Today’s Podcast

Episode 138 FAQ14

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Have you heard of the word galactagogue? Basically it means a food or a drug that promotes the flow of a mother’s milk. It can also be described as a substance that increases milk supply.

Why would a mother need to increase her milk supply? Don’t all mothers make enough milk for their babies?
Can it be that some mothers do make enough, but think they don’t?
Can it be that some mothers do make enough, but they want to make lots more?
Can it be that some mothers don’t make enough milk for their babies?

Before you consider taking a galactagogue, you should first find out the answer to each of those questions.

Let’s break this up and start with the moms who do make enough, but don’t think they do? How can this be? Wouldn’t a mother know if she was not making enough milk? It seems like she would?

Before I became a breastfeeding mother, I could never understand how a mother would not know this? It does not take long after having a baby to have another one of those AHA moments, as in: AHA, now I understand how some mothers might now know.

The reality is, we are all not created equal. If you are walking around with very full and heavy breasts, which soften up once your baby has had a good feeding, you are a mom who might not quite understand how the next mom could never know if she is making enough. I mean,, doesn’t she feel her heavy breasts? Is she not busting out of her bra? Does she not feel that tinging sensation with let down? Can’t she see her baby gulping away?

Well, actually, for some moms the answer is No. After all these years of doing this work as an IBCLC and after weighing many thousands of babies before and after feedings, I continue to be amazed, well not so much amazed at this point, but I guess I would use the word delighted, when I see a baby come to what feels like a breast that does not feel so heavy, does not look real full, a baby that latches on and leisurely drinks without me hearing swallows unless I am very quiet and then weigh the baby after only 15 minutes of feeding, and can see that this baby drank 3 oz. For older babies, past 3 months, this would not be so unusual. For babies in the first month or so of life, this is not as common, but again does happen.

For this particular mom, even though she sees her baby filling out, is noticing diapers get tight, outfits get tight, and lots of output, if it is your first baby, it would not be unusual to question her supply – purely because you don’t feel full like you hear other moms talk about, and you can’t really hear your baby gulping away and you do not feel the let down all the moms are talking about.
combine this with what you think as a first time mom – your babies feeding frequency, like 8 or 9 times a day, and others telling you your baby is feeding all the time. One can understand why you wonder if your supply is enough.

Remember, this is an invisible container that your baby is drinking from as you cannot measure what is going into your baby from feeding to feeding, unless you are using a similar professional scale like I do. Ooooh, and what really puts the nail in the coffin is when you pump, you “hardly get anything.” Well, what you get from the pump is somewhat subjective.

Now we have laid down the common scenario for a mom who is making enough milk for her baby, but thinks she is not.

I am going to put on my IBCLC hat and walk us through all the little pieces that I just mentioned:

Full breasts/heavy breasts: While it is more common to feel full and heavy before a feeding, in the early days of breastfeeding, just because you do not, does not mean that you do not have enough milk for your baby. All this means is that your body is different than the next moms.

Let down/ milk release: This is a sensation that moms typically feel when there milk begins to flow, right before there baby comes to the breast and/or once her baby is feeding. The common sensations are tingling, little flutters, light spasms, accompanied with feelings of calmness, relaxation, peacefulness and drowsiness. I would say that I work with as many moms who feel the let down, as there are an equal amount of moms who just do not feel this sensation in your breast tissue. The mom who is letting down and not feeling it, but is experiencing normal newborn breastfeeding behavior and is exclusively breastfeeding and watching her baby gain weight appropriately definitely is letting down.

This is not to be confused with a mom that is truly not letting down or having difficulty letting down. This is also not to be confused with a mom who is letting down and experienced very negative sensations such as nausea, itching, headaches, strong negative emotions.

Hearing your baby gulp down the milk: This can be a tough one for some moms and I totally understand why you might think that you are not making enough milk. I do read in a lot of books that one of the criteria for a baby that is feeding well and getting enough is if you hear them swallowing. Well, some babies we do hear all that gulping and other babies are taking in a good amount of milk in a reasonable time, however, they just quietly go about their business and while they definitely are transferring milk, you can only hear it if the room is quiet and you put your ear closely to your breast.

To help moms gain confidence in this specific area, I review with them signs of a good latch and observing sucking and swallowing behavior. Point out that pain with breastfeeding, milk leaking out of babies mouth, dimpling of their cheeks, constantly breaking the latch, all these are signs of a poor latch which usually translates to poor milk transfer.

Pumping volume: This is a fun topic I like to educate moms about. First things first: All pumps are not created equal. Meaning, perhaps you are not use a pump that is doing a good enough job. The reality is that there are a lot of crummy pumps on the market. Perhaps you have a borrowed pump and the motor is not effective anymore. Perhaps you are using an excellent pump but not using it correctly. Let’s explore these issues some more.

Using an excellent pump, but it does not work well for you: Perhaps this pump works well for your best friend, but it does not work well for you. So, consider the fact that you have a pump that has been given 5 stars and yet you don’t let down to this pump. As women, just as we respond differently to different relaxation techniques, therapies, medications, etc. we also respond differently to breastpumps.

