Why Has My Pumping Output Decreased?

I love when we receive emails with questions that our blog readers could benefit from!  Here is a question from one of our mamas who is wondering why her pumping output has decreased.  

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Hi Robin!

I met with you awhile back when I first went back to work to set up a good pumping schedule.  It has worked like a charm these last 6 months.  Thank you for that!

My little guy is about to turn one and I’ve noticed a big reduction in my pumped breast milk the last few weeks. I’ve gone from pumping around 25 ounces of milk/work shift to around 15 oz.  It feels like it happened overnight. I’m just wondering if you have any suggestions on things I can do to get milk back or if this is just a normal progression.  I’m not ready to give up breastfeeding yet, but want to make sure he is getting enough milk.  He has been eating ALOT of solid food for about 5 months, so I’m sure this has had an impact on my supply :-(

Thanks for your time!

N

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Hi N,

I am thrilled to hear that our plan worked so well for you!  That is awesome!  

So, pumping output can dip for many reasons, regardless of baby’s age.....

1. Baby is sleeping through the night.  When babies start to go longer stretches in the middle of the night without eating, it can cause a mom’s milk supply to dip overall.  If your kiddo is going to sleep a few hours before you are, you can consider adding in a dream feed or pumping before you go to bed so that your breasts don’t go for such a long period of time without removing milk.  Also, if your kiddo wakes up in the middle of the night, you could consider breastfeeding at that time, rather than soothing back to sleep right away, if you are worried that your supply is dipping too low.

 

2. Pump suction is losing its stamina (which is HUGE and definitely common!)  I would recommend getting your pump suction checked immediately.  Many lactation consultants have pump suction gauges to check the pressure created when running.  A less-than-stellar functioning pump can definitely decrease pumping output, even when supply is right where it needs to be.  Renting a hospital-grade pump will also help you determine if your own pump is not working as well as it should.

3. Pumping frequency has gone down while at work.  As moms get closer to that year mark, many prefer to cut down on the pumping frequency at work.  Sometimes they are able to keep up their supply when this is done.  Others find that their milk supply is more sensitive, so it requires that extra pumping session.

4. Baby is eating solids before breastfeeding (when mom is with baby), so he isn't as hungry when breastfeeding. Up until about a year, solids should be offered after breastfeeding so that babies are getting the bulk of their nutrition from breast milk and getting solids after their bellies are more full.  

5. You got your period and are experiencing a temporary dip. When mom’s hormones are shifting due to her cycle, this can temporarily dip her supply.  

6. Something else has changed in mom’s routine…. More working out on a regular basis, not eating enough calories per day, recovering from stomach flu or a cold, etc.  Again, all temporary.  But, make sure that you are eating at least 2000 calories a day to keep up your supply, as well as even extra, if you are working out.  If you are recovering from an illness, this will take a few days to rebound once you are feeling better.

That being said, 15oz of pumped milk at 1 year is pretty awesome!  At this point, your little guy doesn't need much more than that to complement all of the whole foods he is eating.  Plus, that doesn’t even take into account how much breastmilk he is getting from you while breastfeeding.  As long as he isn't getting frustrated at the breast, then just keep on plugging along, knowing that a breastfeeding baby should always be able to take out more than the pump.

Hope that helps!  Definitely get your pump suction checked, asap, and let me know if you have any other questions.

Warmly,

Robin

 

Breastfeeding the Older Baby: What to Expect at 9-12 Months

Written by Anna Choi, BS, IBCLC

Welcome back to our blog series, Breastfeeding the Older Baby – What to Expect and How to Adjust. Last month we took a closer look at what breastfeeding might look like for a 6-9 month old, and tackled some of the most common questions and concerns we hear from parents with little ones in that age range. We hope you found the information helpful and relevant and are happy to have you join us again!

Today, we’d like to talk about months 9 through 12 of your baby’s life. I think these are the last months we can classify them as babies, right? Don’t they officially become “toddlers” once they are over a year old? Crazy, I know! The days seem so long when you’re in them -- changing diapers, wiping their face clean, rocking them to sleep. But in an instant, the days have become weeks, and the weeks have become months, and soon, a whole year has passed by. Their first year. You kept them clean {mostly}, fed, happy, and above all, loved. Celebrate your accomplishments, mamas! But, I guess I’m getting slightly ahead of myself. My oldest “baby” turns 5 this month and I’m still trying to wrap my brain around it. So as we approach the end of your baby’s first year of life, what does breastfeeding look like?

