Quick Tips to Prevent or Ease ‘Milk Lumps’

If you are breastfeeding your baby, you can sometimes experience these. If a milk duct is not draining well, it can become plugged or clogged, and inflammation builds up. This creates a tender, sore, lump in an area of the breast. These ‘milk lumps’ can come quickly and without warning. For me, it begins when I suddenly notice a bit of discomfort or tenderness in a spot, and then I can feel a small hard lump when I press on the area. Occasionally, I may get a lump forming from over pumping or when baby suddenly revs up demand for breast milk, causing the breasts to try to increase milk production quickly to match the increase in demand. Once the ‘milk lump’ forms though, it seems to take the better part of the day to resolve fully and I have to apply many measures including getting baby to consistently drain that spot for a couple of feeds. So the best thing I would advise is to keep checking (especially the prone breast or side that tends to get ‘milk lumps’ more easily) frequently, even daily if possible. But if you already feel a tenderness and hard lump forming, don’t worry—here are a few things from experience that you can try which may help ease the discomfort:

Massage, massage, massage.
When you feel a ‘let down’ reflex, especially at night, it often helps to massage the breast tissue (especially the outer parts of the breast) thoroughly using the base of your hand/palm in a big gentle circular motion to help with milk flow and circulation. Another tip is to massage the breast tissue all around the nipple as baby is sucking on that breast so as to help drain the different areas of the breast around it evenly.

Try using a different breastfeeding position.
Sometimes the tendency is to stick to a breastfeeding position because that’s what you and baby are used to. But if you find one particular position may be causing a milk lump to form on a part of a breast more frequently, then it may be time to try a new or different position! Your current breastfeeding position may be what is causing the milk lump to form, because a certain area is not being draining properly.

Change baby’s sucking direction.
During the course of a breastfeed session, you can switch positions and baby’s sucking direction a few times, to help drain different parts of the breast. If you already have a lump formed, then try lining up baby’s chin with the location of the lump so that it forms a straight line vertically, diagonally or horizontally to help with draining that specific area.

Try a hot shower.
A hot shower with hot water directed at the area, and some added massaging can help ease the discomfort you feel. Another idea is to put a hot wet cloth on the affected part of the breast a few times a day to help soothe that area.

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Moms Aware! What You Should Know About Keeping Breast Milk in the Fridge

As you may have seen by now, recommended storage times for expressed breast milk (EBM) in the freezer and in the fridge can vary quite a bit, depending on which guidelines you look at and factors like the type of freezer used.  For freshly pumped breast milk, the UK and US government guidelines are generally the same, which is that EBM can be stored in the back of the fridge for up to 5 days at a temperature of 4o C (39o F) or lower.

There is a study, cited in the American Academy of Pediatrics (AAP) 2012 position statement on Breastfeeding and the Use of Human Milk, which looked at the changes in expressed breast milk stored in a refrigerator in a hospital setting. Many factors were measured over time, including the pH, bacterial count, protein level and white blood cell counts. It found that EBM could be kept in a fridge for up to 96 hours (4 days) with minimal changes to its integrity. That’s good news. But, should expressed breast milk really be kept this long in the fridge? What about its taste?

What I have found over the months, is that the length of time the fresh breast milk sits in the fridge also impacts its taste. Very fresh breast milk tastes really good! It has a mild sweet aftertaste but is essentially quite bland. Think of 1% or non-fat cow’s milk but with a lighter, more watery and slightly sweet taste. By day 2, the expressed breast milk is already starting to taste a little ‘off’; you can taste a tiny bit of the free fatty acids from the lipases working, and a whitish layer forming on the top of the milk. By day 3, the ‘off’ soapy bitter taste is even stronger, even after mixing in the fat layer to the rest of the milk. I think at this point the baby may not be as willing to accept the milk already. If this is the case, you could try warming the milk more before offering it to baby, or use it in baby’s solids instead. By day 4, the ‘off’ taste gets even stronger. Much stronger.

