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Making a pumping bra! Handsfree pumping bra

A pumping bra is a very useful article of clothing if you need to pump often. Its main function is to free up your hands: the bra keeps the pump flanges in the correct position on your breasts, so that you don’t need to use your hands to do it.

You can buy pumping bras or bustiers from a number of well-known baby brands, but they are actually very easy to make. No sewing or other crafty skills required!

Making a pumping bra

You will need:

  • A bra: I like to use a sportsbra-type bra that fits snugly and is made from a densely woven material. A snug fit is important to ensure that the pump flanges will be kept in close contact with your breast. If you use a bra that is too loose-fitting, the flanges will move around and they will end up damaging your nipples.
  • A pen or marker of some sort
  • A scissors
  • Optional: fabric glue or sewing kit

Instructions

  1. Put on your bra and shuffle it around until it is nice and comfortable
  2. Use your pen to mark where your nipples are
  3. Take off the bra
  4. Use the scissors to cut a small horizontal slit where you’ve marked. Cut it smallish at first – the diameter of the tube that will be running through it is a good size to start with. You can always make it bigger, but if you cut it too big to start with, you’re kind of stuck.
  5. Before you put your bra back on, insert the flange of your pump. Insert it from the narrow end; you don’t want the shield to fit through the slit or it may fall out while in use! If the slit is too small, cut it a bit bigger until you can just fit the flange through.
  6. Finally, if you’re using a bra made from t-shirt material (like the one I’ve used in the pictures), it might be a good idea to seal the edged of the hole with fabric glue so that they don’t unravel. Or, if you’re clever with a needle and thread, hem it with blanket stitch (way too much effort for me!)

 

Ready to pump!

And that’s it. See, I said it would be easy!

Using your pumping bra

 

The pumping bra with breast pads in place

You can decide whether you want to wear the bra full time or just put it on at pumping times. If you wear it full time, you will have to either put in breast pads or wear another bra over it. Remember, your nipples are poking through for all the world to see! Breast pads work well for preventing uncomfortable situations with people staring.

 

If you throw over a nice scarf, no-one will even know you’re pumping!

When you are ready to start pumping, mover your breasts around inside the bra so that your nipples are peeking through the holes you’ve cut. Insert your pump flanges and position them over your nipples. Switch on your pump, make sure the flanges are seated comfortably around the nipple, and voila: you’re pumping hands free. Enjoy a cup of tea, a good book, or (if you absolutely must) working at your computer- you are a multitasking rock star!

 

How to pump more breastmilk

In today’s world, with working moms and short maternity leave, pumping has become a major part of our breastfeeding journeys. And let’s just get honest for a moment: pumping can be really hard! Sometimes pumping enough milk seems like an impossible task. If you’ve been struggling to pump enough milk, I have good news for you: this post is chock-full of tips and tricks to help you pump more milk.

Get to the root of the problem

If you cannot pump enough milk, you probably have one of two problems: either you have a low milk supply, or you are not pumping effectively. In this post, I will focus on effective pumping techniques, and keep the supply issues for another time. Suffice it to say for now: if your baby has been gaining weight well up to this point, your supply is probably not the problem. But remember, because of the way milk production is regulated, using a more effective pumping technique – and therefore removing more milk from the breast – will also boost your supply. Double win!

Getting a let-down: the key to effective pumping

When it comes to pumping, there’s one thing that is absolutely vital to understand and achieve: the let-down reflex (also known as the milk ejection reflex). In simple terms, this is what allows your milk to flow. What happens in the body is the following: when the breast is stimulated (e.g. by a baby suckling, or by a pump) the brain releases a hormone called oxytocin. Oxytocin causes all the little muscles surrounding the milk ducts and milk glands to contract, which “pushes” the milk out of the breast. Sometimes you can feel the let-down reflex as a tingling or squeezing sensation in the breast, or you may notice that the other breast starts leaking. Some women never feel it, though, or you may feel it at some feeds and not at others. But if you notice the milk flowing as you pump, you can be pretty sure that you’ve had a let-down.

Fun fact: oxytocin also causes labor pains and orgasms! It’s also responsible for those period-pain like cramps you get after birth when your uterus is contracting – that’s why your uterus shrinks back down to its normal size faster if you’re breastfeeding. And as if that wasn’t enough, it’s also a bonding and mothering hormone, so it gives you the warm fuzzies about your baby. Oxytocin is awesome!

But back to the let-down reflex. The let-down reflex plays a vital role in pumping: the majority of the milk you express comes during a let-down. Before the let-down reflex, there is only about 10 ml of milk available in the breast – so if that’s the kind of volume you are getting, you are possibly not having a let-down.

