My Magical Breast: Where No Breast Had Gone Before

My body is not like most. The internet tells me my odd deformity will not shorten my lifespan, but it makes me different. It affected my breastfeeding experience, but what was truly unexpected was the way breastfeeding affected my most peculiar body.

Why should you care? And why should I reveal now my unusual quirks in such a public way? While this account may be too much information for some, my story may give hope to women struggling with milk production.  So here goes.

My Peculiar Body

I appeared normal at birth. My mother told me she first noticed my defect when I was about 3 years old. My breastbone, or sternum, began to indent, creating a cavity in the middle of my chest. My mother said she couldn’t find anyone on either side of our family who had this or knew of anyone else who did. Our doctor told her not to worry.

When puberty hit, I noticed breast buds growing in my left breast but not in my right. As my teen years passed, my left breast developed normally but my right side stayed completely flat.

At age 21, my parents offered to pay for cosmetic surgery, and I decided to do it. By this time, my sternum was deeply indented and my heart was pushed to one side. (Let’s hope I never need CPR!) The plastic surgeon inserted a silicone breast implant through an incision below where my right breast should have been, and he positioned the implant sideways, so that I now had a right breast and my chest indentation was filled in. I didn’t look 100% normal—my chest was still a little sunken below my collarbone—but it was better, and I didn’t feel nearly as self-conscious.

From age 29 to 35, I gave birth to my 3 boys, and I spent a total of 12 years breastfeeding them, nursing on both sides. When I was 5 months pregnant with my first, I learned at my first La Leche League meeting that women could exclusively breastfeed twins and triplets, so I deduced correctly that one working breast was all I needed.

I loved breastfeeding and became a La Leche League leader so that I could help others meet their goals. I also served as a resource for La Leche League International for those with questions about nursing with breast implants. When controversy erupted, I even appeared on CNN to weigh in on whether breastfeeding with implants could cause later health problems in children. (Time and science found that it didn’t.)

A Stunning Discovery

In my 50s, during a routine mammogram, I received shocking news. As the technician took picture after picture, I finally said, “You do know that I have a breast implant, don’t you?” She said yes and added, “But I can’t find it.”

Eventually she found my implant on images taken in my cleavage area. She told me my implant’s location had shifted. By this time, my sternum had become so deeply indented that it nearly reached my spine. (Yes, that grosses me out, too.) Over the years, as the indentation deepened, my breast implant fully migrated into the middle of my chest. Yet even without any implant remaining in my right breast, it now appeared to be fully developed.

I was stunned to realize that my formerly “bionic” right breast was now a real breast.

How did this happen? Science tells us that a woman’s milk-making glands grow and develop during pregnancy, and after birth this milk-making tissue continues to grow (study HERE). We also know that with breast stimulation, women who have never been pregnant can grow functioning breast tissue and produce milk for adopted babies (article HERE). I was aware of all of this when my mammogram tech gave me the news, and I knew immediately that my 12 years of nursing had gradually grown a real right breast where none had grown before.

Using My Story to Help Others

How can my strange story help others? Some women plan to breastfeed only to learn that their breasts didn’t develop normally.  Called “breast hypoplasia” or” insufficient glandular tissue,” in this situation, there are not enough milk-making glands to produce 100% of the milk a baby needs. (See a wonderful book about this HERE.) This might also happen in a woman with a history of breast reduction surgery (see a another wonderful book HERE) or a transgender man who has had top surgery to remove breast tissue and later delivers a baby.

It can be devastating when someone highly motivated to exclusively breastfeed cannot. Breastfeeding is a part of our sexuality, and when a woman discovers she can’t do what others seem to do so naturally, it is a genuine loss—like infertility—that deserves to be acknowledged and mourned. In my private lactation practice, I sometimes sat and grieved with a mother who had to face this heartbreak.

Part of my job in that situation was also to discuss her remaining options. Most assume that giving up on breastfeeding is the only choice, but that is not actually true. Today, when I meet women who are struggling with low milk production, I always share my story. My long-term perspective gives them a glimpse not only of their options today, but how their choices now may affect their breastfeeding future.


Breastfeeding Options

Mothers who produce less than 100% of the milk their babies need can continue to breastfeed while giving supplements of donor human milk or formula. And they can give these supplements in a number of different ways, including something called an at-breast supplementer, pictured here. These devices allow baby to receive any needed milk through its thin tube while baby nurses at the breast.

These at-breast supplementers can be tricky and irritating to use (study HERE). But for a woman with little functioning breast tissue, while using these devices, baby continues to stimulate breast growth. If she nurses for months or years, over time this will grow more breast tissue and increase her milk production for this baby and future babies. These devices also give women who value the closeness of breastfeeding a way to nurse 100% of the time whether they make milk or not. Many adoptive mothers and mothers of babies born via surrogate use these devices so that they can fully experience the intimacy of breastfeeding.

An at-breast supplementer is usually used no longer than one year and sometimes for a much shorter time. After a baby starts eating solid foods at around 6 months, baby’s need for milk steadily decreases. At some point--8 months, 10 months, 12 months--the mother’s breasts alone meet baby’s need for milk.  At that point, mother and child can nurse for as long as they like without the need for supplements.

Of course, using an at-breast supplementer is not necessary. Some supplement their babies in other ways—feeding bottles, cups, spoons--and breastfeed to give comfort and whatever  milk they produce. For both mother and baby, from a health standpoint, some breastfeeding is always better than none. But many mothers value the bonding of breastfeeding most.

As my story shows, women dealt a low-supply card have choices. And some of these choices have the potential to change their breasts and increase their milk production in the months and years ahead. They deserve to know that they can stack the deck in their favor both for their current baby and for babies to come. If my story gives these women hope and a new perspective, I don't mind sharing my peculiarities with the world.

A Conference Not to Miss

I’m delighted to be on the planning committee of a two-day conference geared to those helping breastfeeding families during the first month of life. “Breastfeeding the Neonate” includes some of my favorite speakers—Nils Bergman, Diane Wiessinger, Catherine Watson Genna—and to make it even more wonderful, it will be held in Orlando this coming February 8 and 9.  As a Chicago native I’m thrilled to have a chance to hear some of the best speakers in our field while enjoying a little warmth and sunshine.  How about you?

If you’re feeling tempted, don’t wait to register. There are only 200 seats available, and with this amazing roster of speakers, I expect these 200 seats to fill quickly. All of the conference details are available HERE. This event page also includes links to online registration. You may download the conference brochure HERE.

As another huge plus, we’ve been fortunate to secure an affordable venue that offers:

  • An in-season hotel room rate of only $139 per night (until January 16, 2016)
  • Complimentary airport shuttle
  • Complimentary wi-fi
  • Complimentary parking                                                                                                                                      

12.25 L CERPs have been awarded for this event by the International Board of Lactation Consultant Examiners, and this activity has been submitted to the Ohio Nurses Association (OBN-001-91) for approval to award contact hours.  The Ohio Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Conference registration also includes a Dessert Reception with the Speakers on Monday evening to give you special one-on-one time with these incredible people. This conference is sponsored by Family Health Coaching, a wellness organization run by Dr. Theresa Nesbitt, the obstetrician who appears in many of the videos on my YouTube channel HERE. Dr. Theresa will also be speaking on the Neurology of the Newborn and joining me for two other talks.

