Qn of the Month: How Can I Drop the Middle of the Night Pumping Session?

owlA: There is no hard or fast rule on this.  Here are 4 suggested methods below. Feel free to pick the one that most suits you!

Option 1: Over several nights, gradually cut back on the amount of time you spend pumping during that night session. The goal is to get some relief but not empty your breasts completely. So slowly wean off, by pumping less and less each session. Your body will get the message to produce less breast milk during the night.

Option 2: Don’t drop the night pumping session completely, but just pump a little later each night. The goal is to gradually move it later and later each night until you’re close enough to the morning breastfeeding session to make it without pumping at night. So ultimately, the night pumping session ends up merging with the early morning feed.

Option 3: Stop pumping but switch to hand expressing. However, only hand express enough to relieve pressure and discomfort. Repeat this each night until your breast milk supply adapts to the decreased demand.

 Option 4: You can drop the pumping session at night, but then adjust the breastfeeding times. For example, instead of pumping at night, you could have a breastfeeding session later at night (e.g., 10:30-11pm) and then once more early in the morning at about 6 am.

Hope these suggestions help!

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Qn of the Month: I Need Breastfeeding Help! Who Can I Call?

If you are a new mother having trouble establishing breastfeeding, don’t feel discouraged. There’s help out there for you! Always check out your local hospital (or where you delivered) to access lactation consultants and breastfeeding help. In each country there are often many breastfeeding support groups and non-profit organizations providing resources and peer/professional support. Examples include the La Leche League (US and UK), National Childbirth Trust (NCT) in the UK, and the Association for Breastfeeding Advocacy (Singapore).  In the United States, you may also be able to get lactation consultant help from a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) agency near you, and don’t forget to check out what may be available at the State level. For example, the Arizona Department of Health Services actually operates a 24 hour Breastfeeding helpline for breastfeeding questions.

Here are a few additional handy numbers and resources to take note of (by country):

UNITED STATES:

This is through La leche League (LLL) and is a toll-free number. If no one answers, leave a voice message. You can get connected to a local LLL leader and local LLL support group too.

UNITED KINGDOM (there are lots of phone numbers!):

  • National Breastfeeding Helpline: 0844 20 909 20
  • Association of Breastfeeding Mothers: 0844 412 2949 (9.30 am -10:30pm)
  • Breastfeeding Networks Supporterline: 0844 412 4664 (9.30 am – 9.30 pm)
  • La Leche League Great Britain: 0845 120 2918 (24 hour line)

SINGAPORE:

  • Joyful Parenting and Breastfeeding Helpline: 64880286 (Mon-Sat, 10.00am – 5.00pm)

Want more information? These websites might help:
http://www.abas.org.sg/information.htm
http://www.nct.org.uk/branches/southampton/breastfeeding-support
http://www.lalecheleague.org/nb.html

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.

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.

Qn of the Month: Will Baby Drop Breastfeeds Quickly After I Introduce Solids?

It’s understandable to be worried about this, especially if you are anxious to keep up your breast milk supply.  There are many factors that may affect this, like how old baby is when solids are introduced, how much solids you give baby at a meal and in a day, how close it is to the next breastfeed session, and how fast baby takes to solids!

If solids are introduced gradually, you may not notice too much of a change at the beginning, especially if baby is not taking much solids at a time (e.g., only 2-3 teaspoons in a sitting), and also if baby still considers the breast milk as the ‘real’ food. When I introduced my little one to solids once or twice a day at about 24 weeks of age, she still took a couple of weeks just to get the hang of pureed solids, and to realize that this is food like breast milk!

But as baby gets used to solids and starts to eat a larger amount at a time, you may find the baby’s next breastfeed session may not be as long. Overall I have found that baby will still feed the same number of times at the breast (generally will take some if I offer the breast at the same set times during a day) but the duration of the feeds gradually shortens or seems to drop off in length (e.g., instead of 10 minutes a side, it becomes 5-6 minutes). I guess it could all be nature’s way of dropping the breast milk supply gradually, as baby is still feeding the same number of times but the duration lessens, and your body also gradually as a result drops off in breast milk production – that is, if you don’t keep pumping of course!

