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	ask the experts kathi barber

Kathi Barber
Breastfeeding

• Increasing milk supply
• Preparing nipples for breastfeeding
• C-section delivery: negative effect on breastfeeding?
• Breastfeeding and risk of breast/ovarian cancer
• Infant refusing bottle
• Over abundant milk supply issues
• Infant biting while nursing
• Breastfed babies and weight
• Switching from pumping to breastfeeding
• Increasing fertility while still breastfeeding
• Weaning due to placenta previa
• Traveling concern about germs in water andd breastfeeding baby
• Breastfeeding while sick with the flu
• Dental work, x-rays and novacaine while breastfeeding

What is the best way to increase milk supply? I have started back to work, and I pump while I am at the office (around the same time I would feed my six-month-old son). My milk supply seems to be very low. I only work two days a week, but it takes me all day to pump just one bottle (three times for ten minutes) while I am at the office. I take fenugreek but that has not seemed to help. What else can I do? I would rather not take a prescription. I like natural better!

Let me give you a big, heartfelt "Way to go!" for continuing to breastfeed your son after returning to work. You are providing a wonderful gift to him. It's a challenge for many women to maintain their milk supply upon going back to work. Here are some tips I believe you may find helpful:

1. The best way to increase your milk supply is to have your son breastfeed as frequently as possible. When you are with him, allow him to nurse as often as you can. By doing this, your body will know that it needs to keep producing milk to meet your son's needs. Overnight feedings (if your son is not sleeping through the night) are also helpful for maintaining your supply.
2. Nurse your son right before you leave him for the day, and nurse him as soon as you can after you pick him up.
3. Use an electric pump at work; they are more effective in expressing milk. A manual/hand pump may take longer to pump the amount of milk you desire. Manual pumps are only meant for occasional use.
4. Stress and decreased milk supply go hand-in-hand. If you are under constant stress while pumping at work, you may be thinking: I must pump a certain amount of milk per session. This will hinder your milk supply. Keeping a picture of your baby with you while pumping, as well as breathing deeply, may help with the "let down".
5. You can also build up your stored milk by pumping at home, between feedings, overnight, and during the weekends. This will alleviate some of the stress you may have about storing up your milk during work hours.
6. Taking herbal supplements, or galactagogues, like fenugreek (3 capsules 3x/day), work for some women and not for others. Blessed thistle (3 capsules 3x/day) is another one you might consider. You should carefully read the labels on these supplements, and others, and take as directed.

Is it important to prepare your nipples for breastfeeding? How can I avoid sore nipples after the baby is born?

This is one of the many wonderful aspects of breastfeeding-your nipples and breasts are already prepared for your breastfeeding experience. You don't need to wash or massage them. They are ready for your new baby.

You can avoid sore nipples by checking the baby's latch and position. These are important to correct early to prevent pain. Get comfortable before you begin to nurse, by using pillows for your back or propping your feet up. Make sure that the baby's mouth is opened wide when you put him/her to your breast. Be sure to move the baby to your breast rapidly while targeting the center of his/her mouth. This will help to ensure that your baby latches onto your areola, and NOT your nipple.

If you are using the cradle, cross-cradle or side-lying hold, rest your baby's head in the bend of your elbow and support the baby's bottom with your hand. Remember that your baby's body should be in a straight line, facing you, with his/her stomach touching yours. If you are using the clutch or "football" hold, use a pillow to support the baby and position him/her at the level of your breast. Place your hand at the nape of his/her neck, and pull the baby close to you.

If you feel pain, that is a good indication that the baby is not latched on properly. Breastfeeding should not hurt. While you may feel discomfort in the beginning as you and the baby learn this new experience, you should not be in pain.

References:
An Easy Guide to Breastfeeding For African-American Women by the African-American Breastfeeding Alliance
The Breastfeeding Answer Book by La Leche League International
The Breastfeeding Book by Dr. Williams Sears.

I planned to deliver my baby as naturally as possible. I have been told that I have placenta previa and will most likely have to deliver via c-section. I am concerned that a c-section delivery may have a negative impact on my ability to breastfeed. Is it possible (or common) that this will have a negative effect on breastfeeding?

