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Tag: breastfeeding

Pumping Tips For The Working Mom

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Posted by Dr. Monica Wonnacott | January 14, 2018

A breast pump is a working, lactating woman’s best friend. Like your cell phone, you simply don’t leave home without it. One morning with my last baby, I was in a rush to feed the baby, get ready, get kids dropped off to school, and make it on time to work. I got to clinic and realized I had forgotten my pump. I was filled with dread. Going home would put me way behind (and running behind drives me crazy), but the prospect of not pumping all day is like being told you can’t go to the bathroom all day. You know at some point in the near future, you’re going to be beside yourself with discomfort. Pumping for your baby while working is a lot of work (and sometimes filled with mishaps), but the benefits for your baby are huge. So here I am again, 2 weeks post baby, and I’m in full prep mode.

Before baby:

  1. Get the pump. If you’re serious about pumping when you go back to work, you must have a good double-electric pump. If you’re going to try and have your insurance cover it, work on the details BEFORE the baby comes (the delay can take weeks).
  2. Figure out how it works BEFORE the baby comes. When your boobs are sore and you’re exhausted is not the time to be trying to make sense of the instructions. (The pic of my pump is typical of most pumps; the milk goes through the funnel like cup directly into the bottles, never going through the long tubing).

In the first 1 to 4 days post baby:

  1. If the baby nurses well do NOT pump those first few days. Just allow the baby to stimulate/drive your milk production. Besides, in the beginning, your baby should be feeding every 1-3 hours. You won’t really have extra time or milk to pump.
  2. If the baby does NOT nurse well, then pump every 1-3 hours. Always pump AFTER breastfeeding your baby and make sure you get lactation help/support. Don’t allow those first few days to pass without giving your breasts appropriate amounts of stimulation. Milk production is completely a supply and demand thing. If there isn’t enough stimulation, your body simply won’t make milk later. Make sure you consult with your pediatrician about appropriate amounts of feeding for your newborn if breastfeeding isn’t going well.
  3. Pump right away if your baby isn’t able to feed. There are lots of situations where your baby may be unable to breastfeed initially (e.g., your baby is premature, sick, or has a problem). Again, you’ll need to artificially create the demand for the supply to be there. You will need to pump as often as your baby would feed, if he/she were able.

4 days to 2 weeks post baby:

  1. Pump to increase supply and for relief. Hopefully, your milk is well established at this point and your baby feeds frequently. When you plan on going back to work, getting a really robust milk supply is important (because pumping at work and maintaining milk can be difficult). Having more milk than your baby initially needs is ideal for a working mom. Pump occasionally between feeds (right after breastfeeding is ideal) to relieve pressure and help build milk supply.
  2. Introduce a bottle. Once your baby is a good breastfeeder (can latch within 5 seconds and stay feeding), introduce a bottle. Don’t be afraid of “nipple confusion.” If you’re going to be going back to work, you need your baby to be able to take a bottle. Introducing it early, can save a lot of grief later. Have dad (or anyone besides the breastfeeding mom), feed the bottle. Do this once a day to once every few days (just to ensure your infant has the skills to go back and forth between breast and bottle).

2+ weeks to during the rest of maternity leave:

  1. Pump 1 to 4 times a day. This is the time to help build a store of frozen milk. Choose a time that is convenient for your life. For me, I find it easiest just before I go to bed and in the morning after I get the other kids off to school (these are the quietest moments at the Wonnacott household). Always feed your baby first; you are essentially pumping off the extra.
  2. Get your baby weighed. Typically, after having a baby, you will go to the pediatrician a couple of days post hospital discharge and again when your baby is 2 weeks old. These are great opportunities to ensure your baby is growing well, gaining weight, and getting plenty of milk. All of my suggestions of pumping are dependent on you having enough/extra milk and not taking milk at the expense of your baby’s current needs.
  3. Continue giving a bottle. During your entire maternity leave, you will need to continue to give occasional bottles. While directly breastfeeding is often easier, it is important your child learns to be able to go back and forth between breast and bottle.