Take a break from winter to update your breastfeeding skills and knowledge.  What makes a breastfeeding newborn different from an older nursing baby? How should these differences inform our approach? Based on the most current research and clinical insights, our international experts will share practical and effective strategies for the initiation and continuation of breastfeeding during the neonatal period. We hope you can make it!


Why Do Milk Storage Guidelines Differ?

Reading different milk storage guidelines from different sources can be crazy making! Which guidelines are right? Why don't the experts agree? What do you really need to know?

The good news is that there are logical explanations for these differences. And once you know them, you can store and use your milk with confidence.

 Ideal Versus Okay

In the guidelines provided at the end of this post, some storage times for refrigerated and frozen milk are labeled “Okay” while others are labeled “Ideal.” Within the “Okay” times, expressed milk should not spoil. Between "Ideal" and "Okay," the milk is still good, but more vitamins, antioxidants, and other factors are lost. Some health organizations, like the Academy of Breastfeeding Medicine, recommend the shorter "Ideal" times because they prefer you use your milk before this loss occurs. 

It is always better to use your milk sooner rather than later, but your milk should not spoil within the "Okay" time frames. Milk found in the back of the fridge after 8 days will still be far better for your baby than formula. 

What Temperature Is Your Room?

Some milk storage guidelines also vary because they define room temperature differently. If you live in a tropical or subtropical climate, the higher room-temperature range in the guidelines below may better fit your reality. In the temperate zones, the lower range may better fit yours, at least during colder seasons.

Previously Frozen or Not?

Storage times for fresh and refrigerated milk are longer than for previously frozen milk. Freezing kills antibodies, which protect milk from spoilage. When the milk's live cells are dead, it spoils faster. When in doubt, smell or taste it. Spoiled milk smells spoiled.

Your Situation Makes a Difference

If you’re still in doubt about which guidelines to follow and how best to store your milk, ask yourself the following questions.

Is your baby healthy?  These guidelines are intended for full-term, healthy babies at home. If your baby is hospitalized, your hospital’s milk storage guidelines are likely shorter than these. Preterm and sick babies are more vulnerable to illness, so pumping and storing recommendations may be stricter.

How much expressed milk does your baby get?  If your baby gets most of her milk directly from your breasts, you don’t need to worry about whether the small amount of expressed milk she gets is fresh, refrigerated, or previously frozen. If a large percentage of your baby’s milk intake is pumped milk, consider your choices more carefully. Freezing kills antibodies, so rather than freezing all of your pumped milk, feed as much fresh or refrigerated milk as possible. But even without the antibodies, frozen milk is still a far healthier choice than formula.

Milk Storage Times for Full-term Healthy Babies at Home

Room Temperature (66°F-72°F/19°C-22°C)

• Fresh, never frozen: 6-10 hr

• Frozen then thawed: 4 hr

• Frozen then thawed, warmed but not fed: Until feeding ends

• Frozen then thawed, warmed and fed: Until feeding ends

Room Temperature (73°F–77°F/23°C–25°C)

• Fresh, never frozen: 4 hr

• Frozen then thawed: 4 hr

• Frozen and thawed, warmed but not fed: Until feeding ends

• Frozen then thawed, warmed and fed: Until feeding ends

Insulated Cooler with Ice Packs

• Fresh, never frozen: 24 hr

• Frozen, thawed: Do not store

• Frozen then thawed, warmed but not fed: Do not store

• Frozen then thawed, warmed and fed: Do not store

Refrigerator (39°F/4°C)

• Fresh, never frozen: Ideal: 72 hr, Okay: 8 days

• Frozen then thawed: 24 hr

• Frozen then thawed, warmed but not fed: 4 hr

• Frozen then thawed, warmed and fed: Discard

Refrigerator Freezer (variable 0°F/-18°C)

• Fresh, never frozen: 3-4 mo. 

• Frozen then thawed: Do not refreeze

• Frozen then thawed, warmed but not fed: Do not refreeze

• Frozen then thawed, warmed and fed: Discard

Separate Deep Freeze (0°F/-18°C)

• Fresh, never frozen: Ideal: 6 mo, Okay: 12 mo. 

• Frozen then thawed: Do not refreeze

• Frozen then thawed, warmed but not fed: Do not refreeze

• Frozen then thawed, warmed and fed: Discard


Jones, F. Best Practices for Expressing, Storing and Handling Human Milk, 3rd edition. Raleigh, NC: Human Milk Banking Association of North America, 2011.

Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo, TX: Hale Publishing, 2010.


Looking for a Baby Gift?

Want to give friends and loved ones with Apple devices the gift of breastfeeding confidence? Just follow the simple steps above. The Breastfeeding Solutions app--my antidote to Dr. Google--is a great starting point for any breastfeeding question or concern.  Unlike a book, it's always on hand and once downloaded, users automatically receive updates as new information is added.

Now it's easy to share the gift of confidence.

"Latch Issue Solved! (5 star review): BFing had been going great up until the last week. Thankfully this app has helped baby & I to regain our wonderful BFing experience! I can't wait to read through all of the helpful tools." --Vti10 "Need a great breastfeeding app? The Breastfeeding Solutions app by Nancy Mohrbacher, IBCLC, FILCA is it! I installed it as soon as it was available, and have found it to be easy to use, and full of excellent information."

What Does It Mean to 'Use Your Breast as a Pacifier?'

Nursing mothers are commonly warned: “Don’t let your baby use your breast as a pacifier.” Although often said, this is an incredibly curious statement. After all, which came first, the breast or the pacifier?  The breast, of course, long predates the pacifier (aka “dummy”), a man-made device designed late in human history to soothe babies as a breast substitute.

If the pacifier is indeed a breast substitute, then what on earth could it possibly mean to let your baby “use your breast as a pacifier?”

What Is the Real Message?

The assumption underlying this advice is that baby’s desire for the breast is unreasonable. After all, if the baby’s need for milk was legitimate, the pacifier would never do. By definition, no milk flows from a pacifier. The point seems to be that if the baby nursed “long enough” (and the number of acceptable minutes varies by adviser), the baby no longer needs milk, so sucking on a pacifier should be good enough. However, as explained in THIS POST, some babies are fast feeders and others are slow feeders. The number of minutes a baby nurses tells us nothing about the volume of milk consumed.

Do babies sometimes breastfeed without taking milk? It does happen. Every so often you may notice your baby softly mouthing your breast while mostly asleep. In this case, your baby may indeed be sucking but not drinking. Is this what those who say “Don’t let your baby use your breast as a pacifier” are referring to?

I don’t think so. This advice usually follows a weary mother’s report of a marathon nursing session, a common occurrence in the early weeks.  “Cluster nursing,” or bunching feedings close together during part of the day, is a fast-growing baby’s way of boosting milk production when needed. This works because “drained breasts make milk faster.”

