Expressing Breastmilk

As a general rule if babies are given adequate access to the breast and are not separated from their mothers, expressing is not necessary.  However, if you have an unwell/premmie baby, are returning to work, having a few hours apart from your baby or working on increasing supply, knowing how to express your breastmilk for your baby can be a great skill to have. It’s important to remember that the amount you express is not an accurate reflection of how much milk you have – babies are often far more efficient. There are two ways to express milk – using a pump or hand expressing.  There are pros and cons for both, but both methods are a learned skill and often get easier with practice.  Having expressed my milk for several months, I have a personal interest in this topic.  With any type of expressing, the key to draining the breast is to stimulate a let-down – this makes the milk flow more freely and is how your baby gets most of their milk.  Information on let-down is HERE. Hand expressing is free, can be done almost anywhere and requires no power.  It is also much more gentle than some alternatives and is shown to be more effective in the first few days after your baby is born.  The down side is that it is very-much a learned skill and can be quite time-consuming.  This method is great for when your baby is very young or you need some milk to leave with your baby if you’re going out for the evening. For all pumps, it is important to find one that works for you and is COMFORTABLE.  Most pumps have a flange (the portion that sits on your breast) that comes in a variety of sizes.  Having the correctly fitting flange can make expressing much more effective and comfortable.  Pumps come in three basic varieties.  There are manual pumps, basic electric, double pumps and hospital-grade pumps. A manual pump uses suction to draw milk from the breast.  This is done using one or both hands.  These pumps are often inexpensive and are best for occasional expressing.  The downside is that it may be difficult to stimulate a let-down with these pumps as it’s a bit of  ‘hard work’. Basic electric pumps use either an electrical or battery power supply to do the suction for you.  Some of these pumps...
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What Happens During A Consultation?

If you have not seen a lactation consultant in private practice, you might be wondering what actually happens while I’m with you.  There is a general flow that I usually follow, but ultimately, I work around what the baby and the mother need.  All of my consultations are in your home. There are three basic types of consultations I provide – Breastfeeding Preparation Sessions (for before birth), Breastfeeding Not Going To Plan Consultations (after the baby’s born) and Return To Work Plans.  This post will discuss the Breastfeeding Not Going To Plan Consultation – which are the majority of my work. Before a consultation, there has usually been a brief phone/email conversation to establish what is needed and have arranged timing so that the baby will be looking for a feed at some point during the consultation.  We usually start with a short health history of mum , briefly discuss the birth and the potential impacts this may be having on breastfeeding and then we discuss how feeding has been going.  If your baby is not ready for a feed at this time, we discuss the likely things that may be going on and suggest some strategies that are likely to improve the situation – so you know what to expect and feel prepared when your baby is ready to feed. If the baby is showing feeding cues while we are discussing the birth or feeding history, I usually suggest we go back to the history after your baby has fed. After or during the feed (depending on the length and comfort level of the feed), we make a breastfeeding plan that the mother feels is manageable – trying to meet breastfeeding goals for both you and your baby.  We agree on a timeframe for you to contact me to discuss your progress (usually 24-48hrs depending on the situation)  After I leave, I email a summary of our discussion to you so that you can refer back to it when necessary. The consultation fee is payable on the day and includes follow-up with phone/text/email and a discount should another consultation be needed.  I do my accounts once/week usually and will email the paid invoice to you.  Some private health funds will give a rebate for my services. Things to do if I’m coming to you – Have your child health record handy (the red/maroon book) Write down any questions you...
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Keeping Warm