How to improve your let-down

Because the let-down is driven by oxytocin, it’s useful to look at the factors that will increase or decrease your oxytocin reflex. Oxytocin secretion is stimulated by:

  • Stimulation of the breasts and nipples. For this reason, it helps to start off with your pump on gentle suction until the let-down comes, or to hand express a bit first. Massaging the breasts before expressing and whenever the milk flow slows down also helps a lot.
  • Hearing, seeing, smelling or touching the baby. If you are pumping at work, watch videos or photos of your baby on your phone and take a piece of baby’s clothes to smell. If your baby is in NICU, ask if you can pump next to baby’s bed. You can even pump one breast while baby drinks from the other one.
  • Positive emotions. Think happy thoughts while you are pumping. Visualise streams of milk flowing from your breasts. It sounds kind of crazy, but it works!
  • Gentle massage along the spine. We’re not sure why this works, but it does seem to help: ask someone to massage your back in small circles along the sides of your spine before you pump.

On the other hand, you want to avoid these things that can inhibit the action of oxytocin:

  • Negative emotions. Stress is a big problem here, especially if you’re stressing about how much (or how little!) you’re pumping. It’s a downward spiral: stress inhibits the let-down, which means you get less milk, which makes you stress even more, which inhibits the let-down, and so on into infinity. I find the best way to deal with this is to distract yourself: cover the pump bottle (otherwise you’ll keep looking at it and freaking out), and either read a good book, watch a TV show that makes you laugh or close your eyes and listen to some soothing music. Deep breathing, visualization and guided relaxation or meditation exercises can also be very useful for this.
  • This is important: if you’re still in pain from the birth, don’t try to be a superhero; take your pain medicine. Nothing stops the let-down reflex like pain. The same applies if your pump doesn’t fit well or if you have the suction too high: if it hurts your nipple, you won’t get a good let-down.
  • I’ve never found this described in any of my academic books, but from experience I can tell you it’s absolutely true: you can’t have a let-down if you’re shivering. You can use this to your advantage by placing a hot beanbag on your breast before or while you are pumping.
  • Alcohol inhibits the release of oxytocin, so you will pump less if you’ve had a drink. So no, grandma, milk stout is not a good idea.

 

Extra tips and tricks to help you pump more

There are a few more ways to increase the amount of milk you get out of your breasts. Here goes:

Stimulate more milk production

If you want to boost your milk production, keep pumping for a few minutes after the milk stops flowing. This sends your brain a loud and clear message that “we need more milk here!”

Hand express

If you’ve never tried hand expressing, now may be a good time. Hand expressing can be especially useful if you struggle to get a let-down while pumping: sometimes the warmth of your hands is more conducive to a let-down than the cold, hard plastic of the pump.

You can also try hand expressing after you’ve finished a pumping session. I find that hand expressing can almost always get a bit more milk out when the pump can’t. It’s also more effective to hand express when you’ve only got colostrum.

Hands-on pumping

Hands-on pumping is an excellent technique to get more milk out of the breast faster. It’s very simple: while you are pumping, just use a free hand to grab hold of your breast, quite close to your chest, and squeeeeeze. What you are effectively doing is “pushing” the milk out from behind while the pump is “pulling” it to the front. It can really speed up the pumping process.

Double pumping

Pumping both breasts at once will allow you to get the milk out much faster, for obvious reasons. But it also provides a much stronger stimulus for milk production and for the let-down. There are a number of ways you can do this. The most obvious is to use a double electric pump, but they are quite pricey. You can improvise by using a single electric pump on the one breast and a manual pump on the other breast, or by using two manual pumps, or by using a pump on one breast and hand-expressing the other one (yes, that will take some practice!). You can even let baby help and express on one side while baby drinks on the other side. Whichever way you do it, your body will think you’re suddenly feeding twins, which should give your supply a big boost!

Power pumping

“Power pumping” is a pumping regimen designed to mimic the way a baby feeds during a growth spurt. If you’ve never experienced a growth spurt, it goes like this: baby drinks for a while, stops, relaxes for about ten minutes and then wants to drink again. Repeat, and repeat, and repeat. These short frequent feeds give your supply a major boost.

When you are power pumping, you will do the same thing: First, you pump both breasts well, until the flow of milk slows right down (this usually takes about 20 minutes). Then you take a 10-minute break, and pump again until the milk flow slows down or stops (usually also about 10 minutes). Repeat this pattern of intermittent resting and pumping two or three times. A whole round of power pumping usually takes an hour or a bit more. You can either do one session per day, or do a “boot camp” where you do several sessions a day for a few days (3 sessions a day for 3 days is a good goal). “Boot camp” will get you results quicker, but it’s a lot of effort, so I’d suggest you do it when there’s someone else around to help with the baby.

 

If all this talk of timing and minutes is a bit technical for you, try this relaxed version of power pumping: Put on one of your favorite TV shows (on TV, not video – this is one time when ad breaks are a good thing); then simply pump during the show and rest during the commercials. Or put on a nice CD and pump for two songs, rest for two. As long as you have rhythm of pump-rest-pump-rest-pump, you should get good results.

Power pumping has one other benefit: it takes advantage of the fact that the first let-down of a feed (or a pumping session) usually gives the most milk, because your brain secretes more oxytocin when it’s starting from a “zero” level. The breaks in-between give your brain a chance to reset back to that “zero” level, so you get more oxytocin secreted and a stronger let-down when you pump.

