Krista Gray, IBCLC

Krista Gray, IBCLC – Lactation Services

Positioning and attachmentWhether you’re preparing to breastfeed or need support with your current situation, Krista Gray, IBCLC – Lactation Services is here to help.  I am a certified lactation consultant and offer face-to-face and online breastfeeding support (as well as prenatal breastfeeding classes) to assist you in meeting your breastfeeding goals.   I see clients throughout the Upstate of South Carolina and North East Georgia as well as via Skype and FaceTime worldwide.

Lactation Consultations

Initial Consultation – $135 for a 1 – 1 1/2 hour private consultation.  Sometimes you just need that bit of extra support to get breastfeeding off to a good start or to overcome challenges. I can help you reach your personal breastfeeding goals. This visit can take place in your home or my home office.  (Follow-up phone/text/emails for home or office consultations are always free!) Discount for clients who have a prenatal appointment with me.*

Follow Up Consultation – $75 For new concerns and follow up appointments*

Pump Consultation – $60 Heading back to work and want to make sure your pump is working properly? I can help get your pump set up, ensure the flanges are the right size, and share tips and information about maintaining your supply as you return to work.*

Virtual Consultation – $50 I offer virtual breastfeeding consultations worldwide via Skype or FaceTime. (Up to one hour consultation; Payment made via PayPal) 

Telephone/E-mail Consultation – $30 Do you have a specific breastfeeding question? I can discuss this with you on the telephone (up to 30 minute call) or through e-mail.

Monthly Retainer Option – $150 For those who would like me to be available for unlimited calls/texts/emails throughout the month.  There is no limit to how often you can contact me and, if I am not available at the time of a call/email/text I will always respond the same day.

*In home rate applies to homes within 15 miles of 29655 zip code.  Beyond that area, there will be a fuel surcharge and hourly travel fee, which will be quoted at time appointment is made.

*Payment can be made with cash, check, and PayPal.

*Payment is expected at the time services are rendered.  Nursing Nurture does not file insurance on your behalf, but will provide you with an itemized Super Bill for your health insurance provider.

What happens during a consultation? Find out more here.

Download the forms for your breastfeeding consultation.

Learn more about Krista Gray, IBCLC or contact Krista to schedule a lactation consultation. Continue reading »


Milk Supply Issues

Whether real or perceived, low milk supply is one of the main reasons given for mothers to supplement or wean their baby.  There are a number of things that can cause milk supply issues; these are known as antigalactogogues.  The Top 10 most common antigalactogogues in our western culture are listed below:

  • alcohol, tobacco, other recreational drugs
  • caffeine
  • decongestants & antihistamines
  • contraceptives with estrogen
  • chasteberry (fruit/leaf)
  • greek oregano
  • parsley
  • peppermint
  • rosemary
  • sage

While not every mom reacts to these, if you are at all concerned about your milk supply it would be wise to steer clear.  But it is important to remember that these antigalactogogues are dose-dependent – the more you have the greater the negative impact on milk supply issues. For example, an occasional glass of wine or daily cup of coffee is usually fine for most breastfeeding mothers.  But daily alcohol intake or multiple sources of caffeine throughout the day can definitely cause milk supply issues.  And while most drugs are completely compatible with breastfeeding, decongestants and antihistamines should be taken with extreme caution.  Not only do they dry up the sinuses but they can dry up a mother’s milk supply quite fast.

Perhaps the most often overlooked antigalactagogue is STRESS.  If you are facing milk supply issues, seek out qualified help and support and try not to spend time worrying about making milk.  Also, try to eliminate other sources of stress you may be dealing with.

Two herbal galactagogues that can increase your milk supply are Fenugreek (3 capsules, 3 x per day) and Blessed Thistle (3 capsules, 3x). It usually takes at least 24 hours to begin to see any effect.

In Egypt, home to the fenugreek research for increasing women’s milk supply, the common wisdom is to cook fenugreek (it looks similar to wheat) like you would oatmeal and then serve with milk and honey. All new moms drink this regularly after giving birth.

For any mothers with supply issues, please let me know if you’ve found any of these to be true and what has worked for you!

Additional information about reasons for low milk supply and increasing your milk supply can be found here.


What To Do When Baby Won’t Latch

Cindy and Jana

Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.  You can download their app NuuNest – Newborn Nurse Answers and Baby Tracking for expert guidance through the first crucial weeks after childbirth or visit their website, Cindy & Jana.  You can also connect with Cindy and Jana on TwitterFacebook and Pinterest.

