Working Mom

An audio recording of the 10/5 Instagram Live can be found here.

How to get in touch with Victoria Facelli, IBCLC
Email: durhamlactation@gmail.com
Instagram handle: durhamlactation

Setting Yourself Up for Success

• Victoria’s biggest piece of advice is to get support, get some help in place before baby. Find a friend or family member who can be your “3am buddy”. If you have a Lactation Consultant (LC) picked out, maybe the LC can be that buddy.
• Find a lactation consultant before baby because when you’re in the thick of it, it’s more difficult. LCs can also rule out certain things beforehand.
• Get to know your body so that if an LC asks, “Is that normal for you? Has that lump ever been there?” that you can answer in an informed way. Take the time to get to know your breasts and body NOW.
• Set up self-care stations: try to drink a lot of water and snack stations. Probably not in the nursery – more likely you’ll be nursing in your bedroom or your couch in front of the TV. You need about 500 extra calories a day, which is a glass of milk with a peanut butter sandwich. (That’s what you need from a calorie standpoint but you may be hungrier than that.) So, go to Costco and get those toddler snacks for yourself. Water bottles with a built-in straw are also great.
• Rely on your partner to make sure your glass is always full and the snack stations are set up and stocked up. Also, it’s smart to make sure at the stations you have an extra diaper, onesie and extra shirt just in case.
• Remember this mantra: Don’t quit on your worst day.

Questions Asked

I’m not producing enough milk, what can I do? I don’t want to give my baby formula but I have to because I am not producing.
You need that extra 500 calories. In general, your body is going to thrive if you’re eating well. Unfortunately, your body will choose baby over you so if you’re eating crappy and not taking care of yourself, your milk will suffer. You don’t need to eat a special diet like oatmeal. If that’s something you love, great. But the main thing is to get to foods that you love. If your production is chronically low, then make sure your baby is draining the breast. If not drained, try to pump after. If you’re looking to boost your supply, then supplements like Fenugreek but always check with your doctor or LC first.

I am constantly having let downs, including in between latching. Is my baby still getting enough?
Press on your breasts to tell your body not right now. Don’t be worried about feeling letdowns at feedings; some people feel letdowns and some people don’t. Most important thing is listening for swallows.

Should I eat spinach and salads?
It may or may not impact how much milk you’re producing but you’re going to feel better if you’re eating better. However, it’s more important that you can just eat. The healthier you’re eating, the better you’ll feel but it may or may not impact production.

I have newborn and I am producing too much milk. I am engorged and it’s really painful. What can I do?
People tend to worry about under-production more but over-production can be just as hard as under production. In the first few weeks, the brain controls production and then after about 6 weeks, your hormones settle but leading up to that some women have some big fluctuations in production. Engorgement isn’t just milk, it’s swelling. Do passive expression and massaging of your breasts to allow milk to drain. Massage with coconut oil. Use ice in between feedings for the swellings. If your breast feels softer, passive silicone pump like the Haakaa pump suction on to breast and let a letdown passively drain. Ibuprofen if it’s ok with your doctor. We do recommend using real ice instead of frozen food. Use a newborn diaper, fill it with water and stick in freezer because you’ll get a nice breast-shaped ice pack with the curve of the diaper.

My 13-month-old is less interested in nursing and we’re down to morning and night feedings only. Are we done?
Toddler nursing is a totally different bag of tricks. The number of calories in your milk goes up when your baby is a year old because your body knows that the toddler will be snacking, treating you like a drinking foundation. Nursing before bed and when they wake up – getting all the benefits in those little stints. Toddler is leading more than you are lead. Breastfeeding is less about eating and more about soothing, connecting and bonding.

I have a newborn. My nipples are cracked and sore and bleeding so I got nipple shields. They are life-changing – is there something wrong with using these?
Nipple shields are designed for flat or inverted. Shouldn’t be called a shield but an extender. Tricky thing about using them is that they’re a little bit used as a training wheel. They’re a little bit of a pain when you’re out and about but if they work for you, then that’s your tool. Most babies spontaneously wean off of them. If there is some other kind of issue that is affecting latching like tongue-tied, etc., the shield may make it harder to spot and that can cause other issues down the road. Just be sure to see an MD and LC to rule out anything else.

How to heal cracked and sore nipples?
Milk and moisture – express breastmilk and rub that in. It’s like Neosporin of the gods. Then add any kind of moisture goop like hydrogel, Aquaphor, lanolin or coconut oil. Someone also mentioned Medihoney is good. That’s a kind of honey that has been pasteurized (unpasteurized honey presents a risk of botulism for babies under a year old) and Medihoney is great and really does help healing sore nipples – agreed!

Ideas and recommendations for best breast pump?
Spectra S1 it is cordless, it is quiet, comfortable, efficient, hospital grade and it is multi-user, which means that you can sell it when you’re done. Medela is also good. Everyone should have a hands-free bra and a cordless pump. Everyone knows that once you get your pump set up, your phone is just out of reach. It’s 2017 and everyone should be cordless. I also recommend Freemies, which are cups that hook up to Spectra that tuck into your bra. Check to see if your insurance covers the S1 and if your insurance does not, pay for the upgrade to go cordless – it’s worth it.

