Milk on the Job – Military Mommas

Happy Veteran’s Day, y’all! We are so grateful to the brave men and women in uniform for their service. It is a unique sacrifice to serve in the military, and especially for mothers of young children.

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Like many other jobs, the military has regulations in place to protect working Milky Mommas. Do you know your rights? Here are some resources for our Military Milky Mommas, to ensure that they’re protected when pumping at work, and even services for veteran mommas!

Thank you for your service, and keep on milkin’! ❤

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Hand Expression

Learning to hand express breast milk is a “handy” skill (pun intended!) that so many mommas never learn. It requires some practice to master, but once you do, it is a convenient method for expressing milk anytime, anywhere- no special equipment required.

Hand expression is free, all you need is a cup or bowl to express into, and your hands! It is also a cleaner method of expression than pumping, since the milk comes into contact with far fewer surfaces on its way to baby. Fewer contact points means less chance for contamination- win, win!

Check out this great video from Global Health Media for a comprehensive tutorial on how to hand express.

 

Have you hand expressed? Tell us below! ❤

 

Mastitis

This document is provided for information purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Milky Mommas. If you think you’re having a medical emergency, call your doctor or 911 immediately.

Mastitis is the clinical term for breast infection.

Whenever a lactating woman experiences flu-like symptoms, she should consider the possibility of mastitis, contact her provider, and begin measures to treat / prevent mastitis.

Symptoms of mastitis include:

  • Localized tenderness of breast
  • Localized heat or red streaks on breast
  • Fever
  • General sick feeling
  • Sometimes nausea and vomiting

Common causes of mastitis are:

  • Infrequent feedings or scheduled feedings
  • Missed feedings
  • Poor milk removal due to latch issues
  • Illness in mother or baby
  • Oversupply
  • Rapid weaning
  • Plugged ducts and/or blebs
  • Pressure on the breast that restricts milk flow (like tight clothing)
  • Cracks in the nipple that allow bacteria to enter and infect breast tissue
  • Maternal stress and fatigue

How is mastitis diagnosed?

  • Mastitis is usually diagnosed based on symptoms.
  • Lab tests and diagnostics are not routinely needed or performed for mastitis unless there are repeat infections.
  • Your OB or PCP can diagnose and treat mastitis.

How is mastitis treated?

  • The most important step is frequent and effective milk removal (at least every two hours).
  • Breastfeed as frequently as possible, starting on the affected breast.
  • If it hurts too much to start on the affected breast, it might help to start on the unaffected breast and switch sides as soon as letdown happens.
  • Position the baby at the breast with chin or nose pointing to the blockage to help drain the affected area.
  • Gentle massage may also help remove milk. Massage should be directed from the blocked area toward the nipple.
  • After feeding, pumping or hand expressing may help remove more milk and speed recovery.

Should I continue to nurse if I have mastitis?

  • Yes! Frequent and effective milk removal is key, and nothing is more effective at removing milk than a baby.
  • Mothers who can’t continue breastfeeding when they have mastitis, for whatever reason, should pump or hand express at least every two hours because stopping cold turkey leads to a greater risk of abscess than continuing to feed.

What should I do while recovering?

  • Rest. If possible, take baby to bed for a nursing vacation.
  • Hydrate. It’s important to drink plenty of clear liquids to help your body produce plenty of milk to flush the infection.
  • Ask your provider if an NSAID may be right for you, to relieve pain and inflammation.

Do I need antibiotics?

  • It depends. Contact your provider at the first signs of mastitis and ask what they advise.
  • If symptoms are mild, many breastfeeding experts advocate treating conservatively at home for the first 24 hours.
  • If symptoms do not improve in 12-24 hours or you are acutely ill, experts agree antibiotics should be started.
  • Your HCP will help you decide which approach is best for you and your circumstances.

What kind of at-home treatments may help relieve mastitis symptoms and hasten recovery?