However, if a mother regularly substitutes a pacifier for her breast at these times, this can short-circuit her baby’s efforts to increase her milk. That’s why the American Academy of Pediatrics (AAP) recommends babies be breastfed on cue (see the 2012 AAP policy statement HERE). The AAP encourages parents to feed their babies whenever they show feeding cues (increased activity, rooting, mouthing), no matter how often these cues appear.

Babies’ feeding cues are never unreasonable, according to the AAP. In fact, during the first month, while milk supply is being established, the AAP specifically recommends avoiding pacifier use precisely because too-frequent use of this “breast substitute” can undermine the establishment of a healthy milk supply.   

Can Your Baby Be Trusted?

But there’s another aspect to this “Don’t let your baby use your breast as a pacifier” advice that is positively insidious. The idea that a mother must be careful not to let her baby “use her” has the potential to undermine her trust in her baby, driving a wedge between them and preventing them from getting in sync the way nature intended. This curious warning is the not-too-distant cousin of the indefensible Western myth that newborns can “manipulate” their parents, even before they have the mental ability to do so.

As a case in point, a mother recently said to me at a mother-support meeting that her baby girl didn’t really need to nurse whenever she showed feeding cues because she was mostly doing “non-nutritive sucking.” This mother had been struggling with her baby’s slow weight gain and had recently started nursing more often instead of sticking to the feeding schedule she had first adopted. Because this baby was breastfeeding more, her weight gain had improved.

I asked this mother how she knew her baby was getting no milk during her time at the breast (which is what happens during “non-nutritive sucking”). I could see the realization dawn in her eyes. Smiling, this mother admitted that she really didn’t know that.  I told her that I always assume a baby nursing at breast is getting milk.

At that moment, this mother realized that second-guessing her baby had been counterproductive for them both. She understood that to fully resolve her baby’s weight-gain issues she had to trust her baby to know what she needed, when she needed it, and for how long. (Her baby was full term and healthy, so she could follow her baby’s lead with confidence.) When she made the decision to trust her baby, it became her baby’s job—not hers—to know when to nurse. While I watched these mental wheels turn, this mother visibly relaxed as she felt her burden lifted.

Who Needs This World of Hurt?

What does it mean for your baby to “use your breast as a pacifier?” When you think it through in terms of how breastfeeding works, it is actually total nonsense. But if a mother buys into the assumptions that underlie this advice, it opens her up to a world of hurt. Believing that she has to guard against her baby “using her” has the potential to undermine breastfeeding, her relationship with her baby, and indeed her whole outlook on motherhood. Who needs this kind of negative take on their baby? Even without it, new motherhood is challenging enough.

Where did this odd outlook come from? I’m guessing it stems from formula-feeding norms. After all, when babies are bottle-fed, overfeeding is a genuine risk. Milk from a bottle flows so fast and consistently that babies have little control over their milk intake. At the breast, on the other hand, due to the alternating fast-then-slow milk flow from letdowns, breastfeeding automatically teaches our babies healthy self-regulation. (For more on how breast and bottle affect risk of overfeeding and obesity, see THIS 2012 study.)

To prevent overfeeding during bottle-feeding, it may actually make sense to stop a feed before baby appears to be done and give him a breast substitute to suck on so that his appetite control mechanism has a chance to activate. (Giving a baby regular breaks from fast milk flow while being bottle-fed is one way to prevent overfeeding and is one aspect of the paced bottle-feeding described HERE.) But even though this strategy may be good during bottle-feeding, it is definitely not good when breastfeeding.

Babies know what they need. A happy and satisfying breastfeeding relationship is built on a mother’s trust in her baby. Only in places where formula-feeding norms are still alive in the cultural memory could the “Don’t let your baby use your breast as a pacifier” advice take root and gain traction. If we want to make our world more breastfeeding friendly, part of our job must be to discredit this kind of misguided advice.  


The Clock and Early Breastfeeding

The clock looms large in the lives of many breastfeeding families. When a new baby is born, some parents are told or make assumptions about:

  • How many minutes their baby should breastfeed
  • How long their baby should be satisfied between feedings
  • The longest stretch of time their baby should sleep

Does it make sense to focus on time during the early weeks of breastfeeding? Let’s take a closer look.

What Do Number of Minutes Spent Breastfeeding Tell Us?

One common recommendation is to make sure newborns feed at least 10-15 minutes on each breast and take both breasts at each feeding. But that’s not always possible.

One mother and baby I saw in my private practice stand out in my mind. This mother called me with concerns about her 5-day-old daughter. The baby was born at just 5 pounds and she would only take one breast for 5 minutes before completely shutting down. She also refused one breast completely. I scheduled a home visit and brought my trusty scale. Unlike scales for sale at baby stores, this one was so accurate (to 2 grams) that it could reliably measure baby’s milk intake at the breast.

First I weighed her little girl with her clothes on for a “before” weight. With some small tweaks in positioning, we convinced her to take the breast she had previously refused. I watched her as she nursed. I didn’t see much jaw movement, and I didn’t hear any swallowing. Sure enough, after 5 minutes, she came off her mother’s breast and was unwilling to continue.

I put her back on the scale and to my amazement discovered she had taken 2 oz. (60 mL) of milk, way more milk than most babies this age take during a breastfeeding. (At 5 days, average milk intake per feeding is more like 1 oz., or 30 mL.) When this mother realized that her baby was such a fast, effective feeder, she relaxed. Her baby was doing fine.

Later that day, I saw another mother and her 10-day-old baby boy. This mother was worried because her little guy was spending more time nursing than she was told was normal, around 55 minutes at each feeding. This time my scale showed that he consumed the same amount of milk (2 oz. or 60 mL) in 55 minutes as the baby girl had taken earlier in the day in 5 minutes. Rather than being a fast eater, like the little girl, this baby boy was a slow eater.

How many minutes should a baby breastfeed? There’s not a simple answer. Just like adults, some babies are fast eaters and others are slow eaters. The number of minutes your baby feeds does not tell you anything about how much milk he consumed. On average, it takes most newborns somewhere between 5 and 55 minutes to finish a breastfeed. Both fast and slow nursers usually have periods of wide jaw movements along with some pauses. Over time, most babies get faster and more efficient at breastfeeding, so as they grow, the slow eaters usually speed up and get the same amount of milk (or even more milk) in less time.

Also like adults, your baby may be hungrier at one feed than another, so feeding longer or shorter at different feedings is not a cause for concern. This is perfectly normal. Being finished after one breast at some feedings and wanting both breasts at some feedings is also perfectly normal.

Does the Number of Minutes Between Feeds Mean Anything?

Not really. The most important thing to focus on is how many times each day your newborn breastfeeds. (Count one feeding as any amount of breastfeeding from one or both breasts followed by at least a 30-minute break.)

Most tiny babies need to breastfeed at least 8 to 12 times every 24 hours, but many parents do the math and assume this means they should expect their baby to be satisfied for 2 to 3 hours between feedings. Until your baby is a little older, usually after about the first 40 days or so, regular feeding times are uncommon. This 2-minute YouTube video from my YoutTube channel explains what to expect during the first 40 days.