The take home message? I would recommend using your expressed breast milk within 24 hours if kept in the fridge to optimize its taste and acceptability to the baby. Otherwise, definitely use it up by 4 days (96 hours). And still keep it at the back of the fridge! If you don’t think you’ll use it within 24 hours, then it may be best to freeze it, and then when you need it thaw the expressed breast milk and use it as soon as you can after it is thawed!
 

Sources:
1. Centers for Disease Control (CDC). Proper handling and storage of human milk.  http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm. Accessed 26 October 2013.
2. National Health Service (NHS). Expressing and storing breast milk. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/expressing-storing-breast-milk.aspx#close. Accessed 26 October 2013.
3.Section on Breastfeeding. American Academy of Pediatrics. Breastfeeding and the use of human milk. J Pediatr 2012;129: 3: e827-e841. http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html. Accessed 26 October, 2013.
4. Slutzah M, Codipilly CN, Potak D, Clark RM, Schanler RJ. Refrigerator storage of expressed human milk in the neonatal intensive care unit. J Pediatr. 2010;156(1):26–28.

21 Months and Counting…Pure Bliss!

The best things about breastfeeding my baby have been enjoying those quiet moments of closeness together, and helping to keep her healthy. But personally, one of the other big benefits of continued breastfeeding is this…being period-free for 21 months!

No, I haven’t been breastfeeding for 21 months. But if you add up the pregnancy and breastfeeding for a year, it comes up to about that. In fact, it’s been so long that a period seems like a distant memory…not that I’m complaining! I definitely don’t miss those painful excruciating cramps, emotional rollercoaster feelings and occasional tearful breakdowns. But as I now wind down on breastfeeding, I have to prepare myself that they will be coming again soon! In fact, I am already feeling some of those minor pangs of discomfort happening…I guess there is no escaping the fact that they need to come back some day!

Pump Smart: Make the Most Out of Your Pump Session!

Pumping does takes some time, effort and energy to sustain, but it is well worth the investment! Here are some tried and true strategies to help you maximize your pump session:

Massage
If you are able to, use the fingers of your free hand(s) to gently massage or make ‘C’ shape compressions all around the breast that you are pumping. To make ‘C’ shape compressions, hold the breast with the thumb one on side and the rest of the fingers on the other side, then squeeze the breast firmly. As you massage or make these compressions, rotate gradually around the breast.  Doing these motions while pumping will stimulate the milk flow more, help to make sure you are getting at all the milk glands in the different areas of the breast (especially those outermost areas), and may even help reduce your chances of getting mastitis.

Get a Good ‘Latch’
Though it’s best that the pump horn fits well, don’t worry if it doesn’t fit perfectly at the beginning. Personally, I found the pump horn fitting better over time, probably due to continued breastfeeding and pumping. Try making ‘C’ shape compressions on the outer part of the breast tissue around the pump horn while pumping, to get as good a ‘baby’s latch’ as possible.

Choosing How Much to Pump
What volume should be pumped out?  This depends on your goals.  If you have time to pump out properly, it is better to pump out as much as you can from one or both sides. But if you have no time, then a bit of stimulation is better than none. From my experience, I have found that at least a good 10 minute pump on a side, or removing a minimum of 30-40 ml (about an ounce) of breast milk from one side seems to provide adequate stimulation, especially if a breastfeed session is coming up soon.

If you are able to have a full pump session in the night or at some point in the day, knowing that baby will not be needing a feed for another 2-3 hours or more, then you can aim to pump out more. I found that pumping out 80-90 ml (about 3 ounces) from one side is a good amount to aim for at these times. Pumping more will not only give a bit more stimulation, it will also allow you to build up your frozen expressed milk stores faster!

Mimic Baby
You may have noticed the same with your baby—during a breastfeeding session, baby would at times seem to be barely sucking at all, but somehow this effectively triggers the breast to have a let-down reflex soon after. Then the moment a let-down reflex happens, there is a change in baby’s suck swallow rhythm. All of a sudden, baby appears to gear up to do a good few minutes of hard vigorous sucking — as though baby knows now is the time to get out as much milk a possible!