When you’re back at work:

  1. Pump at least as often as your baby feeds at home. If your baby feeds every 2 hours, you can’t pump once during lunch in an 8 hour day and hope to maintain your milk supply. In the first few days, you’ll make tons of milk and pump big volumes, but after a short time, your body will stop creating so much milk and start weaning. You have to prevent your body from thinking it’s weaning the baby. Depending on your work environment, this is often easier said than done.
  2. Pump for 3 minutes beyond when milk stops flowing. Pumping dry boobs helps stimulate them and, moreover, there is often a little extra burst that will come with the extra few minutes of pumping (this is the hind milk which is nutritionally awesome).
  3. Coordinate (as much as possible) breastfeeding at the beginning and end of the work day. Typically, I will get fully ready and then breastfeed the baby just before I leave for work. I will also call my sitter just as I’m getting ready to leave work for the day to let her know I’m on my way home to feed the baby. That way, she can calm the baby without giving a bottle and then I can breastfeed the baby right when I get home. This approach saves me a couple of times of pumping, helps maintain breastfeeding, and encourages bonding. In complete disclosure, this is easier said than done (especially as I have more children and the other children have increasing needs).

Pumping for your baby when you go back to work is time consuming. Rotating milk, storing milk, finding places to pump, and learning all the ins and outs to safe storage and usage, etc., is difficult at best. But so much of what we do for our children is not what is easiest, but best for our children. Hang in there. Every ounce you can give your baby (even if it isn’t exclusively breast milk) is good for your baby.

See related posts:

BREASTFEEDING BENEFITS

HOW TO INCREASE YOUR BREAST MILK SUPPLY

SHOULD I BUY A BREAST PUMP?

CAN I TAKE THIS MEDICATION IF I’M BREASTFEEDING?

Get Ready, Set, Baby Time!

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Posted by Dr. Monica Wonnacott | November 29, 2017

I haven’t posted in a while because I’m in full baby prep mode. We’re on the count down at our house, 2.5 weeks (at the most) before baby #4 arrives. As I have been trying to fit patients in at work before maternity leave, prep for Christmas, and get everything together for a new baby, I realized that having done this before (and at this crazy time of year) really helps. If it’s your first time (or it’s been a while), here are a few tips:

What to buy?

FOR MOM

After you deliver, you may want to have these products at home to help in healing during the recovery process.

  1. Maxi pads (not tampons). There is a lot more bleeding post baby than many woman realize.
  2. Hemorrhoid pads or cream. Even if you don’t have hemorrhoids, the cream can help with all the swelling and vascular congestion that surrounds the vulva.
  3. Comfortable/stretchy underwear. Think grandma briefs (much more comfortable during the initial healing stages) than your cute thongs.
  4. Stool softeners or laxatives. All the pain meds will make stooling difficult (and no one wants to push against tender, torn, or stitched tissue).

 IF BREASTFEEDING

  1. Nursing pads
  2. Nursing bra
  3. Lanolin cream. Your nipples will likely get sore and it doesn’t have to be removed to feed the baby.
  4. Breast pump (strongly consider). A good double electric pump can be a lactating woman’s best friend.

 IF NOT BREASTFEEDING

  1. Ace bandage or tight sports style bra. This will help bind your breasts when/if milk starts to come in.
  2. Medication, like Pseudoephedrine (strongly consider). Medications like pseudoephedrine (a.k.a., Sudafed) can help dry up milk.

FOR BABY

These are the items you are going to need to take care of your baby.

NECESSITIES

  1. Diapers. You’ll get a few from the hospital, but not enough to last. Just so you have an idea, the average infant goes through 8-12 diapers a day. Be cautious about buying too many of the tiny sizes (like “newborns”). If your baby is big, you may end up straight at a size 1.
  2. I like sensitive or hypoallergenic wipes (like Water Wipes). Babies stool a ton in the beginning and their butts are very prone to diaper rashes.
  3. Crib (possibly a bassinet). You will need somewhere for your baby to sleep (and in your bed is not a good option).
  4. Car seat (5-point harness, infant style is best). This is required at the hospital to take your infant home.
  5. Clothes (including onesies and comfortable sleepers).
  6. Blankets (and burp cloths). You may want a few lightweight blankets because babies often spit up and soil blankets. You’ll need a few back up blankets if you don’t want to be doing laundry multiple times a day.
  7. Feeding support materials (breast care items or bottles and formula).
  8. Digital thermometer (rectal). If your child has a fever in the first 2 months of life (anything greater than 100.4 F), you need to know as it constitutes an “emergency.”
  9. Skin care products (diaper cream and hypoallergenic soaps and lotions).
  10. Nail file. You’ll be surprised at how long a baby’s nails can be and how much scratching he/she can do to his/her beautiful face. Typically, filing in the first couple of months is safer than clipping.
  11. Infant vitamin D drops (if breastfeeding).
  12. Petroleum jelly (if planning circumcision).