Remember the basics

Having said all that, you must always remember to check the basics: that you have a good pump, that it’s working well, that it fits you properly and that you’re using it correctly.

Also, as simple as it seems, you need to make sure you’re pumping often enough. Generally, you should try not to go more than 3-4 hours without either pumping or breastfeeding. If you need to boost your supply, increase that to two-hourly. And if you’re exclusively pumping (no breastfeeds), absolutely do not go below 8 pumping sessions per 24 hours. Whenever you need to get more milk out, add in an extra session or two. Early morning is often the best time to add extra sessions, since most women have more milk early in the morning.

Pulling it all together

So after all that info, let’s just put together a list of all the main points:

  • First and foremost, make sure that your pump is working well, fits your nipple properly and that you’re using the right level of suction.
  • Stimulate your let-down reflex:
    • Massage your breast before starting to pump and whenever the flow of milk slows down.
    • Start your pumping session with light, gentle suction to stimulate a let-down.
    • Keep baby close: pump at baby’s bedside, look at photos or videos of baby on your phone or smell a piece of baby’s clothing while pumping.
    • Use the power of imagination – visualize streams of milk flowing from your breasts.
    • Get a quick back massage before you pump.
    • If you tend to fret, cover the pump so you can’t see how much you’re expressing.
    • Relax: do deep breathing, listen to soothing music, or follow guided relaxation exercises while you pump.
    • If you’re in pain, treat the pain.
    • Use warmth on the breast before pumping. Keep your body warm while pumping. Shivering will stop your let-down reflex dead.
  • If you struggle to get a let-down for the pump, try hand expressing
  • Use hands-on pumping.
  • Pump both breasts at once, or let baby drink from one breast while you express the other one at the same time.
  • Keep pumping for a few minutes after the flow of milk stops to boost supply.
  • After pumping, hand express to get the last few drops of milk out.
  • Power pump to boost supply! Either do one power pumping session per day, or do a boot camp of three sessions a day for three days.
  • Make sure you’re pumping often enough. If you need more milk, throw in an extra session or two – morning is best.
  • Stay away from alcohol.

And if you’ve tried all that, and you still can’t get enough milk… well, then it’s probably time to consult a professional. A lactation consultant will help you to find where your particular problem is and give you some strategies for overcoming it. Good luck on your pumping journey, and good job for putting in all this effort!

Booby Tuesday: Strategies to increase milk supply

“How can I increase my milk supply?” remains one of the most frequently asked questions among breastfeeding mothers. Some mothers have plenty of milk with no problem, but that wasn't the case for me, yet I was still able to successfully breastfeed all three of my children. I'm sure this list is not all inclusive, so comments are welcome if something has worked for you and may be helpful for other mothers, please share!

 

Strategies to increase milk supply

The common methods to improve milk supply basically fall into two categories:

  1. Methods that increase breast stimulation, usually by improving milk removal from the breast. Because of how the physiology works, more milk removal = more stimulation = more milk production.
  2. These are substances – medicines, herbs, foods, drinks and so on that are believed to increase milk production.

Here we will focus on number 1.

Increasing breast stimulation

I’m starting here, because this will be the make-or-break factor. If your breasts aren’t being stimulated by regularly having milk removed from them, nothing else you do will help. Nothing. So it’s absolutely critical that you have to get this right. We’re often so keen to just pop a pill to make more milk, but please trust me when I say that you can’t skip this stuff. In fact, most of the time, just implementing these things will give your supply the necessary boost without needing any pills.

Make sure baby is latching and suckling effectively

This is the number one most important thing you can do! You will know that your baby is suckling effectively if you can see or hear him swallowing regularly – one swallow every 1-3 sucks is a good ratio (one swallow every 10 sucks means he’s just swallowing his own saliva). If your baby is struggling to get a good latch, keeps falling off the breast or is simply not swallowing much, I strongly suggest that you see a lactation consultant to find and fix the problem.

Feed more often

One of the best ways to boost your milk supply is simply to fed more often. Take a “babymoon” if you can – just spend a day or two in bed with baby, breastfeeding as much as possible. Babies instinctively increase their feeds when they are going through a growth spurt and need more milk: those every-five-minutes feeds give your milk supply a huge boost!

If you’ve been feeding on a schedule, trying to “stretch” baby between feeds, stop immediately. You should never limit baby’s time on the breast; it’s a recipe for milk supply issues. Feed baby at the first sign of hunger.

Breastfeed exclusively

This one goes hand-in-hand with breastfeeding more often. Assuming your baby is suckling effectively, the very best way to stimulate your breast is to allow baby to suckle as often as possible! That means no bottles and no pacifiers when you and baby are together. Yes, I’m seriously suggesting that you let baby use you as a pacifier – it will give your milk supply a good boost.

Feed at night

For some reason unknown to science, our bodies secrete more of the milk-making hormone (prolactin, specifically) when baby feeds at night. So throw out the sleep training books and work in an extra night feed if you can. “Dream feeding” is an excellent way to do this – it simply means feeding while baby is still half asleep. Of course, if you have one of those babies that feeds ten times in the night, you can skip this suggestion!