Noella was just 35 weeks into her pregnancy when her water broke. 12 hours later, her baby boy, Nathan, was born. Nathan was admitted to the neonatal intensive care unit  for antibiotics and monitoring. His first feed was a bottle of formula. Noella pumped faithfully throughout Nathan’s two week hospital stay but had little opportunity to try breastfeeding. When he was discharged from hospital, she began to offer the breast every feed but Nathan was used to bottles. Breastfeeding attempts became increasingly frustrating for both mom and baby. After two more weeks, Noella made the decision to discontinue all feeding attempts at the breast and instead focus her energy on pumping, bottling her expressed milk, and enjoying her newborn.  A month later, we received a phone message from Noella: “You aren’t going to believe it.  Nathan is now breastfeeding! I just decided to try it one day and it worked!”

Why babies may not latch at birth

Noella is not alone in her struggles to establish breastfeeding. Many babies are born prematurely and are not yet strong enough to maintain a latch. There can also be other reasons why babies don’t initiate breastfeeding right from the start:

  • Baby may be recovering from a difficult birth.
  • Baby may have a tongue tie.
  • Baby’s first feeds may have been given by bottle and baby is therefore unsure how to suck at the breast.
  • The shape of mom’s nipples may make it difficult to grasp the breast.
  • Baby may have an anatomical challenge such as a cleft lip or palate or the shape of the mouth or jaw may make latching challenging.

If baby will not latch in the first 24 hours after birth:

  • Keep your baby skin to skin as much as possible.
  • “Practice” breastfeeding: express a drop of milk on your nipple and let baby lick and nuzzle. Try to keep these practice sessions pleasant and free from frustration for both mom and baby.
  • Support baby well during feeding attempts to help baby feel secure. If you are feeding in a cradle or football hold, use pillows to support baby. If you are feeding in a laidback position, baby’s body will be well supported against your body.
  • Begin to use hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express with this video.)
  • Feed any drops of milk obtained back to baby with a spoon. Baby will “sip” the milk from the spoon.

If baby continues to not latch after 24 hours:

  • Continue with “practice sessions”. If either you or the baby becomes frustrated, take a break. Calm your baby by snuggling. Remember, dad can snuggle baby if you need a break!
  • Do some massage and hand expression before attempting at the breast so that the milk is “right there” for baby.
  • In addition to hand expression, begin to use a hospital grade electric pump. We suggest you pump about every 3 hours for 10 minutes per breast (or every time the baby feeds). Please do not be discouraged if you don’t get a single drop! The pumping “tells” your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast.
  • Consult an International Board Certified Lactation Consultant to have a thorough assessment. The consultant will have suggestions based on the cause of the difficulties.
  • You will, of course, need to feed your baby. Your health care provider may suggest you feed baby by spoon, cup or finger feeding. The first choice is to use your own expressed milk. If, for medical reasons, your health care provider recommends additional supplement, banked human milk is the next choice. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
  • Some women find using a 20-20-20 principle helpful. “Practice” at the breast for 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying may be too long.)
  • Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
  • Once baby is taking larger volumes, your health care provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. Choose a slow flow nipple. Entice the baby to gape widely when taking the bottle to simulate latching at the breast.
  • A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended. Please discuss this with your Lactation Consultant.
  • Search out a mother-to-mother support group such a La Leche League.

In our experience, with time and patience, most babies who do not latch initially will eventually go to the breast. While working towards getting baby to the breast, stimulating the milk supply and having lots of skin to skin time are the most important things you can do.


Dieting and Breastfeeding

Dieting and Breastfeeding

After giving birth, most mothers are ready to begin to “get their bodies back” and lose those added pounds they gained during pregnancy.  They wonder if it is safe to diet while breastfeeding.  The simple answer is that it is safe, especially when taking a nutritious, whole foods approach.

Dieting and Breastfeeding

Some of the weight a mother puts on during pregnancy is stored by her body to be mobilized for milk production during lactation.1 This is why most mothers who eat sensibly and breastfeed tend to slowly lose weight without much effort during the first six months or so postpartum. While research shows that women who breastfeed tend to lose more weight after giving birth than their non-breastfeeding counterparts, it does also depend on individual metabolism, diet, and exercise.2  After the first six months postpartum, weight that has not already come off usually doesn’t continue to come off just because of the act of breastfeeding.