What does breastfeeding look like in months 9-12? How often should my baby be eating and how long should feedings take?

Breastmilk continues to be your baby’s primary source of nutrition until his/her first birthday. Some babies will continue to space out their breastfeeding sessions as they approach this milestone birthday, nursing 4-5 times during the day, and once or more during the night. As your little one begins to explore the tastes and textures of more solid foods and consume more of them at each sitting,  you may notice your little one begining to nurse less frequently in response to their increased intake of solid foods. As long as baby is continuing to have five or more wet diapers each day, gain an average of 2-4oz per week, and baby seems satisfied and content after breastfeeding sessions, then your little one is most likely getting enough nutrition from breastfeeding.

When will my baby begin to drop his/her nighttime feeding sessions and sleep through the night?

Such a great question, and one that’s frequently on parents’ minds! When will my baby sleep longer at night? The short answer is, I don’t know when your baby will sleep through the night. Every baby is different and the timeframe for when one baby will sleep through the night versus another is going to be different. Babies wake throughout the night for varying reasons, including hunger, a need for comfort, a disruption in their sleep cycle, a need for a diaper change, sickness, teething, etc. Breastfeeding often meets more than one of baby’s needs, so it’s easy to fall into the routine of nursing your little one back to sleep. There is absolutely nothing wrong with responding to your little one’s needs by breastfeeding them! If you are happy with your nighttime routine, then please don’t feel pressured to make significant changes in order to cope with outside pressure and recommendations to “train” your baby to sleep longer at night. That being said, if you find yourself becoming frustrated with nighttime wakings and overtired during the day due to lack of sleep at night, then it might be time to take a closer look at your nighttime routine to make a plan for improving your quality of sleep. I find the following Kellymom article on night weaning to be extremely helpful at offering tips for gentle night weaning of older babies: http://kellymom.com/ages/weaning/wean-how/weaning-night/

I’ve heard people mention teaching breastfeeding manners to older babies.  How does that work?

It’s never too early to start teaching your little one age-appropriate manners. Just as we prompt our toddlers for “the magic word” when they ask for something, older babies can learn to be polite when breastfeeding. Teaching your little one a few basic signs from American Sign Language can be very beneficial in setting the stage for breastfeeding manners. The signs for milk, more, and please are fairly basic and many babies pick up on them quickly. {see here: http://www.babysignlanguage.com/dictionary/first-signs/} Once your little one has mastered the sign for milk, you can calmly remind him/her to sign milk when hungry instead of pulling your shirt down or crying out in frustration. Positive reinforcement will go a long way to reinforce the idea that you would like baby to sign milk when hungry rather than clawing at your chest. Baby will also be calmer and happier, seeing you sign milk, showing them you hear and understand their need and are going to breastfeed them soon.

My baby has been refusing to nurse, could he/she be self-weaning?

If your baby has been refusing to breastfeed for several breastfeeding sessions or days in a row, then it’s more likely that you and your little one are experiencing a nursing strike, rather than self-weaning. It is very uncommon for a baby to self-wean before their first birthday. As we have said before, babies need breastmilk to be their primary source of nutrition until at least their first birthday. Also, self-weaning is usually a gradual process, where as a nursing strike is characterized by a sudden and complete disinterest and refusal to breastfeed. Nursing strikes are common in older babies and can be in response to teething, distraction, illness, bottle-preference, and other developmental milestones. Tips for surviving a nursing strike and encouraging baby to breastfeed again are:

- Always offer breastmilk before any solids during baby’s first year of life. If baby won’t breastfeed, you can offer baby breastmilk in a sippy cup, to ensure baby’s nutritional needs are being met through breastmilk. Solid foods are supposed to complement breastmilk during baby’s first year, not replace.

- Limit or eliminate bottles and pacifiers. Only use bottles when baby is separated from mom and then put baby back to breast when baby is with mom. We want baby’s sucking needs to be met at the breast.

