Ask Milkalicious, Lactation Experts

Replies to This Discussion

Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:10pm

Hello Jennifer,
My post and the initial question was based on research in regards to quantity not quality. Are you looking for a study on maternal nutrition and the effect on fat/calorie content of milk?

Best Regards,
Jennifer

Jennifer L. Hensley said:

Neither of the links have adequate data for my question.

Jennifer Ritchie said:

Hi Jennifer,
Here are some studies for you to review:

Allen LH. Maternal micronutrient malnutrition: Effects on breast milk and infant nutrition, and priorities for intervention. SCN News 11:21-27, 1994.
http://www.linkagesproject.org/media/publications/frequently%20aske...

Dewey KG. Energy and protein requirements during lactation. Annual Review of Nutrition 17:19-36, 1997.
http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.nutr.17...

González-Cossío T, Habicht J-P, Rasmussen KM, Delgado HL. Impact of food supplementation during lactation on infant breast-milk intake and on the proportion of infants exclusively breast-fed. Journal of Nutrition 128:1692-1702, 1998.

Brown KH, Dewey KG. Relationships between maternal nutritional status and milk energy output of women in developing countries. In: Mechanisms Regulating Lactation and Infant Nutrient Utilization (Picciano MF and Lonnerdal B, eds.), pp. 77-95. Wiley-Liss: New York, 1992.

Krasovec K, Labbok MH, Queenan JT. (eds). Breastfeeding and borderline malnutrition in women. Journal of Tropical Pediatrics 37 (suppl 1), 1991.

Institute of Medicine. Nutrition during Lactation. National Academy Press: Washington, DC, 1991.

Best Regards,
Jennifer

Jennifer L. Hensley said:

Do you have links to the studies that show maternal nutrition and hydration have nothing to do with the quality or quantity of breastmilk?

Jennifer Ritchie said:

Hello Jacqueline,
Believe it or not, the amount of milk that a woman makes is most dependent on regular milk removal from the breast, not really influenced by a mothers nutrition and water intake. There is little to no scientific evidence to support the effect of a mothers nutrition on the amount of milk she produces. This helps explain how a mother is able to nourish their babies even under terrible conditions. Breastfeeding is demand and supply, so not enough nipple stimulation and empting of the breast can lead to a sudden drop in supply. We also experience a natural decrease in prolactin levels 2 weeks after we give birth. If a drop in supply is noticed, and the mom is putting the baby to breast 8 or more times every 24 hours, I would recommend Galactogogues. What the heck is a Galactogogue? This can be a food, herb, or drug that help boost your milk supply. Galactogogue foods include: oatmeal (not instant) brown rice, and beans; Galactogogue herbs include fenugreek , blended thistle, and goads rue, and Galactogogues drugs include Motilum and Reglan. The company Motherlove sells a special blend of these herbs in a liquid and capsule form, and many of my clients have had success using it. The two most common Galactogogue drugs are metoclopramide (Reglan) and domperidone (Motilium). Both work by raising prolactin, but Reglan does cross the blood brain barrier and can cause depression. Domperidone does not have this problem.

Hope that helps solve the mystery!

Best Regards,
Jennifer Ritchie
Milkalicious
www.milkalicious.org

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Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:14pm

Hello Julie,
We need to fix the core problem so you can heal this wound. Otherwise, it will continue. I would highly suggest seeking help from a local lactation consultant ASAP. This can be a simple positioning and latch issue, or may be an anatomy issue. They will exam you and your baby and find the best way to fix the problem.

Keep us posted!
Best Regards,
Jennifer Ritchie
Milkalicious

Jill Fremont said:

I have read a Dr. Jack Newman book that suggests an all-purpose nipple oinment which is a mixture of several topical creams (you may need a prescription), but i think these creams together have a healing quality for cracked nipples and irritation. You may want to just search the internet for "Dr. Jack Newman's All Purpose Nipple Ointment" and I believe you will find what you are looking for.

julie mascorro said:

i breastfed my first son for 7 months. i had to stop because i was working too much and i wasnt able to keep up my milk supply. it has been 2 years since i had my son and i now have a newborn daughter who i would also love to breastfeed for the same amount of time but this time my right nipple is torn, i can see flesh and blood. its sore all day, through feedings and all. it closes up with in the hours of feeding but everytime i nurse he it reopens and its extremely painful. is there anything i can do to heal my torn nipple to make breastfeeding joyful again?