  • Nurse, pump, and/or hand express as much as possible (at least every two hours)
  • Rest and hydrate
  • Your provider may recommend an NSAID to relieve pain and inflammation
  • Hot shower
  • Moist or dry heat, whichever feels better
  • Epsom salt soak
  • If inflammation is severe enough to inihibit milk flow, it may be helpful to apply ice for a few minutes before nursing or pumping
  • Gentle massage or pressure from behind the clogged area toward the nipple (use in moderation because massage can make inflammation worse)
  • Stroke gently from behind the clog toward the nipple with a comb or plastic bristled brush
  • If you have a visible bleb or milk blister, notify your provider and ask what s/he would advise

Which antibiotics are commonly prescribed for mastitis?

  • Dicloxacillin
  • Flucloxacillin
  • First-generation cephalosporins
  • Cephalexin
  • Clindamycin
  • If an antibiotic is needed, your provider will prescribe one that’s appropriate for you.
  • Breastfeeding compatibility can be verified at http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm, via the MommyMeds app, or by calling the InfantRisk hotline Monday – Friday, 8 am – 5 pm, CST, at 806-352-2519.

How soon should I start to feel better?

  • Improvement is usually rapid and dramatic.
  • If symptoms don’t resolve in several days with appropriate management, including antibiotics, you should call and notify your provider.

What can I do to avoid mastitis in the first place?

  • Feed on demand.
  • Get a good latch.
  • Learn to hand express so you can always empty your breasts, no matter what the circumstances.
  • Be on the lookout for signs of milk stasis (milk that is not leaving the breasts). Check for lumps, pain, or redness.
  • If you notice any signs of milk stasis, be quick to completely empty the breast, increase the frequency of feedings, and rest and hydrate.
  • Call your healthcare provider at the first signs of mastitis and ask what they advise.
  • Practice good hand hygiene.
  • Disassemble and wash pump parts thoroughly between uses (may be refrigerated for up to 24 hours) and air dry.

Source: The Academy of Breastfeeding Medicine

Additional resources:

This document is provided for information purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Milky Mommas. If you think you’re having a medical emergency, call your doctor or 911 immediately.

Storage of Breast Milk

Storage Guidelines of Expressed Breast Milk:

Freshly-Expressed Milk
               Warm Room : 3-4 hours
               Room Temperature: 4-8 hours
               Insulated Cooler/Ice Packs : 24 hours
Refrigerated Milk
               Refrigerator (fresh milk) : 3-8 days
               Refrigerator (THAWED milk) : 24 hours
Frozen Milk (do not refreeze!)
               Self-Contained Freezer of Refrigerator : 6 months
               Deep Freezer : 12 months

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Mixing Expressed Milk:

Only mix milk at or near the same temperatures.
Freshly-expressed milk can be added to room temperature milk within 4-8 hours. Otherwise, refrigerate milk and then combine. Add refrigerated or partially frozen milk to already frozen milk.

Oops! I didn’t use/need what I HEATED!

Thawed milk needs to be used within 24 hours. Keep refrigerated until next feeding. Heated or warmed milk needs to be used within 2-3 hours. Simply smell milk if you think it may be bad. Don’t toss the milk! Use “bad” milk in the baby’s bath!

Does the milk have a metallic taste or smell funny?

See link for more info:

Helpful Information:

CDC Recommendations:

The STUDIES the Storage Guidelines are based on:

Low Milk Supply

One of the most common concerns of the breastfeeding mother is that they aren’t making enough milk for their baby. Let me assure you, true low supply, or the inability to produce adequate milk, is rarely the problem. What signals your body to make more milk? Removing milk!

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“But he wants to eat all the time!”

Ok…Let’s look at the whole picture:

  • Is baby very young? Newborns have a stomach that, at 10 days old, is still only the size of an egg, and he’s eating a perfect food that is completely digested quickly.
  • How old is he? Just like a teenage boy that eats all the time, babies are growing…and fast! There are several physical and developmental spurts that occur, usually around the same time for each child. Take a look at the Wonder Weeks chart (http://www.whosthatmom.com/wonder-weeks-week-by-week/) and see if your baby is either having a growth spurt or about to have one.
  • Is he latched correctly? Can you hear him swallowing? A proper latch is comfortable for you, not painful, and allows baby to efficiently remove milk from the breast. If you have access to an IBCLC, have them check baby’s latch. There are several valuable resources here, as well: http://kellymom.com/ages/newborn/bf-basics/latch-resources/

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“He fusses at the breast. I don’t think any milk is coming out.”