- If distractibility seems to be playing a role in baby’s refusal to breastfeed, try wearing a nursing necklace to keep baby’s attention focused on mom during breastfeeding. You can also try giving baby a small toy to hold during feeding sessions, nursing in a quiet room, and nursing baby in a baby carrier.

If you feel your milk supply has decreased, and this has led to the nursing strike, then it is a good idea to visit a breastfeeding support group or make an appointment with a Lactation Consultant to come up with a breastfeeding plan to help you increase your supply and meet baby’s needs moving forward.

 

What did breastfeeding look like for YOU during months 9-12?

Join us next time when we discuss breastfeeding during months 12-18!

Giving Up Gluten for Breastfeeding Moms

Written by Stacy Spensley

The last thing you want to hear as a breastfeeding mom is that you can't eat something. You probably want to eat everything! You're legitimately eating for two right now.

But if your baby is showing symptoms of a reaction to something in your diet, you're also probably willing to do anything to make it better. Dietary changes are tough, especially on top of being a new mom, but here are some tips that can help make the process easier.

While there are several common foods that can prompt an elimination diet, today we'll start with gluten. It's a bit of a buzzword nowadays, but it's more than a weight loss trend. Gluten can be tough on your baby's tummy.

WHAT IS GLUTEN?

Gluten is simply the protein found in wheat and other grains than can cause inflammation. Note that the root of gluten is "glue," and that's no accident. Gluten is what makes bread dough stretchy and elastic.

When moms eliminate gluten from their diets, many see results in a week or two, but some may take longer. Eating "limited" gluten won't make a difference - if it is affecting your baby’s digestive system, it really has to be all cut out to make sure.

WHAT CONTAINS GLUTEN?

The big one is wheat - all varieties. In addition, wheatberries, durum, emmer, spelt, semolina, farina, farro, graham, Kamut, einkorn, rye, barley, triticale, malt, and brewer's yeast. Cross-contamination can also be an issue, especially with oats. It's recommended to avoid bulk bins in case of cross-contamination and to look for certified, tested gluten-free products.

The major categories of gluten-containing foods are bread, pastry, pasta, crackers, baked goods, breading/batter for frying, roux-based soups, sauces and gravies, flour tortillas, and beer. Other less obvious foods are soy sauce and sushi, pre-seasoned meat, salad dressings and marinades (often wheat is used as a thickener), seasoned potato chips, granola or energy bars, and some candy.

The Celiac Disease Foundation has a more in-depth list and a longer explanation of cross-contamination if you're interested.

Does that sound like every food ever? I promise it isn't.

SO WHAT CAN I EAT?

www.hipfoodiemom.com

www.hipfoodiemom.com

Fruits, vegetables, meat, dairy, beans, legumes, and nuts, and other grains are all naturally gluten-free. If you buy prepared versions you should check labels, but the plain versions are safe.

Which grains and flours specifically are OK? Rice, cassava, corn, soy, potato, tapioca, beans, sorghum, quinoa, millet, buckwheat (also called kasha), arrowroot, amaranth, teff, flax, chia, yucca, nut flours, and gluten-free oats.

Again, here are more details from the Celiac Disease Foundation.

The safest bet is usually cooking from whole ingredients. But you also have a newborn, and you're hungry. The upside to the gluten-free trend is that there are also tons of gluten-free products on the shelves, and many restaurants actually have a gluten-free menu, or note gluten-free dishes to make it easier for you.

HOW DO I GET STARTED?

First, make a list of all the things you already eat that are gluten-free.  Then you have a foundation for some familiar meals to cycle through.

Next, check your cupboards to see what you can't eat. Some people find it easier for their whole family to go gluten-free to avoid cross-contamination (think toast crumbs in the butter, or dipping crackers straight into the hummus). Read labels carefully.

Many people find it less overwhelming to start with substitutes. Switch to gluten-free pasta, gluten-free cereal, gluten-free pizza crust, gluten-free sandwich bread, there are even gluten-free bagels. The downside is that they do cost more, but sometimes mama needs a (gluten-free) cookie. It's a tradeoff.

www.familyfoodonthetable.com

www.familyfoodonthetable.com

Another approach is just to avoid dishes that are normally wheat-based. If you normally have cereal for breakfast, have eggs or a smoothie. Instead of a sandwich for lunch, have soup and a salad (no croutons!). Try polenta instead of pasta.

