My breastfeeding questions answered

Pearls in April

For me, the first six weeks of breastfeeding were the most challenging. I didn’t know what I was doing. I had a hard time holding him in the right position. I didn’t know how much and how often to pump. I was worried he wasn’t getting enough. His six week growth spurt was brutal, he just wanted to feed all the time and I was beyond exhausted. I knew I needed help and sought the assistance of a few (yes, a few) lactation consultants in my city. The benefits that I got out of my visits were invaluable.

Now that my struggles are behind me and Marko and I are sailing along our milky way, I reached out to one of the consultants I previously met to chat about breastfeeding and some of the humps I encountered. Beth McMillan is a trained IBCLC (International Board Certified Lactation Consultant) that has been in private practice for seven years. I’m hoping that by sharing this, those living a similar experience as mine will be better equipped with the knowledge that I didn’t have at the time.

Here are the highlights of our back and forth email conversation.


Me: Beth, I struggled with a lot of internal disappointment in my first few weeks trying to breastfeed. Some days, I felt like I would never get it right.

Beth: It’s the unrealistic expectations put out there by all the books, social media and society in general. I think we are very separated from our normal physiology; we often rush to do everything ‘right’ that we forget to simply watch our babies and listen to our gut/heart/instinct. It can be super confusing especially for first time moms. I don’t think we do a good job educating young people, starting in high school or even earlier, about what babies need and what their biological norm should be (or our biological norm is). During pregnancy, we put a lot of emphasis – for good reason! – on the birth but don’t spend much time talking about what comes after the baby is born. I think a lot of breastfeeding and early parenting challenges could be avoided if moms had more info about what to really expect in order to better decide what their own personal goals for feeding their baby will be and how to avoid common challenges, like pain or perceived (or real) milk supply problems.

Me: I had set myself a goal to breastfeed for at least the first six months, but some days I would seriously contemplate giving up and calling it a day with a bottle of formula. I had to constantly remind myself of the benefits of breastmilk and encourage myself to keep going. In your experience, what is the number one reason women give up on breastfeeding? What would you say to help them get past that?

Beth: Studies show that perceived low milk supply and pain are the top reasons women give up on breastfeeding. Many women don’t realize that most issues can be addressed and resolved with good help. Taking a good prenatal breastfeeding workshop can be helpful as well. The instructor can often help you find other good resources (not all breastfeeding books and websites are created equal!). Understanding what babies are really like is so important. What does it mean when we say babies eat a minimum of 8x/day?  It’s easy to think that your baby isn’t ‘getting enough’ when he wants to eat ‘again’.

Women who don’t have good family support are also more likely to stop breastfeeding earlier. Having a partner who is supportive can make or break breastfeeding, especially for mothers who are having challenges. Building a support network is helpful. Tell people in advance you plan to breastfeeding and would like their support. Find your nearest breastfeeding support group such as La Leche League and go to meetings (especially great if you can go while still pregnant!).

Me: I had a nurse tell me once that after latching is established, all you need is confidence to succeed at breastfeeding. Thoughts on this?

Beth: It sure is important to trust your body and your baby, but I think there are many moms out there who would disagree with that statement.  For most healthy moms with healthy term babies this is in a large part true, especially if they got off to a good start. For moms who struggle, that statement might be a bit alienating. They might have to adjust their goals and expectations about breastfeeding or need to use a pump or a lactation aid or bottles – they are no less successful, but they might need more than just confidence.

Me: My son spent the first week of his life in the NICU. The nurses and doctors were very strict about the amount of milk he got and how often. Since they work on a schedule with several babies, they would feed my baby exactly every three hours. I wanted to breastfeed but was having a hard time with the latching, and they needed it to be done, so I would only get a few minutes with him before they insisted on bottle feeding. I had the choice of pumping or giving him formula. I chose to pump as often as I could, but didn’t have much help and support in that area. Have you worked with mothers who had their babies in the NICU? What are your thoughts on the support that is provided there?

Beth: So let me say at the outset that hospitals vary in their practices and routines. The same thing applies to the staff’s breastfeeding knowledge. Most staff want to help. The NICU is a world of its own. Some babies in the NICU are very very sick and some just need observation, some have their parents with them almost 24 hrs/day while some rarely have anyone due to family being from out of town, having other children, etc. Nurses are busy so babies are fed on a regular schedule to make sure that everything gets done and done safely. They have many factors to consider in addition to their care routine so feeding routines in the NICU need to fit the NICU schedule.  However, NICUs are slowly changing and becoming more personalized.  Even the sickest and earliest baby can benefit from this. The research available about best practice is fascinating.  Implementing change (such as more parental care, skin-to-skin care, individualized feeding plans, more and earlier breastfeeding in the NICU, etc.) takes time, education, change of mind set and habits – and money.

Specialized lactation support is generally not a priority as far as funding goes. Did you know that our local children’s hospital doesn’t have a Lactation Department? Or a dedicated IBCLC on staff?  Most parents want to breastfeed and most nurses want to help but workload is heavy and timelines are tight and habits are entrenched so breastfeeding and breastfeeding friendly practices (like skin-to-skin) come second to current practice (and, of course, pressing health needs take priority over everything).  I have worked with many ‘NICU grads’.  Some were in hospital for months and months and some for only a few days. All doctors and nurses agree that breastmilk is important and ‘best’ but providing support is challenging given current practices, time and financial constraints.