Skin-to-skin

Keeping your baby skin-to-skin can give your milk supply a great boost. In my experience, this works especially well with newborn babies and premature babies. The skin-to-skin contact stimulates your body to secrete more milk-production hormones. It also allows baby to suckle more often, which increases breast stimulation. Try putting baby skin-to-skin for naps, or carrying baby skin-to-skin in wrap.

Express in addition to breastfeeds

If you are feeding as much as possible and still need a boost, expressing your milk may be just the thing you need. You can hand express or use a breast pump, whichever is easiest for you. For maximum breast stimulation, express after baby finishes breastfeeding. You may not get much milk out, but by demanding milk from an already emptied breast you are sending a very strong message to your body that you need more milk.

If your baby is not suckling well at the breast for any reason, pumping is non-negotiable. You will need to thoroughly pump your breast at least 8 times per 24 hours to maintain a good milk supply.

Keep your breasts empty

It may sound counterintuitive, but you don’t want your breasts to get too full. A full breast sends the message to your body that “whoa, there’s too much milk, slow down!”. So aim to keep your breasts soft. This is where extra feeds and pumping come in. If you can feel fullness in your breast, then congratulations – you have enough milk, and you can stop worrying about increasing it even more.

Booby Tuesday! Breastfeeding with flat nipples: yes it can be done!

Expectant women often worry about whether their nipples will be okay for breastfeeding. They worry that the nipples are too big, too small, too long or too flat. Fortunately, breastfeeding is not so fragile that only a “perfect” nipple will work (whatever that may be!); babies can manage to breastfeed just fine from most shapes and sizes of breast and nipple. In this post, I want to look at the one “class” of nipples that probably causes the most distress for moms: flat nipples and inverted nipples.

 

When is a flat nipple really flat?

That may seem like a silly question – but it isn’t really, not if you look at things from a breastfeeding perspective. We’re not interested in what the nipple looks like when it’s just hanging there; we want to know what it does inside the baby’s mouth. The problem with just looking is this: a nipple that looks flat at rest may be just fine once baby latches, while another nipple that looks identical at rest may be much more difficult for baby to feed on. In order to know the difference, we do a “pinch test”: place the thumb and forefinger on the areola about 2-3 cm behind the nipple, and pinch. The nipple will do one of three things:

  • Stand out – this nipple is elastic and baby should be able to feed from it very easily
  • Stay flat and not protrude – this is what true flat nipples look like
  • Pull inwards into the breast, forming a dent – this is an inverted nipple, and these are the most difficult ones to deal with. Fortunately, they tend to only be found in one breast rather than both.

 

How flat nipples and inverted nipples affect breastfeeding

Here’s a surprising thing: nipples are not really vital for breastfeeding. This clicked for me when one of my mentors pointed out that “babies BREAST feed, they don’t NIPPLE feed.” So the nipple isn’t there for the baby to suck on, it just helps baby to suck on the breast. In short, the nipple has two functions:

  1. It gives baby something to aim at, so that he knows where his mouth should go.
  2. It stimulates baby’s suckling reflex by pushing against the roof of the mouth. Baby needs to feel something quite deep in the mouth to stimulate an effective suck, and the nipple usually stretches all the way to the back of the hard palate.

 

If you have a “flat” nipple of the first kind, that sticks out when you do the pinch test, you should be able to get baby feeding relatively easily. Remember, baby latches on to the areola, not the nipple. The moment baby gives the first suck, the nipple will be drawn deep into his mouth and you can proceed as normal.

If you have a true flat or inverted nipple, it can take a bit more effort to help baby breastfeed, but in most cases it can be done. These nipples have trouble protruding because there is some inelastic fibrous tissue (called adhesions) that anchor the nipple to the inside of the breast. What this means it that when baby sucks, the breast nipple does not elongate and stretch in the way that it usually would. Instead, it just stays where it is, or if it is severely inverted it may even pull back into the breast, causing baby to lose his grip on the breast. This makes it difficult for baby to suckle, because there is nothing for the tongue to push against. Fortunately, there are many techniques that can help babies breastfeed even from flat and inverted nipples.

Helping baby to breastfeed from a flat or inverted nipple

Oftentimes, it is possible to loosen those adhesions that anchor a flat or inverted nipple. This will allow the nipple to stand out a bit more, which makes it easier for baby to latch on and suckle effectively. Here are some things that you can do to help:

During pregnancy

Letting nature take its course

During pregnancy, your body releases a lot of hormones that help your pelvis and other muscles and tendons to relax. Luckily, these hormones also seem to affect the nipples: about two thirds of women who have flat or inverted nipples before pregnancy find that they have disappeared by the time that baby is born. Flat and inverted nipples are also much less common in second-time moms.

The Hoffman Technique

If you want to increase your odds of success, you can do some nipple stretching exercises called Hoffman exercises: place both your thumbs on the areola right at the base of the nipple, and gently pull the thumbs apart to stretch the base of the nipple. Do it in both directions (up-down and sideways); initially do it twice a day and work up to five times a day. The research is not very clear that these exercises work, but some midwives have reported good results. Just please be gentle – you don’t want to overdo it and have cracked nipples even before your baby arrives! You also shouldn’t fiddle with your nipples if you are at high risk of premature labor, since it can help to bring on labor. You can continue with these exercise after baby is born, if you feel it is still necessary.

