Pump Fit Matters

Getting a good pump fit is vital, especially when you pump often and the breast-pump part your nipple is drawn into (the nipple tunnel) is composed of rigid plastic, as is true of most pumps. If it is made of soft silicone, which a few pumps are, it may mold more easily to different nipple sizes.

Figure 1

Pump fit affects both nipple comfort and milk flow. When a nipple tunnel is too small, it can lead to pain, skin trauma, and reduced milk flow, because it compresses the nipple during pumping. In pump-dependent families, this can put milk production at risk.

Pump Fit and Nipple Diameter

Pump fit is based on how well your nipples fit into the pump’s nipple tunnel. Pump manufacturers call the pump part with the nipple tunnel by different names (flange, shield, breastshield). Some parents refer to it as the “horn” or “funnel.”

Figure 2

Nipple tunnel diameter varies slightly by brand (Figure 1), with 24 or 25 mm the standard diameter of most pumps. One sign a different size nipple tunnel is needed is pain or discomfort during pumping, even near the pump’s lowest suction setting. Because the left and right nipples may vary in size, some parents get the best results when they use one size on one side and another size on the other side.

If pumping is comfortable with good milk flow, you probably have a good pump fit. If there is discomfort, even on low suction settings, watch your nipples during a pump session and see how they compare with Figures 2a, 2b, and 2c.  

Depending on the pump brand, larger or smaller nipple tunnels may be available for purchase separately.

How Often Are Larger or Smaller Nipple Tunnels Needed?

More often than you might think. In one U.K. study, 36 mothers with babies in the NICU pumped with a standard 25 mm nipple tunnel, and the researchers noted that because they reported discomfort, the opening was too small for 28%. The authors wrote: “If the [opening] is too small, pressure is highest on the nipple tissue, which can cause sore nipples and ineffective drainage.”2

In a U.S. NICU study, a different brand of pump with a 24 mm standard nipple tunnel was used. When both milk flow and comfort were assessed, a much higher percentage of mothers had better results with a larger diameter nipple tunnel. “[W]e found that 51.4%—or about half—of the 35 mothers who served as subjects in the research initially required either the 27 or 30 mm shield in order to achieve optimal, pain-free nipple and areolar movement during milk expression. As lactation progressed, 77.1%—or slightly more than three quarters—of the mothers eventually found they needed these larger shields.”3

Pump Fit Can Change with Regular Pumping.

A 2019 U.S. randomized crossover study compared the effects of nursing, hand expression and pumping on the nipple sizes of 46 lactating women1. The researchers found that unlike direct nursing and hand expression, with pumping, nipple length and diameter increased in size. Two U.S. lactation consultants used an engineer’s template to measure mothers’ nipples before and after pumping and also found that pumping causes nipples to increase in size. They wrote: “Pre- and post-pumping measurements taken with a circle template reveal that nipple size can increase 3 to 4 millimeters.”4 So even if parents are fitted well when they start pumping, it makes sense for them to check their pump fit over time to see if it has changed and whether they need a larger diameter nipple tunnel.

Signs a Larger or Smaller Nipple Tunnel Is Needed

Consider a larger nipple tunnel if:

• You feel discomfort, even on low suction settings.

• Your nipple rubs along the tunnel, despite efforts to center it.

• Your nipple blanches, or turns white.

• Your nipple does not move freely in the nipple tunnel.

• You notice slow milk flow or less milk expressed than expected.

Consider a smaller nipple tunnel if:

• You feel discomfort, even on low suction settings.

• More than about 1/8 inch (3 mm) of the areola is pulled into the nipple tunnel.

• Your nipple bounces in and out of the tunnel.

• You have difficulty maintaining an air seal.

Major breast-pump brands, such as Ameda, Medela, and Spectra offer fit options ranging from 20 mm to 36 mm. Another product that can sometimes help make pumping more comfortable is Pumpin’ Pal, which provides an angled nipple tunnel. Contact a lactation supporter for help in finding the best fit for you. See also the blog post HERE for other reasons pumping might feel uncomfortable.

References

1 Francis, J., & Dickton, D. (2019). Physical analysis of the breast after direct breastfeeding compared with hand or pump expression: A randomized clinical trial. Breastfeeding Medicine, 14(10), 705-711.

2 Jones, E., Dimmock, P. W., & Spencer, S. A. (2001). A randomised controlled trial to compare methods of milk expression after preterm delivery. Archives of Disease in Childhood. Fetal and Neonatal Edition, 85(2), p. F94.

3 Meier, P. (2004). Choosing a correctly-fitted breastshield. Medela Messenger, 21, p. 8.

4 Wilson-Clay, B., & Hoover, K. (2017). The Breastfeeding Atlas (6th ed.). Manchaca, TX: LactNews Press, p. 80-81.

Infographic Debuts: Is Baby Getting Enough Milk?