As it describes, in the beginning, most breastfed newborns bunch their feedings together during wakeful times or “cluster nurse.” For this reason, it’s not helpful to focus on when baby fed last. Whenever baby shows feeding cues (increased activity, rooting, mouthing), assume it’s time to breastfeed again. Yes, even if it’s only been 10 minutes. If baby seems hungry again soon after feeding, don’t worry about overfeeding and don’t consider it a reflection of your milk production. It’s just what newborns do. This is how your baby helps you build a healthy milk supply.

There is no value whatsoever in trying to convince your baby to go for longer stretches between feeds. Newborns have no sense of time, and putting your baby off only adds stress to your life. If your baby seems interested in feeding or is fussy, try nursing first, and if that doesn’t help, move on to other comfort techniques. As your baby grows and matures (and his stomach grows and can hold more milk), he will naturally become more regular in his feeding patterns. You don’t have to do anything to make this happen.

How Long Is It Okay for a Newborn to Sleep?

Beginning on about second night after birth, don’t be surprised if your newborn goes into a feeding frenzy just about the time you’re thinking about going to bed. Most babies are born with their days and nights mixed up. That’s why it’s best for the sake of your own rest and recovery to sleep when your baby sleeps so that you’re rested and ready for more feedings at night.

It’s not uncommon for a brand-new baby to have one 4- to 5-hour sleep stretch, but it is often during the day. As long as your baby fits in at least 8 feedings every 24 hours and is gaining weight well (after Day 4, an average of about 1 oz. or 30 g per day), there’s no reason to wake your baby to feed.

It usually takes a few weeks for your baby’s body clock to get closer to yours. To speed up this process, try keeping stimulation to a minimum at night (lights low, sounds low, no diaper changes unless baby has a stool). Make daytimes full of light, sound, diaper changes, and before you know it, baby will be taking her longer sleep stretch at night.

Gaining Confidence in your Milk Production

Your baby’s feeding patterns are not a reflection of your milk production. But there are other ways you will know that your baby is getting the milk she needs. Her stool color is one sign. If breastfeeding is going well, your baby’s stool will turn from black to green by about Day 3 and green to yellow by Day 4 or 5. Weight gain is the best way to gauge your baby’s milk intake and your supply. Once baby reaches her low weight on Day 3 or 4, expect a weight gain of about 1 oz. or 30 g per day. Weight gain is the gold standard of healthy milk intake and milk production.

When it comes to breastfeeding and the clock, keep in mind that breastfeeding has been around much longer than clocks. In other words, you don’t need a clock to make breastfeeding work. Sometimes too much focus on the clock can even cause problems by shifting your focus away from what really matters.

Your baby will tell you everything you need to know. The American Academy of Pediatrics recommends breastfeeding babies on cue rather than on a schedule. (See its 2012 policy statement HERE). Don’t be distracted by the clock. Instead, watch (and trust) your baby.



Free and Almost Free WBW Goodies

Happy World Breastfeeding Week (WBW)! In my last post I described some of my new creations that relate to this year’s WBW theme, “Breastfeeding and Work: Making It Work!” In the US, WBW starts today. I also have a few other offerings related to this theme that are free or almost free.

On this newly designed website, I now have a Handouts section, which includes two handouts (no surprise!) available to download freely and distribute widely. The first is a two-sided sheet, For the Caregiver of a Breastfed Baby. It describes how to avoid overfeeding and ways to support breastfeeding mothers. The second, When Stored Milk Smells Soapy or Rancid, contains essential information for any woman planning to store her expressed milk. It describes high-lipase milk (which often develops a soapy taste and smell during storage), and if you have it, what to do to ensure in the months ahead that your baby will accept your stored milk.

Another free resource is my webinar, Working and Breastfeeding Made Simple, which was chosen as the free bonus talk for the month of August 2015 on the website Please share this link with any mothers with an interest in this topic.

Like last year, I’ve also slashed the price of my Breastfeeding Solutions app. Usually $4.99 USD, only from August 1 to August 7 this go-everywhere source of breastfeeding info and help will be available at LESS THAN HALF PRICE: $1.99 USD. Please take advantage of this special deal to get it on the phones of many more pregnant women, new mothers, and breastfeeding supporters worldwide.

Have a great week! And let me know how you’ll be celebrating.

World Breastfeeding Week 2015

"Breastfeeding and Work: Let’s Make It Work!" is the 2015 theme for World Breastfeeding Week (WBW), which in my part of the world happens August 1-7. The official WBW materials are now available at

As you make your WBW plans, if you like my “Made Simple” approach to breastfeeding, please consider some of my creations. If you’re looking for books for giveaways, my 2014 Working and Breastfeeding Made Simple—available in paperback and e-formats—is the most up-to-date resource for employed mothers. You can hear me talk about its approach on my latest podcast here. Want details on bulk discounts? Contact

Brand new last week from Noodle Soup (and perfect for busy millennial moms) is my Working and Breastfeeding infographic (left), available in tear pads of 50 for $10. One side is English, the other side Spanish. You can order it online here.

Also available through Noodle Soup is my brand-new low-literacy brochure, Ten Tips for Working and Breastfeeding (right), which you can order online here. At $0.22 each, it is the newest addition to Noodle Soup’s Ten Tips series.

I always love hearing about the many ways you celebrate WBW. Have a great one!


Introducing Natural Breastfeeding

All mammals are born with responses that Mother Nature builds in to enable them to get to their food source and feed. Yet today, the way most mothers are taught to breastfeed ignores what our babies bring to the table, making early breastfeeding harder than it needs to be. It’s no wonder then that during the first week after birth, 92% of the nursing mothers in one study reported major breastfeeding challenges.

Instead of tackling individually each breastfeeding issue—latching struggles, milk supply concerns, sore nipples--what if there was a single way to address many challenges at once? That’s what Natural Breastfeeding is all about.


What are the roots of this innovative new approach to early breastfeeding? To create the Natural Breastfeeding program, obstetrician Theresa Nesbitt (“Dr. Theresa”) and I drew from the work of many: the Swedish breast-crawl researchers, UK scientist Dr. Suzanne Colson, international brain-science experts, the Prague School, and Americans Dr. Christina Smillie and Dr. Brian Palmer. When we put together these diverse-but-related puzzle pieces, what emerged was our new prenatal preparation program, Natural Breastfeeding: For an Easier Start.

Every baby is born with her own internal GPS, so baby knows where she is and what to do. If a mother knows how to activate and use her baby’s GPS, she can avoid many common early breastfeeding struggles. At the same time, Natural Breastfeeding allows a mother to relax completely, so she can nurse in comfort and rest while baby feeds. In most cases, she can even breastfeed hands free. By taking full advantage of an infant's inborn feeding behaviors, even a brand-new baby can be the active breastfeeding partner Mother Nature intended.

The Natural Breastfeeding program prepares pregnant women for breastfeeding with more than 60 short videos and 100 images of diverse women learning about and using Natural Breastfeeding. This interactive program, which mothers can access on their tablets, computers, and smartphones, is mother-friendly, jargon-free, and fun.


Amazingly, science has already weighed in on this 21st century innovation. One 2015 study found that tablet-based prenatal breastfeeding education can increase breastfeeding initiation, duration, and exclusivity. In other words, this modern, high-tech approach works and can help more mothers reach their breastfeeding goals.

