Great breastfeeding advice from lactation consultant

Mama of five, midwife, and lactation consultant, Stephanie Callaghan-Armstrong shares her advice on how to make your breastfeeding journey a positive one.

Photography mother of wilde

True or False? Breastfeeding is easy because your milk is free, ready to go at the perfect temperature, and is made especially for baby's gestation. My answer? It’s not always quite that simple!   

Yes, your breast milk is ready to go at the perfect temperature, and is the perfect dietary composition of nourishment for babies that changes as they grow. But for a lot of mums, it’s not always easy and sometimes breastfeeding aids can be useful for assisting with milk supply to feed baby optimally.

WHERE TO START?

The most common question I get asked as a midwife and lactation consultant is "Do I need a breast pump? And if so, which breast pump should I buy?". There's no one-size-fits-all answer to that question, but my question would be: what is your plan with feeding baby? Will you be a stay-at-home mum for baby's first year or are you planning to go back to work some months after birth and hope to give baby your expressed milk? Are you having a multiple pregnancy and likely to need to express for your babies in addition to breastfeeding? Were you planning to share baby feeding with another caregiver? I usually recommend that unless there is an expected reason why you might need to pump a lot, just wait until baby is born then decide.

If your baby is having trouble latching initially, some mums find having a hospital grade pump useful in helping to establish supply while mum and baby figure out the latch. Removing milk and stimulating that supply is really important in the early days, so regular emptying/expressing is very helpful. Babies who are born prematurely and have to stay in a Neonatal Intensive Care Unit (NICU), babies who have a cleft palate/lip, a severe tongue or lip tie, or a congenital abnormality that you have discovered antenatally through scans, may also need expressed milk. In these cases a hospital grade breast pump is likely to be recommended, along with working with a breastfeeding expert or lactation consultant. Suckling (or using a pump) tells mum’s brain to supply what baby needs early postpartum and is a vital part of setting up a good supply going forward.

You can hire hospital grade pumps (check out my rentals at babymed.co.nz or from pharmacies) where a rental fee is paid and you buy your own double or single pump parts kit for hygiene reasons. Maternity wards and NICU usually have good hospital grade pumps available to use while you and baby are admitted. If you're wanting to purchase a personal breast pump I'd recommend doing your research as there are a lot on the market. Some don't do the greatest job at removing milk and stimulating your supply, but there are a that few I would recommend. What you want to look for is good suction and good speed that you can custom adjust.

There are less costly milk catching suction aids (like the Haakaa brand) on the market also that you can attach to the non-feeding breast, while baby is latched onto the other side. It’s designed to catch the extra milk that leaks out in the early days when you often have an over supply, and saves lots of soaked breast pads! Some mums find that milk useful to store if baby ever needs a top up. Breast shells can also be worn to catch excess milk and have a function too of pulling out flat or inverted nipples that may make it difficult for baby to latch.

To store expressed milk, you need your container or bag to be clean and dry. If you’re pumping a lot, there are breast milk storage bags available with areas to write days and times. Pop the milk in the back of the fridge (up to 3 days) or back of the freezer (up to 3 months). Wash all bottles, milk storage and pump parts with hot, soapy water.

DO YOU NEED A STERILISER UNIT?

Some mums love them and buy ones for the microwave, or use sterilising tablets to make a solution that soaks equipment. The down side is that they are often large items to store in your kitchen and many mums find they don't really use them. Unless you have a baby with infection risk, hot washing is all that’s needed.

LET'S TALK ABOUT TEATS

One of The World Health Organisation’s (WHO) recommendations for successful breastfeeding includes not introducing teats and dummies to baby. The reason for this is that they can interfere with baby learning to latch, as suckling a latex or rubber teat is very different to a breast.

With breastfeeding, baby is ideally latched onto the areola of the nipple, the nipple is being taken back and compressed by the soft palate of the mouth. Teats tend to promote more of an anterior suckle and nipple confusion can occur because teat suckling is actually easier for babies. Dummies can also be detrimental to a new baby learning to latch as, like a teat, they suck on them differently to a breast and there is a reduction of stimulation to the breast and milk supply as baby may not feed as often if settling with a dummy instead. My advice is to try and go without dummies if you can, although sometimes the benefits of baby being settled outweigh the risks, and only you as parents can make that call.

Another thing to keep in mind about bottles and teats, is suckling on the breast actually promotes optimal jaw and speech development so it's very worthwhile persisting in establishing feeding baby on the breast. Also fresh breast milk has live antibodies so feeding straight from mum or baby given newly expressed milk is best. 

Breastfeeding aids to use instead of teats include cup feeding (allowing baby propped upright to lap from a little cup – ask for a professional to teach and help you do this safely) or syringe feeding, where small amounts of milk are given to baby with swallows so they don't spit it out. Other non-teat 'baby friendly' ways to feed breast milk are with a feed line either while latched to the breast and baby suckles milk by suction, almost like a straw, or as a finger feeder so baby sucks a finger (pad turned upwards) and the suction brings milk up the tubing. The feed line can also be attached to a syringe and the milk pushed through for extra support if baby's suck isn't strong enough. If you are wanting to introduce the bottle and teat to baby, try to wait until at least four weeks old, and breastfeeding and latching is well established.

