The Tot Q&A: Your breastfeeding questions answered
The Tot Expert & Lactation Consultant, Rebecca Agi of Best Milk LA answers your breastfeeding questions.
Q: My 9 month-old will no longer take a bottle. It started 4 months ago after he was diagnosed with a dairy allergy and I didn’t have anymore non-dairy milk pumped to give him. Now I’ve replenished the supply but he won’t take the bottle or a sippy cup. He only wants to nurse. But he takes a pacifier fine. I’ve tried waiting until he’s really hungry but that doesn’t work either. He’s not getting the hang of the sippy cup. Any suggestions? I would like to be able to go out or go to work and not worry he’ll be hungry.
A: Sounds like your baby has developed a strong preference for you only! Rather than wait until he’s hungry, I recommend offering the bottle before he’s due to feed. Waiting until he’s hungry can make him even more frustrated and give him another reason to reject the bottle. Second, I recommend having someone else offer him the bottle because if he knows you’re available, he’s likely to only want you. And third, smell your defrosted milk. Some mother’s milk has excess lipase enzyme, which is completely harmless, but can change the taste and smell of defrosted breast milk giving it a soapy smell and taste. If that’s the case, you can scald the milk prior to freezing it. If the milk does smell soapy, I highly recommend reaching out to a certified lactation consultant for guidance on scalding. Hope these tips help!
Q: How do you know what quantity of expressed milk to send to day care with 3-month-old baby when starting back to work after maternity leave?
A: This is a really good question that lots of moms have! Most exclusively breastfed babies take in an average of 25-30 oz. of breast milk per day (24 hours). You can divide 25 oz. by the number of feedings your baby takes per day to get an estimate for the amount of milk your baby will need at one feeding. Remember that this is just a “ballpark” number and every baby is different, but it’s a good starting point to figure out quantities. I encourage you to practice with a bottle of expressed milk at home before sending the baby to day care to see how he/she does with it. Good luck!
Q: My 4 month-old only wants to take one breast at a time… She eats every 1 or 2 hours. At this age, is this normal is it too often? Should I try to make her take both breasts? And if yes, how? Thank you so much for your help and answers!!
A: It is normal and common for breastfed babies to only take one breast per feeding, especially when mom has a great milk supply, but I encourage you to offer the second breast since she seems to be hungry soon after the first side. You can simply switch her over to the second breast after she unlatches from the first side or burp her after the first side and then offer the second side. If she takes it (even if it’s for a minute or two), great! If not, keep offering it at every feed. She may take it at some feedings and not at others. Both instances are totally fine!
Q: Any tips for encouraging milk to come in after a C-section?
A: Whether you deliver vaginally or with a C-section, you’ll want to breastfeed often (8-12x per 24 hours) starting as soon as you’re able to in order to help kick start the milk-making process. The football position can be especially useful for mothers who’ve had C-sections since the baby is kept away from the incision area. For even more tips, I encourage you to read my 10 Tips for Breastfeeding Success on The Tot!
Q: How long (how many days) do you have to wait for milk to come in after delivery before you have to give up?
A: Breast milk usually starts to increase in volume (AKA milk “comes in”) between days 3-5 after birth. My number one recommendation for producing enough breast milk from the start is: breastfeed, breastfeed, breastfeed! You’ll want to aim for at least 8-12 feedings (the more the better) per 24 hours to help establish your milk supply and the breastfeeding relationship from day 1. With the right information and support, you won’t need to give up!
Q: What advice do you have for an expectant mother who doesn’t know much about breastfeeding and there aren’t any Lactation Consultants in town?
A: I recommend reading all my breastfeeding articles on The Tot and taking my online breastfeeding course available on BestMilkLA.com! Studies show that prenatal breastfeeding education leads to increased confidence with breastfeeding and a longer breastfeeding relationship. It can also be helpful to find a nursing mom in your town who you could turn to for support. Good luck!
Q: How can you get a breastfed baby to eat on more of a scheduled basis and not just snack every 30 mins or so? Also is there anything you can do to increase supply if you fall pregnant while still breastfeeding?
A: First and foremost: full meals at the breast! In the early days, breastfeeding averages about 40 minutes per feeding (20 min per breast) and takes a tremendous amount of patience but the good news is that feedings eventually do get shorter as baby gets more efficient at the breast. If your baby is past the newborn stage, breast massage and compressions can help him get more milk in a shorter amount of time, especially if he’s a distracted nurser. Regarding increasing milk production during pregnancy, breastfeeding during pregnancy is almost always permitted but pumping to increase milk supply is not recommended since increased breast stimulation releases oxytocin, the hormone that causes uterine contractions during labor. To be safe, I recommend discussing your individual needs with your healthcare provider!
Q: What are your best tips for preventing mastitis?
A: I’ve written an article all about this! My Mastitis article on The Tot discusses steps you can take to reduce your chances of getting it or increase your chances of fixing it as soon as any signs occur. Be sure to read it and good luck!
Q: Once baby starts sleeping longer and going longer in between feedings, can you stay on his schedule and still preserve production or do you need to consistently pump every 2-3 hours?
A: You can absolutely stay on his schedule! In fact, breastfeeding on-demand will help your supply regulate to meet your baby’s exact needs. At first you may feel some breast fullness and/or engorgement once baby starts sleeping longer stretches at night, but soon enough your supply will regulate to produce more during the day. Just be sure to follow baby’s lead and feed more often during the day.