  • Let’s talk about supply and demand. Babies demand milk…and you supply it. Fussing at the breast, beating on you, on-and-off nursing, etc, all signal your body to make more milk. Your breasts don’t ever truly become “empty”, they continuously make milk.
  • Does he need to burp? Is he distracted or overstimulated? Are you distracted or stressed?
  • Is he getting too much milk? Check our document on oversupply to see if it sounds like you.

“I’m pumping barely anything.”

  • Pumping is never a good way to judge what you’re actually producing. Babies are much more efficient at getting milk out than a pump.
  • Also see our document on Pumping Tips for help when pumping at work.

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“My breasts feel empty. I think my supply dropped.”

  • Probably not. Most of us only experience super-full feeling breasts for a limited time. What is most likely happening is that your supply is regulating. Your body and your baby’s demands have come to an understanding and your are meeting his needs without becoming overfull.
  • Your breasts always make milk. When milk is removed, they make more. “Your breasts are a factory, not a storage facility.” They are never truly empty.
  • Babies can typically always get out more milk. Even if it’s minimal; they are very efficient at their job.

“How do I make more milk?”

  • Firstly…nurse your baby more. Most concerns about supply can be fixed by simply nursing more.
  • Nurse baby on demand. Let him decide when he wants to eat.
  • Pay attention to baby’s hunger cues. Rooting, smacking lips, sucking hands, etc, are all signs of hunger. Crying is a late hunger cue.
  • Soothe at the breast. Comfort nursing can be frustrating sometimes, but it is the best means of comforting your baby and ensuring an abundant supply of milk.
  • Nurse until baby lets go. Let him decide when he’s done.
  • Don’t be a clock-watcher. Allow baby to run on his own time.

Signs that your baby is getting plenty of milk:

Birth-2 weeks:

  • baby starts gaining weight after your milk comes in. Remember, weight gain varies with every individual. Don’t compare your baby to your friend’s or yourself.
  • baby is having at least 3 quarter-sized poops per day. These can be spread out over a 24 hour period. More than three is fine.
  • baby is swallowing when he’s nursed.
  • baby is nursing at least every three hours until he reaches about 10 pounds. Again, more is fine.

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2-6 weeks:

  • baby passes birth weight by around 2 weeks. Remember to calculate that by baby’s lowest weight.
  • baby continues to gain weight.
  • still has 3 quarter-sized poops per day. Until around 6 weeks, this is what we want to see. Others may tell you that it is normal for exclusively breastfed babies to go several days or even a week or more without pooping. That is not true until around 6 weeks, and even then, not the norm.
  • baby has gotten the hang of latching on and staying attached.
  • baby is sucking with long, steady sucks soon after latching.

6 weeks on:

  • baby continues to gain weight.
  • baby is meeting developmental milestones.
  • baby has plenty of wet diapers and regular poops (they become less frequent around 6 weeks).
  • baby is getting longer and gaining in head circumference.

What if your supply is truly low?

Sometimes baby really isn’t getting enough milk. It’s important to understand why.

It’s important to figure out if he’s not taking enough because you’re not making enough, or if you’re not making enough because he’s not taking enough, or if he’s taking plenty but not using it well.

Source: The Womanly Art of Breastfeeding, 8th ed., p.396

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What might be the issue with baby?

Possible causes of baby taking too little milk are:

  • he’s improperly positioned
  • his nursing time is being cut short
  • he’s being fed too infrequently
  • he has a tongue-tie or other latching issue

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What might be the issue with me?

Possible causes of mother making too little milk are:

  • thyroid problems
  • PCOS (Polycyctic Ovary Syndrome)
  • breast surgeries

If your supply is truly low and your baby is not thriving, it is our advice at Milky Mommas to seek out and meet with an IBCLC to identify and correct the problem.