There are many different diets and nutritional ideas out there – low-fat, low-carb, no grain, paleo, vegan, vegetarian, whole foods, raw foods, and on it goes. For some diets, it is important to restrict or reduce calories; others are more concerned about what foods are eaten, rather than the quantity or calorie content.  Either approach can be okay with breastfeeding.

However, it is important to realize that your body needs even more food than you did while pregnant in order to breastfeed your baby.  Breastfeeding moms typically need about 500 extra calories per day.  Think of it like this:  your baby is now even bigger than when you were pregnant and your body is still her exclusive source of nourishment for the first six months of life!

Therefore, do not restrict your food intake to the point where you are rapidly losing weight – more than 2 lbs/week for a sustained duration.  Make sure to drink to thirst – plenty of water is the best source of hydration.  Eat a well-balanced, whole foods diet with lots of fresh veggies and plenty of protein for energy.  Be skeptical of fad diets that promise quick weight loss.

If you are on a diet that restricts major food groups entirely, make sure you are getting all the vitamins and minerals your body needs.  For example, vegan mothers will need to be extra diligent to ensure they are getting enough B12.  And realize that if you do rapidly lose weight, environmental toxins and contaminants that are stored in fat cells will be released into breast milk in larger quantities.3

You may also be interested in reading about exercise and breastfeeding.


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How long should I breastfeed?

Babies were born to breastfeed.  It is not just best; it is normal.  Anything other than human breast milk has known and well-documented risks and harms that don’t just last while a baby is nursing but can pervade throughout a person’s life.  For example, scientific research continues to show that formula-fed babies get sick more often and more severely than their breastfeeding counterparts.  Babies who are sustained on formula have higher instances of asthma, ear infections, allergies, diabetes, obesity, childhood cancers, respiratory and gastrointestinal illnesses, and Multiple Sclerosis, to name a few.  Mothers who don’t breastfeed their babies have higher rates of breast, ovarian, and endometrial cancers, retain their baby weight longer, have higher rates of anemia and diabetes, and see an immediate return to menses without sustaining the luxury of natural contraception through breastfeeding (LAM).

Armed with this information, moms who may not have been inclined to breastfeed may decide to try and mothers who were only going to breastfeeding for a couple months may decide to nurse longer. That is wonderful!  But how long should you nurse your child?  What is necessary to garner these benefits and when is breast milk no longer beneficial to your baby?

The World Health Organization states the following:

Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development.  Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large…Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. 1

The American Academy of Pediatrics recommends, “exclusive breastfeeding for about the first six months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.” 2

Great Britain recommends exclusive breastfeeding, “for around the first six months of a baby’s life.  After this, breastfeed alongside other foods for as long as you and your baby wish. This might be into their second year or beyond.” 3

The Public Health Association of Australia recommends breastfeeding according to WHO guidelines, as do most countries around the world.

So, how long should you breastfeed your baby?

Ideally, you would nurse exclusively for the first six months and continue alongside solids for at least the first two years of life.  Then carry on as long as you and your child are happy with your breastfeeding relationship; even considering allowing your child to wean gradually on his own timing.  If left to make the decision on their own (without cultural and sociological factors influencing a child) babies typically self-wean between the ages of 2 ½ – 7, with most being between ages 3-4. 4  This is not always the message women hear in the Western world though!

Breast milk is always beneficial to your baby no matter how long you nurse.  Even toddlers, especially toddlers, need the immunological properties to help fight off all the germs and bacteria that is going in their mouth from toys and playing and that they are contacting daily. Their immature immune systems need mother’s milk to help them fight these bacteria!  Breast milk continues to benefit your child every time she receives it, and there is no age limit for these benefits.

When and how to wean your child are personal decisions.  Being informed about the benefits of breast milk, optimum feeding practices, worldwide health association recommendations for breastfeeding, and listening to you and your baby’s needs are all important pieces to consider.  In the end, weaning because of pressure from family, friends or society as a whole is usually not going to bring a big fanfare for your decision, or a sense a peace and closure to you if everything had been going well but you felt societal pressure to begin the weaning process. As you are pregnant and thinking about breastfeeding, it can be a huge stress reliever and quite relaxing to follow your baby’s breastfeeding cues and make a conscience decision to find joy in this phase of your life and not rush it long.  Get excellent lactation support in the beginning to help get nursing off to a great start, and then follow your heart and your baby’s needs and see where it takes you in your breastfeeding journey.  You may even want to join the ranks of other moms nursing toddlers and be a part of changing our western culture’s idea of breastfeeding duration.  Whatever you choose to do, arm yourself with information and make the decision that is best for you and your baby!


