1. Is it normal to have my breasts leak milk while I am pregnant?
Some women may begin leaking thick, creamy milk (colostrum) before they give birth. This is completely normal and is not a sign that you will give birth any time soon. If you have this problem, you might want to consider wearing breast pads in your bra to absorb the colostrum and prevent you from leaking through to your shirt.
2. Will I still be able to breastfeed if my nipples are flat or inverted?
Yes, you can breastfeed if your nipples are flat or inverted. It is not uncommon to have flat or inverted nipples that gradually change and protrude outward by the end of the pregnancy. If the nipples remain flat or inverted, most babies can still breastfeed without any problems. If the baby is having trouble latching correctly, a lactation consultant may be able to help get the baby to latch on correctly, especially when the baby is first learning to nurse. Paying close attention to the baby’s position on the breast, how they latch on, and having a bit of patience is important.
Trying any of the following may help to raise the nipples for easier feeding:
- Use a breast shell 30 minutes before planning to feed
- Use a breast pump before feeding
- Just prior to nursing, stimulate the nipple by gently rolling it between your thumb and index finger for a minute followed by applying a cold cloth for another minute
- As you are supporting the breast to let the baby latch on with your thumb on top and four fingers below the areola, gently push the breast tissue back towards the chest wall, which should help raise the nipple
- Use a flexible silicone nipple shield while nursing if other techniques don’t help the baby latch on better
You can find additional tips on to how to nurse with flat or inverted nipples on the La Leche League website.
3. How long does it take for my milk to come in?
It typically takes three to four days for your milk to come in, sooner if you have nursed a baby before. Some women notice that their breasts feel fuller or heavier when their milk first comes in but don’t worry if you don’t get this feeling. Not everyone experiences this. Prior to your milk coming in, your baby gets the colostrum or thick, creamy first milk.
4. Is it common to have one breast produce more milk than the other?
Yes, many women will notice that one breast produces more milk than the other. This may be because the baby is feeding more on one side than the other. When you first start to breastfeed your newborn, it is important to have the baby nurse evenly from both breasts to help avoid this. It may also help to pump after feeding the baby, especially on the side that is producing less milk. Despite these efforts, one side may continue to produce more than the other the entire time you nurse, which may just be normal for you.
5. How can I tell if my baby is getting enough breastmilk?
Wanting to know if your baby is getting enough milk while they are nursing is a common concern among breastfeeding moms, since you can’t see how much milk they are actually drinking. There are some signs that you can look for that will tell you if your baby is getting enough milk. These include:
- Your baby feeds six to eight times per day and seems content after feedings
- Your baby has at least four to six wet diapers (six to eight cloth diapers) per day after they are five days old. During the first five days they may have as few as one or two wet diapers per day, which can be normal.
- They are making three to four yellowish color stools per day by five days old
- Their lips and mouth look moist, not dry or cracked
- Your breasts feel softer after your baby feeds
If you have any concerns that your baby is not getting enough milk you should talk with your pediatrician. Seeking help from a lactation consultant or a breastfeeding support group can also help. Often, they will have you weigh your baby prior to feeding, have you nurse the baby, and then weigh them again after the baby nurses. The difference in weight can give you an idea of how many ounces of breastmilk they are getting when they nurse. While this isn’t necessary to verify your baby is getting enough milk, it can offer some nursing mothers reassurance (or drive other mothers crazy).
6. How can I increase my milk supply if it is too low?
This topic has been covered in a previous blog post which can be found here. Most nursing moms will worry, at some point, that their milk supply is too low to adequately feed their baby. Before trying anything to increase your milk supply, you should talk to your pediatrician to see if there is any reason to believe that your milk supply is indeed too low. Usually, if your baby is gaining weight appropriately and producing a normal number of wet diapers, it is a sign that your baby is getting enough milk. If your pediatrician has told you that your baby’s weight gain is inadequate, then you can consider trying the following recommendations to increase your low milk supply:
- Make sure you are drinking enough fluids to stay well hydrated (your urine should be clear) and are eating a healthy, varied diet.
- Nurse your baby on demand for as long as they want to nurse. Most babies will nurse from 20 to 45 minutes at a time, six to eight times per day.
- Offer the baby both breasts at each feeding.
- Gently massage your breast from the outside of the breast towards the nipple while the baby is nursing.
- Use a double breast pump for five to ten minutes on the highest comfortable setting after each feeding. You should do this at least eight times in 24 hours until your milk supply increases.
- Make sure that you and your baby are using the correct technique for nursing. If you are not sure then consider seeking help from a lactation specialist, breastfeeding support group, or your pediatrician to verify that your technique is correct.