Shaping the nipple to help baby latch

The pinch

The simplest thing you can do to help baby latch is to shape the nipple and areola when baby is latching on. You simply place a thumb and forefinger about 3-5 cm behind the areola, push your hand back toward your chest, and squeeze to flatten the breast. One important note: be sure that the flattening of the breast lies in the same direction as baby’s mouth! When baby opens his mouth to latch, pull him in close so that as much as possible of the areola goes into the mouth. You can release your fingers once baby has started suckling and he is firmly attached to the breast.

This technique basically just helps baby to latch deeply and get a good mouthful of breast. As long as baby’s mouth is full of breast, it’s easy for him to suckle effectively; it really doesn’t matter whether it’s nipple or areola that’s lying against baby’s tongue. This technique by itself is often enough to let a baby breastfeed from a flat nipple, but an inverted nipple may need a bit more help.

Pull out the nipple before feeds

For a more stubbornly inverted nipple, it can be useful to stretch the nipple using gentle suction immediately before latching baby. One simple way to do this is to use a breast pump before you put baby to the breast – simply pump for long enough and hard enough to draw the nipple out a bit. Pumping in-between feeds can also help to loosen the adhesions under the nipple. If your baby is having trouble latching, you will need to pump to stimulate your milk supply too, so it’s a double win.

 

Nipple shields

If all else fails, a nipple shield may be a useful tool to help baby latch. You should also enlist the help of a lactation consultant to help you monitor your milk supply and to help transition you to feeding just at the breast.

Give it time

One thing is clear from all the information I’ve looked at: flat and inverted nipples improve over time. The hormones of pregnancy and the sucking action of breastfeeding and pumping all help to make the nipple more elastic. So be patient; in most cases you will eventually get to a point where you can just breastfeed normally without worries. And as always, I advise you to team up with a lactation consultant that can help you and guide you through the process.

Do you have flat or inverted nipples? Did you manage to breastfeed? Please share your tips and tricks by leaving a comment below!

 

Foremilk & Hindmilk

If you’ve ever heard people talking about foremilk and hindmilk, I’ll forgive you if you’re feeling a bit bewildered. Since when do you make different kinds of milk? And the advice that comes with it is often equally confusing: “If your baby has green poops, it means he’s getting too much foremilk” – I thought I was only giving breast milk?! Or “you must keep baby on the breast long enough to get the hindmilk” – and how long is that? Besides, I thought we weren’t supposed to be timing baby’s feeds?

The whole concept of foremilk and hindmilk is very useful to explain some of the dynamics of breastfeeding, but unfortunately the message has gotten a bit garbled. In this post, I will try to separate the fact from the fiction and help you understand how this is relevant to your breastfeeding journey.

What is foremilk and hindmilk?

First of all, let’s clear up a major misconception: foremilk and hindmilk are not two different types of milk. The terms were coined to describe the differences in milk composition that occur during the course of a feed:

  • If you express milk before a feed, you will notice that the milk is quite watery, sometimes even bluish in color. This is the so-called foremilk. Foremilk is relatively higher in water and lower in fat.
  • If you express milk after a feed, you will notice the milk is a lot creamier; it will be opaque white or even yellowish. This is the so-called hindmilk. It is much higher in fat – it has at least twice as much fat as the foremilk, and often three times as much or more.

Where we go wrong is in seeing foremilk and hindmilk as two distinct “types” of milk. But as I will explain, they’re just the same milk seen at two different times.

The fat level in breast milk changes during a feed

Your breast doesn’t suddenly change from making foremilk to making hindmilk at some random point during the feed. Instead, the fat content of the milk gradually increases throughout the course of the feed. So if you were to express some milk in the middle of the feed, you would see that it is somewhere between the creaminess level of the foremilk and the hindmilk. La Leche League have a great way of explaining this in the Womanly Art of Breastfeeding: at the beginning of the feed, it’s like your baby is drinking skim milk. As baby drinks, the milk becomes fattier and creamier – so then it becomes like low-fat milk, then full-cream milk and then half-and-half. So the closer the baby gets to emptying the breast, the fattier the milk becomes.

Why does the milk fat content change?

How does this work? Simple: milk fat is sticky. If you’ve ever pumped breast milk and left it to stand, you’ll know that the cream floats to the top and sticks to the bottle, and it can be really difficult to get it all mixed in again. Well, something similar happens in the breast: the milk fat sticks to the sides of the breast ducts. At the beginning of a feed, when the breast is still full, the milk flows out easily and doesn’t pull a lot of the fat with it – this is why the first milk is so watery and low in fat. As baby keeps drinking and the breast becomes emptier, more and more of the fat is “pulled along” into the milk, and the milk gradually gets creamier. So the milk at the end of a feed is creamier and higher in fat than the milk at the beginning of the feed.