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Feminism and Breastfeeding

Breastfeeding should be considered a modern-day feminist issue. Though some may equate feminism with treating men and women exactly the same in everything the simple truth is that men and women are different. Equality between the sexes does not have to mean they are treated identically, in all things. It is certainly easier to assert this sort of “identical equality” in the work force, university admissions, etc. But when it comes to parenthood there are unique roles that men and women play and demanding that each person do exactly the same thing in the name of “equality” not only undermines the structure of a family, but demoralizes a woman and the amazing role she was created for.

Why is it that study after study dramatically shows that breastfeeding is healthiest for mom and baby; impacts the course of a person’s entire life in terms of growth, development, and wellness; saves billions of dollars in healthcare costs annually; and saves millions of lives around the world – not just the third world but the first world too – and there is still a discussion about guilt, a woman’s right to choose, and the almost “known fact” most women will not have enough milk? Why is it that as soon as breastfeeding comes up many women become uncomfortable, even downright ugly, emphatically asserting that breastfeeding is their choice and it suppresses women to being the sole caregiver, keeping them at home and not allowing them to work, earn an income…perpetuating a woman’s inequality in relation to a man?

Breastfeeding empowers women and contributes to equality between the sexes. Women alone have the awesome power and responsibility to nourish the next generation. It is a privilege and something our culture should value so highly that women should not have to choose between mothering through breastfeeding and working outside the home. Women should not have to “fail” at breastfeeding because they had inadequate support or misinformation perpetuated by formula manufacturers, well meaning friends, and the medical community. This is exploitation and oppression and does not value a woman’s role in reproduction. Establishing a supportive breastfeeding culture increases gender equality and allows women to be valued for their wonderful and unique roles in reproduction and nourishing offspring and mothering.

What really is feminism anyway? Is it that men and women should be the same in every way? Does it mean mothers and fathers must equally divide feeding their child, changing diapers, and time off work? We’ve been down that road before with the Equal Rights Amendment in the 1970s. Men and women are equal and they are also different. Breastfeeding doesn’t encumber a woman. On the contrary it frees her. It allows her to listen to her body and her baby; to fulfill a role she was created for. To nourish her baby the way every mammal on earth does – with species specific milk made for her baby. It allows her to parent instinctually; to have a bond with her baby that runs so deep that connection will impact their relationship for life. There are many ways to share responsibilities for the upbringing of a new baby. The history of the human race doesn’t have to be changed to formula-feed infants for the sake of “equality.”

Most women seem to want to breastfeed their babies. The CDC’s Breastfeeding Report Card (2012) states that 76.9% of women start off breastfeeding but only 16.3% are exclusively breastfeeding at six months. What happens? The lack of support for a breastfeeding mother should be seen as a feminist issue and every level of our society should be involved in helping mothers succeed.

The American Academy of Pediatrics and every major pediatric association in the world states babies should be exclusively breastfed for the first 6 months with complimentary food introduced alongside nursing thereafter. And the World Health Organization states breastfeeding should continue for the first TWO YEARS of life and beyond. At 12 months, only 25.5% of babies are receiving any breastmilk in the US, and in quite a few states that number is less than 15%. Breast milk is the great equalizer between rich and poor around the world; it affects the entire course of a person’s life. It’s not about holding a woman back because she “has to breastfeed.” Rather it’s about knowing and supporting, as a society and culture, all mothers so they can fulfill their unique role in parenting, impacting the next generation in terms of social, economic, and health benefits for every child.

And that’s why breastfeeding is a feminist issue. Women are not adequately supported to breastfeed their babies, especially after maternity leave ends. Most workplaces do not have laws allowing breastfeeding moms time and a place to pump at work. Women are looked down upon for doing the most natural thing in the world – feeding their babies while in public. Even immediately following birth, most mothers do not receive adequate breastfeeding support, which is the leading reason why moms “don’t have enough milk” or it “just doesn’t work out.”