How do I transition back to the nipple from the nipple shield?
Be patient. This is what I meant by a nipple shield can be a training wheel. It may be hard for your baby to latch after you’ve been using the nipple shield. If your baby can’t, keep calm and put the nipple shield back on. Then keep trying without during future feedings until eventually baby can latch without it.

After pumping or feeding from the breast, I get a shooting pain – is that normal?
It could be functional pain or a vasospasm. Vasospasm – when blood rushes back into the nipple. I always joke that summer is mastitis season and winter is vaso spasm season. Use warmth – fleece nipple pads and sit on them when nursing and then put them on your nipples right after. It could also be a functional pain, when your body is overreacting and sends out a large pain response to ibuprofen + allergy med without decongestant. decongestants will dry up milk supply!

I am an overproducer but I stop early. I do 4oz on a breast in 9 minutes. Does this sound ok?
Sounds good as you’re trying to regulate your production down but use massages if you’re still uncomfortable.

Can letdown be affected with menstrual cycle? My milk shoots out when I have my period.
Letdowns are all about hormones and oxytocin so it’s totally possible that your menstrual cycle is affecting. Advice is lean back for letdowns. Let baby control the letdown and flow. If it’s too fast, the baby can just let it drain. (Get leaned back and comfortable anyway so that you can avoid that full body breastfeeding claw.)

When I feed baby, I get a burning sensation – what can I do?
What is your baby doing with his or her mouth? Is there a compression issue? Sounds tricky, go see an LC in your area. It sounds like a mouth behavior that needs to be checked out.

I recently read about cleaning wires, bottles and pump parts – what’s the best way to do that?
Breastmilk is pretty cool food; it cleans itself and has its own bacteria-fighting components so in general you don’t have to worry too much about sterilizing and those things. You can put everything in a basin or in a bag and then put it in a fridge. You don’t have to wash your pump every time; you can wash every 8 hours or twice a day. Don’t wash the tubes because they can get moldy. In a closed system, milk cannot get the tubes anyway. If you do wash them by accident, just make sure they get fully air dried. For bottles and other parts, take them all apart and keep them in a DRY basin. Sink and standing water can present the problem. Wash everything in hot water and dish soap, then put on a clean towel with paper towels on top. Don’t forget to clean your bottle drying racks! Many drying racks don’t have an outlet.

I have a 5-week-old and she will nurse about 5 minutes and then she starts kicking and screaming – what can I do?
It’s entirely possible that she has eaten enough in those 5 minutes and it’s also possible that she is overwhelmed by flow. I would suggest leaning back and letting her bob and get her own latch. Does she still seem hungry or is she just done? Also check to see that nothing is bothering her like pillows on her feet and always make sure baby is totally calmed.

I have an insanely quick nurser; she nurses 5 to 10 minutes total. Normal diapers, happy, alert, chubby baby – does this sound possible?
This sounds totally possible. Everyone’s body is different and everyone’s baby is different. For every baby that takes an hour to nurse, I know a baby that takes 5 minutes so that sounds totally normal. If she is happy and gaining weight and happy, enjoy it!

Going back to work in 12 weeks. Only breastfeeding now. When do I start pumping and introducing bottle?
I see a lot of stress on families that don’t take bottles so I recommend introducing a bottle a little sooner than a lot of other LCs do. I am all about how you give bottles. Start pumping into bottles after 2.5 or 3 weeks so that you have a few weeks to get hormones settled and get breastfeeding established. If that’s all going well, then start by pumping after the first morning feeding when babies are fullest and often doing their nice long sleep stretch. Get your wireless pump and pump for 15 minutes so that you can signal your body and get your milk production up. It might take a few times to do it before body starts producing. That routine will eventually transition into a work routine and it might be your first pump time at work. Then you can introduce your bottle to your baby. We first start with the bottle and then we work on a stash in terms of priorities. Stash is just back-up. Come to peace with what you need in your stash, introduce a pump after one of your other feedings and then put that stash in your freezer. I recommend that once folks start bottles, doing at least two or three a week. Then if you want to skip a few days and put the others in your stash, you can. Sometimes folks are like, “Oh, baby takes a bottle!” and then don’t offer it again but then baby forgets to take a bottle and it gets stressful before mom returns to work. Try paced water feeding – when baby sits up when taking a bottle and baby is doing the working with an uphill flow, where they’re doing the work. I don’t tend to see nipple confusion – more so flow preference. Where baby takes a bottle, and thinks, “this is so easy” and then goes back to the breast and thinks, “this is too much work.” So, if we make the bottle a little harder, then baby goes back and forth a little more willingly. Check out Victoria on YouTube showing Paced Bottle Feeding here:

Sometimes folks worry about baby getting air. You actually swallow air when you drink too quickly – think about when you’re chugging too quickly. You don’t swallow air when you sip something so again, do that paced bottle feeding. Good luck with your transition back to work!