For most people, something in the middle works well. If you really want pizza, splurge on gluten-free crust and feel like a relatively normal person. Most GF sandwich bread isn't great, so finding an alternative may be better than feeling disappointed (especially at $7 a loaf). Most gluten-free flour blends also contain binders like xanthan and guar gums which aren't inherently bad, but can upset some people's stomachs.

WHAT ARE SOME COMMON MISTAKES?

At home, make sure you have a gluten-free prep area. Toasters are a major source of cross-contamination. It's not like it will kill you, but you don't know how much contamination it takes to affect your baby.  If the rest of your family still eats gluten, you can't share a jar of peanut butter. Either scoop out a portion before spreading on anything, or get your own jars and label them clearly.

At restaurants, don't be afraid to ask about gluten-free options from the start. There can be hidden ingredients in many sauces and marinades that you don't expect. Or seek out restaurants that advertise GF options to make it easier on yourself.

Don't give up too soon. Like I mentioned above, it can take several weeks for the gluten to completely clear your system, but that doesn't mean it's not making a difference.

BUT HOW DO I MAKE IT THROUGH A WHOLE WEEK?

Again, Celiac Disease Foundation to the rescue with a 7-day gluten-free meal plan.

I highly recommend meal planning. You can download a weekly menu planning template here. For recipes, Pinterest is an amazing resource, and the app is easy to use on your phone while you're nursing. I have several boards full of gluten-free recipe ideas.

Just having a roster of recipes can make a difference. Then you have a gluten-free menu to choose from when planning your meals. I even make a list of snacks so if I get hungry I don't even have to think. Stocking your pantry and fridge with foods you can actually eat makes the experience much easier.

A FEW MEAL IDEAS

Here are some basics for each meal to give you some ideas.

Breakfast: scrambled eggs or an omelet, green smoothies, GF oatmeal, breakfast hash, chia pudding parfait

Lunch: soup and salad, tacos (corn tortillas), GF pasta, lettuce wraps, quinoa salad

Dinner: "Paleo-style" burgers (no bun, just wrapped in lettuce) with fries, stir-fry with gluten-free soy sauce, burrito bowls, polenta with roasted veggies, grilled chicken or fish with veggies and rice

Snacks: trail mix, fresh fruit, carrots and GF crackers with hummus, hard boiled eggs, yogurt with fruit

It's a big change, but it IS possible! I hope this helps make the transition easier for you and your baby.


Stacy Spensley is a healthy life coach and semi-crunchy mama. She works with new moms and dads through classes and coaching to normalize the parenting experience so they feel more confident making parenting decisions and maintain their sanity while keeping everyone alive. She also helps families create meal plans when they have to incorporate an elimination diet.  Her friends would tell you she's bossy in the best way. Folding laundry is her least favorite activity. If you're a semi-crunchy mama, click here join the club and learn more.

Two Things More Important than Portion Sizes when Offering Solids to Infants

Join Rachel Rothman, MS, RD in our three-part blog series to learn more about introducing solids to your little one.  Rachel is a pediatric dietitian and the instructor of our Introduction to Solids classes here at the SDBFC.  To learn more and to sign up for an upcoming class click here.

Introduction to Solids, Serving Sizes, Feeding Relationship

When babies are 4-6 months of age, many moms start thinking about how much solid food kids should eat.  It’s easy to get caught up in a race toward the “starting solids” milestone, but what comes next?  Many parents wonder, now that their little one has started eating solid foods, how much is enough?  Am I making him/her overeat?  Am I wasting food? Am I teaching poor habits? 

What might reassure you is that as long as your selections contain a balance of protein, carbohydrate, fats and vitamins and minerals, measuring “servings” of food consumed may not necessarily be the best way to ensure your baby’s success at adopting a solid diet.  

How much should your little one be eating?

First, take a step back. Renowned feeding expert Ellyn Satter, MS, RDN, MSSW gives parents the helpful suggestion of a “division of responsibility.”  Parents are responsible for the “what, when, and where of feeding; children are responsible for the how much and whether of eating” (Satter).   Babies have the innate ability to self regulate.  They will let you know when they want more, such as opening their mouths when food is offered.  Conversely, will let you know when they are full, such as turning away from the spoon and sealing their lips tightly.  