Yes, men and women are equal. And different. Women have the profound privilege of pregnancy and childbirth. And we also can experience the joy of breastfeeding. This is a feminist issue – not because it holds women down and keeps them from gaining equality with men but because deep down in the soul of women is a desire to mother this precious life she’s just birthed through breastfeeding and our culture should empower and provide support to all women to nurture the next generation.  Our society must begin by removing obstacles such as supporting breastfeeding in public, pumping when mother returns to work, and adequate maternity leave for mother and baby to bond and get breastfeeding right.



Side-Lying Breastfeeding

Why Breastfeed at Night

Sleep is something our bodies need and yet something that most new moms seem to feel deprived of.   Worrying about not getting enough sleep once your baby comes and then worrying about how to sleep more after your baby arrives can dominate a mother’s thoughts.

And then there’s breastfeeding and sleep.  These can seem to be completely contradictory.  Though the majority of moms want to breastfeed, many also want the “freedom” to have others give bottles at night because they believe they will get more sleep.  Breastfeeding is important and has lifelong health implications for both you and your baby.  The sweet cuddles and precious moments shared while feeding your baby at your breast will forever forge a bond between you and this new life.  So hang in there…because it is possible to not only get sleep with a breastfeeding baby, but also get more sleep than your formula-feeding counterpart!

Why is it important to nurse at night?

Nursing at night is important for a variety of reasons, here’s 5:

  1. To regulate your milk supply.
    Every time your baby breastfeeds your body gets the message to continue to make milk.  It’s the law of supply and demand.  An empty breast makes more milk.  If your baby nurses when she’s hungry your body knows to continue to make milk.  However, if your baby takes a bottle, then your body doesn’t get the message to make milk (unless, of course, you pump in which case you will not be sleeping) and your supply can be negatively impacted. The first six weeks or so after birth are critical in establishing your milk supply.  When supplements are given, your milk supply could be affected to the point that you never develop a full supply to feed your baby. (Conversely, always feeding on demand – and waking a sleepy baby – will allow your body to regulate enough milk for your baby…increasing enough to exclusively nurse twins or triplets even!)
  2. Prolactin levels are higher at night.
    Prolactin is a hormone that helps build and maintain your milk supply.  In the early weeks of breastfeeding, prolactin receptors are being laid down in your breasts to help regulate the amount of milk your body needs to make to feed your baby.  The more prolactin you have, the more milk your body makes. Prolactin levels rise with suckling; the more a baby nurses the higher the prolactin levels. 1 Prolactin levels are higher at night and nursing at night helps to establish a strong milk supply for the duration of breastfeeding.
  3. Babies consume 20% of milk at night.
    Feeding your baby throughout the night is important.  Babies take in 20% of their daily milk volume during the night! 2  Not only is this important to building and maintaining a mother’s milk supply but it also is important for proper growth and development of a new baby. Nearly 2/3 of babies are waking up at night when they are 6 months old. 3 Nursing at night is a need for your baby.  So, the question is not about how to schedule a baby so she can sleep at night, but how to manage night nursing so both mother and baby can nurse and get sleep. There are many strategies for getting rest with a newborn.
  4. If your baby begins waking at night again after sleeping through, he may still need milk.
    Some mothers find that their babies begin to sleep for a long stretch or through the night entirely by the time their babies are a couple months old, only to then begin to wake again a few weeks/months later.  As babies grow they become more interested in the world around them and many begin to nurse less during the day because they are so interested in all that is going on.  Nighttime is their time to catch up on milk intake and so they begin to wake again because they need milk.  It is not a matter of scheduling your baby and helping him “learn to sleep” thinking that since he has proven he can do it he should continue.  Instead, your baby may be waking because he truly needs to nurse at night.
  5. Essential for using LAM as birth control.
    The Lactational Amenorrhea Method is a very effective form of birth control during the first six months following birth when your baby is exclusively breastfed and nurses on demand both day and night.

Why not nurse during the day and give a bottle at night?