Other factors affecting milk fat content

Interestingly, there are also other factors that influence how much fat there is in the milk:

  • How full the breast is: The fuller the breast is, the bigger the difference in fat content between the foremilk and hindmilk. You will notice if you pump from a very full breast the first milk is much more watery than when the breast is emptier.
  • How long it has been since the last feed: this goes hand in hand with the previous point. If baby feeds at short intervals, the foremilk is likely to have a higher fat content than if baby feeds at long intervals. (In my head it works like this: if the milk has been in the breast for a long time, the cream has more time to separate out and stick to the sides of the ducts. Like when a bottle of pumped milk has been standing in the fridge for a few hours. In reality it probably doesn’t work like that, but it makes sense in my mind).
  • Duration of feeds: this one makes sense if you understand that the fat content in the milk changes gradually. The longer baby stays on one breast, the more fatty and creamy the milk becomes.
  • Length of pregnancy: if your baby was born prematurely, the average fat content of your milk overall is about 30 percent higher. Nature knows that premies need all the help they can get.
  • Age of the baby: interestingly, the breast milk of women who have been lactating for more than a year is substantially higher in fat. Again, I suspect this is nature’s way of compensating for the fact that toddlers are doing a lot of growing, yet they’re often not that interested in eating.
  • Breast massage: there’s some speculation that massaging the breast can “release” more milk fat into the milk. Again, in my mind, this is like shaking up that bottle of expressed milk. A recent study also showed that hand expressing yields milk with a higher fat content than pumping, and this is thought to be the reason.

You will notice that “mom’s diet” does not appear on that list. The fat that you eat will determine the kind of fat in your breast milk (e.g. if you eat a lot of omega 3 fats, your milk contains more omega 3, and if you eat a lot of saturated fat, your milk is higher in saturated fats. Yet another reason to avoid trans fats!) but the amount of fat in your breast milk is completely independent of what you’re eating. So there’s no point in eating lots of fat to try and make “richer” milk.

Balancing foremilk and hindmilk

This is where everyone starts to panic: how do I make sure than my baby gets in enough of the hindmilk? Fortunately, in most cases, you really don’t have to worry about it. Your body and your baby will adjust to each other so that baby gets in enough fat overall – that’s the wonder of breastfeeding on demand. So if all is going well with your baby, you can immediately stop worrying about foremilk and hindmilk, and just enjoy your breastfeeding relationship. However, it does sometimes happen that babies get too much foremilk, or you want to give extra hindmilk for some reason. I’ll look at two such scenarios next.

Oversupply and lactose overload

Although every breastfeeding mom dreads not having enough milk, having too much can be just as much of a headache. In cases where there is an oversupply of milk, baby may never empty the breast enough to get to the “hindmilk” – in other words, there’s so much milk in the breast that baby’s tummy is full before he gets to the higher fat milk.  In the context of foremilk and hindmilk, oversupply causes your baby to get only foremilk: because there’s such a lot of milk, baby’s tummy is full long before he gets to the fattier milk. All this high-lactose, low-fat milk causes a lactose overload – which leads to nasty, smelly, slimy green stools. Baby may also show poor weight gain, since he doesn’t get enough fat.

To fix this problem, you want to make sure baby spends enough time at each breast to empty it. If you have a very high milk supply, baby may not be able to drain the breast during one feed. In that case, you may need to do two or more feeds in a row from the one breast –keep using only the one breast until it is soft and fairly empty. (While you are doing that, you can express a bit of milk from the other side if it gets uncomfortable – you don’t want to end up with engorgement!). Once the first side has been drained, switch sides and repeat the process. This is called block feeding, and it usually sorts out the problem within a day or two.

Of course, you can also create a scenario where baby gets only foremilk if you restrict baby’s time at the breast – say, only allowing baby to drink for five minutes at each side. This is just one reason why it’s important to always follow baby’s lead for breastfeeding!

Feeding hindmilk to boost weight gain

The other scenario where foremilk and hindmilk become important is when a baby is not gaining weight well. Sometimes, we can fix that by ensuring that baby gets a higher dose of high-fat hindmilk. I’ve often used hindmilk feeding to improve weight gain in premature babies. If you are pumping, it’s simple: you pump for 2-3 minutes after the first let-down, and store that milk in a bottle labelled “foremilk”. Then you pump again, and store that milk in a bottle labelled “hindmilk”. The milk from the hindmilk bottle is what we then feed to the baby. Alternatively, you can pump a bit to remove the foremilk, then breastfeed (so that baby is getting high-fat milk straight from the breast), and then pump again to collect the hindmilk. You can even take it further: pump extra milk afterwards, allow the milk to separate, and then skim off the cream and feed that to baby. The extra fat intake can make a big difference to weight gain.

Practical implications

So where does all this leave us? As I mentioned before, you rarely need to worry about whether your baby is getting the “right” mix of foremilk and hindmilk. You’ll probably be fine if you just follow these two simple guidelines:

  1. Let baby finish the first breast before offering the second. That way, you know baby is getting all the fat from that breast.
  2. Let baby set the pace. If you allow baby to feed as often and for as long as he likes, you’re not likely to have any major hassles.

