for both you and your baby. Instead, we recommend trying the “training wheels” of breastfeeding - Laid Back Nursing.  It’s very comfortable for you and your baby and no special pillows are needed. The parent finds a comfortable position to sit in so that the baby can rest on top of them tummy down. When a baby is tummy down, they are resting on top of their parent (and not falling away), have more head and hand control, and can tap into all of their newborn feeding instincts and reflexes.

Here are some excellent resources for Laid Back feeding:

• A beautiful video by Global Health Media called “Breastfeeding in the First Hours”. It shows newborns babies doing the breast crawl - self-latching after being placed tummy down on top of their mothers. Any baby can do this in the first few weeks/months, and sometimes a baby that didn’t get a chance to do this at birth can “re-set” and improve their nursing skills!

• A wonderful article with the eye-opening title "Many Moms Have Been Taught to Breastfeed Incorrectly"

• A very helpful video on laid back feeding  (also called “Natural Breastfeeding”), or you can watch YouTube video clips from the video.

How to Ensure A Deeper, More Effective Latch

Very often parents are told that their baby has a great latch simply because the baby has their mouth on the breast. However, if a baby is attached only to the nipple, the latch is likely to hurt mom’s nipples. This is because a nipple-only latch will compress the nipple in the front of the baby’s mouth, and - because less milk-making-tissue is under the nipple - a shallow latch is also less likely to provide milk for the baby.

That means you want to see your baby’s latch go well past the nipple and compress the areola - this places the breast (and the deeper milk-making-tissue) in the back of the baby’s mouth, where there is only soft palate. When this occurs, baby is are much more likely getting milk (and mom is much more likely to be comfortable!).

In addition to some of the info in previous posts on how to know if baby is getting milk, here are some of our favorite resources describing how to get a deeper, more effective, and more comfortable latch:

• This wonderful video from Global Health Media describes the asymmetric latch, and  explains why having the baby approach the breast asymmetrically (rather than as a “bullseye”) achieves a deeper latch. This video also describes ways to tell if your baby is probably getting milk.

• This amazing animation shows how deeply the breast must be taken into the baby’s mouth in order to get milk.

• Another very helpful video, this one from Cherubs Breastfeeding.   While describing the asymmetric latch, she uses extremely helpful analogies to help visualize how to achieve a deeper more comfortable and effective latch.

• And, one more great video from Janet Jones, IBCLC - highlighting the asymmetric latch using very supportive pillows and the cross-cradle position.

• Supporting your breast while feeding also helps baby hold the breast more deeply in their mouth. This also makes it easy to do breast compressions, which help your baby get more milk at a feeding (and also increase supply!) - this wonderful video describes this easy and valuable skill.

• Also check out our previous blog posts for more resources relating to effective latching.

Nursing Effectively & Getting Enough Milk

One issue that troubles many new families is knowing if your baby is nursing effectively and getting enough milk.

Many people are told that "latch is good" but there are telltale signs beyond a baby placing their mouth on the breast.  Here are a few of our favorite resources that will help you determine if your baby is nursing effectively:

• This excellent video from Global Health Media describes how to count diapers to know if baby is drinking enough, and also describes how to tell if baby's latch is effective enough to get milk.

• This printable handout describes how to count diapers and more - it's helpful to print and have with you just after birth.

• And, the International Breastfeeding Centre (Dr. Jack Newman's site) has many informative videos that show effective vs. non-effective latching.  Compare the videos to your baby's latch to help assess how things are going!

Breastfeeding 101

Breastfeeding should not hurt!   Some discomfort is normal in the beginning but sores, bleeding and pain are not.  For our first blog post, we are proving a printable double sided sheet - perfect for the basics and having with you at the start of your breastfeeding journey. Here, you’ll find our favorite resources for breastfeeding information - videos, informational pages, and more - Enjoy!

Breastfeeding 101