We were delighted to have Lactation Consultant and Breastfeeding Expert, Naomi Hull answering some common breastfeeding questions from our very own community at our Ask the Expert Segment recently. We have put all the questions and answers into an easy to read blog for you!
Preparing for Breastfeeding
Q: What’s the best way to prepare for breastfeeding in pregnancy? I was woefully unprepared with my first and unsuccessful so would love to set myself up for success this time!
A: It may help to have an antenatal lactation consult, OR go along to an ABA breastfeeding Education Class. Forearmed is forewarned. It may also help you understand what happened last time so you may be able to avoid similar issues this time. The more information you can gather the more prepared you will be. When bub is born skin to skin is super important for as many days and weeks as you can manage. Avoid separation wherever possible. Feed as often as baby needs and if you hit any hurdles – like attachment issues/damaged nipples seek help straight away. This is really useful to look at and have with you at the birth. CLICK HERE
Q: I have some scar tissue on one side from mastitis and many aspirations with my first, will this make me more prone to blocks and mastitis/latching problems? Is there a way to break up the tissue to prevent issues? I’m currently 30 weeks pregnant.
A: Scar tissue can be present and it seems common that women who had recurrent mastitis for one, do seem more prone to recurrent mastitis in subsequent children… but also depends on the cause/reason. If inadequete milk removal was the only issue with poor treatment, that may not be an issue second time around… or some women may happen to have a naturally higher bacterial load than others and is more prone to clinical infections.. some say that a probiotic called Qiara may help those women to decrease the incidence and possibly prevent clinical symptoms of mastitis when taken consistently. Dermatologists can correct scar tissue with laser – I would look at getting referral if you think the scarring is bad enough.
The best prevention is understanding the causes of mastitis, optimal positioning and breast drainage by baby. Ultrasound can’t hurt, but breast massage may also help.
Q: What would be your top tip/s to get breast feeding off to the best start possible? Baby #2 on the way and had a lot of supply issues with bub #1.
A: First of all it could be worthwhile (if you haven’t already) to consider speaking with an IBCLC to talk over what happened last time that may have impacted on your supply, and how to address that. The other thing to know is that every lactation is different, so wont necessarily be the same this time.
The number one way to ensure a good supply is frequent milk removal – either by the baby (preferable) or the pump. The more milk that is removed in the early days, the more milk you will have at two to three months and so on. Skin to skin ++++ is also a contributor to milk supply as it increases the release of oxytocin (the hormone of labour, love and lactation) which helps in the release of your milk.
Breastfeeding Newborns
Q: I have a six day old bub, he latches like a champ and sucks/swallows perfectly for around 3-4 minutes but then he’s out like a light! I’ll burp him to wake him and put him back on and it’s the same story. Both sides, every feed! Is this normal for a six day old? He has had around five wet nappies today and he’s pooped three times, all very runny. He’s a very content bub, only really cries when he wants a feed. He will sleep between feeds IF I can get him to have a decent amount, if not he seems to “nap” and constantly feed. Hoping it’s to try and up my supply but I really have no idea! I’m demand feeding so generally every 3 or so hours but quite often in the day it’s much more frequent.
A: There are no rights or wrongs with breastfeeding – best way to tell is by his output and contentedness. What you’ve described all sounds very normal and like you are both on the right track. The nappies are the best indicator of your supply and your baby knows best when he has had enough. They will have periods of time in the day when they will cluster feed – it is usually in the afternoon but at this early stage it could be any part of the day. Give yourselves time and trust that your body can do this bit just like it did the making and growing the baby bit. In general newborn babies will feed on ‘average’ 8-11 times in 24hrs.
Q: Is it okay to give bub formula while breastfeeding? My baby is only 1 month and 1 week old. My breastfeeding for the past 3 weeks is very painful my breast are really sore. I think I have that what they call mastitis.
A: It is possible to mix feed, but if you feel you are developing mastitis it is best to continue feeding as not removing the milk will make mastitis worse. When you have mastitis it can feel like you have the flu – there are symptoms like headaches/aches/pains/fevers/chills. I would try to see a Lactation Consultant or your GP to help you work out what is going on.