Before a pregnant woman gives birth, the demonstration videos and simple exercises in the Natural Breastfeeding program make its concepts clear and integrate its moves into her body memory. Even if her birth attendants are unfamiliar with this approach, after completing this program, a mother should be able to make it work on her own.


Natural Breastfeeding is like the training wheels on a bicycle. While mother and baby are learning, it helps them avoid unnecessary pain, strain, and struggle. By making the most of what baby can do, Natural Breastfeeding helps mothers use the behaviors built in by Mother Nature to successfully feed and nurture their newborn.

Intrigued? To view some of our basic videos, go to my YouTube playlist HERE, our "How-Tos" Prezi HERE, or browse the videos on my YouTube channel HERE.

If a pregnant woman wants to prepare for breastfeeding rather than just planning to breastfeed, she can download this program at

Please help us spread the word.

Tongue and Lip Ties: Root Causes or Red Herrings?

Tongue tie photo.jpg

Tongue and lip ties are red-hot issues. There’s no doubt that tongue tie causes suffering for some breastfeeding mothers and babies when baby’s "lingual frenulum" (the membrane under the tongue that connects it to the floor of the mouth) prevents normal tongue movement. Also known as ankyloglossia, ultrasound research (link HERE) shows that restricted tongue movement in a breastfeeding baby can lead to nipple pain and/or poor milk intake. When tongue tie is the root cause of a breastfeeding problem, this needs to be addressed pronto.

What is a lip tie? This refers to restricted lip movement from a tight "labial frenulum," the membrane that connects baby's upper lip to her gums. To tell the difference between a normal labial frenulum and one that can cause problems, see this online article (link HERE) by Oregon ear, nose, and throat (ENT) surgeon Bobby Ghaheri.

An Epidemic?

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision, a minor office procedure to release the tie. Some mothers describe taking their babies for multiple revisions with no pain relief or improved milk intake during breastfeeding.

There is very little that is "right" or "wrong" about breastfeeding choices. What matters is whether a strategy brings a mother closer to meeting her breastfeeding goal or moves her further away from it. If self-diagnosis corrects the problem, great. But if it doesn't--if the self-diagnosis is a red herring--it can prolong suffering and lead to complications, making getting back on track more difficult.

Studying Tongue Tie

A recent study (link HERE) offers a new perspective on the tongue-tie epidemic. It found that tongue tie is NOT a common source of breastfeeding problems and reinforced what we’ve always known. When a mother is in pain or the baby’s weight gain is low, the best place to start is by focusing on basic breastfeeding dynamics, such as how the baby latches and baby’s feeding patterns.

What did this new study find? One of the doctor-researchers trained the others to identify infant tongue tie using the Coryllos tongue-tie classification system, which defines four types, including posterior tongue tie. After making sure everyone was using the same definitions, they began visually examining the tongues of 200 healthy babies during their first 3 days of life and used a gloved finger to feel the frenulum under their tongue. During the study, the researchers were blinded to any breastfeeding problems.

What Are the Odds?

Amazingly, 199 of the 200 babies were identified with 1 of the 4 types of tongue tie. However, only 3.5% (7 babies) had breastfeeding problems related to tongue restriction. A tongue-tie revision solved the breastfeeding problem in 5 of these 7 babies.

As a result of these findings, the authors suggested we change our terms. “Short frenulum,” they said, should be abolished, because the frenulum can’t be accurately measured. They suggested the term “asymptomatic tongue tie” for the vast majority of babies (192 out of 199) who had an identified tongue tie and no breastfeeding problems and “symptomatic tongue tie” for the few (7 of 199) in whom the tongue restrictions affected breastfeeding. Clearly, even if a baby has an obvious tongue tie, we should not assume it is the root cause of a mother’s nipple pain or baby’s weight-gain issues. It makes sense in these cases to see if other interventions may help alleviate the problem.

Just to be clear, this study included mothers and babies without breastfeeding problems as well as those with breastfeeding problems. Obviously, among mothers and babies having breastfeeding problems (those seen by most lactation consultants), the percentage of babies with symptomatic tongue tie would be higher.

Why Does It Matter?

If tongue-tie and lip-tie revisions are minor office procedures, why do unnecessary revisions matter? As the researchers point out, complications are rare, but sometimes excess bleeding can occur. Also, the procedure can cost parents hundreds of dollars out of pocket.

But there is an even more important reason this matters. When mothers focus only on tongue or lip tie, other issues may be overlooked and problems can continue for weeks or months. When adjusting to life with a newborn, no family needs this kind of unnecessary stress. In one study, long-term, ongoing nipple pain was linked to depression and sleep problems in mothers. A U.S. lactation consultant colleague who works in a large, breastfeeding-friendly pediatric practice put it this way:

I appreciate the growing awareness of tongue- and lip-tie issues and health providers willing to do interventions. Yet often the diagnosis is coming from friends, Dr. Google, and Facebook discussions. It has become so widespread that many mothers look first to a possible tie and other issues get buried. I now encounter the following scenarios frequently:

1. Mothers who believe their baby has a tongue or lip tie and consider this the primary cause of low supply, failure to latch consistently, weight gain issues, mastitis, nipple pain, etc., etc. They may spend so much time pursuing tongue tie as the root cause that they fail to address other possible causes and find themselves in a bigger jam. They may be dealing with a tongue tie plus something else, but addressing only the tongue tie will not fix things completely. Sometimes there is no tie at all.

2. Mothers with well-gaining, happy, exclusively breastfed babies who experience no discomfort yet feel their baby has a tie that needs to be revised. Some mothers schedule consults for this with me after seeing an ENT doctor who has told them there is no issue. Many say that ENTs and other doctors don't know what they're doing with tongue ties, which in some cases may be true. Yet their ongoing search for a “cure” in the absence of an issue makes breastfeeding fraught with worry, rather than the satisfying and empowering experience it should be.

One Mother’s Story

During my visit to Ireland 18 months ago, I attended a La Leche League meeting. Also attending was an Irish mother coming for the first time. She had taken her 3-month-old baby to the doctor for a tongue-tie revision but was still experiencing nipple pain. The group’s leaders asked me to talk with her. As she breastfed, I noticed an obvious shallow latch. No wonder she was sore!

I asked this mother if she had ever seen a breastfeeding supporter about her pain. She said no. She had gone online, done some reading, and assumed her problem was tongue tie. She then went to the doctor and asked for a tongue-tie revision. Throughout all this, she was breastfeeding shallowly and that hadn’t changed. With a shallow latch, her nipple was compressed against her baby’s hard palate, causing pain. I told her I thought that a small tweak in how her baby latched to her breast was probably all she needed to make breastfeeding comfortable. I explained that there is a place in her baby’s mouth called the “comfort zone,” and when the nipple gets there, there is no friction or pressure.