  1. Exclusively breastfeeding mothers get MORE sleep.
    Nursing mothers are able to help their babies latch while lying down, then enjoy a burst of oxytocin to help them relax and fall back to sleep.  Conversely, mothers who are not nursing still wake and think about, sometimes even worry about, their babies. 4  Even if mother is never the one who is responsible for giving a bottle at night, research shows that mothers wake when their babies eat – it has to do with the harmony between mother and baby. In one study, exclusively breastfeeding mothers got on average 20 minutes more of sleep each night. 5  Kendall-Tackett’s research even suggests that mother’s who are not exclusively breastfeeding not only have more disrupted sleep but also higher rates of depression. 6 Bottle-feeding at night is not associated with better sleep; conversely, breastfeeding is not only associated with better sleep, but better quality sleep.
  2. Milk supply can decrease.
    Nighttime nursing helps to establish and maintain a mother’s milk supply.  Without night nursing, some mothers would not be able to produce enough breast milk to continue to exclusively breastfeed.  Once supplements are introduced, a mother’s supply can continue to decrease, even to the point where she no longer makes enough milk to feed her baby.
  3. Formula is difficult to digest.
    Not only does formula lack much of the nutrition that is in breast milk, it also takes twice as long to digest.  This may seem like a positive as babies tend to sleep more and go longer stretches between feeds when formula-fed.  In actuality, a baby’s body is having to work harder to digest a foreign substance, which is one of the reasons why she feeds less frequently when given formula.
  4. Overfeeding with bottles is common.
    It is easy to overfeed with a bottle as it is more of an effortless suck than the breast – tilt the bottle and milk comes out.   This can lead to obesity as well as a further decrease in a mother’s milk supply as baby is taking a disproportionate about of milk from bottles and then consumes less during the day.
  5. Someone still has to feed baby at night.
    The mechanics of giving a bottle are also more demanding than nursing.  A bottle must be mixed, adult and baby have to be in a more alert state to feed, and then bottles must be cleaned and sterilized afterwards.  Formula that is mixed and not eaten is wasted.  Compare this to arousing enough to help a baby latch while lying down and mother resting or falling back to sleep while baby is able to nurse.

How can I nurse at night and still get sleep?

  1. Practice safe bed sharing.
    Around the world and all throughout history, mothers and babies have slept together.  It is only in our “modern” world that issues have risen about nursing mothers and babies resting side by side.  Up to ¾ of all nursing mothers in the West will sleep with their babies at some point during the night. 7 Proper precautions in bed sharing should be taken, but, when practiced safely and while breastfeeding, it can allow both mother and baby to get more sleep and nurse more frequently.
  2. Get help with diaper changes, etc.
    Only you, the mother, can nurse your baby.  However, your partner can be responsible for changing a baby’s diaper, tending to needs you may have (a glass of water maybe?), and/or picking baby up from his crib and bringing him to you in bed.  Having help with these things can allow you to rest comfortably in bed throughout the night without having to get up or rousing until you are fully awake.
  3. Keep baby in your room and nurse lying down.
    If you are not comfortable with bed sharing, co-sleep by keeping your baby close by – perhaps in a cot in your room – as this will make it easier to know when he wakes.  Having a safe bed area to nurse – firm surface, no other pets/children in bed, covers that aren’t too warm, etc. – can allow you to at least rest/dose while nursing before returning your baby to his space for sleep.
  4. Sleep when your baby does during the day. 
    Whenever possible, try to catch a few zzz’s during the day when your baby does.  This can be extra challenging if you have older children as well, but during those times when the house is calm and baby is sleeping, try to rest yourself rather than surfing the internet, chatting with friends, etc.
  5. Remember the big picture. 
    If you have tried some/all of these tips and still feel sleep deprived, remember that you have a new baby and he will grow up all too fast.  One day you’ll look back and wish you could just hold that tiny baby during the night.  The sleepless nights feel long but the years in parenting are way too short.

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Exclusive Pumping

When a baby isn’t breastfeeding, effective milk removal from the breasts becomes critical in order to build or maintain a milk supply.   Exclusive pumping can be necessary in a variety of settings: when a baby is born prematurely or cannot breastfeed due to illness; when a baby refuses to latch at the breast; in cases of adoptive breastfeeding, induced lactation, and relactation, or when mom needs to be away for a period of time.  Some moms begin pumping and, though the reason they initially began to express is resolved, find that their baby prefers receiving expressed breast milk. If you are in a situation of exclusively pumping, here are 5 tips for your situation.