Rather than a fixed “serving” - offer food to your child, but look for signs that they are full.  With that in mind, you have two things in your control: when is mealtime, and what are you serving.

 

When is mealtime?  

 

A general idea of how many meals you should offer each day depends on the age of your child:

Once you have an idea of when those mealtimes and snack times fit into your baby’s wake and sleep schedule, you’ll want to establish some strategies for how much to offer at each serving.  Start small: when first introducing solids, 1-2 teaspoons is enough for your little one.  And remember, up to one year of age breast milk or formula will continue to make up the majority of your baby’s calorie intake.  

 

Next, think about the overall composition of the meal:

Thinking about the composition of meals, know that all babies are different and some may progress through textures more quickly (or more slowly) than others. That’s okay.  As discussed above, you can only control the what and when.  Your child is in control of the how much and whether.

This process is bigger than serving size.  You’re trying not merely to nourish your little one; but to introduce your little one to a variety of new foods, textures, flavors, and nutrients.  This diversity is part of a journey you’re on, together with your young child, to ensure their healthy relationship with food.  These approaches will help your child to develop the tools to succeed when making food decisions on his/her own.

 

Stay tuned for my next post: “How To Help Your Little One Feel Full” to learn more about introducing new foods to your child.

Breastfeeding... It has to get easier, right???

When I started working with Galit 10 1/2 months ago, I knew immediately that she would be one of the most dedicated, hard-working, and comedic mothers I would ever encounter.  Her breastfeeding journey has been wrought with painful nipples, engorged breasts, and twins who had difficulties transferring milk.  It has also been blessed with sweet moments of tandem nursing, gaining an abundance of milk, and confidence to overcome any challenge that lay in her path.  Happy 1st birthday to your adorable boys, Galit, and happy 1st nursiversary to you!  You continually inspire me!  

Here is Galit’s story, in her own words!

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I had twins at 37 weeks 3 days who were 5.5 and almost 6 lbs (FRIGGING AMAZING) after preterm labor at 23 weeks and 4 months of bed rest!  I wanted nothing more than to provide for them and ensure their health. Breastfeeding started out pretty rough.  My colostrum was hard to obtain and milk took forever to come in.  We were told to supplement with formula to keep them out of the NICU (they lost weight after birth, as all babies do), so we obliged. We went home with two healthy boys after 4 days and they were with me the entire time!

For several weeks, we used a gloved finger-straw-tube thing to help the boys practice sucking.  Then, out of desperation and exhaustion, we switched to a bottle and for several months (yes, months), we had to pull their chins down to help them open their mouths wider and also tilt the bottle up and down to simulate the natural flow of breast milk. No one was really capable of helping my hubby and I because there was just too much to remember.

My schedule was: nurse one baby, nurse the other, supplement both with bottles with as much breast milk as I could pump, then another separate bottle with formula (we were told not to mix breast milk with formula.  We tried several organic versions before finding one that worked for us), then pump. Between pumping 8+ times a day and nursing 10-12 times a day, I had between 10 and 25 minutes to eat OR to sleep at a time, around the clock, for almost two months. Ugh. I was always hungry and tired. If someone didn’t put food in front of my face, I didn’t eat. Great diet plan, aside from the feeling of extreme hunger, lack of energy, and need to consume extra calories to help my body make milk! 

After a couple months of serious struggles with nursing, we were desperate. The boys both had extremely tight frenulums (tongue ties), hampering their sucking abilities and leaving them very inefficient (45 minute feeds to take in less than an ounce), and me in incredible pain due to their pinching. We were told to have them clipped to allow their tongues to work better (ouch, but not too bad). This didn’t do enough (the frenulums were posterior and thick), so several of our doctors recommended we have them lasered (under their tongues and under their upper lips). Holy hell, this sucked so hard!  Then, worse, for a month and a half after the laser (until they healed), we had to stretch their wounds every time they ate. They cried. I cried. It was a very hard decision and experience, but we did what we thought would be best for our babies, for nursing, and for other reasons. So we resorted to these “drastic” measures. They eventually healed and can do all sorts of things with their tongues now! Oh the trouble they will get into some day. 

