Emma Kupsch IBCLC

20/02/2024

💦💦 Antenatal Expressing 💦💦

You may have heard of it, are considering it, been encouraged or educated to do so or may be doing it/have done it.

Some factors to consider/be aware of:
👶🏻 Some women leak colostrum from 20 weeks onwards, some women do not leak at all-both completely normal
👶🏻 If you don't leak colostrum, as mentioned this is completely ok and does not predict your breastfeeding journey/supply
👶🏻 If you're having a well pregnancy there is no need to antenatally express as it is an intervention and not required unless of course you want to.
However it can play on your perception of your short and long term supply negatively because…
👶🏻 Colostrum comes in tiny amounts! (.5ml-2mls per expressing session). Which is completely normal as your newborn’s belly is only the size of a marble!
👶🏻 You cannot increase your supply through antenatal expressing because it is impossible.. there's a beautiful placenta in the way inhibiting hormones that make milk; meaning you're still in lactogenisis I and lactogenisis II (when copious milk is made day 3-6 after birth) is inhibited-until the birth of your placenta which then allows prolactin to surge.
👶🏻 Antenatal expressing is/may be a helpful intervention if there is a clinical indication. e.g. mother is diabetic or gestational diabetic, pre eclampsia or you and baby are expecting to be separated shortly after birth due to medical reasons.
👶🏻 If there is no clinical indication to antenatally express.. then don't.. unless you want to of course..but it isn't needed to ensure your breastfeeding journey, so many other factors that influence your journey such as the birth of your placenta (no retained products), immediate skin to skin, breast-feeding within the first hour, mother and baby not being separated, feeding when baby shows early feeding cues, no breastmilk substitutes given unless medically indicated (unless the mother wants to do so which should be an informed decision and counselled correctly about) no dummy or teats introduced until breastfeeding established and appropriate support on discharge (Midwife, ABA national and local supports and IBCLCs).

🗣️The latest systemic review Feb 2023 in the Breastfeeding Medicine Journal ‘Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review’- by Sobik et al found an array of conclusions:

"Women felt empowered when they were able to obtain colostrum and mothers were upset if formula was provided instead of using their expressed colostrum in the hospital."

"Women felt a sense of failure or guilt as well as relentless anxiety of having insufficient colostrum if they were not able to express colostrum antenatally"

"Visualization of Antenatal Breast Milk Expressing (ABME) helped provide reassurance and security for successful breastfeeding"

"Women reported that ABME can be embarrassing, awkward and is a time-consuming process"

16/01/2024

Engorgement 🥵

Lactogensis II.. when copious amounts of milk is made after the birth of the placenta. Most mums experience this around day 3-5 post birth. Many mums then find positioning and attachment can be difficult with very full breast and it can lead to sore and potentially cracked ni***es.

Things that you may find help relieve your engorgement include:

🤱🏻Feeding when baby shows feeding cues/needs/not skipping feeds (responsive feeding)
🤱🏻Hand expressing prior to feed to help shift the odema (fullness) and soften the ni**le and ar**la making it easy to shape the breast.
🤱🏻Reverse pressure softening.
🤱🏻Wearing supportive maternity singlet or bra but not restrictive clothing
🤱🏻Cool pack in-between feeds.
🤱🏻Consider pain relief/anti-inflammatories.

ABA has some super helpful tips with managing engoorgemnt and a video on reverse pressure softening you might find helpful.

https://www.breastfeeding.asn.au/resources/engorgement

06/11/2023

Short answer No..... unless...

1. Baby is a late pre term 37-38 weeks of gestation at birth
2. Baby is low birth weight 2.5kg or less at birth after 37 weeks gestation.
3. Baby is premature (born before 37 weeks gestation)
4. Baby is jaundice requiring intervention (phototherapy)
5. Baby had a medical condition such as infection or heart condition or has low blood glucose levels post birth
6. Mum had strong or large amounts of opioids for labour/birth and or is taking opioids for pain relief post birth (This is because it can interfere with baby's primitive reflexes and their responsive feeding/demanding to be fed).

🤱🏻🤱🏻🤱🏻🤱🏻🤱🏻🤱🏻

Additional to this correct positioning and attachemnt is vital- a deep latch with baby effectively suckling and transferring milk regularly and frequently a) ensures they receive necessary claorie intake and stay hydrated. b) to ensure in the early days mammory cells are laid down to make milk and prolactin (hormone that makes milk) can surge appropriately thus 'milk coming in' and long term milk supply established.

If you're concerned your baby is sleepy or displaying signs of poor feeding/poor milk transfer please escalate to your midwifery service or reach out to an IBCLC.

It is recommended that baby has minimum 8 feeds in a 24 hours period this means 3 hourly feeds (a baby breastfeeding 4 hourly is not ok and/or normal in many cases) and it’s always best to offer both breasts in the early days regardless of any risk factors mentioned above.