Most of these scenarios are completely reversible, so don’t give up hope. Remember, if you must supplement due to medical indication – and at the recommendation of a professional – there’s a strong chance that supplementation need be only temporary and you can return to being your child’s sole source of nutrition.

Pumping Tips

Many breastfeeding moms want to or need to pump in order to provide breast milk when away from their babies. Never fear, Milky Mommas Blog is here! Check out our top tips for comfortable and productive pumping.
Key Points:
  • Pump output does NOT indicate milk supply. Don’t compare your output to anyone else’s!
  • The frequent removal of milk is vital to maintain or increase production. Breast milk production is based on supply and demand.
  • Hand expression after pumping can increase output by an ounce or more!
  • It is typically best to avoid pumping before 6-8 weeks, unless medically-indicated.
  • Teaching caregivers how to paced bottle feed ensures baby is taking in appropriate amounts, and allows mom’s pump output to keep up more easily.
Use a Quality Breast Pump!
What type of pump are you using? Is it in working order? Most pumps are designed for a single user, single year, and single baby. Avoid sharing an open-system pump, as doing so puts you and your baby at risk for blood borne pathogen transmission. Pumping moms need a sturdy, double-electric pump that is designed for frequent use.
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Aim to express milk (nursing or pumping) at least every three hours.
The key to maintaining or increasing milk production is the frequent removal of milk.
Learn how to use your pump to adjust suction and speed and how the let down button works. Use it frequently. Going longer and possibly allowing your breasts to become engorged may make it harder to express milk and maintain supply.
Pump for at least 15 minutes, or 5-10 minutes after the last drop. Then hand express! Then pump again!
These articles give tons of good information about timing of pumping, how much milk you might need to send and milk storage for future use:
Use Properly-Sized Equipment
Make sure your equipment is properly sized and comfortable and is in good working condition. Are your flanges correctly sized? Your nipple should move smoothly through the tunnel, not be jerked or squeezed in the tunnel. https://www.facebook.com/media/set/?set=oa.407831619385777&type=1
If a flange is too small, this can compress milk ducts and make it hard to express anything at all. Signs that you have a poorly fitted flange include (but are not limited to): purple/white nipples after pumping, a “ring” around the inside of the tunnel that does not blot off or discomfort during pumping.
Follow your manufacturer’s recommendations about care of parts. Some manufacturers recommend boiling parts occasionally, others require the flexible membranes (duck bills, caps, etc.) to be changed every so often. Pay attention to the wear and tear on your pump parts and replace as needed.
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Pumping Should Not Hurt!
Is the suction too high? Remember, you are trying to trigger a let-down reflex, not pull milk from the breast. Turning the pump suction too high in an attempt to get more milk can actually work against you, squeezing the milk ducts shut. Think of trying to suck a thick milkshake through a straw by applying more suction- the straw just folds flat.
Plan Ahead for Pump Part Storage
Keep extra pump parts available at work in case you forget a piece. Many moms have 2-3 sets. Use a lunch box to store parts and bottles. Find a cute purse/bag that all of your gear fits into. Pump setup and breakdown is part of the equation. You will get more efficient at it. Wipe out the milk in the tunnel with a paper towel and just store the entire flange assembly in the fridge without washing. Other mothers use the quick clean wipes sold by pump manufacturers to wipe and go. Store milk at room temperature or in a refrigerator until use or freezer storage.
Tip: Get the free pump kit from the hospital when you deliver. Many of the parts can be used on any pump!
Use your hands!
Pumps are as low as 40% efficient, meaning you may be leaving 60% of the milk in your breasts after pumping! Hands–on pumping or breast massage while pumping may yield higher output. Hand expressing for a few moments after you are finished pumping can help empty your breasts more completely.
Here are some great videos on Hands-On Pumping & Hand Expression!
Hands-on Pumping: http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
Encourage baby to snuggle and nurse while you are together
Many mothers choose to send only the milk they pumped the day before at work and allow baby to “make up the difference” while they are together.  Some babies reverse cycle (http://kellymom.com/bf/normal/reverse-cycling/) and begin feeding more at night to get some extra snuggles and extra milk.
Eat Nutritious Foods and Drinks and take care of yourself:
A diet as close to nature as possible is recommended. No supplements or shakes or shortcuts can replace proper nutrition for a nursing mother. See our post on Diet and Nursing for more info!
Train Your Mind and Love Your Pump
Many mothers find it helpful to train themselves to “look forward to” pumping.  Be it a promise to play a game on their phone, a piece of chocolate before or after pumping, etc.
It takes time for your body to learn to let down for a pump.  Babies have cute, snuggly little fat rolls, smell like angels and grunt like tiny, perfect sumo wrestlers.  Pumps just don’t have that appeal and it takes time to learn to make milk for the pump. Be glad that you are continuing to provide your precious milk for your baby.
Make a “Safe” Place for Pumping
Are you in a “safe” place that is conducive to relaxation?
Think about the environment in which you pump. A closed, locked door may help.  Some mothers find it helpful to use earplugs to drown out any outside noise or the sound of the pump, others enjoy watching videos of their babies or listening to recordings of their babies snuggly snuffling sounds or cooing. Deep breathing, calming thoughts, even thinking of rushing rivers may help.  This is individual for each mother and you will find your groove with it.
Pumping for a NICU/Preemie Baby
Pump every 2 hours during the day and 3 hours at night.
Visit with the hospital lactation consultant frequently.