My Medela electric pump comes with two pump settings: a gentle quick pumping motion, and a slower more rhythmic motion. What I found effective was to use these two different settings to mimic baby’s sucking pattern at the breast.  During pumping, I often start with the gentle quick pumping motion for the first few minutes (the pump starts with this motion automatically for 2 minutes before it switches to the slower motion). I find that this helps to get the milk flowing, and a let-down reflex often occurs soon after. If a let-down reflex hasn’t occurred by the 2 minute mark, I sometimes just stay on the quick pumping motion until it does. Then I quickly switch to the slower more rhythmic motion and turn up the pump setting so that there is a stronger pumping action, so as to pull out as much milk as quickly as possible. I stay on this slower rhythmic motion for a period of time until I find the milk flow lessening and eventually stopping. At this point, I either stop pumping, or switch back to the gentle quick pump motion, to encourage another let-down reflex. I find that following this strategy has helped me to pump much faster and obtain more volume.

So if your electric pump also has two or more settings, use these to your advantage. However, when you change to the slower more rhythmic motion, don’t ‘overpump’ by turning the pump setting too high so that the pull action is too strong. I have done this before and found that it often does more harm than good!

My Brest Friends

Let me introduce you to my 3 brest friends: Pump, Pillow and Chair. I have found these 3 companions  indispensable on my breastfeeding journey. Let me explain why:

Pump: My sis-in-law said the breastfeeding pump was essential. Now I understand why. Even if you are not working or planning to return to work, a good breastfeeding pump will help you establish your milk supply faster during those early weeks, enable you to quickly build up a store of frozen breast milk (very useful when you are sick, need a rest or when you just need to be out and about, as others can help to feed baby) and to maintain your breast milk supply when baby’s intake at the breast starts to diminish gradually with the introduction of solids.

Some simply hand express or use a manual hand pump. I have found that the electric breast pump worked best for me. What kind should you buy? Well, my sis-in-law used the same freestyle Medela pump (backpack style) for her 3 children without problems, and I have been using a freestyle Medela pump myself for almost 9 months without problems either. However, it’s true that this is on the pricier side, and other pumps on the market may work just as well. At the time, I really struggled to make a decision on which pump to invest in, but having read nearly all the reviews on Amazon for the Medela freestyle and Philips Avent electric pumps, I resigned myself to the fact that all pumps will come with some negative reviews. Some say that the Medela pump has too many parts to clean afterwards, but I haven’t found it difficult to clean the four parts that the pump breaks up into. But do be careful with the ‘membrane’ piece which is quite delicate and make sure the pump horn fits you well. In the end, you will just have to take the plunge and choose one.

Pillow: Absolutely necessary! After purchasing 2 different breastfeeding pillows (one was a standard poofy cresent shaped pillow that fit my waist in front), I have found one that works the best. It is called (surprise, surprise) ‘My Brest Friend’ (www.mybrestfriend.com). It comes with a back support piece, which I have found crucial in helping to improve my posture and reduce lower back strain during breastfeeding.  It also has a little pocket and a keyring so that you can hook one or two toys to keep a bored baby entertained during breastfeeding. This pillow has been extremely useful during traveling as well, and also for a new breastfeeding position I invented myself (more on this in an upcoming post). Even now, almost 9 months later, I am still loving and using the pillow!

 Chair:  You will definitely need a comfy breastfeeding chair, preferably one that has a tall back to provide a headrest, as you will be spending LOTs of time in the chair. If you breastfeed, you could be spending anywhere from 20 minutes to 60 minutes per breastfeed session in the chair (from breastfeeding both sides). Imagine doing this a few times a day, so it is worth getting a chair you enjoy sitting in. A good breastfeeding chair doesn’t have to be expensive—we got ours at Ikea and it works great (see post on “Top 5 ‘Must-Haves’ in Your Baby’s Room” for more details). Use additional pillows as needed so that you can make the seat as comfortable as possible for you and baby!