Today’s busy families want lactation information that is quick, easy, and lovely to the eye. That’s why I joined forces with the talented people at Noodle Soup to create a series of infographics on some of the most in-demand lactation topics.

 I’m thrilled to announce a new addition to this series! The #1 reason new parents give for formula use and premature weaning is worries about milk production. This new infographic—“Is Baby Getting Enough Milk?”—directly addresses these concerns. My hope is that it will help more families meet their feeding goals.  

All four of my infographics come in tearpads of 50 with one side in English and the other side in Spanish. Click on the titles below to link to their order pages on the Noodle Soup website.  

• Is Baby Getting Enough Milk?  Includes reliable signs that baby’s milk intake is adequate, expected feeding patterns in nursing newborns, and the most common false alarms. 

• Working & Breastfeeding  The most important aspects of working and breastfeeding that nursing families need to know to meet their long-term feeding goals.

• Pumping Primer  A simple guide to expressing milk that includes the key points needed for successful pumping.

• For Baby’s Caregiver  Ways caregivers can support nursing families, including how to pace bottle feeds to avoid overfeeding during the workday.

Research on the Breastfeeding Solutions App

Great news! The first STUDY of the usability and impact of the Breastfeeding Solutions app appeared online September 20, 2018 in the Journal of Human Lactation. This small longitudinal prospective cohort study found that nearly 80% of the 29 women who used the app and completed the study surveys at 3 and 6 months were breastfeeding at 6 months. The local average of any breastfeeding at 6 months was 50%--nearly a 30% difference!

Because this Australian study had no control group, the researchers could not infer that the Breastfeeding Solutions app was responsible for this difference in nursing outcomes, but I am still thrilled with this result. When I developed this app, my goal was provide an accurate, easy-to-use digital resource that could help nursing families meet their feeding goals. It is wonderful to receive such positive feedback from this study! (To see how the Breastfeeding Solution app works, scroll to the bottom of this post for a 2-minute video demo.)

The study’s aims were to explore the app’s usability among rural Australian women in a sparsely populated area and to describe the nursing outcomes of the study participants, comparing them to the local average. Because this study is not in an open-access journal, I’d like to share some of its details.

The App’s Usability

Regarding theusability of the Breastfeeding Solutions app, the researchers reported that

• 94% rated the app favorably

• 97% found the app helpful

• 87% would recommend the app to others

Study participants wrote

“Provided me with the information I wanted.”

“For first-time feeders there’s some very relevant and helpful information.”

“Helped me understand the latch.”

Of course, in our digital age, many online sources of breastfeeding information exist. Some study mothers mentioned social media as one alternative source, but as one noted:

“Searching the web comes up with all sorts of contradictions; books become outdated. I think the app, so long as it is regularly maintained and information updated, feels much more trustworthy.” 4

Along these same lines, the researchers wrote that some participants

“…expressed apprehension regarding advice found on the Internet and social media sites, and they were uncertain if the content was trustworthy.”

But what about the paper brochures and handouts many birthing facilities send home with new parents? Is an app a better choice? According to one study participant:

“…pamphlets and booklets all get lost…An app is just perfect.”

Ultimately, the researchers concluded that the app fulfilled the need of these families for evidence-based information.

An App Will Never Replace Personal Help

As this study illustrated, a breastfeeding app can work well as the first source of answers to parents’ questions. But no app can ever replace one-one-one breastfeeding help. Five of the participants commented that health professionals are key to nursing success. Not surprisingly, one study participant wrote: “I still prefer face-to-face contact with a lactation consultant.”

But in some parts of the world, in-person breastfeeding help is not readily available. In places like rural Australia, an app can be a practical tool where the environment is not breastfeeding friendly. As one study mother wrote:

“I needed someone to observe feeding to help with pointers which I could not find where I live…very few places to breastfeed when out….Also in small towns there are hardly any change facilities so you don’t feel encouraged to get out and about.”

Suggestions for Future Improvements

With any breastfeeding resource, there’s always room for improvement. One study mother thought the information in the app was “too generalized.” Certainly, any resource that is not customized to one family’s experience runs this risk. Three of the study mothers suggested that adding more pictures and videos to the app “would have been awesome to better understand what the written information meant.” (This addition is definitely on my list of things to do!)

In their list of key messages, the study authors included:

“The app fulfilled a need and met a gap, providing rural women with access to reliable and evidence-based information regarding breastfeeding, in spite of their location.”

If you are unfamiliar with how the Breastfeeding Solutions app works, watch its 2-minute video demo HERE. The app is available worldwide for Android and Apple devices through the App Store and Google Play.