Q: Any tips for mums who have cesarean sections? Both planned and unplanned. Some mums are concerned about the pain medication going through to the baby.
A: Many mums go on to breastfeed after a c-section, it doesn’t have to mean that there will be problems. Things to do are to ensure that the staff in the theatre know that you want to breastfeed and would, therefore, like to have the baby skin to skin as soon as possible – this will vary from hospital to hospital as to whether this can happen while still in theatre, but that is your goal and you are well within your rights to ask for that. Seperation of mother and baby must be reduced. So in case of unplanned c-section it is important that partner or support person/doula knows that this is your wish.
Next trick is to have baby close by preferably in a sidecar cot so that it is easy for mum to access baby for feeds etc. When they are placed in a traditional hospital cot it is very difficult for a mum to get up and lift baby out of the cot – so if that is the case important for partner/friend/ other family members to be available to help get baby in and out of cot. Make sure you accept pain relief when needed – pain can hinder the letdown reflex preventing milk flowing to your baby. So no need to tough it out. Here is some more info – HERE
The hospital staff will not prescribe any medication that would be a concern. Secondly most pain medications are the type that do not go through into the milk and if they do are either in such minute doses by then or not orally bioavailable – therefore they are just processed in the bubs gut with little effect. Maternity hospitals spend all day everyday prescribing medications for breastfeeding mums so you can be sure they know what they are doing. There is a great resource called Lactmed where you look up medications and how they impact the bub through breastmilk if you want to check or are uncertain. Lactmed
Q: I have a 6 week old and for the past 3 or so weeks one breast is significantly larger and more full than the other. It’s almost like it never fully drains. I know it’s all about supply and demand and I’m trying to feed on each breast somewhat equally but I cant help doing slightly more on the full, heavy one. I’ve tried heat (packs and warm showers) before feeding and ice packs after. Is this normal? Will it even out? Any tips?
A: It is often around the 6-10 week mark that things do really start to settle down. Often breasts will start to feel softer – not a sign that milk supply has dropped just a sign that inflammation has settled. Often babies will have a side that they prefer to feed from or that you are more comfortable feeding from, this will mean that your supply in this breast will be higher. If you would like it to settle try starting feeds on the other side, then switch to fuller side, then go back to first side again all during the same feed. Ensuring that the fuller side is drained enough to relieve discomfort and to avoid mastitis.
Q: I’m concerned about the amount of weight my 2 month old baby is putting on as there is suggestion that it is not enough. I feed on demand and he is a very happy and content baby.
A: So good to hear he is a happy and content baby. The best way to know if your baby is getting enough is by looking at the nappies – does he have 5-6 heavily wet nappies a day, and at least one bowel motion? Weight gains can vary for breastfed babies ie some weeks they have large weight gains and others they have smaller ones. So nappies best way – if it doesn’t go in it can’t come out – therefore if good amount of nappies = good amount of milk. See my blog post here for more info – Is Baby Getting Enough Milk?
Q: I’m a doula and have attended a few births recently where baby has done the breast crawl, found the nipple but then not latched by itself. Is this common? Should mum step in to help baby or wait a while?
A: Some babies may not be quite ready straight away – it can take up to an hour or two in some instances. A lot depends on how the birth went -ie was it long, or was it fast – either can leave the baby feeling a bit sleepy or dazed. It would be great if you could support them to have as much uninterrupted time as possible. In saying that if mum instinctively wants to help then support her to do that. If baby hasn’t latched after 2hrs then may be worth supporting a bit more, or hand expressing colostrum and feeding this from a spoon. A great podcast to listen to about these innate reflexes is https://www.birthful.com/podcast-baby-mammal-breastfeeding/
Q: When I had my baby 13 years ago I was struggling to produce enough milk, I started alternating my breastfeeding with formula so my daughter would get enough, until I was told by a midwife that I had to choose one way or the other and giving both wasn’t something I should do. I of course then chose to formula feed, but was disappointed that I didn’t get to breastfeed my daughter. Was what the midwife told me correct or would I have been able to give formula to top up until I was producing enough milk? 