 NICETIES

  1. Pacifiers. Most hospitals use a “soothie” style brand (these are the blue/green ones that you can stick your finger into to aid in the infant sucking). Long term, these aren’t great binkies because they don’t come in different sizes and can’t grow with your infant, which can create dental problems as the child’s teeth come in.
  2. Monitor. While a video monitor is much more expensive than a simple audio one, they are really nice to have. A video monitor wasn’t economically feasible for our first couple of kids, but having one for subsequent children has been nice (especially for things like watching the child when they are older and you’re sleeping training/crying it out).
  3. Diaper bag. There are really fancy, beautiful bags out there with all the bells and whistles (changing pad covers, wipe holders, etc.). However, if your budget is tight, any old bag can hold some diapers, wipes, and a change of clothes.
  4. Stroller. When we lived in New York City, a stroller would have been classified as a “necessity.” Depending on where and how you live, this purchase can swing hundreds of dollars depending on what you need the stroller to be able to do for you.
  5. Play pen. These are as nice to keep older children out as much as they are to keep baby in. They are nice, but not necessary. They do make for great portable cribs though (especially if you travel or go to grandma’s house).
  6. Bouncer. These come in all sorts of varieties. If you plan on using one with your very young infant (younger than 3 months), make sure that it is pretty reclined (some sit up too much for a young infant to be able to support his/her body).
  7. Swing. Some parents swear by these. I borrowed one for my first kid, hated it and never bothered with subsequent children.
  8. Breast pump (if applicable). 

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Continuing my new baby series today talking about what your baby needs. There are a dozen cool products out there, but what are the basics? ⁠⠀ ⁠⠀ Swipe to watch my must-haves list. Let me know in the comments what you would add, and what cool gadget you can't live without!⁠⠀ ⁠⠀ Tomorrow I'll talk about baby item safety and what you should NOT get. ⁠⠀ ⁠⠀ ⁠⠀ ⁠⠀ ⁠⠀ ⁠⠀ #babyontheway #mothertobe #firstpregnancy #breastfeeding #breastfeedingtips #breastfeedingcare #pregnancydiary #momtobe2020 #smallbabybump #babybump #9monthspregnant #expectingmom #40weekspregnant #36weekspregnant #soontobemom #soontobemommy #bumplife #mummytobe #newbaby #38weekspregnant #30weeks #thirdtrimester ⁠#babymusthaves #babyessentials #babygear #bestbabyitems #bestbabystuff

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What Happens The Day I Deliver?

  • Go to the hospital when your water breaks or contractions are 5 minutes apart, or less.
  • When you arrive, the staff will contact your OB/GYN.
  • If any problems are anticipated with the baby, or if things don’t go well, the NICU or your pediatrician will attend the delivery to assist your baby. Otherwise, your pediatrician will come the following day.
  • Your OB/GYN and pediatrician will see you and your baby each day you are in the hospital.
  • If you have a C-section, plan on needing more help.
  • The average hospital stay (counting the day of delivery) is 3 days for a vaginal delivery and 4 days for a C-section.

Relax, You’re Prepared.

Planning ahead takes the worry out of what can be an otherwise stressful situation. Ask yourself:

  1. Do I have all the products I’ll need for me and my baby?
  2. Have I packed a bag for the hospital (both for mom and baby)?
  3. Do I have the help of family or friends arranged for the first few days home post-delivery?
  4. Have I chosen a pediatrician? If not, start looking. Most pediatrician’s offices will do some version of a complimentary “meet and greet,” which allows you to meet the doc and ask questions before the baby comes. It is a good opportunity to make sure you feel comfortable with the pediatrician because everyone’s style is a little different.

Good luck! Don’t’ worry. At the hospital you’ll be surrounded by experienced people who are ready and waiting to help you.