If you follow these two guidelines, you’re unlikely to have any problems; you can forget about the technicalities of foremilk and hindmilk, and just enjoy breastfeeding your baby.

It's Booby Tuesday! All about Colostrum

What is colostrum?

Colostrum is the first milk that your breasts produce for your baby. Your breasts will already start to produce colostrum from somewhere around the middle of your pregnancy – so it is already there and waiting when your baby is born. Some women even leak colostrum while they are still pregnant! But don’t worry if you don’t notice anything in your breasts: most women don’t leak – in fact, in most cases you wouldn’t even know the colostrum is there unless you really know how to look.

What colostrum looks like

Colostrum is quite a funny-looking milk. In fact, it doesn’t look like milk at all – it’s usually translucent rather than opaque white, and the color can range from clear to off-white, yellow, orange, brownish or even green tinged! It also usually isn’t very liquid; the consistency is more like syrup.

Sometimes colostrum can be a reddish-brownish-pinkish color from dried blood: this is known as “rusty pipe” colostrum (if you’ve ever opened a tap attached to an old, rusty plumbing system, you’ll know where the name comes from!). This happens if there was some bleeding in the ducts when the breast grew during pregnancy. It is actually quite common in first-time mothers and nothing to worry about; the colostrum is still perfectly safe for baby to drink.

What makes colostrum so special?

Because colostrum doesn’t look like “real” milk, some cultures (and even, I’m ashamed to say, some health professionals) regard it as an inferior substance that cannot possibly nourish a baby. The yellowish color has even led many cultures to believe that colostrum is dirty, and that it will harm the baby. Nothing could be further from the truth!

Colostrum is possibly one of the most amazing substances known to man. It is perfectly tailored to provide exactly what a baby needs in the first few days of life:

  • Extremely high in antibodies and other immune factors. Colostrum has been called a baby’s “first immunization”, because of the high level of disease-fighting antibodies it contains. Remember, up until the time of birth, baby has never been exposed to any foreign bacteria, so his immune system hasn’t been activated yet. Baby needs the immune factors from breast milk to protect him against illness until his own immune system is able to take over the job. This is especially important in the first few days, when babies are particularly vulnerable to infection.
  • Easy to digest. Colostrum is lower in fat than mature milk – perfect for a baby’s digestive system. Fat is relatively more difficult for babies to digest.
  • Concentrated protein. The protein levels in colostrum are around four times higher than in mature milk. This is perfect for a newborn: not only for growth, but because a lot of those proteins perform other functions in the baby’s gut and body, for example helping the gut to mature, assisting with the digestion of nutrients and protecting against illness.
  • Protecting the gut. Colostrum contains high levels of growth factors that help the gut to mature. This is very important: at birth, a baby’s gut is “open”, meaning that any substance in the gut can easily pass into the blood. If a foreign substance is introduced while the gut is still open, it can more easily lead to the development of allergies and other illnesses. The growth factors in colostrum prompt the cells of the gut to grow and close up, and the antibodies in the colostrum goat the inside of the gut and repel invaders.
  • Pre- and probiotics. While we are talking about the gut, it is also important to note that colostrum contains prebiotic substances as well as probiotic cells that help to colonise the baby’s gut with “good” bacteria. We’re learning more and more about how vital our gut bacteria are to our overall health – they don’t just protect against digestive disorders, but may even influence things like the risk of obesity and diabetes later in life. Babies get their healthy good bacteria primarily from two sources: vaginal birth and breast milk. So for babies born via c-section, especially, colostrum should be a non-negotiable.
  • Thicker consistency makes it easy to swallow. Baby is still getting used to swallowing, and a thick liquid is less likely than a runny one to accidentally make its way into the lungs.
  • Small volumes ensure that baby’s brand-new digestive system isn’t overloaded. The stomach can’t hold much liquid immediately after birth, so baby needs to be fed in small amounts. Small volume also means that the milk doesn’t flow too quickly, which gives baby more time to figure out how to co-ordinate swallowing and breathing.

Colostrum really is the original “liquid gold”. It is food and medicine, all wrapped up in one perfect package.

Is colostrum enough?

Probably the most common concern mothers have in the first few days is that the colostrum isn’t enough for the baby. It seems impossible that this watery liquid, coming out a drop at a time, could possibly be enough for a growing baby. And the fact that the newborn baby feeds very often simply seems to confirm this fear – surely if the baby was getting enough milk, he would go a few hours between feeds?