I am grateful to Australian researchers Nikita Wheaton, Jacinta Lenehan, and Dr. Lisa Amir for being the first to study the Breastfeeding Solutions app. I am also pleased that a larger study on the app is currently underway in southern California, where the plan is to include more than 200 families.

Today’s parents expect to receive breastfeeding information and education in the formats and platforms they prefer. With more and more millennial families having babies, my hope is that the Breastfeeding Solutions app—which we can now recommend as supported by research—will find its way into the hands of many. Please help me spread the word.

Reference

Wheaton,, N., Lenehan, J., and Amir, L.H. (2018). Evaluation of a breastfeeding app in rural Australia: Prospective cohort study. Journal of Human Lactation,  doi: 10.1177/0890334418794181

Infographic for Baby's Caregiver

I’m delighted to announce the release of the third of three infographic I created with the fantastic people at Noodle Soup. Currently available only in the U.S., these two-sided sheets (one side English, the other Spanish) come in pads of 50. They are ideal for busy parents who want quick, cut-to-the-chase guides that are also lovely to look at.

 For Baby’s Caregiver, the latest infographic, describes specific ways caregivers can support nursing families, including how to pace bottle feeds to avoid overfeeding while mother is away.

 Also available from Noodle Soup (click on the titles for order information) are:

• Pumping Primer, a simple guide to expressing milk that includes the most important points needed for successful pumping.

• Working & Breastfeeding, an overview of the key details that enable working and nursing families to meet their long-term feeding goals.

Introducing the Natural Breastfeeding Professional Package

Are you a breastfeeding support professional?
Would you like access to the latest breastfeeding tools and technologies?
Do you want to add another income stream and expand your practice?

If you answered yes to any of these questions, I’d like to introduce you to the Natural Breastfeeding Professional Package which I designed with obstetrician Dr. Theresa Nesbitt, RN, MD.

Geared for lactation consultants, doulas, breastfeeding and childbirth educators, breastfeeding peer counselors, nutritionists, nurses, doctors, midwives - everyone who works with pregnant and new families—this package offers the high-tech resources millennial families prefer.

What’s Included in the Natural Breastfeeding Professional Package?

• Client access to the online Natural Breastfeeding Program, a breastfeeding preparation course that families can view on their tablets, computers, and smartphones. This fun, parent-friendly program includes more than 60 short videos and more than 100 images of diverse mothers and babies breastfeeding. If purchased by families individually, this online program usually costs $97.

But when you buy the Professional Package, you choose whether to charge your clients a fee for access to the online program (you determine the price) or provide it at no extra charge. For professionals starting or running a private practice, this is a fantastic opportunity to set yourself apart from other local providers and grow your client base. For those who work in hospitals, this is a way to take your teaching to a whole new level.

A 2015 STUDY found that digital breastfeeding education was overwhelmingly preferred by families over group classes. You can also offer it as a supplement to your in-person classes. If you decide to sell access to the online program, you get 100% of the proceeds.

• Three online presentations for providers (2.5 hours of talks) to give you the background you need on this innovative approach to breastfeeding preparation. You may also show these presentations to other health-care providers.

• Downloadable visuals: 60+ images and 25 short videos, which you can use in classes and download to your handheld devices as teaching aids when working one-on-one with families.
  

What’s the Cost of the Natural Breastfeeding Professional Package?

Just $129/year gives you access to the digital program for an unlimited number ofclients.

Where Can I Buy the Natural Breastfeeding Professional Package?

You can learn more about the program and purchase the Professional Package online by clicking HERE. Need more information? Scroll down on the program webpage to read the FAQs, or email us at info@naturalbreastfeeding.com.

Please help us spread the word12

Feb. 15 Webinar Recording Available: Helping Families Who Exclusively Pump

Register HERE to listen to my 75-minute webinar recorded on Thursday, February 15, 2018 and sponsored by the nonprofit organization BreastfeedLA and Martin Luther King, Jr. Community Hospital.  Registering will give you access to this recording during all of 2018!

Content Summary: Why focus on exclusive pumping? We are in the midst of pumping epidemic! In "Helping Families Who Exclusively Pump," I will summarize pumping trends and describe the specific strategies that make it possible for families with babies in the NICU and those who choose to pump and bottle feed to most effectively build a healthy milk supply.  I will also share what the research tells us about how often and long to pump in order to keep up milk production over the long term and ways to customize pumping plans based on an individual's breast storage capacity, a physical difference that varies from person to person. But these families need more than just reliable facts. They also need emotional support, so learn how we can best become the champions many pumping families genuinely need.

Continuing Education Credits: For IBCLCs, 1.25 L CERPs are available and Registered Dieticians can provide the program agenda and certificate for CPEs for Professional Portfolios. For RNs, 1.5 contact hours are available through the California Board of Registered Nursing. For more details, see the downloadable brochure HERE.