First, I want to applaud your efforts to seek further information about breastfeeding after a c-section. A c-section birth does not have to have a negative impact on breastfeeding. In fact, most women have breastfeeding success after a c-section birth. Some advantages to breastfeeding after a c-section are: faster healing because your babyis sucking stimulates your uterus to contract; bonding that can heal emotional pain your may feel if you're separated from the baby after delivery; and breastfeeding can help you to feel confident even after a traumatic delivery.

You should also know:

You can breastfeed after the use of spinal or epidural anesthetics. You may need help putting the baby to your breast.

If the baby can room-in with you, breastfeeding can get off to a great start quicker. You will need assistance from your spouse, family or hospital staff if the baby stays with you.

A comfortable breastfeeding position for many women after a c-section is the clutch/football hold. To get in position, sit comfortably and hold the baby under your arm, like a football, with the babyis head facing your breast and the baby's body tucked under your arm. Support the baby's neck with your hand and babyis back with your forearm.

If you are separated from the baby, you can express your breastmilk to be fed to the baby.

Medications and antibiotics for pain relief are generally safe while breastfeeding. Check with the doctor and he/she can find an alternative medication if there is a concern.

Check to see if the hospital has a policy on breastfeeding. It may be routine that babies be given pacifiers and artificial nipples, which could interfere with a good start at breastfeeding.

Does breastfeeding reduce the risk of breast/ovarian cancer?

Yes, breastfeeding does reduce a woman's risk of breast and ovarian cancer. Breastfeeding between 4 to 12 months has shown a reduction in pre-menopausal breast cancer by 11%, according to the New England Journal of Medicine. This study stated that, "if all women with children lactated for 24 months or longer, the incidence of breast cancer might be reduced by nearly 25%." By breastfeeding your baby for 1 to 2 years, you can also reduce your risk of ovarian cancer by almost one-third. Not only is your baby benefiting from your breastmilk, but you are also enjoying the preventative benefits of breastfeeding as well!

I have placenta previa and will most likely have to deliver via c-section. I am concerned that a c-section delivery may have a negative impact on my ability to breastfeed. Is it possible (or common) that this will have a negative effect on breastfeeding?

First, I want to applaud your efforts to seek further information about breastfeeding after a c-section. A c-section birth does not have to have a negative impact on breastfeeding. In fact, most women have breastfeeding success after a c-section birth. Some advantages to breastfeeding after a c-section are: faster healing because your baby's sucking stimulates your uterus to contract; bonding that can heal emotional pain your may feel if you're separated from the baby after delivery; and breastfeeding can help you to feel confident even after a traumatic delivery.

You should also know:

• You can breastfeed after the use of spinal or epidural anesthetics. You may need help putting the baby to your breast.
• If the baby can room-in with you, breastfeeding can get off to a great start quicker. You will need assistance from your spouse, family or hospital staff if the baby stays with you.
• A comfortable breastfeeding position for many women after a c-section is the clutch/football hold. To get in position, sit comfortably and hold the baby under your arm, like a football, with the baby's head facing your breast and the baby's body tucked under your arm. Support the baby's neck with your hand and baby's back with your forearm.
• If you are separated from the baby, you can express your breastmilk to be fed to the baby.
• Medications and antibiotics for pain relief are generally safe while breastfeeding. Check with the doctor and he/she can find an alternative medication if there is a concern.
• Check to see if the hospital has a policy on breastfeeding. It may be routine that babies be given pacifiers and artificial nipples, which could interfere with a good start at breastfeeding.

My daughter is seven weeks old. We have successfully fed her expressed milk from a bottle in the past, but in the last few days she has started to refuse anything but the breast. We have tried several different bottles, a sippy cup, with me home, without me home, different positions, giving it to her at different times, when she's not too hungry etc. Wondering if there's anything else we could try?

It may be that your daughter is experiencing a growth spurt, which generally happens around three weeks, six weeks and three months. A growth spurt means that your baby is trying to get your milk supply up to meet her needs. This should only last for a few days. If your baby continues to refuse to take a bottle from you or your husband, you could try to have grandmother, other relative or friend try to offer to her. Look at it this way, she may just want more of you. Smile!

I have an over abundant milk supply, which is controlled pretty well by nursing only on one side per feeding. However my son, 3 wks old, seems to have difficulty handling the rapid flow of my milk. He chokes, pulls off a lot, or his mouth slips around on the breast with milk pouring out both sides. Is there anything I can do to help him w/ this? Will he out grow this as he gets bigger?