  1. Establish your milk supply.
    The most important thing you need to do when exclusively pumping is establish a full milk supply. Your body needs to get the message to make enough milk for your baby. Perhaps your baby was born prematurely and isn’t taking much milk in a 24 hour period. This will change in a few weeks and your body needs to make sure it has the supply ready for your baby. In the beginning, a mother should pump a minimum of eight times in a 24 hour period for at least 20 minutes on each breast.  It will help to record what time you pump and how much milk you get. A double electric pump is the most efficient way to do this.  Though hand expression, single pumps, and manual pumps are all other options, a double electric pump of good quality has been found to stimulate greater milk production. 1
  2. An empty breast makes more milk.
    It’s the law of supply and demand. Therefore the more completely the breast is drained and the more frequently this occurs, the more milk a mother’s body will make. 2 It is completely possible for you to make enough milk to exclusively nurse twins or even triplets!
  3. Shorten pumping duration AFTER supply is established.
    After a full supply is established (25-35 ounces per baby every 24 hours) 3 then you can shorten the duration of pumping at each session to the amount of time necessary to gather the required milk. Many times this is as short as 5 minutes!  In general, once a strong milk supply is established, one nighttime pumping session can be dropped but it is important to ensure you are still pumping at least once during the night and never going more than 4-6 hours between pumping during the longest interval between sessions. Every mother is different and every breast has a different storage capacity. While a few mothers may be able to go 10-12 hours between their longest stretch, other mothers can only go 3-4 hours. Full breasts make milk more slowly so the longer a mother waits between pumping sessions, the slower the milk production becomes. Every mother will have to work out what her “magic number” is for how many times to pump and how long in order to maintain supply.
  4. If you begin to notice a drop in supply, increase pumping sessions and/or duration.
    A general guide, once milk supply is established, is to pump 6-7 times in a 24 hour period, at least once during the night, and only for the time it takes to get the required amount of milk. Should you notice your milk supply beginning to decrease from the shortened pumping duration and/or number of sessions you should return to pumping more often and for a longer duration.
  5. Your “magic number” will be different than another person’s.
    Don’t worry if you have to pump more often than another mother to get enough milk. Don’t worry if you don’t have to pump nearly as often. Every mother is different. Not only is every mother’s breast storage capacity different, but each breast on the same mother can vary! It only matters what your magic number is. Therefore, once you have worked out how frequently you need to pump and it works for you, don’t worry if someone else does it differently.

Expressing breast milk is hard and can be very emotional. You may need to grieve not being able to nurse your baby at the breast. While expressing milk can help you connect with your baby, it also is a symbol of the disconnection. 4 Realizing that grieving is not only important but normal is critical to dealing with one’s feelings and healing. Also realize that no matter how long a mother has been exclusively pumping, transitioning back to breastfeeding is an option.

When the time comes to wean from expressing there are ways to do this both safely and comfortably.


woman holding pills

Is Breast Milk Compatible with Medications?

woman holding pillsIntroduction

Most mothers will take some sort of medication while breastfeeding.  Whether it is an herb, high-dose vitamins, prescribed medication, or something else, finding accurate information as to the safety and efficacy of continued breastfeeding is important.  The good news is that most drugs are completely compatible with breastfeeding!  The following information will help you maneuver through the landmines of finding reliable information.

Are drug inserts reliable?

Drug inserts are not a reliable form of information as to the drug’s impact on baby via breast milk as the drugs are not tested on breastfeeding women.  To protect them from litigation, drug manufacturers place a blanket statement that their drug is not compatible with breastfeeding.  The Physician’s Desk Reference (PDR) is based on these drug inserts.  This can make finding correct information challenging and frustrating for both a breastfeeding mother and her doctor.

Are there any drugs which are safe to take while breastfeeding?

Yes! In fact, most medications are safe to take while breastfeeding.  There are some that are safer than others.  And there are typically multiple medications which can be prescribed for the same illness, so understanding which drug will have the least impact on a mother’s breast milk and baby are important considerations for a breastfeeding mother.

The benefits of taking a medication should always be weighed against its potential harm to a breastfeeding baby.  The known risks of formula should be weighed against the potential risk of the medication.  If a drug is not essential, delay its use until later.  This is true for many herbs as well.  Yet, when a mother has a need for medication, understanding how medications pass into breast milk and how a baby’s body metabolizes the drug can help a mother and her doctor make the most informed decision possible.

What is considered a safe amount of medication to receive via breast milk?

For most drugs, ingesting 10% of the maternal dose is considered safe. 1  With some drugs (for example, fluconazole and metronidazole) the dose can be much higher than this.  And usually, the dose ingested is less than 1%.  Thus, most medications truly are compatible to take while breastfeeding.  This is especially true in light of the 1000s of studies that show the detrimental side effects of formula.

Where can I go for accurate information?