Perhaps you have a great pump and you can let down to it, however, there is a user error. You are not following the instructions correctly. I have seen all sorts of cockamamie things going on when watching moms pump. You are not using the parts correctly. You are using the wrong size flanges. There is a crack in the parts or a hole in the tubing. You are taking parts from one pump from a different manufacturer and using it on your pump. You are jury rigging some of the parts .. like taking tubing from one pump, cutting off the tips and then putting them on your pump. I can’t help myself sometimes. I ask a mom why you cut the tips off and you say: well because it did not fit right into this whole or piece in my pump And I say, that is exactly right, it did not fit well, meaning it does not work with your pump. It does not have a good seal, air gets into the tubing, you don’t get good suction, it throws everything off. Ladies – pumps are not one of those things you want to try and save money on.

Time and timing of pumping. When moms are new to this pumping thing…we don’t know, what we don’t know. When I find out that a mom pumped right after her babies good feeding and hardly got anything, I explain to her that her baby took out the bulk of what she had to offer and there was little left over. This is fairly normal.

Time spent on pump: Again, here we don’t know what we don’t know – You put the pump on for 5 minutes, barely got drops, in frustration you shut it off. Time spent on pump should be at least 2 minutes for lots of you to get the milk flowing. Some it takes longer and you just get going after 5 minutes. You need to leave the pump on for at least 15-20 minutes.

While I am not suggesting you do so, a better judge of milk volume would be if you were to pump closer to 3 hours after you babies less feeding. With a good pump, that you do let down to and that you keep on for 15-30 minutes, you will probably pump a good volume.

Mother’s who do make enough milk, but want to make more: I would first explore the reasons you do want to make more & how much more you want to make.

Donation: If you are naturally making more than you need for your baby and you want to donate your milk, the milk banks and other moms appreciate this. However, when I brought this up with Julie from the NY Milk Bank, she said that they do not want moms taking medication or herbs to help increase their supply as they likely cannot accept the milk in these circumstances. They also do not want moms purposefully pushing their bodies or spending time away from their own baby, to purposefully make more milk.

Build up a freezer stash: It is normal for moms, particularly working moms who are separated from your baby, to want to have a supply put away. To be a few days or a week or so ahead of your baby is a nice luxury and this is probably not going to be harmful to you or your baby.

Once you start making many ounces a day more than your baby needs, this puts you at risk for – losing the convenience of breastfeeding, in that you always find yourself needing to pump several times away.

Clogged milk ducts – particularly if you miss a pumping here or there. Your breasts become overly full and the milk has nowhere to flow and you get kind of backed up. Sometimes you get so hard and such big lumps, it causes your breasts to be in a lot of pain. Chronic clogged ducts can be a risk factor for mastitis, which is a breast infection. Chronic clogged ducts also puts you at a risk factor for lowered supply as your body keeps having to recover from constant clogged ducts and infections.

Babies feeding behavior: Lots of extra pumping, equals lots of extra milk in the breast. If your supply is so large and the letdown is so forceful, this can make for a very difficult and unpleasant feeding experience for your baby. This can sometimes cause breastfeeding difficulty for your baby who begins to have a problem dealing with the possible quick and fast and furious milk flow. Causing them to come on and off the breast, milk spraying all over the place, then coughing and choking on the fast flow, spitting up large volumes,, very messy feedings, excessive gas taken in as they come on and off the breast frequently during the feeding and the worst case scenario, starting to reject the breast because each time they come to the breast it is like they are drowning in your supply.

Picture one of those very large gallon jugs of water. Now picture yourself laying on your couch, flat on your back, with your belly button and eyes looking up at the ceiling. Now picture someone taking that full jug of water and placing it over your mouth. Feel that fast flow of water rushing into your mouth like water out of a fire hose. Think about how you will respond. If you have access to your hands you will be pushing that jug out of your way while turning your head from side to side and your legs will probably be flailing too. What if you are a baby, all swaddled up and can’t move your arms and legs freely. You are jerking your head from side to side trying to get away, trying to catch your breathe. If feedings start to become consistently like this, your baby will respond by rejecting the breast.

My regular listeners will know what is coming up next: I often say that I refrain from using the words ALWAYS and NEVER, because there are some moms and babies that will prove me wrong. I have met you in my practice. I am enamored about how well you and your baby do under these circumstances. I am here to say… Now not every mother or every baby responds the same way. Incredibly enough, some babies do seem to be able to cope with this flow and learn how to manage it quite nicely. So, I would never say never to building up a huge excess supply. I did want to warn you that this is a possibility and if you see it heading down that road, back off from the pumping.

Now we get to the moms who truly do not make enough milk for their babies: Not being in the breastfeeding world, OR being a mom who has breastfed 5 babies and never had a problem with supply, I can see how you might not believe this actually can be a problem for moms. However, when you work intimately with thousands of moms over a very long period of time, you will learn as I have, that there are some medical conditions and some unknown reasons why some moms just cannot make any milk, drops or milk, a quarter or half of their babies supply. Try as they might, they just cannot make enough to meet their babies needs.

Lori J. Isenstadt, IBCLC

Lori j Isenstadt, IBCLCLori Jill Isenstadt, IBCLC is a huge breastfeeding supporter.  She has spent much  of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years.  Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant.  She has been helping moms and babies with breastfeeding for over 25 years.  Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges.  She is an international speaker, book author and the host of the  popular itunes podcast, All About Breastfeeding, the place where the girls hang out.  You can reach Lori by email at: [email protected] or contact her via her website:  allaboutbreastfeeding.biz/contact

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