When babies are born, their stomachs are about the size of a grape and hold less than an ounce (~5-7 milliliters) of milk at once. Colostrum (the thick, yellow breast milk in the early days after birth) is tailored to what your baby needs, both in nutrition content and volume. Newborns need to eat frequently (typically, at least every 2-3 hours or 8-12 times every 24 hours) because their stomachs can only hold so much milk at once. Frequent feedings in the early days also help promote an abundant milk supply. It’s important to remember that even though the rule of thumb is to breastfeed every two-three hours, it doesn’t mean your baby will only want to nurse within those exact time frames. Think about your own eating patterns – do you always want to eat at the same times every day? Do you sometimes need to eat more than usual to feel satisfied with a meal? Do you sometimes “graze” throughout the day? Like adults, babies’ hunger isn’t always going to follow a schedule. This is why watching your baby’s hunger cues is a helpful guide (see #2).
At the core of caring for babies is understanding their behavior and how they communicate their needs. For example, knowing the signs that a baby is hungry (e.g., sucking on their fists, opening their mouth and turning their head looking for the breast) helps caregivers be responsive to the baby’s needs, which don’t follow an exact schedule. Also, parents may assume that something is going wrong with breastfeeding if a baby wakes up in the middle of the night or cries often. Knowing that it’s normal for babies to wake up at night or cry for reasons besides hunger can help correct the assumption that a baby is waking up or crying because something is wrong with the breast milk or breastfeeding, which can help families continue breastfeeding and meet their goals.
It’s normal to feel tugging or pulling while a baby breastfeeds, but pain can be a sign that something isn’t going like it should. Oftentimes pain may indicate a shallow latch, but other factors can contribute to pain as well. While pain during breastfeeding is commonly experienced, the myth that breastfeeding is supposed to hurt can keep breastfeeding moms from seeking the breastfeeding help they need.
Physiologically, breast milk production is driven by demand. Milk removal, whether by breastfeeding or milk expression (e.g.., hand expression or pumping), triggers the body to make more milk and is the most important factor for ensuring adequate supply. Let’s say you’re at a sit-down restaurant, and you order a soda to drink. If you’re regularly drinking the soda, the waiter will probably top off your soda as your drink. The more of soda you consume, the more your cup is going to be filled. Likewise, breastfeeding more frequently triggers the breasts to produce more milk. On the other hand, if you’re not drinking much of your soda, the waiter may not refill your drink at all; similarly, if a nursing mom isn’t breastfeeding or expressing milk often, her breasts will take that as a sign that they don’t need to produce as much milk.
Experiencing the highs and lows of breastfeeding can feel like a roller coaster. Lactation consultants can offer education to help you make informed decisions about your breastfeeding journey, address your breastfeeding concerns and questions, and walk alongside you to help you meet your breastfeeding goals.
In order to help increase awareness and understanding of eating disorders and empower those in a position to support those in recovery, here is my list of top things I wish people understood about eating disorders.
Eating disorders frequently affect a person’s body image, self-esteem, and sense of identity and are normally unrelated to vanity or desire for attention. Instead, food is used as a tool to help a person control their emotions.
According to the DSM-5 (a diagnostic and statistical manual to diagnosis mental disorders), there are five diagnoses under the eating disorder umbrella: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, ARFID (Avoidant Restrictive Food Intake Disorder), and OSFED (Other Specified Feeding or Eating Disorder). One eating disorder diagnosis is NOT superior to another. All can wreak havoc on the body and cause devastating effects.
Everyone has highs and lows throughout recovery, just as most people do in their day-to-day lives. There will be good and bad days. There will also be moments where more support is needed, such as a higher level of care or someone checking in more frequently, while other times a person can manage on their own. No matter where someone is on their journey, compassion and kindness go a long way.
Eating disorders can’t be “cured” overnight, and they certainly don’t appear overnight. Think about any habit you have acquired in your lifetime. It didn’t just happen without practice and consistency. Similarly, eating disorder behaviors acquire over time, usually quietly, until the behaviors affect so many aspects of life that they can’t be ignored. Just as it took time to build up these habits, it takes time, patience, and consistency to change them.
You can’t make someone recover if they don’t want to. Like anything in life, you cannot make someone change which isn’t ready to change. You can provide recommendations or encouragement that aligns with recovery, but this is their journey that they have to discover when they are ready. Voicing concern and worry are acceptable emotions to relay, but trying to guilt someone doesn’t make a recovery sustainable and leaves the person feeling hopeless.
Eating Disorders: Beyond Gender and Stereotypes
Eating disorders can affect anyone, not just females. Although the majority of those struggling with eating disorders identify as female, eating disorders, DO NOT discriminate and can impact people no matter their gender, age, race, body size, ability, and socioeconomic status.
Unveiling the Hidden Reality of Eating Disorders
And lastly, eating disorders are very serious illnesses, regardless of how “sick” someone feels or presents. Not everyone who struggles with an eating disorder has a noticeable change in their physical appearance. This can cause people not to seek help when they need it because they don’t think they are “sick” enough for treatment. What does being “not sick enough” mean in the eyes of an eating disorder? Sometimes it can be not being skinny enough, restricting enough, or they are told they “look healthy.” One can never tell how much someone is struggling simply by physical appearance. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), “less than 6% of people with eating disorders are deemed ‘underweight.’”
For more statistics and information regarding eating disorders, please visit https://anad.org/eating-disorders-statistics/
To increase milk supply, whole grains such as oats and barley are often recommended. Oats are commonly used in “lactation cookie” recipes. It is thought that whole grains like barley can increase the hormone prolactin, which is responsible for milk production. While whole grains contain many vital nutrients, there is no evidence showing that whole grains alone increase milk supply.