If you doctor recommends weaning or “pumping and dumping” your milk while taking a medication, make sure you talk with a lactation consultant first.  There are many great resources with research and information on drugs and their impact on babies via breastfeeding.  Arming yourself with knowledge, you can then share research and information with your doctor to select the most appropriate medication for your needs that will also allow you to continue nursing your baby.

Medications and Mother’s Milk by Thomas W. Hale, Ph.D. is an excellent resource book.  This website is another great resource for accurate breastfeeding and medications information as is the LactMed search on the sidebar of this article.

When treatment is truly not compatible with breastfeeding…

This is a difficult time and breastfeeding mothers need lots of love, support and encouragement.  Is it possible to pump and dump (or freeze) your milk?  Sometimes breastfeeding need only be interrupted for a time (hours or days) and then can be resumed.  During this time, it is important to keep up your milk supply by pumping each time your baby feeds.  If you don’t have enough breast milk for your baby, you could use human donor milk or formula.  By pumping and keeping up your supply, you can then return to nursing as soon as it is safe to do so.

Other times mothers need help and support in weaning.  Usually in this circumstance there is not time to wean slowly.  Care not only needs to be made at keeping the mother comfortable but supporting both mother and baby emotionally.  If you find yourself in this circumstance, rejoice in the wonderful nursing relationship you were able to have with your baby.  Every drop of breast milk was a precious gift and you should be very proud of yourself!  Also, remember that this is not the end of your relationship with your baby but the beginning of a new era.  With the warm and loving bond you have already forged, this next phase can be even better.

If your baby is under a year and you are concerned about giving formula, check to see if there is a human milk bank you can get donor milk from.  Alternatively, there may be friends in your local community who informally share human milk.

Click here to read more about how medications affect breast milk and how drugs in breast milk affect your baby.


Eczema on Nipples

Eczema on Nipples

What is eczema?

Eczema is a skin dermatitis which is an inflammation of the skin that can occur anywhere on the body, including on the breast and nipple. Eczema on nipples causes itching, burning, and pain, which can worsen over time.

What causes it?

There are a variety of causes of eczema on the nipples, including the following:

  • History of eczema
  • Using nipple creams/ointments that irritate the skin
  • Expressing with a pump that has too high of a suction can damage the skin, creating an environment for eczema to develop
  • Allergens that cause eczema breakouts on other parts of the body can also affect breasts
  • If mother is sensitive to residual foods, teething gels, etc. in baby’s mouth when he breastfeeds
  • Cold and dry climates or being hot and sweaty
  • Disposable breast pads can also cause irritation

What are the symptoms of eczema?

Eczema on nipples typically begins with tiny blisters or raised areas that then turn red, swell, and become crusty.  The skin is very dry and will thicken and becomes scaly.  Eczema causes itching, burning, and pain, especially while breastfeeding.  It is common to appear on both breasts and worsens over time.  Scratching can exacerbate the condition and allow for the development of a bacterial or fungal infection as well.

How do you treat eczema on nipples?

There are several natural remedies that can help.  It is important to determine what caused the inflammation and remove that allergen.  Some possibilities include the following:

  • Nipple creams and ointments
  • Disposable breast pads
  • Soaps and laundry detergents
  • Allergens in mother’s diet
  • Allergens in baby’s diet – when his saliva then comes into contact with mother’s breasts

Home treatment options:

  • Rinse nipples in cool (not hot) water and pat dry immediately
  • Do not allow skin to “dry out” but moisturize with non-allergenic cream (creams are better than lotions for skin with eczema)
  • Avoid having breasts/nipples become “hot and sweaty” – e.g. workouts, sitting in front of warm fires, extra covers, hot showers, etc.
  • Avoid perfumes, dyes, and other products that could cause allergens to this area
  • Eliminating allergens in your diet – things such as grains, dairy, sweets, etc. could exacerbate the eczema

If these do not help improve the eczema, contact your health care provider about possible topical ointments.  These medications can still be compatible with breastfeeding especially when it is applied immediately after nursing and gently wiped off before breastfeeding.

Please note:  If symptoms do not significantly improve within 3 weeks, a mother should see her doctor to rule out Paget’s Disease, a very rare form of cancer. 1  Early detection of this aggressive form of cancer is critical.

Can I still breastfeed if I have eczema on my nipples?

In short, yes!  A baby should not be affected by his mother’s eczema and breastfeeding can safely continue for baby.  As her symptoms subside, the pain she experiences while breastfeeding should also improve.