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First topic in my New Baby series: What to pack in your hospital bag.⁠⠀ ⁠⠀ The good news is the hospital is going to have everything you technically *need* to have your baby and recover. There are a few tips and tricks I have picked up after having my 4 children that I've included in this video.⁠⠀ ⁠⠀ I'd love to hear your favorite things to pack! Leave them in the comments below so our expecting mamas can have a great list to reference. ⁠⠀ ⁠⠀ ⁠⠀ #babyontheway #mothertobe #firstpregnancy #pregnancydiary #momtobe2020 #smallbabybump #babybump #9monthspregnant #expectingmom #40weekspregnant #36weekspregnant #soontobemom #soontobemommy #bumplife #mummytobe #38weekspregnant #30weeks #thirdtrimester

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Should I Buy A Breast Pump?

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Posted by Dr. Monica Wonnacott | March 17, 2016

If you are having a baby and planning on breastfeeding, you may want to consider buying a breast pump. The most valuable time to have a breast pump is generally in the first few days after having a baby. So if you’re going to invest in one, do so early.

Consider buying a breast pump if you’re planning on breastfeeding and…

  1. You’re going to go back to work.
  2. You want to be able to leave your infant for more than three hours (you could use formula for the baby, but your breasts will still need emptying).
  3. You ever have to have surgery (you will be advised to “pump and dump”).
  4. You’re going to have more than one child.
  5. Your baby is premature (premie babies often can’t feed initially).
  6. You have anything unusual about your anatomy that may make it hard for a baby to feed directly (inverted nipples, etc. – although, sometimes a nipple shield can help with some of those problems)

Features of a good pump.

I once went to a medical conference when I had a breastfeeding baby at home. I dutifully took my pump, but realized when I got there that I was missing a piece to make the pump work.  After traveling for hours, I was dying. It was in the middle of the night and no baby stores were open. The only place open was a 24-hour Walgreens. I bought a cheap hand pump and resolved to hit a lactation store to get the missing piece the next morning. After 40 mins of hand squeezing the dumb pump, I only extracted a small fraction of the milk and my hand muscles were seriously cramped. Needless to say, the hand pump went in the hotel garbage. I learned a valuable lesion that day. When it comes to your boobs, buy the best. Words to live by. Nothing works better than a good, double-electric pump. Be prepared, they can be expensive. (However, some insurance plans are now covering them, so it may be worth asking your insurance company). I bought the Medela Pump in Style Advanced Breast Pump. Although, I bought it 9 years ago, it’s still one of the best pumps on the market. I’ve used it 5+ times a day for over a thousand total days and it has always worked (that is, when I have all the pieces) without problems.

Breastfeeding Benefits

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Posted by Dr. Monica Wonnacott | January 26, 2016

Most women have heard the statement: “Breastfeeding is best for your baby.” Here’s why: If you are pregnant and considering breastfeeding, carefully read the information below as you make your decision. If you are currently breastfeeding, or have breastfed your baby, congratulations! This is how you helped your baby.

Benefits to baby

  1. Immunoglobulins, which help protect against diseases and illnesses, are passed from the mother to the baby. The following are some of the acute (short-term) disorders breastfeeding may help against.
    1. Acute (short-term) disorders
      1. Diarrhea
      2. Otitis media (ear infections)
      3. Urinary tract infections
      4. Necrotizing enterocolitis (portions of the bowel die, seen primarily in premature infants)
      5. Septicemia (infection of the blood stream)
      6. Infant botulism
    2. Chronic (long-term) disorders
      1. Insulin-dependent diabetes mellitus (inability to metabolize sugar properly)
      2. Celiac disease (inability to digest gluten)
      3. Crohn disease (inflammatory bowel disease)
      4. Childhood cancer (e.g., lymphoma and leukemia)
      5. Allergies
  2. Decreases hospitalizations
  3. Decreases infant mortality (death)
  4. Increases maternal infant bonding
  5. Improved cognitive (process of thought) functioning
  6. Improved motor (muscle movement) abilities

How to increase your breast milk supply

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Posted by Dr. Monica Wonnacott | January 11, 2016

Most women at some time during the breastfeeding experience question how to increase or maintain breast milk supply. The short answer is that breastfeeding is a complete “supply and demand” experience. The body is an amazing machine; if you feed a lot (that is, breastfeed a lot), it will make a lot. How else can we explain women that make enough to feed twins or triplets? So to make more, you have to feed more. As simple as that sounds, there are a few tricks to try.

