FAQ

Your baby will nurse frequently, averaging at least 8-12 feedings per 24-hour period; this means your baby will nurse anywhere from every 1-3 hours, or even sooner. Your baby should be allowed to determine the length of the feeding, and if they want one, two, or even “three” breasts. Watch the baby, and not the clock. No need to time feedings! Baby’s swallowing sounds are audible during breastfeeding when actively sucking. Once your mature milk comes in, usually on the third or fourth day, your baby should begin to have 6-8 wet cloth diapers or 5-6 wet disposable diapers. Your baby will also have at least 3-4 bowel movements in a 24 hr period. Your baby should gain at least 4-7 ounces per week after your milk comes in and is well established. Your baby will be alert, appear healthy, have good color, and will be growing in length and head circumference. Mothers should follow their baby’s lead in how often to breastfeed, as long as their baby is waking to feed and showing hunger cues. If not, it is OK to wake a sleeping baby. Breastfed babies regulate themselves; they take what they need at each feeding, and from each breast. Many babies will continue to have at least 3 to 5 bowel movements every 24 hours for the first several months, although some babies will switch to less frequent but large bowel movements at about 6 weeks. *Note, a baby that does not rouse to breastfeed, is generally lethargic, or doesn’t have enough wet or dirty diapers may need to be assessed by an IBCLC or other health care provider to make sure that he is adequately hydrated and getting enough milk. If you have concerns, give us a call!

Often mothers think that their milk supply is low when it is really isn’t. This can be caused by oh so many things! Were your breasts feeling full and now they don’t, has your baby’s nursing pattern suddenly changed, has your baby who was eating pretty regularly started to “cluster feed”, or your calm, content newborn started to become fussy, especially in the evening hours? Or maybe you had a baby who slept through the night, but now they wake several times a night, or you may now doubt yourself because of something you read on the internet or a comment made by a well meaning family member or healthcare provider. The list of things that can make a parent doubt themselves goes on and on...Do any of these sound like you? If so, you are not alone. There is so much information out there that can cause a new parent to start to doubt themselves, especially their milk supply. This is one of the biggest questions we get. "Do I have enough milk?" The good news is, yes, most of the time you do. If your baby is gaining weight well on your breastmilk alone, then you do not have a problem with milk supply. As we say, “the proof is in the pudding”! It’s important to note that the feel of your breasts, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby. Over time this can and will change. Many babies also become more efficient and some babies can even get all the milk they need for that feeding in 5 minutes or less! However, if your baby is struggling to gain weight on your milk alone, your baby is falling asleep very early on in the feeding, your baby’s output is low (pees and poops), you are not hearing sucks and swallows (after day 2-3 or so), you didn’t feel any breast changes in pregnancy and/or postpartum, and never felt any fullness at all, these may be signs of a milk supply issue. However, sometimes if baby is not gaining weight, it’s a baby issue and not a milk supply issue. Baby may not be efficient at accessing your milk for a multitude of reasons. In this case, Mom may need to pump and provide baby with their milk, in addition to continued breastfeeding, while we wake baby up a bit and figure out why they are "falling asleep on the job". It is important to know that breastfeeding is a "symbiotic relationship" between Mom and baby, which means Mom impacts baby and baby impacts Mom, so baby can affect Mom’s supply too. If you have concerns about either your supply or baby’s ability to access your milk, and/or need help figuring out what is going on, give us a call. We assess the entire picture while figuring out the why-is this a baby issue, a Mom milk supply issue or both? Not only do we help figure out the cause, we then come up with a treatment plan that is specific to you and your baby’s individual needs. To learn more about milk supply, including causes for decreased milk supply and how to best increase it, give our office a call or email us to make an appointment!

No food is excluded from the list of foods a breastfeeding mother should eat. It is best to make sure the foods you eat are fresh and healthy. The concept of variety is important to your health, because by eating a number of foods, you can be sure to obtain different nutrients that your body needs to stay healthy. However, to make enough breastmilk and for your breastmilk to be caloric, studies actually show that a mom doesn’t typically need to eat a certain way (* Note, if you eat a vegan diet or don’t eat animal proteins, including dairy and eggs, make sure that you are taking a B12 supplement, as a B12 deficiency can have adverse effects on your baby. Generally, anything you are happy eating is okay for you to eat while you are breastfeeding. Of course, there are exceptions to this rule. If you notice that your baby reacts badly after you have eaten something, it may be best to leave that food out of your diet for a while.La Leche League has some excellent suggestions here.

You may have heard that mothers produce two kinds of milk: foremilk, the thinner milk the baby gets first, which has a lower fat content; and hindmilk, the high-fat, creamier milk that follows. These terms can make it seem as if the breasts produce two distinct kinds of milk, which is not the case. The milk-making cells in the breasts actually produce only one type of milk, but the fat content of the milk that is removed varies according to how long the milk has been collecting in the ducts and how much of the breast is drained at the moment. As milk is made, the fat sticks to the sides of the milk-making cells while the watery portion of the milk moves down the ducts toward the nipple, where it mixes with any milk left there from the last feeding. The longer the amount of time between feedings, the more diluted that leftover milk becomes. This “watery” milk has a higher lactose content and less fat than the milk stored in the milk-making cells higher up in the breast. So, what this means is that if your baby is eating often, then you typically don’t have to worry about what kind of milk she is getting; it will be in the perfect balance for what she needs, and will continue to change to meet her needs as she grows.