Some further info from ABA that you may find helpful 🙂

https://www.breastfeeding.asn.au/resources/wake-my-baby

30/10/2023

A question I get often asked- Does my baby have a tongue tie? (Sent with a photo).

👶🏻 This is tricky, as a tongue tie can't be identified with just a photo alone. A classic comment often said to a mother is 'Looks like baby could have a bit of a tongue tie'. What does this mean? There's so much more to it. It's how the tongue functions, watching a breastfeed or bottle feed and seeing how the baby is attaching and suckling and a detailed history is vital.

👶🏻 When we look at the research, the only sound evidence is in regards to anterior tongue ties. Which is when the lingual frenulum (skin under the tongue) is attached to the tip of the tongue or near the tip. Yes, these type of ties can appear obvious when looking at them as baby often has a 'heart shaped' appearance of the tongue when he or she tries to stick it out or cries- this may be the case but on the contrary the mother may have no ni**le pain or breastfeeding issues. The evidence is there in terms of anterior tongue ties and impacting breastfeeding negatively and often a Frenotomy (cutting with scissors or laser) is advised particularly if multiple 'red flags' appear.

👶🏻 Posterior tongue ties aren't well researched and is referring to the lingual frenulum inserting further back under the tongue, these can't be seen. In saying that a detailed assessment and multi discinplary/conservative approach is often best in managing these types. Some health professionals also are wary of their exsistence at all.

👶🏻 None the less, a proper oral assessment is required and detailed breastfeeding history and breastfeeding assessment imperative to identifying a tongue tie. If something doesn't sound right or doesn't feel right, trust your instincts and seek second, third opinions. Breast-feeding shouldn't be painful and poor weight gains shouldn't be a matter of just 'top them up' and/or 'you aren't making enough milk'.

03/10/2023

Do I need a breast pump to breastfeed?🤱🏻

Short answer NO

Long answer
🪷Most women establish and sustain breastfeeding without ever needing to use a breast pump.
🪷Remember you are at the brunt of marketing as a pregnant and postnatal woman and companies are very good at making you think you may need a pump in order to breastfeed. This is simply not true. Times that a mother may need a breast pump may include:
-expecting a premature baby or baby is unwell/sick
-true low supply and frequent stimulation is needed to help increase supply
-choosing to exclusively pump
-returning to paid work
-you are relactating or inducing lactation

🪷There are so many pumps on the market and it is often overwhelming. Unfortunately it is a matter of 'what you spend is what you get'. Depending what you are needing the pump for also determines the quality of pump you may need. But for the above dot points, a hospital grade pump is required.

🪷You may find reading this link from ABA helpful or I'm happy to answer any questions you may have via messenger.

https://www.breastfeeding.asn.au/resources/choosing-breast-pump

14/09/2023

Here’s a mum using a supply line out and about 😍

Do you need to give bub a top-up feed?

Some mums find using a supply line works for them - bub gets the extra milk and sucks at the breast at the same time.

Find out more about how a supply line works, and if it will help you at www.breastfeeding.asn.au/resources/supply-line

14/09/2023

Supply lines- have you seen one? Have you heard of them? Do you know that they're an option?

-Alternative for bottle top ups
-Stimulating breasts at the same time which can help for multiple reasons
-You can buy fancy ones or they can be made cheaply with help from a midwife or IBCLC
-Can be for long term use or short term use

More info on the ABA website
https://www.breastfeeding.asn.au/resources/supply-line

07/09/2023

Does breast size matter- NO!

Glandular tissue and sufficient amounts are key for lactation.

Breast size can more so mean variance in volume capacity but this very normal to have a variation between a woman and her own breast let alone from woman to woman. Some women find they prefer one side to another and/or their baby does this may because there is more or less glandular tissue and r more or less openings on ni**le (baby may prefer faster or slower flow). For example a mum with an A cup size breast has no issues with lactation or supply, however might find her baby needs both breast or 3 per feed due to smaller volume. Or she may not. Each breast, each woman and each baby is different. Also did you know some women purely feed from one side? They’re just a bit lopsided 😅

Signs of plenty of milk for your baby are:
💦Noticing a let down (You may or may not feel your let down but can see milk coming out of your breast)
💦Your baby after Day 5 post birth is having 5 heavy wet, clear, non odorous wet nappies (disposable nappies) or 6-8 wet cloth nappies in a 24 hour period
💩A soft yellow bowel motion or more per day (Within first 6-8 weeks).
☀️Some growth
☀️Meeting milestones
☀️Baby behaviour is not stand alone indicator of supply adequacy but if concerned baby continues unsettled with combination of able factors not met reach out.