First, your "over abundant milk supply" is a good thing! It seems that your son may have difficulty with controlling the forceful flow of your milk, which he will outgrow. Trying different nursing positions may help, such as the football or side-lying positions. It may help to tilt your son in a upright position while nursing, his face slightly above your nipple. By nursing "uphill," it may be easier for him to control the milk flow. You can also try to nurse more often and burp repeatedly during each feeding. Finally, expressing some milk before he latches on can take away some of the force of the letdown.

Is there anything I can do to keep my infant from biting me while I nurse? I am committed to breastfeeding, but it is getting very difficult and painful with those sharp little teeth.

One beauty of breastfeeding is that it's designed for a newborn to a toddler with a full set of teeth to feed without pain for the mom. If your baby is a bit younger and is teething, or just getting his first teeth, then he may be biting by accident. He's more likely trying to learn what to do with these new "things" in his mouth, or trying to soothe aching gums. The older baby may be trying to get a reaction from you. As you say, "ouch" after a biting, he may give you a smile or a look of innocence. You can simply say, "no, you can't bite mommy because it doesn't feel good." If he continues to bite, you can safely break the latch (place your finger in the corner of the baby's mouth) and not nurse for another twenty or so minutes. Soon, he should learn that biting mom has a consequence. Think of this as the beginning of the soft side of discipline. Your baby is smart, it won't take but a few times for him to catch on.

I have a 4 mo. old baby girl that weighed 9 1/2lbs. at birth & 25" long. I breastfeed exclusively & do so on demand. She now weighs 20lbs. & has grown 1". I am somewhat concerned about her weight but my mother-in-law thinks I feed her too much & she is getting too big. I thought breastfed babies eat what they need but I am confused & doubting myself.

I understand your concern. Your baby is growing at a rate that is individual for her needs. That's what makes breastmilk so perfect: it will allow each baby to grow in a way that will meet his/her specific nutritional needs. Some breastfed babies are lean, and others are more round. Both are healthy. Just think, only your breastmilk can provide your baby with what she needs to grow optimally. Hurray for you!

My daughter is 5 months old, and she has been taking pumped breastmilk from a bottle since she was 1 month old due to many complications with mom and baby. I desperately want to put her back on my breasts again, but am not sure on how to do it. Is it too late for us to try again?

CONGRATS on being committed to providing breastmilk for your baby! It can be a challenge to pump milk for an extended period of time. It's not too late for you to try, however, it will take some time. She's older now and she may not exclusively breastfeed from your breasts again. For the past few months your daughter has been used to being fed from a bottle; which allows for the milk to be release with little effort from her. Learning how to nurse from the breast will take more work on your daughter's part. It will be important for you to work closely with a Lactation Consultant and your pediatrician to be sure that your baby is getting enough milk during and after the transition from bottle to breastfeeding; and to ensure that she is continuing to gain weight. Here are a few ideas for you to try to get your daughter nursing again:

• Be patient.
• Give her skin-to-skin contact, hold and cuddle her as often as possible.
• Allow her to get her sucking needs met at the breast, much like a human pacifier.
• Take baths and sleep together.
• Use a baby carrier, sling or other such item to carry and keep her close during the day and evening.
• DO offer the breast when she's sleepy or calm.
• DON'T offer the breast if she's too hungry, screaming and/or crying. You want her to connect breastfeeding with a good experience. So if she's resolute to Not nurse at a feeding, try again at another time.
• Offer the breast when you are free of interruption, play quiet music.
• Use good position: get comfortable; hold baby with your tummy to hers and with her body in a straight line facing you.
• Use good latch: make sure her mouth is open wide so that you can get a good portion of your areola (brown area around your nipple) into her mouth. This helps to prevent sore nipples and allows for your daughter to get the breastmilk she needs.
• Place some of your breastmilk on your nipple, or infant formula, to encourage her to take the breast; and drip some pumped milk onto the areola while she is trying to latch so that she'll associate your breasts with receiving the breastmilk she's already familiar with.
• Try cup feeding the baby expressed milk between feedings.
• Find an online discussion/support group of breastfeeding women.
• Be patient

I have a one year old who still breastfeeds regularly. I have not menstruated yet since becoming pregnant with her. My husband and I are interested in having another baby and would like to start trying soon. I really do not want to wean yet. Is there anything I can do to increase my fertility while still breastfeeding?