As for pumping, most moms with babies in the NICU do need to pump.  Having the pump at the bedside so mom doesn’t have to leave her baby is important. Having someone to teach her the most effective and comfortable way to pump is important – how to know if the flanges fit well, how to pump hands-free and hands-on, how long to pump, how high to turn up the pump, etc.  A new mom who is worried about her baby, tired and sore may have a hard time sorting out a pumping routine that works best for her. We need staff that can help. Or moms need to be referred to someone who can help…that is often a solution that people don’t think of: Out-sourcing! Find someone in your community who can guide you – they may work with you in person or over the phone or on-line.

Me: When I was told they would have to bottle feed him in the NICU, my options were pumping and formula in the meantime. Why was donor milk not an option?

Beth: Wouldn’t that be wonderful if we had donor milk to offer to every family! Unfortunately, most people don’t know about the option to use donor milk and because of the way the system is set up, only the very sickest and most premature babies get offered donor milk. Canada had a system of milk banks years ago but when the hepatitis/HIV crisis hit in the 1980s, the milk banks closed for safety reasons. However, the importance of breastmilk for babies is well known and now milk banks are popping back up across the world. We have one in Ontario but supply is limited so only the sickest, earliest babies whose mothers cannot provide for them get the milk.

Some families decide to provide donor milk to their babies that they source in the community through family or friends. This is something that has happened throughout human history. Mothers have always shared with other mothers in need. Some of this milk sharing is informal between friends or family and some is sourced through organizations such as Eats on Feets or Human Milk 4 Human Babies. Until the milk banking system grows and is fully funded, mothers will likely continue to share their milk this way.


Me: After being released from the hospital, I became obsessed with tracking exactly how many ml of milk he was getting. After speaking to other mothers, this seemed to be a common concern. How can women get over this NICU-mentality and move forward with breastfeeding without worrying about numbers?

Beth: Much of ‘successful’ breastfeeding is about trusting your baby and your body to do what they are supposed to do–that is often harder for moms who have come through the NICU where everything was measured, timed and calculated. If mothers are able to build up a good milk supply through pumping I think it is easier for them to trust that the baby is getting milk. For moms who are struggling with supply the transition is more of a challenge. Good support during the transition is crucial. Again, it comes back to education. Moms need to know what to expect, what is normal baby behaviour, normal newborn feeding patterns and where to go for help or extra support. Moms need to understand that it’s the big picture that counts, not every individual feeding.

Going to a drop-in to check baby’s weight can be reassuring to moms and provides important information about how their baby is doing outside the hospital; but moms need to know other important cues that breastfeeding is going well. I believe moms and babies being discharged into the community need a direct link to breastfeeding support. Regular contact with someone knowledgeable(such as an IBCLC) about how to safely wean away from pumping, how to reduce supplemental bottles or what it means to ‘follow baby’s cues’ when they are used to a 3hr feeding schedule is important for mom’s peace of mind and for continued breastfeeding. A healthy baby doesn’t necessarily feed every 3hrs and certainly doesn’t take the same amount at every feeding – we sure don’t eat like that! Our babies don’t either.

Me: I was often confused about how to safely pump if I want to build a reserve or have my partner or someone else help with a feed once in a while. How can one pump in a healthy, balanced way?

Beth: For moms that would like to have some milk on hand for ‘emergencies’ or just because they want to return to their Thursday night volleyball game, one way is to pump a little bit, say, an ounce (30ml) from each breast after the baby has fed. Then a day or two later do that again and voila! You have 4oz of milk to put in your freezer and you’ve done it with very little stress and without disturbing your supply.

My job is to provide information so mothers can make an informed decision about why, when and how to pump and even which type of pump to purchase. If moms do want to pump, it’s my job to ask questions like ‘what will you do with your full breasts if you sleep longer than usual and your husband feeds the baby?’. Mothers may not think of asking themselves these kind of questions.

Me: As you know, I donated my milk due to my son being intolerant to the dairy I consumed while pumping. What are your thoughts on milk exchanges among women? Do you consider it safe?

Beth: I believe in informed decision making. Some women will be driven to share milk as they know human milk is the specific food our babies are biologically intended to have. I think that more information and more openness is very important for safety. It’s better to go in with full understanding of what the potential risks are and how to mitigate them (same thing goes for formula feeding). Formula is an attempt to approximate human milk. It is generally considered safe, though there are some people with allergies, considerations (concerns re family history of) about diabetes, and the fact that there have been recalls on formula to consider. Generally speaking, if a woman is feeding her own healthy child and altruistically shares her milk without impacting her own breastfeeding relationship, I think that’s a good and generous thing.

Me: What are some questions women looking to accept donor milk should ask?

Beth: You can find the answer to this is on either the Eats on Feets or Human Milk 4 Human Babies website. Generally a mom should consider dietary restrictions she or her child may have for health or religious reasons, medication the donor mother might be on, health conditions the donor mother has (or her partner has), as well as lifestyle considerations (smoking, alcohol, recreational drug use) and the impact of donation on the donor mother’s child – if any, cleanliness and milk storage safety, how milk will be transported, etc.

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