A: That must have been really tough for you to choose. As mums we always just want to do what is best for our babies and can only do that with the tools/support/information we have at the time. It is absolutely possible to mix feed. Any amount of breastmilk your baby can receive is great, so sadly this midwife may have just not had the skills to support you in that way. I’m sorry that happened to you and your bub.
Q: My two week old little girl easily latches to my right but seems to slip off my left more often than not. She does get milk out of the left and will eventually latch. Am I doing something wrong or what can I do to make her more successful on both sides? Should I persevere on both sides? Should I take bub to a chiro to check her neck?
A: Some babies have a preference for one particular side – sometimes for no particular reason and other times it can be because of positioning in utero – ie they may have been a bit squished and have a tight neck on one side – torticollis, which then sometimes means they don’t attach as well on one side. Sometimes it is because the mum may have an old injury or chronic pain on one side of her body that means she is more tense or holds baby differently without even being aware.
For now persevere but think about changing how you hold bub on the right side and see if you can do something differently – lie down, recline back, stand up etc…if you think there may be an alignment problem and you know a good paediatric chiro who is experienced with babies then yes, otherwise a physio could help too.
Q: My munchkin is 1 week old and does not like to open his mouth wide enough to feed properly and I think he’s only really getting the foremilk. I’ve been feeding him on the same side twice in a row but he’s up wanting food every hour or so this way! Any tips on how to get him to open his mouth wider to get the optimal latch? He tends to like the cradle position. I was only worried as it can be quite pinchy when he latches and I can see his mouth is just on the nipple. He’s also had some colic/ reflux which google tells me can be a sign of a poor latch.
A: Positioning can make a big difference to how baby uses it’s own innate reflexes. When you go to latch her is her nose in line with your nipple? This then means she has to tip her head back to find the nipple then her chin touches your breast first, once the chin touches the breast her brain will tell her mouth to open wide. Also are you in a reclined position with your bub fully facing your body – chest to chest? This also makes her have to pivot on her chin and will support her to open wide also. If you would like more assistance it may help to do that in person for something lke this. An IBCLC consult could be useful.
You could offer both breasts rather than sticking to the same side twice in a feed. This way you will get a bit more milk into her. It is not uncommon for newborn babies to want to feed every hour or two so may not be anything wrong. It is something that is worth sorting as pinched nipple can get worse if you don’t remedy it. Try reclining back so he has gravity to help him and start with his head up under your chin and let him bob down to your breast with your support along his back. Sometimes if we are sitting straight upright with a newborn they are not strong enough to fight gravity to get into the right position but reclining back can help alleviate that issue. Colic is crying for more than 3hrs a day more than 3 times a week. But is really just a symptom of other things rather than a diagnosis itself. Reflux is when a baby vomits regularly after feeds and has significant discomfort with that. Many babies spit up and it is completely normal. Once again true reflux is a symptom of something else rather than a diagnosis in itself. Have you spoken to any health professional about this? If you would like to see an IBCLC face to face you can find one here – https://www.lcanz.org/find-a-lactation-consultant/
Q: I have been breast feeding for over 3 months exclusively and I have an oversupply. Still saturating breast pads and leaking. Everywhere. I have been block feeding which has improved the situation but what else can I do? Baby is putting on weight and is healthy. I am feeding every 3-4 hours now, pushing more towards 4 hours.
A: Sometimes an oversupply can be just as challenging as an undersupply hey? You can feed as often as you like but from the same breast each time within that time frame. So if it was 2pm when you feed from the left side, if the baby wants to be fed again at 3 or 4pm then you feed from the left again. The idea behind this is that each time you go back to the breast the fat content of the milk will increase and it reduces stimulation to the other side and thereby possibly reducing the supply a little. If 3-4hrs hasn’t made much difference you can increase to 5hrs but just be careful that the side that isn’t getting used isn’t getting too full/uncomfortable – if it does hand express just the slightest amount to feel comfortable again. Have you tried any herbal supplements? Sage tea/peppermint tea? Some mums find they have a negative impact on supply – only anecdotal evidence at this stage. More information can be found here – https://www.breastfeeding.asn.au/bfinfo/toomuch.html
Breastfeeding Infants 
Q: My 6 month old has just started refusing the second side on feeds – acting like he is full – even after a night sleep stretch of 6-8hrs. We have just started solids once a day in the evening and only a few spoonfuls. Would that be the cause? His output is much the same.