Actually, that’s all untrue, and it’s a mistake we make because we’ve come to think of formula-fed babies as “normal”. Colostrum really is all that a baby needs for the first few days of life, and frequent feeds are what you would expect if everything is going normally. Here’s a few things to keep in mind in those first few days:

  • Babies don’t need a lot of milk. In fact, they’re born with so much extra fluid that they can go a full 24 hours without drinking anything and not be harmed. The main function of colostrum on the first day is for health, not nutrition.
  • Babies can’t drink a lot of milk even if they try. A newborn baby has a stomach capacity of about 5-7 ml – that’s just one teaspoon! So they could not take a lot of milk, even if it was there. (By the way, you’ll even see this in bottle-fed babies: on the first day of like they take very small volumes of milk, and if you force them to take more they simply vomit it up.) Now think: if you had to eat your food for the day one spoonful at a time, how many times a day would you need to eat? Exactly.
  • Colostrum is thick and sticky – if you don’t believe me, try hand expressing it: you’ll see it’s really hard to get it out, kind of like trying to squeeze honey out of the bottle when it’s been in the fridge. Even baby has to work quite hard to get the colostrum out of the breast (although they’re much better at it that we are!) So even though baby is only taking 5 ml or so at a feed, it can take a loooong time to get that 5 ml out. It’s important to let baby take all the time he wants. And the bonus is, the more time baby spends suckling, the quicker your milk volume will increase, and the better your milk supply is likely to be even many months down the line.

Come on, give your baby the best!

I hope you’ve seen in this post that colostrum is a truly amazing substance – everything your baby needs for the healthiest possible start to life. I also hope I’ve laid to rest any fears about that first milk not being enough, or being somehow inferior to “normal” breast milk. I encourage you – no, I urge you – to commit to giving your baby at least this much. Even if you have no intention to breastfeed, at least give your baby the gift of colostrum. It will benefit you both for months and years to come.

What are some of the advantages of being a breastfed baby?

What are some of the advantages of being a breastfed baby?

  • Breastfed babies grow in a healthy way. They tend to gain weight a little bit more slowly that formula fed babies, but this is normal and a good thing. Formula fed babies have a much higher risk of being obese as children and even into adulthood; and with obesity comes and increased risk of all the lifestyle diseases such as diabetes and heart disease. On the other hand, those babies who do get “fat” on breast milk tend to lose that fat as they get more mobile. Getting fat on exclusive breastfeeding carries no increased risk of obesity later on.
  • Breast milk helps to fight disease, which means that baby gets sick less often. Babies who are not breastfed get illnesses like diarrhea, lung infections, ear infections and malnutrition more easily. This is because breast milk is full of anti-infective proteins that physically attack any bacteria, virus or other germ that it comes into contact with. Breast milk also strengthens baby’s own immune system to be able to fight illness more effectively: when breastfed babies are vaccinated or exposed to a germ, they produce more antibodies and develop a stronger resistance to disease. When a breastfed baby gets ill, the illness is usually milder and passes much more quickly.
  • Breast milk supports baby’s gut bacteria. We all have a huge number of bacteria living in our intestines, some good and some bad. Breast milk contains compounds that feed the good bacteria and kill the bad ones, causing the gut bacteria of a breastfed baby to look very different from that of a formula-fed baby. If the good bacteria in the gut outweigh the bad, baby has a lower risk of all sorts of illnesses – everything from diarrhea to diabetes.
  • Breast milk is constantly changing to provide exactly what baby needs. From day to day, or even at different times in the same day, breast milk contains different amounts of the various nutrients, all tailored exactly to baby’s needs. The antibodies in the milk also change to protect baby against specific germs that he has been exposed to.
  • Breast milk is gentle on the delicate newborn digestive system. Breastfed babies are far less prone to digestive problems such as constipation and colic. That is not to say that breastfed babies never get stomach problems – but as many mothers will testify, changing the baby to formula almost always makes it worse.
  • Breast milk contains all the nutrients needed for the brain to develop optimally. Breastfed babies literally become intelligent children: studies have shown that children who were breastfed consistently score higher in intelligence tests that children who were not breastfed.
  • Breastfeeding has a life-long protective effect. Even into adulthood, a person who was breastfed as a baby has a lower risk of getting diabetes and heart disease.
  • There is some evidence that breastfeeding helps to reduce the risk of developing allergies. Of course, the development of an allergy is a complicated process that is affected by much more than just diet, but breastfeeding is the one thing that was found in most studies to help prevent (or at least delay) the onset of various allergies.
  • The action of breastfeeding helps the muscles and bones of the face to develop correctly. Babies who drink only from the breast develop a differently shaped palate than babies who use a bottle.
  • Breastfed babies are less prone to developing ear infections. If you’ve ever had to care for a baby with an ear infection, you’ll agree that this is a big thing! The reduced risk is thought to be partly due to the way the throat and jaw move when suckling at the breast, and partly due to the anti-infective qualities of breast milk.
  • Breastfeeding is one of the main factors for reducing the risk of sudden infant death syndrome, or SIDS. In countries where breastfeeding is the norm, SIDS is very rare event. Along with putting baby to sleep on his back and refraining from smoking, breastfeeding is one of the most important interventions for reducing the risk of SIDS.
  • And let’s not forget that breastfeeding has immense emotional and psychological benefits for baby. Breastfeeding provides babies with a sense of security and lowers their levels of stress hormones. To a baby, the breast is their happy place and their safe house all rolled in to one.

Booby Tuesday Blog

LUX Baby Booby Tuesday Blog is open for expectant and experienced moms to share breastfeeding information & experiences.

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