I have painful lumps in my underarms and underneath my breasts. I’ve seen an LC and had a lymphatic drainage. How can I get rid of these?
Are they plugged ducts or persistent lumps of some other kind? A lot of people have a lot of breast tissue around that area. So, you can massage pushing straight back and massaging down or massaging while pumping or nursing for bigger lumps. If they’re smaller bumps of plugged ducts, I would recommend a supplement called lecithin for smaller bumps. If they’re not going away and they’re not changing, I would recommend seeing a doctor. We always want to check out lumps in general and rule out any issues with them.

Do you have a YouTube channel?
Not yet! I will get working on that. You can find me at durhamlactation@gmail.com

Been exclusively breastfeeding and baby won’t take any bottle or cup, what should I do?
So frustrating and why I recommend introducing the bottle a little earlier. I do a thing called baby bottle bootcamp – a sneaky way to get baby to take the bottle. First I get a warm bottle, not hot but a pretty warm bottle. Then I watch the monitor to see when baby is in that REM (rapid eye movement) part of sleep. I don’t turn on any lights or do anything to wake baby, I just sort of slide that bottle in there and see if baby will take it. I let them take as much of it as they will and if they push it off, then I just back off and try again at the next nap. If they take that well, then I introduce it when they’re gradually more awake. Sometimes I get a stubborn baby but try those sneaky warm sleepy bottles. The other thing I recommend is offering a bottle when baby is being soothed in another way – I like trying bouncing on a yoga ball. Don’t try to wait until they’re super hungry or else they may be unreasonable and cranky. If they’re in that state, it could be easier to try to nurse them a little bit first and then offer them a bottle.

My 10-month-old won’t take a bottle either, what should I do?
At 10 months old, lean into the solid foods. If you’re at 10 months then bring down the importance of milk in the diet

After feeding baby is gassy and making grunting noises – what can I do?
I have two things I do for gas. First one is probiotic for mom. One on Amazon called Biokult that’s a powder. Drink yourself or put on nipple if that’s ok with your pediatrician to build up that gut health. Sometimes that is just what they’re witching hour is and it’s not even gassiness. With the grunting though, it does sound like gas. Take a baby massage class or watch a video and try baby massage. There is also a craniosacral massage therapist who works really gently to massage baby and I have seen it work wonders for babies who have blockage in their tummies. Sometimes tummy time – though not fun in the middle of the night – can help a gassy baby.

Baby is going to be four or five months and at daycare when I go back to work – how much milk does he need?
My baseline is to plan on an ounce an hour. So, for eight hours, I would send three 3oz bottles. I err on the side of more smaller bottles as opposed to fewer bigger bottles because eating in smaller quantities is better for us anyway. Then the caregiver can give a 3oz bottle every three hours and if baby is still hungry, the caregiver can dip into that extra bottle. If caregiver says baby is hungry, then go from there and maybe increase. The more baby sleeps at night, the more he or she will eat during the day so that may be a reason to send a bigger bottle. I typically don’t send bottles bigger than 5oz.

It takes me 35+ minutes to pump only 4oz per session, is there a way to speed it up?
My big thing would be massage and hands-on pumping. Doing massage while you’re pumping. Get a more efficient pump and maximize your settings. If you’re between letdowns then going to that faster setting.

If my baby is latching correctly – checked with an LC – what would be the reason my nipples stopped hurting and then starting to hurt again?
If the LC ruled out any tongue issues, could be something funny baby is doing with the mouth, it could be functional pain or sensitivity. I would start by leaning back and letting baby latch themselves. I would google something called Gestalt breastfeeding from the Possums Clinic in Australia. They might have some good ideas for maximizing that latch with your little one. It’s hard for me to comment on what it could be without seeing what’s going on. I hope that the pain resolves soon!

Is an Ameda pump good enough?
An Ameda pump similar to a Medela is good enough. It’s a little louder, a little clunkier, a little less efficient than the Spectra, but it will totally get the job done

My son is 8 weeks old and started spitting up after each feeding, is this a sign of over-feeding?
It could be. That is something to definitely keep an eye on. Spitting up is normal for babies. It’s a mess but if they’re not in pain, it’s ok. If the voice is raspy, if baby can’t lay on his back or is really uncomfortable – those could all be signs of reflux. If he is happy and laughing and spits up and may be startled by it but not upset, it’s just a normal part of their immune system. I would just hold that little one up for a little bit after each feeding.

I have high lipase milk. My baby only wants fresh pumped milk and won’t drink my frozen milk, what can I do?
What we do with high lipase milk is that we actually scald it before freezing. Unfortunately for some of the already frozen milk, your baby may not accept it. So you may want to go ahead and donate that milk to a milk bank. Check your milk and make sure it doesn’t smell soapy.

I am combination feeding my 5-month-old as required by our pediatrician due to weight gain issues. When we feed him bottles, should we limit to a certain amount of ounces?
I would go based on what you’re seeing in terms of weight gain. If your baby is gaining between .75 and 1 ounce a day, then you’re good to go. If baby is gaining more than that, you know that you can back down on the formula a bit. Ideally you’re watching their cues to see when they’re hungry or floppy armed full and that should guide the amount you offer them.