#1 Cause of Nipple Pain

How often does a deeper latch solve breastfeeding problems? A French lactation consultant checked the records of her private practice during a 6-week period and found that of the 37 mothers who came to her with nipple pain, a deeper latched resolved the pain completely in 65% (Darmangeat, V. The frequency and resolution of nipple pain when latch is improved in a private practice. Clinical Lactation 2011; 2(3):227-24). Other causes of pain included bacterial and yeast infections, skin conditions, and yes, tongue tie.

During my 10 years in private practice, getting a deeper latch resolved pain in about 85% of the mothers I saw. A deeper latch can also improve baby’s milk transfer, giving baby more milk with every suck.

Don’t Assume, Seek Help

Is tongue- or lip-tie revision the right thing to do for some breastfeeding mothers and babies? No question! But because tongue tie is the root cause of the problem for a minority of babies, it is a terrible place for most mothers to start. When nipple pain or weight-gain issues occur, a much better starting point is to contact someone who can help adjust baby’s latch and evaluate baby’s feeding pattern.

Free breastfeeding services are available in most areas through volunteer mother-to-mother support organizations and public health departments. Another option is to see a board-certified lactation consultant (link HERE). Make it a number-one priority to quickly find and address the root cause of the problem. Trying to live with an ongoing, unsolved breastfeeding problem is a type of misery no woman should have to endure. Don't go it alone. Seek help, and always start with the basics.

Coping with Fast Milk Flow

Mother's question: "I need help! My daughter is a week old tomorrow and I can’t seem to get my milk flow under control. It just pours out and she chokes. What do I do to make it easier for her?"

During the early weeks, while your milk supply is adjusting to your baby’s needs, your feeding position can make all the difference. If you sit straight up during feedings, your milk flows downhill into your baby’s mouth, which makes coping with milk flow more difficult for her. Instead, use positions like those pictured here. Move your hips forward and lean back with baby’s whole body resting on yours so your baby’s head is higher than the breast. In these positions, gravity makes milk flow easier for her to manage. Many mothers also find these positions much more comfortable.

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You can read more about these positions at this post.

Lying on your side to breastfeed can also help because baby can let overflow milk dribble out of her mouth rather than having to swallow fast to prevent choking. (Lay a towel under baby first!)

Most important is never to hold your baby’s head to your breast when she wants to pull off and catch her breath. Fingers crossed these tips help!

Don’t Miss It! Breastfeeding Solutions App FREE August 1 to 7

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This year my World Breastfeeding Week (August 1-7) gift to the world is to make my newly redesigned Breastfeeding Solutions smartphone app (usually $4.99) FREE to everyone. No need for a promo code. For this limited time, my app will simply be FREE from AMAZON'S APPSTORE (for Android phones) and the APP STORE (for iPhones). Due to Google Play’s pricing rules, it will be 99 cents there.

Download it now AT NO CHARGE, and all future updates will be FREE, too.

To see how my app works, check out its 2-minute YouTube video. You are also welcome to share the above image. The badges below are direct links to download the free app.

Will you please help me spread the word? I’d love for my friends around the world and the mothers they help to take advantage of this unique opportunity to take my app for a test drive.

Happy World Breastfeeding Week!

Reviews of the Breastfeeding Solutions App "Need a great breastfeeding app? The Breastfeeding Solutions app by Nancy Mohrbacher, IBCLC, FILCA is it! I installed it as soon as it was available, and have found it to be easy to use, and full of excellent information."

Best for Babes Foundation: "It appears that Nancy Mohrbacher, IBCLC, FILCA has created the WORLD'S BEST BREASTFEEDING APP. If you don't want to waste hours googling answers to your breastfeeding issues, or reading through thousands of threads, this app is for you." 

Elise F. (mother-to-mother breastfeeding counselor): “I find myself using the app all the time when responding to questions from new moms.  It's easy to navigate and gets me to the answers I need quickly.  I am also able to use it as a sort of 'checklist' when sharing info with moms to make sure I've not forgotten anything.”

Radiolana:“An app written with the new mother in mind—concise and respectful troubleshooting with links to information for further reading. Have seen no app better than this!”

amaag4:"Just recently I became concerned with my BFing supply. I was very worried and google was giving me mixed answers. An LC in my area posted this, so I decided to buy it. Within the first 10 seconds of looking through the app I found exactly what I was looking for. I can't wait to read through other concerns!"

Dana Thomson: "Worth every penny! Helped save my breastfeeding relationship! I recommend this to anyone who wants to breastfeed. Regardless of whether or not you have a problem."

Free Publicity?


What business wouldn’t love free publicity? Well, for one, lactation consultants, when the free publicity is coming from a company that violates their professional ethics.

Day before yesterday I received an email from Erin, who works for a public-relations firm representing infant bottle manufacturer, Munchkin. It started, “In light of your very focused blog content around breastfeeding I wanted to touch base with some news from a company that is offering a unique solution and unrivaled support for breastfeeding moms.” She went on to describe how Munchkin’s new bottle line is “like the breast” and has an “anti-colic valve.” Of course these are the same kind of baseless claims made by all of the bottle manufacturers, and I knew better to accept them at face value.

However, that wasn’t the worst of it. Erin went on to say:  

"Taking it a step beyond traditional bottle manufacturers to fully demonstrate their support of breastfeeding mothers, Munchkin is also providing moms with a Lactation Consultant Database ( because they understand just how many challenges they may face in this process and want to help them achieve their individual breastfeeding goals."

That got my attention. When I followed the link to the Munchkin site, above its Lactation Consultant Locator was copy that sounded for all the world as though lactation consultants endorsed its products. You have to read the following very carefully not to get that impression:

"We partnered with lactation consultants to develop our [xyz] bottle because we believe they offer the best expert advice for breastfeeding Moms. While we worked with a select few, there are thousands across the country that can help you reach your breastfeeding goals. If you’re a mom who needs help on how to get a good latch, how to increase milk production, or how to find the best breastfeeding position, find a Lactation Consultant in your area by simply entering your zip code or address below:"

When I entered my zip code in the locator, I noticed that all of the IBCLCs in my area came up. It appeared as though Munchkin had created this list from other sources. And I was almost positive that none of those listed knew that their names were connected online to this company and its products.

I responded in two ways. First I wrote back to Erin to say:

"As an FYI, I left a lucrative position with a company when it started to market its infant feeding bottles and nipples directly to parents, which is in violation of the World Health Organization's International Code of Marketing of Breast-Milk Substitutes and counter to my code of professional conducts. Munchkin’s marketing claims are part of the problem, not part of the solution.

"I know that many of the IBCLCs currently listed on Munchkin’s Lactation Consultant Locator have no idea that their names are connected to Munchkin in this way. It needs to ask permission before including their names and contact information on its website. Please remove me from your contact list."

Then I posted on Lactnet, my professional listserv and included Erin’s email, her links, and my reply. Just as I suspected, the emails began coming from colleagues thanking me for letting them know and copying me on their emails requesting they be removed from the locator. When checking the locator, one lactation consultant found her home address listed. Another was listed at her husband’s office. To be removed, call or email Monica Kapadia, Marketing Manager at Munchkin, at: 818-221-4241 or You can also contact Munchkin directly at this link.