Q: What are the top signs to look for regarding problems breast feeding? I am due at the end of the month and I am nervous about clogged ducts, etc I’m not sure what is normal and what is not…
A: Congratulations and great job doing some research beforehand! I’ve written up a list of the most common breastfeeding problems I see in my private practice. I highly recommend reading 10 Common Breastfeeding Problems & Solutions on The Tot. To give you an idea, the top 5 include engorged breasts, sore nipples, a sleepy baby, back pain and an overactive let down. Be sure to read the article for more information and solutions to the issues. I also suggest taking a prenatal breastfeeding class if you haven’t already. Check out my on-demand breastfeeding class on BestMilkLA.com. I teach everything you need to know beforehand!
Q: How do you encourage your newborn to feed with a wider (or larger) latch?
A: Great question! I always recommend tickling the baby’s upper lip with the nipple just before latching. This usually gets baby to open up wide. If that doesn’t work, try expressing a few drops of milk onto the nipple before bringing baby to breast and then try latching. As the baby grows and gets bigger, opening wide won’t be as challenging but for now these tips should help!
Q: How can I get my 5-month-old breastfed baby to take a bottle of expressed breast milk?
A: If your baby has only been breastfed up until now, it’s common that he/she will reject the bottle as breast has become the preference. Getting your baby to take the bottle will just take a lot of patience and practice but it is possible! A few tips: try offering the bottle before baby is actually hungry, express a few drops onto the bottle’s nipple to give baby an instant reward, and have someone else give the bottle. A breastfed baby will often refuse the bottle if he/she knows mom is available!
Q: How do I ensure I keep up my supply when I’m away from my baby? I’m currently on vacation without him and I’m noticing I’m not making as much.
A: To keep supply up while you’re away from baby you’ll want to pump as often as baby feeds. Staying on a pumping schedule is key for maintaining production while you’re away from baby. Also be sure to read my Breast Pumping 101 article on The Tot!
Q: I am going back to work when my baby is 5 months-old and my husband will be home with my baby. Right now he is 2.5 months and we EBF with a sort of schedule based on his nap/awake times. (1) how do I maintain supply with pumping when I return to work? And (2) This is my second child but breastfeeding is different compared to my first because my milk production is higher than my first and my baby is able to get a lot more in a shorter period of time. Sometimes, later in the day a few hours before his bedtime, he just turns his head and doesn’t want/need to nurse. Should I just consider this as him not needing it? He will wake up after his bedtime to nurse but I didn’t experience this with my first so it confuses me sometimes. Will this refusal interfere with my supply? THANKS so much in advance!
A: Once you go back to work, you’ll want to continue pumping as often as your baby eats when you’re away from each other. I recommend setting pumping reminders on your work computer and/or phone since it’s so easy to get busy and forget a pumping session once you’re back to work. You can read my Breast Pumping 101 article on The Tot to learn more! To address your second question, if you offer and he refuses, that’s ok. As long as you’re following baby’s lead and feeding him when he is hungry, your supply will continue to match his demands. Sounds like you’re doing a fabulous job!
Q: If you have the help of a night nurse during the first month, can you sleep through a normal feeding time or do you still need to wake up and pump?
A: During that first month it’s still really important to either breastfeed or wake up to pump for those middle of the night feedings since you’ll still be establishing your milk supply. You can have the nurse bring the baby to you if you choose to breastfeed and then let the nurse burp and change diapers after (which is a huge help!) or you can wake up to pump. Whichever you prefer!
Q: My daughter is a week old today. Born via c-section. I am not producing enough milk. She ended up in the ER on Sunday bc she was so dehydrated. Now I’m pumping and bottle feeding and supplementing with formula. I am pumping consistently every 2-3 hours with a hospital rented pump and only getting about 1/2 an ounce total each time. I am sad and frustrated and ready to give up. Any suggestions before I totally throw in the towel?
A: I am so sorry to hear you’ve had some complications but applaud your efforts for trying everything you can to increase your supply and make breastfeeding work for you and your baby. It sounds like you would really benefit from a visit with an International Board Certified Lactation Consultant who could provide guidance on supplementation, pumping to increase milk supply and anything else that needs to be addressed. You can visit ilca.org to find an IBCLC near you. I wish you so much luck!
Q: Is morning milk composition different than evening milk comp? I’m pumping at night – will this be ok for baby to drink during the day?
A: There is some difference in the hormonal composition between milk produced in the morning vs. evening, but it is totally fine for your baby to get your pumped night milk during the day!
Q: After my last pregnancy it took 3-4 days for my milk to come in. That time around I tried pumping from day one (baby wouldn’t latch and I wanted to increase milk supply ASAP; nothing came out besides a drop before day 3-4 (pp). Was this a good move (pumping so soon) or should I just wait until the milk comes in this time around?
A: Breast milk usually comes in between days 3-5 and before that it’s all colostrum, which is only produced in small amounts (totally normal and expected!). This time around, you can try exclusively breastfeeding from the start, as pumping can actually lead to over-stimulation and over production if started too soon. For more information on pumping, you can read my Breast Pumping 101 article on The Tot!
Q: How do you help baby prevent gagging when you have a fast letdown of breast milk? And how long do you suggest feeding baby on each breast? Is it likely that baby will be hungry more often if you feed him over a short period of time because of the fast letdown? Thank you.
A: For a fast/strong let-down I recommend laid-back breastfeeding. This position helps give the baby more control over the fast flow of milk. The length of each feeding really varies and depends on baby’s age, but newborn feedings typically take about 40 minutes total (20 minutes per breast). As baby gets older and becomes a more efficient eater, feedings get much shorter!