A: Regardless of solids as babies get older and stronger they get more efficient with their feeds, so sometimes they can get all they need in less time than before. Best way to tell is that he still has enough wet nappies and poo is still nice and soft – although solids can impact on poos also.
Q: I’ve had a problem recently with my third EBF Bub – she’s just 11 months and when cutting her top tooth literally put a hole in the side of my nipple. I had to stop feeding on that side for 3 days just expressed and it’s much better now that the tooth is through but the teeth (all four) still graze constantly (one side only). She does have a slight upper lip tie (not corrected) so has to work hard with lips. Any tips on helping her relax the grip or change her latch a bit. The other two kids had a similar problem but only lasted a couple of days then they adjusted.
A: It sounds like it is positional. Is it possible for you to revisit the basics of attachment – nose to nipple, chest to chest, head flexed back so nose slightly clear etc…that may help? Otherwise, try direction change – maybe koala type hold so she is sitting upright straddling you rather than lying down? At this age, they often get a little distracted with feeds and don’t get that nice deep latch that a newborn will – encourage her to do this and relatch her if she hasn’t.
Q: I’m due with my first baby in around 5 weeks and I’ve heard that some babies go off breast milk when your period comes back and a few of my girlfriend’s got mastitis and had to switch to formula when this happened. I’m wondering if I can pump enough milk and store in the freezer in case this happens whilst on my period and then pump and either donate or just throw away the milk that she won’t drink?
A: Yes sometimes when periods return it can change the taste of your milk or affect the supply (drops a little) but generally most mums will continue to breastfeed through this. It can take 6-12months or more for periods to come back when exclusively breastfeeding so will hopefully be a long way off for you. One of the bonuses of breastfeeding! Periods can come back earlier if baby is having long breaks between feeds/starts sleeping through super early or when breastfeeds are being replaced with something else – like bottles or solids. On the odd occasion periods can return early even if the baby is being fed around the clock every 2-3hrs but this rare and it is still possible to continue breastfeeding. Once your milk has come in you may wish to start expressing occasionally to get a little store in the freezer but try not to do this too often as it will tell your body to make more milk than you need.
Breastfeeding Toddlers
Q: What are good feeding positions for toddlers with chompy teeth??!! He just does little testing nibbles, I watch him and say please don’t bite, be gentle and he’s generally ok. Sometimes I feel his teeth grazing me a bit.
A: I’m not sure that positions will make any difference here but you may need to take your toddler off the breast as soon as they bite and say firmly ‘no’. Try not to react in a way that will be entertaining. It may well be that he has had the majority of his milk by then and is just playing. You could just take him off and finish the feed.
Q: I’m wondering about when is the ‘right’ time to night wean a baby 2.5 years of age?
A: That’s a tricky one as no-one else can tell you when the right time is – it is really up to you and your bub. Is the baby still feeding during the day? As it is usually easiest to wean from day time feeds first.
Q: Tips to wean a 16 month old?
A: That is a tricky age – they are a little too old to be fooled, and a little too young to rationalise with. At that age keeping them busy is a great strategy and delaying the feeds as much as possible. So putting them off whenever you caneven if it is for 5 mins or ten minutes it all helps. The other line I like to use is ‘don’t offer, don’t refuse’. When you can make yourself unavailable for feeding. Have their favorite foods at the ready so you can offer as an alternative. And patince – it will take time. Start with the day time feeds. Good luck!! https://www.breastfeeding.asn.au/bfinfo/weaning-toddlers
Naomi Hull
Naomi Hull Lactation Consultant
https://www.naomihulllactation.com.au/