Timing

The key time to establish a good milk supply is at the beginning. Frequent, effective feeding will really drive your milk to come in. You must stimulate the milk to come in. This is ideally done within the first few hours after birth. If your baby isn’t a great feeder, has problems, or is otherwise unable to eat (e.g., a premie in the NICU), you can “trick” your body after birth into making lots of milk by pumping. Typical newborns feed every 1-3 hrs for 20 or so minutes. If you are going to pump, you must do so as often as a baby would feed. If you want to make milk for twins, you must feed/pump twice as much.

Pumping

Sometimes, when a mom experiences a dwindling milk supply or experiences a problem (e.g., mom or baby got sick) that affects her milk supply during the breastfeeding experience, I will recommend something I call power pumping. Once again, it is the concept of trying to trick your body into making more milk. Know in advance that it is a lot of work/time commitment and doesn’t always work. This is how to do it: pump an extra time for every time your baby eats. Take for example a baby that feeds every 3 hours. First, breastfeed your baby. About an hour later, pump both sides of your breasts (the key is to pump for 3 minutes beyond when there isn’t any more milk coming out, to get any remaining hind milk). Then two hours after that, feed your baby again. The cycle just repeats itself. I typically recommend doing this for 24-48 hours. If your breasts will respond to extra stimulation, you will see an increase in the amount of pumped milk throughout the power pumping.

Drugs

Drugs or medications can increase or decrease milk supply. The most common medications that lactating women unknowingly take which can decrease milk supply include: combination birth control pills (it is usually the estrogen component that creates problems) and antihistamines/allergy medications (esp. those with pseudoephedrine). As for which drugs increase milk supply, there is a drug called Reglan (a.k.a., metoclopramide) that is sometimes used. However, the drug does have a black box warning on it, so I tend not to recommend it. There are also a few other drugs (not commonly accessible in the U.S., so I will not elaborate here). Some women have success with an herb called Fenugreek. If I were to use an herb, this is probably the one I would use (it has a good safety profile and is fairly effective). There are other herbs of note like alfalfa and blessed thistle (I have less experience with them and the safety profile is a bit less established).

Taking Care of Mom

Probably the most important aspect of milk production is appropriate care of the woman producing the milk. Lack of sleep, stress, and not eating well (doesn’t this sound like all new moms) can all contribute to less milk supply. I acknowledge that it is easier said than done, but try to get sufficient sleep. Eat well (especially high-protein foods). Consume enough calories (moms eager to lose baby weight may have strict diets that inhibit their body’s ability to make a good milk supply). Drink lots of water. Decrease your stress load. Stay healthy. All of these things will increase your milk supply.

Age of The Baby

Most babies start solid foods around 6 months of age. Since breast milk production is a supply and demand thing, most babies “demand” less milk as they eats solids. Consequently, most women gradually start to make less milk. You can help offset this effect by having other care givers feed more solid foods when you are not around, so you can breastfeed more when you are around.

Relax

Ultimately, relax. If you don’t make enough milk to feed your baby, it is ok. Many women have this “all or nothing” approach to breastfeeding. The truth is, any amount of breast milk you can give your baby is good. Certainly, something is better than nothing. Do what you can and use formula for the rest. It’s ok, you’re doing great.

Allergy Shots and Breastfeeding: Is it Safe?

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Posted by Dr. Monica Wonnacott |

It is hard to know what medications are safe to take when pregnant and breastfeeding. Ask anyone who has ever suffered from serious allergies and you know how miserable they can be without his or her allergy medications. The good news is that most allergy medications are safe to take. As for specific information about allergy shots, it appears (by the published literature) that they are generally safe. Most of my investigating into the matter has revealed that the injected allergens appear not to be transmitted into the breast milk. Consequently, there should be little risk to your baby regardless of when the shots are given or when the baby is fed.

When I did a quick search on The American Academy of Pediatrics published site, I could not find anything that would show a contraindication to breastfeeding and allergy shots. It is generally believed that shots should NOT be initiated for the first time when pregnant or breastfeeding (due to the risk of anaphylaxis and subsequent risk to the fetus), but are safe to continue.

As an aside, the “D” part of many allergy medications (e.g., Zyrtec-D, Claritin-D) is usually pseudoephedrine. This medication should NOT be used while breastfeeding because it will quickly dry up a woman’s milk supply.