Persistent nipple pain in the early weeks of breastfeeding, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by “thrush”, which is a yeast infection of the nipples (also known as Candida). Additional symptoms can include: Itchy or burning nipples that appear pink or red, shiny, flaky, and/or have a rash with tiny blisters Cracked nipples Shooting pains in the breast during or after feedings Intense nipple or breast pain that is not improved with better latch-on and positioning Deep breast pain You may be at higher risk for developing thrush if you or your baby has had a recent course of antibiotics, your nipples are cracked or damaged or you are taking oral contraceptives or steroids (such as for asthma) or if you are consume a high sugar diet or are a Diabetic. Be sure to examine other causes of nipple and breast pain with your IBCLC or healthcare provider. Dr Jack Newman of www.breastfeedinginc.ca has a Thrush/Candida Protocol on how to best identify and treat thrush here:

When you’re preparing to return to work, it’s hard to know how often you will need to pump your breasts in order to provide milk for your baby. Ideally, you should pump at work as often as you would have breastfed your baby at home. Realistically though, mothers often find that in an eight-hour workday they are able to pump during morning, lunch and afternoon breaks. Since time is in such short supply, using a pump that allows access to both breasts at the same time can be a huge help. By double pumping, mothers keep their prolactin (an important lactation hormone) levels up, and they may be able to pump in 10-15 minutes rather than 20 to 30 minutes. Many mothers find that double pumping, three times a day during the first few months, gives them enough milk to leave for their caregiver for the next day. As the baby gets older and begins eating solids they may not need to pump as frequently.

Remember that babies BREASTfeed, not NIPPLEfeed. As long as baby can take a good portion of the breast into his mouth (baby’s mouth and gums should bypass the nipple entirely and latch onto the areola), most types of flat or inverted nipples will not cause problems with breastfeeding. Some types of nipples are more difficult for baby to latch onto at first. However, in most cases, careful attention to latch and positioning, along with a little patience, will ensure that baby and mother get off to a good start with breastfeeding. How can I tell if my nipples are flat or inverted? Just looking at the breast often won’t tell you the answer. Instead, you can determine whether or not your nipples are flat or inverted by doing a “pinch” test. Gently compress your areola (the dark area around the nipple) about an inch behind your nipple. If the nipple does not become erect, then it is considered to be flat. If the nipple retracts, or becomes concave, it is considered to be inverted. It should be noted, too, that true inverted or flat nipples will not become erect when stimulated or exposed to cold. If the nipple becomes erect during the “pinch” test, it is not truly inverted and does not need any special treatment.

It is a fortunate baby that has a close, loving relationship with both of his parents. Babies need lots of physical contact, and when not breastfeeding, a partner’s loving arms are a wonderful place for baby to be. “[Both parents] need to spend time with their babies in order to get to know them better and get ‘tuned in’ to their needs” (WOMANLY ART OF BREASTFEEDING, p. 193). Watch for cues that baby is ready for more playfulness and interaction. A hungry baby won’t be at all interested in playing. Once baby is satiated at the breast, your partner can take over. Even the baby that breastfeeds very frequently can enjoy a satisfying relationship with your partner. Try letting your full breastfed baby lie on your partner’s chest. Rocking baby on a shoulder, diaper changing, bath time and babywearing are great ways baby can bond with her other parent.

We provide one-on-one evaluations and evidence based treatment for feeding and/or lactation challenges based on a multitude of factors. We not only assess the baby and parent, but look at the entire medical, social-emotional and feeding history along with current challenges when devising an individualized feeding plan that is unique to the family unit. We specialize in more complex feeding challenges that may be due to an infant hospitalization, underlying medical diagnosis or illness (Mom or baby) and growth concerns in baby. Many providers are unaware that although we specialize in breastfeeding and lactation, our dual certified Speech-Language Pathologists and Occupational Therapists also assess and treat issues related bottlefeeding, transitioning to solids and alternate feeding methods such as NG and G-tubes. Our Occupational Therapists also address gross or fine motor concerns, such as torticollis, plagiocephaly, and overall development. Our Breastfeeding Medicine Team can help with specific concerns related to persistent nipple pain and damage, “plugged ducts”, mastitis, and mental health concerns such as postpartum depression and/or anxiety. Our pelvic floor Occupational Therapist can help mamas who are struggling w incontinence, pelvic pain, and/or sexual dysfunction following the birth of their baby. We offer a free weekly Breastfeeding Support Group for anyone experiencing breastfeeding challenges and/or for anyone who just wants to connect with other mamas and get support in their breastfeeding/feeding journey in a non-judgmental, supportive environment.

There are various ways to refer families to Milk and Honey. Medical offices can send referrals to us directly via fax or phone. You can also encourage families to call or email us directly, so that we can obtain all of the information we need in order to help them set up an appointment here at our office. If your office sends us a referral via fax or phone, we will then reach out to the family to complete the scheduling process.

We accept most BCBS and Tricare plans. Many insurance plans also reimburse for services. We can provide you with a Superbill to submit and in some cases you can get a Gap Exception prior to the appointment to have your services covered. We also accept most HSA cards. ***And, stay tuned as we are currently working on contracting w several new insurance plans as well! Please call us if you have any questions.