Also after 7-8 months, I’ve noticed that the hunger cues in a baby appear to be not as immediate or urgent so baby may not alert you that he or she needs to breastfeed as readily. But if you offer the breast at the usual times, baby will often ‘remember’ the hunger and take some. As a result, I had to take more of an initiative and be more proactive in offering the breast.

So don’t worry, your milk supply may not be affected much when baby first starts solids. And even after baby starts to get used to and take more solids in a day, there are still many ways to keep up your breast milk supply to continue to meet baby’s needs!

Reaching the One Year Mark

We have lots to celebrate this week with our baby turning 12 months. My husband and I are celebrating having survived the last 12 months of parenting (though we know the harder parts are yet to be experienced and coming up!). I’m also celebrating having made the one year mark in breastfeeding!

There were definitely times I did not think my milk supply would keep up. It has been a long and often hard journey of pumping a few times a day (including once in the middle of the night) especially in the latter months as baby’s intake of solids has increased and breastfeeding sessions dropped correspondingly. But it has all been worth it! I think there is definitely a sense of empowerment in achieving something that you did not think might be possible, and I’m extremely thankful we’ve been able to come this far!

As I now let up in my pumping, I am sad that baby and I will soon not be able to share these sweet bonding times together. I’ll always be grateful for these moments together though. It’s a strange feeling as well to suddenly realize that I won’t be needing that pumping machine for very much longer. The World Health Organization (WHO) recommends exclusive breastfeeding till 6 months of age, and then continued breastfeeding with appropriate complementary foods up till 2 years of age or beyond. So though I’m winding down on my breastfeeding, you can keep breastfeeding for as long as you and baby desire!

Fresh Versus Frozen: The Taste of Thawed Breast Milk

Frozen thawed milk tastes different from fresh. How do I know? Because I was basically dared by my mother-in-law (MIL) to try my own breast milk (yes…). At the time, my baby was about 3 months of age and wasn’t taking breast milk well from the bottle. My MIL suggested it was the taste of the thawed breast milk, as her friend said her grandchildren had the same issue because the thawed breast milk did not taste good. I knew breast milk usually tasted slightly sweet because of the lactose content, but I didn’t really believe my MIL that there could be such a vast difference in taste between fresh and frozen to affect baby’s intake. Especially since I had learned as a dietitian that a baby doesn’t usually develop a strong taste preference until after 6 months of age. Before then it was often possible to get a baby established onto a more bitter tasting hydrolyzed formula even if the baby had been used to the sweet taste of breast milk. And after all, if the expressed breast milk had been quickly frozen, wouldn’t that slow down the lipase enzymatic action on the fats within the breast milk and so prevent the breast milk from going ‘off’ in taste? Well, my MIL then implied that if I didn’t believe her I should taste the breast milk myself. So I did. In front of her.

And okay… there IS a difference. Fresh breast milk tastes…fresh…a bit like cow’s milk but lighter, more watery and with a slightly sweet taste. The thawed breast milk tasted more bitter and metallic. I found it had to be heated more in temperature to make it more palatable tasting.

My little one still took the thawed frozen breast milk (sometimes with a bit of cajoling and distraction with a toy) from a bottle until about 4-5 months of age, then after that she seemed to get wise to the fact that it really didn’t taste very good, and so refused more adamantly to take it (even when she was really hungry). She would always drink fresh pumped breast milk though!

What I have found I needed to do was this: Give the frozen breast milk as soon as it has thawed. This means really within the first hour or two after it has been thawed out in the fridge. Doing so will keep the thawed frozen breast milk tasting as close as possible to freshly pumped milk. Any more than that, and the bitter, metallic and soapy taste starts to appear, especially the longer it sits (mainly because of the active components within the breast milk like the lipases which start to break down the fat within the milk).

Note that even if there are some taste changes in the thawed breast milk, you can still use it in the baby’s food, assuming the baby is eating at least a few tablespoons’ worth of solids in a sitting. This gets easier to do as baby gets bigger and eats more at a time. So don’t toss all your hard work of pumping away!