For mothers and babies it can take some time to adjust to cooler temperatures.  Babies can begin to wake more frequently and mother’s nipples can have a painful reaction when exposed to the cold air. Babies are born very immature.  They need a lot from their parents – one of them being warmth.  Immediately after birth, the best way to keep a baby warm is to place them skin-to-skin with their mother, wrap the two of them up and leave them be. Once you get your baby home, they need to have their temperature regulated by you.  Some babies will wake frequently through the night if they are not comfortable with the temperature.  When the weather’s chilly, it can be a bit of a challenge to know what to dress them in and how to keep them at the right temperature.  Again, having lots of skin-to-skin time is great, but it’s just not practical to do skin-to-skin all day every day until they’re 6 months old, so we need to put some strategies in place to keep them cosy.  Here’s some ideas Dress them in a singlet, nappy and all-in-one suit with layers over Have your baby sleep in the same room as you.  This way you are more likely to be aware of the room temperature and can adjust it if necessary Heat the room to a suitable temperature Use safe bedding to either wrap them or cover them in the cot/bassinette/rocker etc Sometimes babies can be distracted by wraps and blankets when they are first learning to feed, so this is when you can have them in just the basics then cover the both of you It’s not just the baby who needs to keep warm.  When breastfeeding, sometimes a mum’s tummy is exposed to the cool air.  There are many styles of breastfeeding tops available that help cover the tummy and only expose the least amount of skin possible. Sometimes the cold can exacerbate a condition called nipple vasospasm.  This means that the cold stimulates a reaction in the nipple which is very painful.  If you need information on this, please contact me. So, while the weather’s cool, rug up and enjoy a bit of snuggle time with your little one – it keeps everyone warm and is a great way to bond with your...
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Painful Breastfeeding

When mothers are seen breastfeeding their babies, it is often the picture of serenity.  For some mothers this happens straight from birth – the baby goes to the breast for the first time, latches well and takes in the liquid gold.  For others it can be a rocky journey which takes time, patience and assistance to get right. Breastfeeding should NOT be painful.  As Christina Smilie says – pain is the body’s way of guiding us to comfort.  There are many reasons why breastfeeding may be painful.  There may be a simple adjustment which can help the situation such as improving the baby’s position.  The baby may have had a difficult birth and may need supporting for a time until feeding improves.  Some babies have a tongue tie which is restricting the baby’s ability to feed and causing damage to the mother. With all these situations (and others), a lactation consultant can help to work out the cause of the pain and make breastfeeding more comfortable and enjoyable.  If breastfeeding is painful, you can contact me to discuss if your particular situation might benefit from a...
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Mother-To-Mother Support

When working with a mother, I often get a range of parenting questions mixed in with the breastfeeding ones.  I’m happy to answer these when I can.  Some mothers can feel somewhat isolated when they have a baby and may be looking for information about what to expect from this period of their baby’s life and reassurance that they are meeting their baby’s needs. When a mum’s breastfeeding situation no longer requires an LC, I often suggest they get in contact with their local ABA group.  These groups can be a great source of information, support and friendship with mothers who are in a similar stage of life.  It is also one of the World Health Organisation’s 10-steps to successful breastfeeding. To find your local ABA group, click...
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The Great Dummy Debate – A Personal Perspective From An IBCLC

All my children had dummies…. Was this a good thing?  The answer is both yes and no for me.  For my first child, having a dummy was the means to an end and also the beginning of a slippery slope to early weaning. When I brought my first beautiful newborn baby home from hospital, I was elated.  This lovely scene came crashing down around me when breastfeeding went very wrong.  My baby was drowsy and I was getting more and more frustrated that she wasn’t feeding.  Eventually after she became more alert, she REALLY wanted to feed.  By this stage breastfeeding was excruciating.  I dreaded attaching this beautiful little bubba to my breast to feed.  I started trying anything I could to delay feeding her and stretch the feeds out.  This inevitably led to using a dummy.  There were two things wrong with this. Firstly, she was crying because she wanted to feed and make up for the days that she had been drowsy.  She was showing me all the feeding cues and I just didn’t recognise them.  Also, my breasts were not getting the stimulation they needed to make the amount of milk my baby needed. Secondly, she was already attaching poorly and introducing a foreign teat which in no way stretches and functions like a breast was, in my opinion, contributing to her trouble. In the end I couldn’t face the toe-curling pain with each feed and chose to express my breastmilk and feed it to her with a bottle.  I was disappointed and sad that breastfeeding hadn’t worked out for me.  It wasn’t all about the dummy, but it certainly didn’t help. My second and third babies also had dummies.  This time around I was more informed and more determined to get things right.  So I chose to focus on establishing breastfeeding as a priority after I had the baby – electing to use other settling techniques and delaying the use of a dummy until about 6-8 weeks.  When I did use the dummy it was sparingly and when I knew that the baby’s tummy was full.  I tuned into my babies and looked for feeding cues, I also realised that I had a limited milk storage capacity and that my babies really NEEDED to feed frequently to thrive – which they did.  I used the dummy to help them to get to sleep, in the car...
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