For more info:

https://www.breastfeeding.asn.au/resources/large-breasts-small-breasts-does-it-matter

https://www.breastfeeding.asn.au/resources/baby-getting-enough-breastmilk

20/08/2023

Galactagogues- is a fancy word for substances claiming to increase milk supply. Many women at some stage doubt their milk supply. Perceived low milk supply vs true low milk supply are very different. A mother may think she has low milk supply due to baby's behaviour/frequent feeding/wakefulness and unhelpful comments from Great Nan or Aunty Judith, however there is likely to be no issues. True low supply isn't common but absolutely exsists and may be for a range of reasons such as breast surgery, hormonal conditions and insufficient glandular tissue to name a few- something that should be identified by a trained breastfeeding health professional and not self diagnosed or assumed. None the less Aunty Judith or a friend or Facebook/google may suggest the following:

🍺 Stout- Has increased barley which can increase prolactin and use to be suggested to mothers to drink to help with supply (I think it actually use to be on the breakfast trays in Ireland in hospital back in the day!!). Yes, barley can increase prolactin however the alcohol actually is contraindicated 1) passes through to baby which is not recommended if consumed in large and frequent amounts 2) alcohol inhibits/decreases oxytocin which is essential for the let down reflex meaning decreased let down = decrease milk removal which = less milk production = low supply 🤯

🍪 Brewers yeast- Is often the key ingredient in lactation cookies and is believed to increase supply. There is no evidence to support this. It is high in Vit B and Chromium which are trace minerals and great for overall health. If you get gifted some post birth, enjoy the yummy biscuits but don't rely on them to increase supply or think you need to consistently buy/consume to increase supply.

💊 Domperidone (Motilium)- is the most commonly prescribed or suggested Galactagogue by Doctors. It is actually an antiemetic (medication that helps with nausea and vomiting). There is research that it dose increases prolactin levels however it is crucial that with being administered that milk is being removed from the breast more than what was occurring before. e.g more frequent feeds and/or pumping. Working closely with an IBCLC or trained breastfeeding professional will ensure that your body and breasts are getting the most stimulation possible to increase supply. There's a small risk associated with high doses causing cardiac arrhythmias therefore contraindicated if the woman has a cardiac history but the study that supports this was on older people in hospital who were using it as an antiemetic. Also, this medication is very unlikely to have an effects on increasing prolactin if prescribed 5-6 weeks post birth. The window of opportunity is 1-4 weeks post birth.

🥣 Oats- Contain beta glucan and is thought to increase prolactin, however once again no sound research to this. Rolled oats are low GI which is great for digestion and slow release of glucose in the blood stream. They're a good source of iron which low iron (anaemia) in pregnancy and postnatal can effect supply however as a sole source to increase supply- don't rely on.

🌱 Fenugreek- is a herb and often suggested. There is limited research of it's effects and increasing supply. In contrast, there is actually one study where some mothers where given Fenugreek three times per day and another group given a placebo. They then had their prolactin blood levels taken each week and all had the same/similar prolactin levels regardless. Fenugreek should not be taken if you have peanut or a chickpea allergy or alter thyroid function ❌. There are actually some anecdotal evidence between mothers who claim that Fenugreek actually decreased their supply.

💫Take home message 💫

YOU are enough for your baby. Let your baby lead the way. Trust your body and eat and well balanced diet for your overall health.

Supply=Removal of milk
Supply=Removal of milk
Supply=Removal of milk

A well attached baby who can effectively transfer milk and is fed as he/she needs (No schedule or restricted feeding) will ensure your supply meets her/his needs 🤱🏻

ABA's stance on galactagogues
https://www.breastfeeding.asn.au/resources/galactagogues-substances-claimed-increase-supply

10/08/2023

🪷Have you ever heard of/about milk transfer? Milk transfer refers to the ability of your baby to 'get' your milk out of your breast literally transferring milk from your breast into their mouth. Some babies are very good at removing milk from a breast thus effective milk transfer. However, some babies struggle to effectively transfer milk, this may be because of poor positioning and attachment, oral dysfunction, prematurity, cranial nerve dysfunction and tongue tie.

🪷Effective milk transfer also is applied to expressing. A correct sized fl**ge and an effective pump are essential for removing milk from your breast.

🪷Effective milk transfer is important for your overall supply.

🪷If your concerned, reach out 🫶🏻

01/08/2023

What is your favourite hold? Do you have one? 🤱🏻

There are many holds/positions that a mother/lactating parent may use. Comfort, breast/ni**le anatomy and ease may be a few reasons why one hold is preferred over another.
Positioning and attachment in the early days is often best aided with cross cradle or laid back/baby led attachment. Below are two links from the Australian Breastfeeding Association which both have videos of mother led attachment and baby led attachment. Find what works best for you as in varies from mother to mother 💖

But on a side note how good is breastfeeding laying down 😴



https://www.breastfeeding.asn.au/resources/positioning

https://www.breastfeeding.asn.au/resources/baby-led-attachment

23/07/2023