Although you have not received your menstrual cycle, there is still a chance that you are ovulating, and may be able to get pregnant. Since your baby is one year old, he/she is probably: not nursing exclusively; is being fed juice, water, food or other supplements; and is sleeping for at least one or more 3 hour stretches. These factors can interfere breastfeeding’s natural ability to suppress ovulation. Do know that you don't have to have a period to get pregnant. Check the book, Natural Fertility Awareness, by John Davidson, which may be able to give you more information on knowing your own fertility pattern.

I am 23 weeks pregnant and have just learned that I have placenta previa. Do I need to wean my 32 month old child? Also, I have been told I will need a c-section. I have heard some information that a c-section could effect my milk supply. Could this procedure make breastfeeding more difficult?

Breastfeeding creates contractions in your uterus, and while this may be safe early in a pregnancy, it may not be safe during the latter half of your pregnancy. Since you have been diagnosed with placenta previa, which can cause preterm labor, it would probably be safer for you and the life of the unborn baby, to wean your toddler. However, it is very important that you talk with your doctor and inform him that you are still breastfeeding your 32-month old and get his take on breastfeeding. Since you are committed to breastfeeding your baby, a c-section shouldn't be a problem. Breastfeeding is particularly important for women who have c-section deliveries because breastfeeding can help you and the baby feel close, which is important if you and the baby are separated after delivery; and breastfeeding helps the uterus to contract quickly, aiding in the healing process. Check your hospital's policies about having the baby room-in with you, routine pacifier and bottle usage, allowing your spouse or a friend to stay overnight with you to help with the baby. Also, talk with your physician to let him know your desire to breastfeed. Some medications used during your delivery may affect your alertness after the baby is born. If you are sleepy afterwards, you may need help getting the baby latched on or you may need some time before the medication wares off. Let the hospital staff know that your baby will be breastfed; and if your separated from the baby for an extended period of time, tell them to feed the baby with an alternative method, such as feeding cup or syringe. It will be important for you to have access to the baby as often as possible and to nurse soon, and often to get your milk supply going. A comfortable nursing position for you might be the football hold or side-lying positions. With support from family and/or friends, and your own resolve to breastfeed, you should have a successful breastfeeding experience.

I am travelling to India with my 4 month old who is exclusively breastfeeding. I am fine drinking the local water but I am wondering if I should boil it and drink it since I am breastfeeding? Will any germs in the water actually get passed on to her and possibly affect her even though they dont affect me?

Exclusive breastfeeding for your baby is best while you're traveling because it is sterile and contains immunities to fight disease and infection. To be safe, you can drink bottled water while you are travelling. Since you are traveling out of the country, you should check with your doctor, your baby's pediatrician and the Centers for Disease Control to find out about the health concerns in that area.

I have the flu and am breastfeeding my healthy 3 mo old. Is it safe to continue breastfeeding while I am sick?

Yes, it's safe for you to continue breastfeeding your baby. Your body creates antibodies to colds and flu-like infections that pass through your milk to protect your baby. Be sure to drink plenty of fluids and take advantage of nursing while lying down so you can be well rested. You can be confident that even if your baby happens to get sick, she'll likely have a lesser version of the cold.

I received dental work (for four days in a row) which included X-rays and novicaine and I am concerned about what my son may be experiencing via my breastmilk.Today being the first day after the completion of my dental work my son seemed very fussy and his bowels were very gassy and green. I have five more appointments in february and am wondering if spacing them out is better or having them close together is better? Is the novicane used a risk to my son in any way?

It is generally safe to continue breastfeeding if a mom has to have dental work. Dental x-rays are thought to be safe, as well as light local anesthesia, including nitrous oxide (laughing gas.) If you are still concerned, you can nurse your baby before your procedure and then a few (about 4) hours after your procedure. The types of anesthetics used in dental offices normally clear your bloodstream in a matter of minutes or a few hours. Talk with your dentist to help put to rest any fears your may have. You can also pump and store your breastmilk in advance of your dental work. Since you know that you will have additional dental work done, you may want to enlist of help of your spouse, friend or family member to assist you during the hours after your appointment. If your baby is experiencing gas and a change in his bowel movements, it may not be due to your dental work. You should contact your baby's pediatrician.