- Many women turn to nutritional supplements like fenugreek, blessed thistle, red raspberry, and brewer’s yeast. There isn’t a lot of science that shows these supplements will help but many women do notice some difference within two to three days of starting them. Of all of the supplements, taking two to three capsules of fenugreek three times per day seems to be the most effective. When taking fenugreek, you may notice a maple syrup smell to you or your baby, which is normal.
Eating oatmeal is another common recommendation for increasing your milk supply. Again, there is no evidence that this will increase your milk but it is a healthy food that won’t cause any harm if you do try it.
If you have exhausted all of the other methods for increasing your breastmilk, there are two medications that can be used to increase milk supply – metoclopramide and domperidone. Only metoclopramide is available in the US and you will need a prescription to get it. Studies vary on how effective it actually is at increasing milk supply but if it is going to work for you there should be a noticeable difference in milk supply within two to three days. It may work well for you but many women find that they cannot tolerate it because of side effects that include fatigue, depression, and irritability.
7. How can you tell if you have a blocked duct or mastitis? Is there anything you can do at home to treat either problem?
Note: For both of these conditions, it is completely safe and highly encouraged to continue breastfeeding the baby from the affected side. No infection will be passed on to the baby.
Ducts that bring milk from the breast to the nipple can get clogged or blocked. When this happens, a tender, sore lump forms just below the areola and the skin around the lump may turn red. A blocked duct tends to cause pain that comes and goes but should not make you feel ill or cause a fever.
When this happens, it is important to get the duct unclogged so that you don’t get an infection. To unplug the duct you should continue to have the baby nurse on the affected side. It is best to have the baby start nursing on the sore side first to help completely drain all of the milk from that breast. It may also help to change the baby’s position while nursing so that all of the milk ducts are drained equally. Other things to try include:
- Massage the sore area by pressing the heal of your hand against the lump and pushing the lump towards the nipple
- Apply a warm, moist compress to the area for a few minutes before feeding or let warm water run over the breast in the shower
Mastitis tends to be worse than a blocked duct and is inflammation of the breast that causes it to be red, swollen, and tender with constant pain. It can also cause you to have a fever (temperature more than 100.4) and to feel generally unwell. When you get mastitis, you can try a few things at home to see if the symptoms improve before calling your health care provider. These include the following:
- Have the baby nurse on the affected side frequently
- Massage the affected area moving your hand towards the nipple
- Alternate between warm and cold compresses
- Take an analgesic like acetaminophen or ibuprofen to relieve the fever and pain
- Drink plenty of fluids
If after a few hours of trying these your fever goes up or you feel worse, you need to contact your health care provider for possible antibiotic treatment.
8. Is a manual or electronic breast pump best?
The type of pump you choose will depend on what your pumping needs are, cost, and portability of the pump. Some women may not need a pump at all, while other women greatly depend on one.
A manual pump is one that is hand operated and frequently costs only $15 to $50. These are good options for women who only pump occasionally because they can be time consuming and therefore tend to get less milk than electric pumps. However, these are small and easily portable, making them easy to take with you when you do need to pump.
There are also electric pumps, which cost more than the manual pumps, anywhere from $30 to $350, but work much quicker to pump milk than a manual pump. Usually, the more you spend on an electric pump the more features the pump will have. Most electric pumps will give you several different speed/suction options for comfort and the more expensive pumps will have let down features to promote milk let down. There are also the more expensive, hospital-grade breast pumps, which cost from $1,000 to $2,000. Because of their high cost, these are usually rented and used while you are waiting for your breast pump to arrive in the mail, if you need to increase your milk supply, or for use while your baby is in the hospital. These are by far the strongest and most durable, however they are not portable and really more than most nursing moms really need.
Most private health insurance companies (excluding Medicaid and some older policies) are now required to cover the cost of a breast pump for a nursing mom. Talking with your health insurance company about which breast pumps they provide is probably the first place you should start when picking a breast pump. However, it is important to know that your choices will probably be very limited and you usually can’t get the pump until after the baby is born. Either way, starting with the insurance company is still the first thing you should try. Talking with other nursing moms about which breast pumps they liked and reading reviews on Amazon can also help you decide on a pump. Keep in mind that you don’t necessarily need to spend a lot of money on a pump in order to find one that meets your needs.
9. How long should I breastfeed my baby?
This topic has been covered in a previous blog post which can be found here. Determining how long to nurse your baby is a personal choice. It can depend on how long you desire to nurse, how long your baby wants to nurse, and your work and personal life demands. The American Academy of Pediatrics recommends nursing exclusively for the first 6 months and then supplementing solid foods with nursing until the age of 12 months or more.
10. Are there any reasons why I shouldn’t breastfeed?
Very occasionally, there are sound medical reasons for not breastfeeding – for example, if you have HIV or, in rare cases, if you’re taking a medication that could harm your baby, such as drugs for treating cancer. If you’re not sure whether you should breastfeed your baby, speak to your midwife or health visitor for information and support.