As a side note, just before uploading this post, I got word that Munchkin had taken down its locator, no doubt due to the unexpected pushback. (If you need to find a lactation consultant, go instead to the website of lactation consultant professional association, which has permission to list their contact information.)

Were those at Munchkin doing a good deed for the breastfeeding community? Some of them may have thought so. But they were also using the good name of our profession to hawk its products and imply our endorsement. Is all publicity good publicity? Not in this case.

Green Poop: When Should You Worry?

Baby poop is high on many new parents’ worry list. How often should baby poop? Does baby’s poop provide clues to how breastfeeding is going? What do color and consistency mean? When should you worry?


Normal Color and Consistency

Baby’s first stools are the black and tarry meconium that was in her gut at birth. When breastfeeding is going well, by about the third day, baby’s poop changes to “transitional stools,” which have a dark greenish color. By the fifth day or so, the poop’s color changes again to yellow. Its consistency now (and until baby begins consuming anything other than your milk) may look like split pea soup, liquid with seedy bits in it. But if your baby’s poop is all liquid and no seeds, this is also normal.

Baby’s yellow poop is made mostly from the fat in your milk. During the first six weeks, babies gaining weight well usually poop at least 3 to 4 times a day with stools at least the diameter of a US quarter (22 mm) or larger. There is no such thing as too many poops. (Lots of pooping just means your baby is getting lots of milk, which is great.) But too few poops mean it’s time for a weight check.

If your baby is younger than 6 weeks old, is pooping fewer than 3 to 4 times per day, or her stools haven’t turned yellow by the fifth day, a weight check will tell you if this is just a normal variation or a cause for concern. It’s not until after 6 weeks that some healthy breastfed babies poop much less often, sometimes even once a week. Check baby’s weight at a health-provider’s office. A bathroom scale just won’t do. A weight gain of about 1 oz. (30 g) or more per day indicates that all is well. No matter what your baby’s age, as long as she is gaining weight well, don’t worry if she has fewer stools than expected.

Causes of Green Poop

Despite what you may have heard (see the next section), green and brown are in the normal range of poop colors. They are not a reason to worry if baby seems well and is gaining weight.What can cause green poop?

  • Your diet. Eating lots of greens or other green foods or drinks (green gelatin, green sodas, green sports drinks) can turn poop green. Natural and artificial food colors can change the color of both your milk and baby’s poop.
  • A tummy bug. When your baby is ill, this can cause a change in poop color that may last for weeks. Keep breastfeeding! It’s the best way to help baby recover.
  • Oversupply. If you produce so much milk that your baby receives mostly high-sugar/low-fat milk, it may overwhelm baby’s gut and cause watery or green stools. (Click HERE more details and tips for adjusting milk production downward when needed.)
  • Ineffective breastfeeding. If on the fifth day, baby’s stools turn green instead of yellow, as in the case of oversupply, this may be a sign that baby can't drain the breast well enough to get past the low-fat/high sugar foremilk. In this case, though, a health or anatomy issue (like tongue tie) may be the cause. Unlike oversupply, baby’s weight gain may or may not be below average. Now is the time to see an IBCLC.
  • Sensitivity to a food or drug. When a sensitive or allergic baby reacts to a drug you’re taking, something in your diet, or something baby consumes directly, this may turn her poops green or mucusy. You may even see bits of blood in it, which is not considered serious. (Click HERE for info you can share with your health-care provider.)

Food sensitivity occurs most often in families with a history of allergy. When this is the cause, expect to also see other physical symptoms, such as skin problems (eczema, rashes, dry patches), tummy upsets (vomiting, diarrhea), or breathing issues (congestion, runny nose, wheezing, coughing).

What about Foremilk-Hindmilk Imbalance?

Many new parents read online that “foremilk-hindmilk imbalance” is the most likely cause of green poop. This term was coined in a 1988 journal article that reported the experiences of a few mothers who breastfed by the clock, switching breasts after 10 minutes even though baby hadn’t finished on that side. Its results have never been duplicated, and newer findings call into question this article’s conclusions. Many now wonder if foremilk-hindmilk imbalance even exists. To learn more, click here.

Setting Worries to Rest

In most cases, green poop is nothing to be concerned about. But it helps to know what’s normal, possible causes, and some of the common myths about this experience. If your breastfeeding baby is healthy and thriving, that’s the most important thing you need to know.

Supporting You & Helping to Beat the Booby Traps®

Big news! Starting today, everyone who downloads my Breastfeeding Solutions smartphone app gets more than a go-everywhere source of breastfeeding help. They also support the amazing work of The Best for Babes® Foundation.

A portion of every app download goes to Best for Babes to help beat the Breastfeeding Booby Traps® – the cultural and institutional barriers that prevent parents from making informed feeding decisions and prevent mothers and babies from achieving their personal breastfeeding goals.

The Best for Babes seal of approval is now prominently featured on the app’s home page, and links to the app are featured on the Best for Babes online shop.

When you recommend Breastfeeding Solutions, you provide reliable help to the mothers in your circle and you support the greater breastfeeding cause. Please help spread the word! You can download the updated flyer HERE. Click on "Share" and then "Download."

Breastfeeding Solutions 1.2

The Breastfeeding Solutions version 1.2 smartphone app (now expanded and improved) is available on the App Store, Google Play, and Amazon.

Thanks to many of you, the Breastfeeding Solutions app has been a resounding success. More than 1200 people in 18 countries have downloaded the app since it debuted at the end of October. If you have helped spread the word about this groundbreaking new breastfeeding support tool, please accept my heartfelt thanks.

Reviews of Breastfeeding Solutions

For a demo of how the Breastfeeding Solutions app works, see the review by the U.K. group Andover Breastfeeding Mums or visit my Pinterest page. More online reviews of the app are at The Badass Breastfeeder and Breastfeed Chicago. It has been gratifying to receive such positive feedback from some of my favorite breastfeeding support people:

KellyMom: "Need a great breastfeeding app? The Breastfeeding Solutions app by Nancy Mohrbacher, IBCLC, FILCA is it! I installed it as soon as it was available, and have found it to be easy to use, and full of excellent information."

Best for Babes: "It appears that Nancy Mohrbacher, IBCLC, FILCA has created the WORLD'S BEST BREASTFEEDING APP. If you don't want to waste hours googling answers to your breastfeeding issues, or reading through thousands of threads, this app is for you."

What’s New in Version 1.2

Today—in response to suggestions from users—we launched the new and improved 1.2 version of the Breastfeeding Solutions app. Those who already have the 1.0 or 1.1 versions on their smartphone or tablet should receive notification of this update from wherever they purchased it, the App Store, Google Play, or Amazon. If you have already bought the app, there is no charge to download its 1.2 version, which features three main improvements.

A new Index. The app’s home page (above right) now features a button that takes you to its Index (left), whose purpose is to make it even quicker and easier to find what you’re looking for. Now to find a specific issue, instead of browsing through the app’s Articles section, you can use the Index to go straight there.

The screenshot on the left shows the new Index landing page. To find your burning issue, press the button that corresponds to its first letter.

More content. As one example of new content, if you’d like to read about reflux, press the index button “R.” On the next screen (right), below each index heading are buttons with page titles that correspond to every page within the app where that topic is mentioned. Press whichever button title best meets your need.