Returning to Work?

Begin pumping 1-2 weeks before your return. Add in one pump a day. You only need enough milk for the first day. You will pump milk for Day 2 on Day 1.
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Contact your HR rep and boss before your return to inform them of the accommodations that need to be made. Present them with your plan and required pumping schedule. There are state and federal laws to protect you and your right to breastfeed.  Please let us know if you need further help with your specific situation.
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Flexible or Part-Time Work
Discuss your options with your boss. Returning to work doesn’t have to be all or nothing. Ask for a transitional week or use your remaining leave hours to work a reduced schedule at your convenience as you transition from the major life event. This is allowed per FMLA laws.
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Alcohol & Breastfeeding

Alcohol and breastfeeding is a topic that comes up every day in the MM community. The information provided here is intended to help women research and educate themselves to make an informed decision for themselves and their families. We encourage all of our members who choose to drink to do so responsibly, in moderation, and occasionally.

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The American Academy of Pediatrics Committee on Drugs considers
alcohol compatible with breastfeeding. It lists possible side effects if
consumed in large amounts, including: drowsiness, deep sleep, weakness,
and abnormal weight gain in the infant, and the possibility of decreased
milk-ejection reflex in the mother.

Dr. Jack Newman, member of the LLLI Health Advisory Council, says this
in his handout “More Breastfeeding Myths”:

Reasonable alcohol intake should not be discouraged at all. As is the case
with most drugs, very little alcohol comes out in the milk. The mother can
take some alcohol and continue breastfeeding as she normally does.
Prohibiting alcohol is another way we make life unnecessarily restrictive
for nursing mothers.”

 Thomas W. Hale, R.Ph. Ph.D., member of the LLLI Health Advisory Council, says this in his book Medications and Mothers’ Milk (12th ed.):

“Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Alcohol transfers readily into human milk. Alcohol is not stored in milk;
rather it enters and exits according to blood alcohol level. Levels of alcohol in milk peak at approximately 30 to 60 minutes following ingestion, then decline rapidly if no more is ingested.

Evidence shows that excessive consumption of alcoholic beverages during lactation affected infant development, such as weight and linear growth from 1 to 57 months.”

In terms of milk supply, new data now clearly demonstrate that alcohol
actually inhibits oxytocin release from the pituitary, thus impeding the let down process so that milk is not released from the breast as efficiently. One study showed a 23% reduction in milk release while alcohol is present in the mother’s blood. In another study, alcohol completely blocked the release of oxytocin.