DO YOU NEED A BREASTFEEDING CHAIR?

From experience, the mums who buy a dedicated chair tend to end up using every other chair in the house and the breastfeeding chair ends up being a glorified laundry basket!

If you do have your heart set on one, choose chairs where your feet touch the ground or have a foot stool. It’s important to sit up straight, or your shoulders and back will over time get painful and strained.

A breastfeeding pillow, however, is a very useful thing because it helps get baby in the optimal feeding position – tummy to tummy, at breast height. They're also useful for propping babies over for tummy time and back support when learning to sit and also to elevate after feeds to prevent spilling.

NURSING BRAS - A MUST HAVE

Having a comfortable supportive breastfeeding bra will help provide easy access when feeding as well as support for heavy breasts. There are also clothing ranges that are designed for breastfeeding access which is really handy if you plan on being out and about and need easy access. My tip is you don't always need to spend a lot, Kmart does some great low-cost nursing bras made of t-shirt material that you can buy a bunch of and know that there'll always be one on hand.

BREAST PADS

Most new mums find they need these at the beginning of their breastfeeding journey to catch the extra milk that leaks out. There are loads of options on the market, both disposable and washable/reusable. The benefits of washable pads are that while they're more expensive to buy initially, they can get endless use. Disposable ones, however, do have the benefit of being able to be changed regularly and help to keep everything clean and infection- free. Warm milk soaked in a breast pad sitting directly on the nipple can be ideal bug-breeding conditions for things such as nipple thrush and bacteria, so be mindful of this and change them regularly.

Little muslin cloths or the old-fashioned cloth nappies with the red stripe are great for spills and popping in nursing bras instead of pads during feeds to catch the letdown when feeding on the other side. You really can’t have too many and will use them well into your baby’s toddler years.

SORE NIPPLES?

Tender nipples is really common. Baby suckling around the clock every few hours will take a bit of getting used to. I'd recommend getting professional support early to ensure baby has a good latch and prevent any major damage. Cracks and grazing tend to be related to incorrect or poor latching with baby chewing on nipple ends rather than having the whole areola in their mouth. Sometimes there are anatomical reasons this occurs such as flat nipples or tongue tie. As well as professional help,  it's good to have some nipple creams or balms in the baby kit ready for use. I always say treat your nipples how you do your lips. Creams or emollients such as lanolin, pawpaw, and rescue cream can help heal. Other things that help include gel pads and silverette cups (which harness the healing properties of sterling silver). Sometimes medicated creams are needed if your nipples develop an infection, such as antifungal medications for thrush. Other natural ways include reducing sugar in your diet as it can cause overgrowth of  candida in the gut causing thrush . Always talk to your GP or midwife if you experience pain. Panadol and anti-inflammatory meds may also help to get you through this time while your nipples heal.

A WORD ON NIPPLE SHIELDS

When used under medical advice, shields definitely have their place. In my practice as a lactation consultant I occasionally recommend them once mum's milk is flowing, if baby isn't able to latch and suckle with stability, in order to keep baby feeding off the breast. They can be useful to help baby latch and then actually pull mums nipples out as flat or inverted nipples are usually from the muscles being contracted and with suction are able to lengthen. They are easily purchased online or in a chemist store, so I would just wait to see if they are needed. Expressing several times a day while using shields is also very important, as there is decreased latching stimulation to send those important messages to the brain to establish your milk supply.

MILK SUPPLY

The medical term for something that boosts supply is galactagogues. Common galactagogues include blessed thistle capsules, goat’s rue, homeopathic sprays, and also breastfeeding teas. Planning prenatally can definitely help as well, including making sure your iron levels are healthy before birth in case of blood loss.  A balanced diet with plenty of protein and whole grain carbs, drinking lots of water, good regular meals and snacks, and resting and taking care of yourself as much as you can are top priorities too – easier said than done I know! Plan ahead for your family and village to support you and say yes to help and meals. Make double meals and freeze one so you’ve got an easy dinner ready to go on those tricky days.

Occasionally your midwife or doctor may recommend medication such as domperidone for increasing your milk supply. Sometimes medical conditions can be a cause of your milk not being established or if you had no or little breast tissue changes in pregnancy.

Some medications can actually inhibit milk production too such as cold and flu remedies taken internally for stopping mucous secretion. Always read the instructions for any medications you take. These are just a few of many breast feeding aids! Feel free to look me up if you have any questions, I’m always happy to help mamas feel confident in their breastfeeding journeys. Arohanui, and all the best!

NEED SUPPORT? Visit lalecheleague.org.nz or call PlunketLine on 0800 933 922 for a free consultation. Alternatively, your midwife may be able to recommend a lactation consultant in your area. 

Stephanie Callaghan Armstrong is a mum of five, experienced Lead Maternity Carer, Midwife and Lactation Consultant and also runs a breast pump rental and sales business with husband, Dr Mikey from The Barnstead in Coatesville. Find her at babymed.co.nz, @babylove.midwife.life and @babymednz on Instagram.

Photography: mother of wilde