To learn about reflux, press the button “Reflux and the Breastfeeding Baby,” which takes you to the page below left and is new content in version 1.2. Other Index headings that lead to this same new content are “Spitting up” and “Vomiting after feedings.”

More links. To make the Solutions section of the app easier to use, more links have been added to improve navigation. The goal is to make it easy for any mother to quickly get her question answered. All of the updates in version 1.2 were designed to do just that.

Please email any feedback you’d like to share about Breastfeeding Solutions to my app-comment address: The beauty of an app is that unlike a book, it’s easy to update what you already have on hand without the need to buy a new edition. If you buy the app now, you automatically receive future updates.

Click here to download the app’s updated flyer and help spread the word. Thanks in advance for sharing this new helping tool with women worldwide!

For the Caregiver of a Breastfed Baby

As some of you know, I've written a book for employed breastfeeding mothers, Working and Breastfeeding Made Simple, that's available on Amazon and through Praeclarus Press. This is its handout written for the breastfed baby's caregiver. You may also download it as a pdf HERE.  --Nancy

For the Caregiver of a Breastfed Baby

You already know that you make a difference to the breastfeeding baby in your care. But you may not know what a key role you play in helping baby’s mother meet her breastfeeding goals. Here are some of the many ways you can support her.

Avoid Overfeeding

If baby takes too much milk while mother is away, baby will be less interested in breastfeeding when they are together. Less breastfeeding puts mother’s milk supply at risk. She may also need to provide more pumped milk. Anything you can do to reduce the amount of milk mother needs to pump makes her life easier. Here are more basics.


Know breastfeeding norms. Most breastfed babies take smaller feedings and feed more often than babies fed formula. At an average feeding, a breastfed baby older than 1 month takes 3 to 4 ounces (90 to 120 mL) of milk.

Feed when baby shows signs of hunger rather than on a schedule. Cues such as rooting and hand-to-mouth mean it’s time to feed. It is common for breastfed babies to feed more often during some parts of the day than others.

Feed slowly using paced bottle feeding. When fed slowly, baby feels full with less milk, reducing mother's need to pump. If baby is older than 6 to 7 months, she may be fed by cup. If bottle fed, expect feedings to take about 15 to 30 minutes. Here’s how paced bottle feeding works:

  • Hold baby semi-upright or upright (see photos) and tap her lips with the nipple until she opens wide.
  • Help baby latch far enough onto the nipple so her lips close on the nipple’s base rather than its shaft or tip. (Gagging means baby needs a shorter nipple.) If baby’s lips are pulled in, use your fingers to flange them out.
  • During feedings, hold the bottle nearly horizontal, so the flow isn’t too fast.
  • Build in pauses every few minutes by lowering the end of the bottle so milk runs out of the nipple. Or remove the nipple from baby’s mouth and rest it on her lower lip.
  • Repeat throughout the feeding until baby is done. Switch sides halfway through.
  • Stop when baby stops, even if there’s milk left.
  • Burp baby after feeding to bring up any air.

Encourage Breastfeeding

One key way mother keeps her milk production steady is frequent breastfeeding. You can help by encouraging her to sit down and breastfeed just before leaving baby with you and as soon as she returns. To make this easier:

  • Make comfortable seating available.
  • Offer a private area for nursing, if desired.
  • Make it clear that breastfeeding is welcome and encouraged.
  • If mother is due to arrive soon and baby seems hungry, feed just a little milk until she can breastfeed.

The more times each day a mother breastfeeds, the less milk she must pump. Breastfed babies need on average about 25 to 30 oz. (750 to 900 mL) per day. The more milk baby gets directly from mother, the less pumped milk is needed.

Store & Handle Milk with Care

You can also support mother by handling her milk with care so that little milk is discarded.  

  • Let mother know if baby regularly takes less milk than is in her containers.
  • Follow the milk storage guidelines she provides.
  • Thaw and warm milk gently and gradually, keeping heat low. Swirl the milk to mix layers. Don't shake it.

Milk can be thawed in the refrigerator or overnight. You can also thaw or warm milk in other ways.

  • Hold the container under warm running water for a few minutes.
  • Hold the container in water previously heated on the stove. Do not heat the milk directly on the burner.

If you use water to thaw or warm milk, tilt or hold the container, so the water cannot seep under the lid. Feed thawed milk right away or refrigerate it.

Do not thaw or warm milk in a microwave,which changes the milk and heats it unevenly. Even if you swirl or shake the milk afterwards, hot spots remain that can burn baby’s throat.

By supporting breastfeeding in these ways, you can provide great quality of care for the breastfed baby. And at the same time you can make life easier for mother and the entire family. 

Hanging Out


Yesterday I took part in my first Google+ On Air Hangout, where I enjoyed the enthusiasm and thoughtful questions from the winners of our Facebook Rafflecopter contest, "Win a Hangout with Nancy." The awesome Lara Audelo, author of one of my favorite books, The Virtual Breastfeeding Culture, moderated the event and kept its pace lively. The 19-minute Hangout is now available for viewing on my YouTube channel.

During our Hangout, whose purpose was to answer questions about the Breastfeeding Solutions app, we discussed:

  • Why the App Store gave Breastfeeding Solutions a rating of 17+ (I’m sure you can guess), and how that age restriction might affect the app’s availability to younger mothers
  • What motivated me to develop the app
  • How best to contact me with suggested changes or improvements
  • Why some of the app’s buttons are pink and others are aqua
  • The importance of submitting positive reviews to Google Play and the App Store to encourage more mothers to download and use the app

It has been two weeks since the app became available for Apple and Android devices, and the response has been gratifying. More than 550 people worldwide have downloaded it, nearly 400 from the U.S., 57 from Canada, 45 from the U.K., and 33 from Ireland, as well as some in Australia, Mexico, the Netherlands, Israel, Switzerland, Norway, Sweden, Singapore, Taiwan, Hungary, Germany, Estonia, and New Zealand. Thank you all!

My hope is that breastfeeding supporters will add the app to their own devices and show it to mothers. If you’d like to know more, take a look at a step-by-step demonstration of how the app works on my Pinterest page. That page also includes a jpg of a newly designed flyer you can share with mothers (download its pdf here). Until the end of the year, to make downloading the app easier for you, I’ve reduced its price by nearly 30% to $4.99 USD.

The Breastfeeding Solutions app is not intended to replace in-person help and describes how--when needed--mothers can use the website to find IBCLCs in their local area. But it can be a great first resource, as it covers many of the most common problems and questions and when it's downloaded into a smartphone, it goes with mothers everywhere. Check out the first independent review of the app, which appeared this week on the Breastfeed, Chicago website.

Thank you again to Lara Audelo, and all those who participated in yesterday’s Google+ Hangout On Air: Tova Ovits, Susan Pack, Katy Linda, Ali Kulencamp, Johanna Iwaszkowiec, and Amie Norris. And thanks to all of you who have helped make the Breastfeeding Solutions app such a resounding success! The next step is to get the word out to more mothers. Any help you can give in spreading the word would be greatly appreciated!