While many people believe that dark beer enhances milk supply, that belief is purely anecdotal. If you choose to have one drink while nursing, it should be metabolized before your next nursing session (unless your infant is cluster feeding).

Standard drinks are measured as follows:
12 oz beer,
8-9 oz malt liquor,
5 oz wine, or
1.5 oz liquor.

Pump and Dump?

Because alcohol is not stored in milk, there is no need to pump and dump
to rid your milk of alcohol. However, nursing mothers may need to express
milk for comfort and to avoid milk stasis while too intoxicated to nurse. This milk can be used for a milk bath or diluted with milk that doesn’t contain alcohol and fed at another time.

If you are very concerned or intend to consume several servings of alcohol
in one sitting, you can pump ahead of time and store expressed breast milk to be used in case your infant needs to be fed while you have a drink or two. Then, when enough time has passed for alcohol levels to go down, you may resume breastfeeding.

Please Note:
● Alcohol test strips are NOT reliable.
● Infants should NEVER EVER EVER bed share with an adult who has been
drinking alcohol.
● Chronic or heavy users of alcohol should not breastfeed.

Additional Resources:

http://www.infantrisk.com/content/alcohol-and-breastfeeding

● To calculate BAC based on weight and standard drink count: http://brown.edu/Student_Services/Health_Services/Health_Education/alcohol,_tobacco,_&_other_drugs/alcohol/alcohol_&_your_body.php
http://www.llli.org/faq/alcohol.html

Inducing Lactation & Re-Lactation

It’s worth noting that no matter which method of lactation induction you choose, working closely with an IBCLC is essential, and a strict and disciplined milk removal schedule is required. The only scientifically proven way to make more milk is to frequently remove milk. Throughout this post, we’ll refer to inducing lactation, but if you’re trying to re-lactate, the same principles apply.

There are several ways to induce lactation: hormone therapy, natural supplements, or even just frequent nipple stimulation.
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Hormone Therapy
This is the most aggressive method to attempt lactation induction. The most commonly used protocol is called the Newman-Goldfarb Protocol – as in Jack Newman and Lenore Goldfarb. If you’re going to take this route, you absolutely must be working with a health professional to determine the best course of action for your situation.
Ideally, you start making some milk by the time baby arrives, and then putting baby to breast continues the stimulation of milk production. Any supplementation to feeding the baby should be done with a supplemental nursing system to increase milk production.
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The above picture is a starter supplemental nursing system. It’s good if you’re supplementing a small amount. (link)
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Above is a larger one. If you’re just getting started pumping but you want to supplement baby at the breast, I’d get this one. (link)
You’ll need to replace the SNS (at least the tubing) every month or so, depending on how often you’re using it.
This website talks about the Newman-Goldfarb protocol in a LOT more detail.
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Natural Supplements
Some women can’t or don’t want to take prescription meds to attempt to induce lactation. In this case, there is anecdotal evidence about the efficacy of some natural supplements.
Even if you go this route, it’s important to work with your health care provider to be sure there won’t be any interactions with drugs you may already be taking. Even though these supplements are natural, there may still be side effects, so it’s important to pay attention. Before taking any natural supplements, please consult with your doctor — we are not medical professionals, and we cannot report on the efficacy or safety of these products.
As with the hormonal protocol, the most important part of using natural supplements to induce lactation is to pump, pump, pump. Strive to pump every 2-3 hours during the day and every 4 at night. Before any milk comes out, pump for 15 minutes; after you start making milk, pump for 5 minutes after the milk stops flowing.
Nipple stimulation
In this situation, you simply pump. Strive to pump every 2-3 hours during the day and every 4 at night.
In all of these situations, you want to use hand on pumping. Check out our post on pumping tips for getting the most out of your efforts.
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Here are some resources that we’ve found helpful:
Lenore Goldfarb’s website — www.asklenore.info
Jack Newman’s website — www.breastfeedinginc.ca
Jack Newman’s Guide to Breastfeeding – this book is so full of good info, and it is great to have a hard copy resource to look through. The revised edition (at the time of writing this) is only available on Canadian Amazon — www.amazon.ca