Brewer’s yeast contains nutrients like B vitamins and chromium, which may play a role in different mechanisms that influence milk production and milk ejection. However, much of the research on brewer’s yeast during lactation has been done on animals, not humans. Different products containing brewer’s yeast have different nutrient compositions, making it difficult to determine what size dose would affect milk supply.
Flaxseed has phytoestrogens, and omega-3 fatty acids thought to increase milk supply. While available scientific evidence doesn’t support the claim that flaxseed can increase milk supply, the types of fatty acids that breastfeeding mothers consume in their diets can affect the fat in their breast milk. Therefore, it’s possible that flaxseed could help increase the concentration of omega-3 fatty acids in breast milk.
Fenugreek is a frequently recommended herb for increasing milk supply and is a common ingredient in mother’s milk teas. Despite numerous studies on fenugreek and lactation, results on its efficacy are mixed. Herbs and supplements should be used cautiously as some may have unintended side effects, make certain medications less effective, and cause allergic reactions. For example, someone with a peanut allergy may also be allergic to fenugreek. Consult a medical provider before taking herbs or supplements.
Beer is thought to increase milk supply for different reasons, including its hops and barley content. However, there is no evidence to suggest that drinking beer actually increases milk supply. Moreover, breastfeeding mothers should be mindful of their alcohol intake during breastfeeding, as excessive intake may impair milk production.
A quick Google search shows a wide variety of foods and supplements that claim to increase milk supply. While there is limited evidence to support such claims, many of these foods are nutrient-dense and can have other health benefits outside of their impact on lactation. A balanced diet with enough calories and fluids is the most important dietary factor for ensuring a sufficient milk supply.
If you’d like to learn more, please consider making an appointment with our registered dietitian and board-certified lactation consultant!
You might see pictures on social media of families with “freezer stashes” of milk. In reality, you don’t need a freezer full of milk to go back to work! You just need enough to make sure your baby has enough to eat during the day when you’re apart because you’ll continue pumping at work to maintain your milk supply. In general, starting to pump between breastfeeding sessions a couple of weeks prior to going back to work can be helpful to give you time to acclimate to pumping and to start building up a store of milk. A rule of thumb for a 1-6 month-old baby is to leave 2-4oz per feeding. Storing milk in smaller quantities can help prevent wasting milk.
To establish the breastfeeding relationship and ensure a sufficient milk supply for your baby, it is generally recommended to wait at least four weeks before introducing a bottle to your baby. Each time your baby gets a bottle, it’s important to protect your milk supply by adding a pump session so that your body knows to keep making milk. Your baby may be more likely to take a bottle the first time if another caregiver feeds your baby while you are out of the room.
Having an article of clothing that you’ve worn recently nearby can also help so your baby can smell you and feel more comfortable when feeding from a bottle. Using the paced bottle-feeding technique to mimic breastfeeding allows the caregiver to be responsive to the baby’s cues and can make it easier for the baby to go between breastfeeding and bottle-feeding.
You may have questions about whether or not your employer will provide the time or space for you to pump at work. Familiarize yourself with federal and state-level legal protections for workplace breastfeeding/pumping accommodations and begin having conversations with your employer about your rights.
It is important for caregivers to know how to properly store, prepare and feed breast milk, both at home and at another childcare location. Some states have breastfeeding-friendly childcare designations to recognize childcare facilities’ efforts to support breastfeeding; consider looking for a facility with this designation in your state or ensuring the facility follows steps that promote breastfeeding. There are many resources available for childcare providers to support breastfeeding moms and children receiving breast milk while in childcare.
When possible, consider having a gradual transition back to work to ease you and your baby into this new routine. Make your first day back to work in the middle or end of the week to make the first week a little easier.
Your body will need time to learn how to respond to the pump, so it’s normal not to get as much milk as you’d expect when you first start pumping. As your body adapts to pumping, you should see your milk yield increase. Breast massage before and during pumping and hand expression for a few minutes after pumping can all increase milk yield.
Consider wearing a hands-free pumping bra that holds the flanges in place so you can massage your breasts as you pump. Keep an extra pumping kit (i.e., flanges, bottles, valves, etc.) at work to ensure you have everything you need if you forget to bring some of your pump parts from home.
There are different factors to consider when determining how much you may need to pump at work, such as how old your baby is, how long you’re separated from your baby during the day, how often you pump outside of work, and if your baby is being supplemented with infant formula. Generally, if you’re working an 8-hour shift, you should pump at least three times for 15-20 minutes per pump session.
Because breastfed babies are less likely to get sick compared to formula-fed babies, parents of breastfed babies are typically absent from work less often, which results in increased employee productivity and lower healthcare costs for employers. There are resources for employers like the Business Case for Breastfeeding, Employer Solutions, and other toolkits to learn more about the benefits of breastfeeding and how to support breastfeeding moms returning to work.
If you’d like to breastfeed your baby during lunch or other breaks during your day, consider choosing a childcare facility close to where you work. Ask whether the facility has a space set aside for breastfeeding mothers. You may also like breastfeeding when you’re dropping off and picking up your baby. Ask your childcare provider not to feed your baby in the hour before pickup if you want to breastfeed at pickup.
It’s normal for breastfed babies away from their mothers to eat less during the day and eat more at night when the breastfeeding mother is present, looking for comfort and closeness. Wearing your baby can help you still get things done at home when your baby wants to be close to you. If you notice your milk supply decreasing when you go back to work, increasing pumping during the workday and increasing breastfeeding at times when you and your baby are together can help increase your supply.
Although everyone’s circumstances, family, and baby are different, these tips can provide a starting point for preparing to go back to work. A lactation consultant can help you with making an individualized plan for going back to work, how to talk to your employer or childcare provider about pumping and breastfeeding, learning how to pump, estimating how much milk to leave for your baby when you’re apart, and more!