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Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:21pm

Hi Jill,
As a breastfeeding mom that has had thrush, I can sympathize with your frustration. It is very hard to get rid of, and some of the treatments we are being prescribed simply do not work. Thrush can be transferred back and forth, and unless both mom and baby are treated effectively, it will be impossible to get rid of. Now let's talk about the treatment you were prescribed. Studies show Nystatin only works 30% of the time, and should be used as the first course of treatment only. Based on your history, you and your daughter need to be put on Diflucan, at the same time, to kill the yeast for good. You should be on a 400mg-loading dose, followed by two 100mg doses per day until you are symptom free for 1 week. That usually is a 3-week dose. Your daugther should be 6 mg/kg on the first day, followed by 3 mg/kg once daily for 2 weeks. I would also like you to boil anything that comes in contact with your nipples or your son's mouth for 5 minutes a day for 1 week. This includes bottle nipples, pacifiers, and pump parts.

Best of luck!
Jennifer Ritchie
Milkalicious

Jill Fremont said:

Hello,

My daughter is 8 weeks old as of yesterday. We have been battling thrush for almost 6 weeks. We have tried three rounds of nystatin for her and nothing. This week we have also tried the gentian violet and her mouth has definitely cleared up, but I am still having the shooting pains through my breasts which is a symptom of thrush. We are on our 3rd day of our gentian violet treatment today and we have been painting the baby's mouth as well as my nipples. I feel like she is getting better, but my symptoms are not. I am so frustrated because I have tried everything - garlic, grapeseed extract (drinking it), probiotics, acidophilus... you name it and I've done it with no luck. Can you offer any advice? Please help!

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Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:24pm

Hello Sarah,
Does your 16 month old have any white patches on his or her tongue? If so, it may be a case of thrush.

Sarah Deveau said:

I have a nursing 16-month-old with a mouthful of teeth, but she's not actually biting. I think it's the rubbing of her teeth on my nipples that is so painful. It hurts to nurse, but it's bearable. It's really painful to have anything touch my nipples when not nursing - even a soft bra. I travelled recently for five days and by the end of the trip - bliss! The pain was completely gone. But as soon as I returned, within two nursing sessions it was back.

I'm not prepared to stop nursing yet - and neither it she! However, everything I can find online deals specifically with biting. Any suggestions? I met with a lactation consultant, who basically said I should stop, that we've gone as long as we could.

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Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:30pm

Hi Laura,
I am worried about the "painful" comment. Can you expand on that? The best way to supplement is by doing a "top off", letting your baby nurse on both breasts and then offering a bottle. If you replace a feed with a bottle of formula, you are loosing out on that much needed nipple stimulation.

Let me know about that pain!

Best Regards,
Jennifer

Laura Renauld said:

As I mentioned in an earlier post, I am alternately nursing and formula-feeding. Which is the better way to keep/increase my milk supply (short of pumping, which I have no time for): Should I nurse a bit at every feeding and then immediately supplement OR should I allow my son to completely nurse for a feeding and then supplement the next feeding? (Note: it is too painful to fully nurse and supplement at every feeding.)

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Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:39pm

Hi Jen,
You are describing what I teach all of my new moms, compressing the breast when the baby latches. You may have seen the Carl's Jr. commercials with the six 6 dollar burger. When the supermodel eats the burger,
she compresses it to get the most burger in her mouth. All nursing woman should do the same thing when the baby latches. We want the maximum amount of breast tissue in the babies mouth, because that nipple needs to go all the way back to their soft palate.

Here's the scoop, if you are doing the football hold, compress your breast like a sandwich, if you are doing the cradle hold or nursing while laying down, compress it like a taco.

I hope that answers your question!

Best Regards,
Jennifer Ritchie
Milkalicious

jennydecki said:

I had some trouble with breastfeeding with my first two daughters and I want this one (due on 9/20-ish) to be a little easier.

My question is: With large breasts (they manage an E or EE when full but not overly so) and "average" nipples - is it more helpful to try and squeeze the breast so it is more vertical, matching the baby's mouth when it is sideways and nursing...or should i be squeezing the breast so it is horizontal and turn baby to a comfier position once latched?

Hope I was able to express that somewhat clearly.

Thank you for being willing to answer questions!!

Jen

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Permalink Reply by Jennifer Ritchie on June 16, 2009 at 12:47pm

Hi Kendra,
There is nothing more discouraging than pumping and not getting a lot of volume. What you are doing right now is trying to take any EXTRA milk that you have in your breasts and store it. When you return to work you will REPLACE a feed with a pumping. There is a big difference, and the difference will be the volume. You will get a lot more volume when you pump to replace a feed, therefore you will have extra to freeze. Just get some rest and be with your baby right now, you will have plenty of time to pump when you go back to work.

Good luck to you!

