LACTATION FAQ’s – SANDY B. SIMMONS
1. It’s day 3 – help my breasts are rock hard and I can’t get baby attached, what do I do?
It sounds like your milk has ‘come in’. Between 2-6 days after you have given birth it’s normal to find that your breasts become larger, feel heavy, warmer and uncomfortable.
At this time many new Mums’ breasts feel severely engorged and nipples become flattened and taut, making it difficult for babies to attach to the breast.
Engorgement is caused by a build-up of milk, blood and fluids in the breast tissue. This is normal.
When experiencing severe engorgement, it is important to ensure that baby is attaching well and feeding effectively, and that the length and frequency of feeds are being determined by the baby’s needs.
To relieve engorgement -
- Take your bra off completely before beginning to breastfeed.
- Before breastfeeding gently massage your breast or use warmth for a few minutes to help trigger the let down reflex.
- To soften the breast tissue under the areola, express some milk either by hand or pump. This will help the nipple to become less taut and flat and easier for baby to grasp.
- Massage the breast gently while you are feeding.
- If necessary, express for comfort after feeds.
- Use cold packs or chilled, washed, cabbage leaves (only leave on until they become warm) after a feed to reduce inflammation.
- To feed your baby often during these early days. Between 8-12 breastfeeds in 24 hours is normal.
- Wake baby for a feed if your breasts become full and uncomfortable, especially at night time.
- Ensure your baby is positioned and attached correctly, this helps to maximise the amount of milk baby is getting.
If you are still experiencing difficulty latching your baby, have sore or cracked nipples or find that your milk is not flowing easily and you are both becoming frustrated, please seek professional assistance from a Lactation Consultant (IBCLC) immediately.
2. I’ve been told to stop breastfeeding because of medication, is that right?
That’s a difficult place to be in for you as a new Mum.
Although medicines are often needed by Mums who are breastfeeding, there is often a lack of, or ambiguous, information about the safety of medicines transferred to their baby’s in breastmilk. This has meant that breastfeeding is stopped unnecessarily or a different, potentially less appropriate treatment prescribed.
Most medicines are excreted in breast milk to some degree, the amount is usually less than 10% of the maternal dose. Medicines excreted at less than 10% are considered compatible with breastfeeding. Therefore, with a few exceptions the majority of medicines may be used.
If your doctor is unsure whether or not you can breastfeed safely while taking a particular medication, ask that they check with drug information experts.
For current information about the use of medicines/drugs during breastfeeding (or pregnancy), contact the Medicines Information Centres in your state. Phone numbers are listed here - https://www.breastfeeding.asn.au/bf-info/safe-when-breastfeeding/breastfeeding-and-prescription-medications
You may find the following article useful. It lists the compatibility of commonly used medicines with breastfeeding. http://www.medsafe.govt.nz/Profs/PUarticles/June2015/June2015Lactation.htm
If you find that your medication is compatible with breastfeeding, find out the best time to take medication. For example, breastfeeding your baby immediately prior to you taking medication may reduce drug exposure.
Please contact a Lactation Consultation (IBCLC) who will have the latest information if you need further assistance.
3. What contraception is safe whilst breastfeeding?
Oh, that is such a weighted question for most new Mums. There are a number of factors to take into consideration. It’s about your preference for either hormonal or non-hormonal methods, your partners and what has worked for you previously.
For the first 3 weeks after giving birth, it’s recommended not to use a method that has the hormone estrogen, like the pill, patch, or ring. It is said that after 3 weeks, you may start any of these methods. Ask your health practitioner on your first checkup or prior to giving birth.
Perhaps you feel more inclined to use non-hormonal methods and would prefer to stay with less invasive methods. Non-hormonal birth control options include condoms, internal condoms, diaphragm and cervical cap.
If you have used a diaphragm or cervical cap in the past, wait until your first postpartum checkup to begin using that method again. Most doctors will recommend that you don’t put anything in your vagina until your first checkup, somewhere between 3-6 weeks. You may also need a new size. Many doctors also recommended to abstain from sex until after 6 weeks of giving birth.
So what if you are over the condoms and other non-hormonal methods. Is there anything else?
Well, yes. There is the Lactational Amenorrhea Method (LAM), which offer 98% protection from pregnancy for fully-breastfeeding Mums with no periods whose babies are younger than 6 months.
LAM only works if:
- You are fully breastfeeding during the day and night. The baby is only receiving your milk.
- You have not started your periods. (Bleeding during the first 2 months is not a period. After 2 months, bleeding or spotting that lasts at least 2 days is classed as a period).
- The baby is younger than 6 months.
Fully breastfeeding means:
- No regular use of formula, water, juice or baby food.
- Baby does not go longer than 6 hours without breastfeeding.
What if I miss a breastfeed?
- Mums who are sometimes away from their baby for up to 6 hours can replace one breastfeeding with pumping or hand expression.
- Mums who are often separated from their babies should not use LAM.
Read more here...
If you need more information, contact a Natural Fertility Educator or Family Planning clinic.
4. Can I drink any alcohol when I’m breastfeeding?
The answer is yes, you may enjoy a drink with a meal, when out with friends or on a special occasion.
It is known that not drinking alcohol is safest. However, knowing the facts about how alcohol affects breastfeeding will help you to decide how best to combine breastfeeding with drinking some alcohol.
- It is best to avoid alcohol in the first month after birth.
- Alcohol gets into your breastmilk from your blood, moving freely from the blood to the breastmilk, and back out again. Alcohol will be in your breastmilk 30-60 minutes after you start drinking.
- The amount of alcohol in your blood is the amount of alcohol in your milk.
- Only time will reduce the amount of alcohol in your breastmilk.
- A standard drink contains 10g of alcohol, ie 100mls of 13.5% wine; 1 stubby (375mls) of mid-strength beer, or 1 pre-mixed bottle (250mls - 5% alcopop) or 30mls of spirits.
- It takes generally 2 hours for an average woman to get rid of 1 standard drink and therefore 4 hours for 2 drinks, 6 hours for 3 drinks and so on.
- Breastfeed your baby before you drink. You can then enjoy a drink knowing you’ll be unlikely to need to feed again within the next couple of hours.
- Eat before and whilst drinking.
- One way to reduce the amount of alcohol you drink is to alternate alcoholic with non-alcoholic drinks.
As baby gets older you may have a night out. It’s a good idea to express (and freeze) or leave some freshly expressed breastmilk on hand for the babysitter (who is free of drinking alcohol) in case baby wakes or you arrive home later than expected.
If you miss a feed while you are drinking alcohol, and your breasts are feeling uncomfortable, express some milk and throw it away. This will help with your comfort and will maintain your milk supply.
Remember to not sleep with your baby if you (or anyone else in the bed) are affected by alcohol.
The following article and review gives more comprehensive information: