- My nipples are cracked and sore. What should I do?

Get help from a lactation consultant! If you have a crack, bacteria can get in, which left untreated can lead to a breast infection called mastitis. A lactation consultant has been trained to assess the baby, your nipple, the injury, the latch, the suck and the techniques used and will be able to devise a plan that will meet your needs. A friend might tell you to put “X” on your nipples, but if the problem is from a tight frenulum or poor technique, then cream isn’t going to fix the problem.

What should I do if I am taking a prescribed medicine?

- Can I still breast feed? Many medications that you could not take while pregnant are ok to take while breastfeeding. Make sure the prescribing doctor knows that you are breastfeeding your baby. The book: Medications and Mothers Milk, by Thomas Hale, is a wonderful resource to have. There is one written and available for the non-medical person. Or call your local lactation consultant and ask them to look up the questionable medication. It seems funny to me that most postpartum moms go home from the hospital on narcotics and stool softeners and anti-inflammatory pills (all of which are fine), but 6 months later when they are getting a dental procedure and the dentist wants them to take motrin and vicodin they think they are going to have to pump and dump!

Can I use over-the-counter products and nurse?

Most over the counter medications are safe for you to take while breastfeeding, but you should always check with your doctor or lactation consultant just to be sure. The ingredient that you want to stay away from in OTC medications that is commonly found in cold medications is: pseudoephedrine, as it can decrease your supply. Medications that contain this ingredient are now more commonly found behind the pharmacy window and require your signature. But you should keep in mind that if you take a medication that makes you tired, it may also cause your baby to be tired. And it is always good to remember that herbs are medications too and you should also check on there safety. (did you know that peppermint can decrease your supply???)

When should I pump?

The majority of moms will notice that they produce more milk between midnight and 5, so they will have excess milk for the first few feedings. This is the milk that you will want to pump out for your bottles. When your baby is finished at the breast, just pump for about 5-10 more minutes. Most baby’s will take 2-3 oz. from a bottle. If you pump 1.5 oz out after feeding your baby, then you will want to pump again after the next feeding. It is OK to mix freshly expressed milk with refrigerated milk and it is OK to mix different pumping sessions together. You will save the amount needed for the daily bottle and freeze the rest. (milk can be collected in the refrigerator for 48 hours before freezing).

What should I do if I am going back to work at 2 months?

Any mom who would like her baby to be able to take a bottle, whether returning to work or not, should introduce her baby to the bottle between 2-4 weeks of age. All baby’s will accept a bottle at this age with very little effort. The longer you wait, the more difficult it will be to get your baby to accept a bottle. There are two important things to remember with regards to bottles. The first is that you need to keep a bottle in your baby’s routine. Most baby’s will show preference for the breast and refuse the bottle around 2 months of age if given at irregular intervals. It is recommended that a bottle be given at least every other day to keep your baby interested in it. You do NOT need to get your baby used to 3-4 bottles a day before returning to work. The second is that YOU want to be the one who sets the PACE of the bottle feeding! Given the opportunity, all babies will guzzle down the milk. When they drink this fast, they often take down a lot of air and will either throw it all back up, or pass a lot of air, or worse yet, get a tummy ache! It is recommended that you use a “vented” bottle system. (some popular examples are: Playtex ventair, dr brown, and avent) With these “vented” bottles, you don’t need to keep the nipple full of milk. So keeping your baby more upright for feedings and the bottle more horizontal will help to slow down the pace of the feeding. You can further slow down the pace by tilting the bottle in such a way that there is no milk in the nipple. If this is done about every 3 swallows, the baby will be forced to drink more slowly. If she “sucks air” when you do this, then you may need to fully remove the nipple from her mouth after about every 3 swallows. Just keep the nipple touching her lip so that she knows it is just a break. She will tell you when she is ready for more by “rooting” for the nipple. As the feeding progresses, she will slow down naturally and you will no longer have to remove it from her mouth.

When should I use a nipple shield?

- Nipple shields are used for many different reasons! They can be very helpful and be the difference between you “hanging in there” and “throwing in the towel”, but they can also cause problems! The important thing is that your baby’s weight is being monitored while you are using a nipple shield, as some baby’s have troubles transferring the milk well and won’t gain weight as well as they should. So, all that said, you should not just go out and get a shield to use from day 1 because your friend said it was awesome! They may be needed when moms nipples are flat or inverted , though the nipple has to be “suctioned” into the shield to work properly in these cases, so be sure to receive proper instruction on how to do this. They are often used when the baby is born early and needs the extra “tactile” sensation to keep them sucking longer. They may be used to protect moms nipple when the baby has a tight frenulum or when he is chomping versus sucking. So, it may be used for protection or for a teaching tool. It is normally a “short term” device to help get you over a hump. We usually want moms to pump at least 3 times a day (after feedings) when their baby is using the shield for every feeding, as we need to be sure the baby is able to transfer the milk well and not have your milk supply compromised in the interim!

quote from Diane Wiessinger

In regards to a mom with complaints of a low supply and not being able to keep up with her baby's needs:

"I think her single biggest problem is that she's trying to use her breast as an Intermittent Source of Significant Meals, rather than as conversation, love, comfort, entertainment, shutter upper, topper offer, and just plain meeter of all baby and mothering needs. And I'll bet she'll see a
*significant* increase in supply once she triples (and uncomplicates) her nursing frequency."