Jennifer Ritchie
Milkalicious

Kendra Skeene said:

My son is 7 weeks old, and I've been trying to pump for about 3 weeks now to store up a milk supply for when I go back to work in a couple more weeks. I know that while I'm home with him, my son is getting enough milk. He wets tons of diapers each day, and is gaining weight adequately, but he's not overweight.

The problem I'm having is that I don't have a large storage capacity, so he is nursing what feels like all day long... there isn't really an opportunity for me to pump much during the day. When I do pump in the morning when I am most full (pumping one breast while he nurses the other), he decides he wants more and starts getting fussy because I've pumped some of his breakfast away. I have tried pumping while he naps, but again his nap may only be an hour long and so when he's ready to nurse, there's not enough there for him. My last option is to pump after I put him down to bed for the night, but then I'm lucky if a get a half ounce, AND I lose sleep since I'm not going to sleep when he does - he still gets up to nurse 3 times a night, for an hour each time, so I prefer to go to sleep as soon as he does so I get some sleep.

Even on a good day when everything goes perfect, I'm lucky to get 2 ounces of milk to freeze.

My concern is that I won't have enough stored up for him once I have to go back to work, and I don't even know how much he's getting each day to know how much he needs. I'm also concerned that once I am pumping at work, if I'm not able to pump as much as he eats, I'll quickly run out of what little stored milk I manage to stock, and won't have enough to leave him when I go to work.

I've been trying to read tips online at places like kellymom but so far nothing seems to be much help... like I said above, advice like "pump in the morning" does me no good because he nurses a lot each morning and doesn't leave me anything to pump (I've been trying to nurse him to sleep for close to 2 hours already this morning so he would nap and I could pump, but so far no luck on the sleep).

Suggestions?

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Permalink Reply by Sarah Deveau on June 16, 2009 at 3:04pm

I hadn't thought of that - I'll check as soon as she wakes up from her nap! I suspect she may just be a chewer though - she flattens her juice box straws and they're demolished with teeth marks. Gah!

Sarah

Sarah Deveau said:

I have a nursing 16-month-old with a mouthful of teeth, but she's not actually biting. I think it's the rubbing of her teeth on my nipples that is so painful. It hurts to nurse, but it's bearable. It's really painful to have anything touch my nipples when not nursing - even a soft bra. I travelled recently for five days and by the end of the trip - bliss! The pain was completely gone. But as soon as I returned, within two nursing sessions it was back.

I'm not prepared to stop nursing yet - and neither it she! However, everything I can find online deals specifically with biting. Any suggestions? I met with a lactation consultant, who basically said I should stop, that we've gone as long as we could.

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Permalink Reply by Bonnie P on June 16, 2009 at 5:00pm

Hi Jennifer,
Thanks for this awesome support resource for us moms. I'm from a very small town and sometimes it's hard to find other breastfeeding or even supportive women to talk to about breastfeeding issues. I have a quick question: if I want to "night wean" my 9 month old son, will that in any way effect our breastfeeding relationship during the day? We've been going so well and I don't want to ruin a good thing, but it would also be nice to sleep more than a 3 hour stretch during the night! Oh and I wanted to share a cute thing that my son does - when I ask him if he wants to nurse now, he looks at me, gives a big grin and giggles! It's so precious!
Thanks for any input you can give!
Bonnie.

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Permalink Reply by Pam on June 17, 2009 at 8:55am

Hello,

I am breastfeeding twins (age 1 year), and they aren't very interested in daytime breastfeeding. They feed at 1 p.m. and 7 p.m. But then they nurse through the night--at 11 p.m., 2 p.m., and 5 a.m. I don't want to discourage breastfeeding in general, but I would love to not be nursing them so much in the night. Is there a way to discourage this while maintaining the daytime feedings?

Also, how much formula or cow's milk should I be given them, considering how little they nurse during the day?

Thank you!

Pam

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Permalink Reply by Angela York (Yamamoto) on June 17, 2009 at 12:30pm

Congratulations on your pregnancy. We just had our second homebirth May 24. Loved it again :0)

Becky L Maher said:

I am Due July 9 2009 (planning a Home birth) just wanted to make contact so if I have any questions I can contact you ! Also reading over other questions others have asked may be very helpful!
Thanks,
Becky

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Permalink Reply by Angela York (Yamamoto) on June 17, 2009 at 12:35pm

I have 2 children ages 3 weeks and 2 years old...I'm tandem nursing. My youngest nurses every 3 hours and my 2 year old 1 to 2 times a day. I'd like to build up extra milk for my youngest when my hubby & I have date nights so that our dates don't have to be so short. However when I'm pumping I'm not getting too much -- 1 to 2 ounces at best. Any suggestions/tips?

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