Cost: $30.

Support the wonderful work of BreastfeedLA while you learn!

Breastfeeding Solutions App 80% off August 1-7

This year, my World Breastfeeding Week (August 1-7) gift to the world is an 80% discount on my Breastfeeding Solutions app. Usually $4.99 USD, until Aug. 7, you can download it for only 99 cents.

No need for a promo code. For this limited time, my app will simply be available at this discounted price for Apple devices in the App Store and for Android devices in Google Play.

Download it now at this one-time cost of 99 cents, and all future updates will be FREE. To learn more about the Breastfeeding Solutions app, scroll down to view its 2-minute video demo. Under the video, read its reviews.

More than 30,000 people have downloaded the Breastfeeding Solutions app since its first version debuted in October 2013.  The badges below are direct links to download Breastfeeding Solutions at its current discounted price.

Will you please help me spread the word? I’d love for my friends around the world to take advantage of this unique opportunity to download my app at 80% off. Happy World Breastfeeding Week!

To see how my app works, view this 2-minute video.

Reviews of the Breastfeeding Solutions App

KellyMom.com: "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." 

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

Vti10: "Latch issue solved. 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 topics!"

Pumping Primer Infographic

The Working & Breastfeeding infographic I created with the help of Noodle Soup is such a success that we decided to put our heads together again and create a one-page resource on breast pumping. There are so many misconceptions about pumping, we thought this simple guide would make the lives of many new mothers easier.

Again, one side is in English, the other side in Spanish, and they come in pads of 50. Clicking on the image will take you to the order page. Enjoy!

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 live cells in the milk, 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

 References

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

KellyMom.com: "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 You as a Pacifier?'

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

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

What Is the Real Message?

The assumption underlying this advice is that baby’s desire to nurse 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 nurse without taking milk? It does happen. Every so often you may notice your baby softly mouthing your nipple 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 you as a pacifier” are referring to?

I don’t think so. This advice usually follows a weary parent’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 nursing parents regularly substitutes a pacifier for nursing at these times, this can short-circuit their baby’s efforts to increase milk production. That’s why the American Academy of Pediatrics (AAP) recommends babies be fed on cue (see the 20223AAP 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 you as a pacifier” advice that is positively insidious. The idea that parents must be careful not to let their baby “use them” has the potential to undermine their trust in their 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 peer-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 was 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 nursing 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 if her baby was getting milk then or not.  I told her that I always assume during nursing a baby 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 you as a pacifier?” When you think it through in terms of how nursing works, it is actually total nonsense. But if parents buy into the assumptions that underlie this advice, it opens them up to a world of hurt. Believing that they have to guard against their baby “using them” has the potential to undermine nursing, their relationship with their baby, and indeed their whole outlook on parenthood. Who needs this kind of negative take on their baby? Even without it, new parenthood 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. During nursing, on the other hand, due to the alternating fast-then-slow milk flow from letdowns, nursing automatically teaches our babies healthy self-regulation. (For more on how nursing and bottle-feeding 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 nursing 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 nursing.

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

The Clock and Early Nursing

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

• How many minutes their baby should nurse

• 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 nursing? Let’s take a closer look.

What Do Number of Minutes Spent Nursing Tell Us?

One common recommendation is to make sure newborns feed at least 10-15 minutes on each side and take both sides 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 nursing session. (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, this baby boy was a slow eater.

How many minutes should a baby nurse? 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 feed. 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 nursing, 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 side at some feedings and wanting both sides 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 nurses. (Count one feeding as any amount of nursing from one or both sides followed by at least a 30-minute break.)

Most tiny babies need to nurse 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 video from my YoutTube channel explains what to expect during the first 40 days.

As it describes, in the beginning, most nursing 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 nurse 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 on 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. (For more on this, see my post HERE.)

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 passes a stool). Make daytime 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 nursing 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, during the first 3 months, 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 nursing and the clock, keep in mind that nursing has been around much longer than clocks. In other words, you don’t need a clock to make nursing 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 nursing 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 iMothering.com. 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 worldbreastfeedingweek.org.

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 scott@praeclaruspress.com.

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, see our 38-minute video on our NaturalBreastfeeding.com website HERE, go to my YouTube playlist 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 www.NaturalBreastfeeding.com.

Please help us spread the word.

Tongue and Lip Ties: Root Causes or Red Herrings?

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.

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!

Spanish Breast Storage Capacity Infographic

Here is the latest translation of my Breast Storage Capacity infographic. Thanks to Alison Velasco for her excellent work! French, Bulgarian, and basic Chinese translations of this infographic are also available in the Multimedia section of this website. Just click on this link and scroll down. You have my permission to use them freely. --Nancy