When they were about a month old, I got mastitis. I thought I was dying. The pain, all over my body, was horrible. I cried all the way to the hospital (and I’m not a crier when it comes to physical pain) and got antibiotics.  It took about four days before I felt okay enough to try breastfeeding again. I was in so much pain I couldn’t handle the babies biting/pinching, so I was only pumping. So much pumping. My parents (and in-laws) came to help care for the boys, as I couldn’t even hold them. 

Then, thanks to the antibiotics, I think got thrush (a yeast infection in the nipples. I had never had a yeast infection before, thus I am conjecturing that antibiotics was the cause).  I didn’t show any symptoms, aside from what I called “fire needle nipples.” The pain went all the way up to my armpits.  This lasted for 3.5 months. AAACK!  We had to sterilize everything, including pump parts, bottles, bras, and even my boobs(!) all the time.  My attempt to destroy thrush was energy and time consuming, to put it simply. I continued to sterilize everything after each use until I stopped pumping (at over 9 months). I still change nipple pads several times a day.  I’m so very thankful the boys never showed any signs of thrush, as I probably would have gone cuckoo! 

I ended up getting mastitis again a few weeks later (OMG!).  Thankfully, Robin came to my rescue with her “mastitis protocol.”  I healed within 1.5 days, with NATURAL supplements, pumping, massage, heating pads, hot showers, etc. without antibiotics! YIPPEE!  In total, I’ve had mastitis 10 times (WTH?), 5 of them pretty bad, leaving me mostly dysfunctional. Damn you, Plugged Ducts!  I know how to deal with it now (phew!). I worked for months to restore my milk production to the level it was before infections and scar tissue hampered my supply. I still produce less on the left side, as compared to my right; however, I still made enough to feed both my boys! 

In addition to dealing with mastitis and thrush, I had severe breast (and surrounding area) pain, for several weeks.  I was mostly pumping and wasn’t nursing more than once or twice a day due to the intense discomfort (So. Many. Bottles.). I discovered I have vasospasms but, thanks to Robin’s protocol, the pain is now gone! Thank goodness for Robin.  Phew!  My daily supplements can fill an aisle at Sprouts, but at least they are all actually helping, homeopathic, and aimed at health rather than disease. 

Big milestone: at about 3 months, I realized the boys were only being bottle supplemented with MY milk. I was finally producing enough to feed two growing boys and we were off formula! HOORAY!  From 3 – 5 months, I was weighing the boys before and after each breastfeeding session to see how much they were taking in (as if I wasn’t doing enough already).  We rented a scale from a local hospital to make sure the boys were eating enough.  Then one day, at about 5 months, I looked at their thighs and BAM!  I noticed they were chunky monkeys!  We immediately returned the scale! SCORE!  

At 8.5 months, we were meeting and overcoming new “opportunities for growth.”  These “opportunities” have slowed greatly, but they still come.  With 4 new teeth, one of my boys bit me. Hard.  I instinctually yelped, so he cried. I soothed for 5 minutes and we tried again.  He bit again. Hard. I yelped (no self control) and he cried harder, longer.  15 minutes later we tried again. Guess what happened? He bit. Again. I yelped (OMG control yourself, Mama!) and he was hysterical, hungry, and absolutely refusing to nurse, for 45 minutes. I gave him a little bottle of my pumped milk to calm him and his belly and put him down for a nap.  I was sure he would never want to breastfeed again.  Thank the heavens, as my hubby suspected, when he awoke, our baby had forgotten the morning ordeal and all was normal again. PHEW!  

 

So, was all this craziness, horrible frustration, and extreme pain worth it? HECK YES!!! So far, my boys have always been healthy!  In their whole first year, they’ve never even had a sniffle! Holy cows!  I’ve had two colds and my hubby had three! Was it the breastfeeding?  I’d like to think so. In addition to their health being friggin amazing, we get some great bonding time. I pet their heads, they give me smiles, hold each others’ hands, and sometimes giggle while nursing. They eat 3 solid food meals a day now, and I nurse them 5 times a day as well. The enzymes, antibodies, and good stuff my milk provides for them is so important.  Breastfeeding is just the BEST and I’m SO grateful my body has provided. 

We’re learning, growing, and laughing so much every day. We’ve hit the latest “golden age” of our babies and are enjoying each moment.  It’s just amazing.