Q&A with Houston breastfeeding experts

Advice for all moms on how to navigate their breastfeeding journey

In honor of national breastfeeding month, Dr. Pamela Berens and Dr. Julie Gutierrez with UT Physicians address some of the common questions and concerns mothers have about breastfeeding.

Q. How to get off to a good start?
A. Skin-to-skin after delivery (or c-section), try to nurse within the first hour, feed frequently and when the baby wants to nurse.

Q. How do I know if my baby is getting enough milk?
A. Babies learn to be more efficient and the feedings may shorter as the baby gets older, there may also be a greater amount of time between feeds.

Q. How much breastmilk do babies need in the first couple of weeks?
A: So, the baby’s stomach stretches over the first few days.

(Think Day 1 - marble, day 3-ping pong ball, day 10-extra large chicken egg, adult - softball)

This correlates really well with the way the milk changes from low volume colostrum (nature’s “vaccine” as it is high in immune components) to higher volume more mature milk over the first 2 weeks. The small volume at first also helps the baby to learn how to coordinate sucking/swallowing/breathing. Babies usually will take around 2-3 ounces every 2-3 hours after the milk comes in which is commonly around day 3. If your milk isn’t in by day 5 that can be a concern so you should check the baby’s weight. 

There is a huge variation in the volume of milk that women make. An average milk volume is around 700-800 ml/d. (23-27 ounces). Some women make higher volume more “watery” milk while others make smaller volume higher “cream” milk, but both can have babies that grow well. Bottom line is to follow the baby’s growth.

Q: What if you your baby isn’t gaining enough weight?
A: Babies often lose weight in the first 3 days before mother’s milk “comes in”. Once the milk is in, the baby should begin gaining weight. Normally babies should not lose more than 8-10% from their birth weight. If the baby has lost more than 10%, supplement or pumped milk may be needed. Baby should be back to birth weight by 2 weeks. Again, if the baby isn’t back to birth weight you should follow up with the baby’s physician, use supplement (or banked milk) and work with a lactation consultant to see what can be done to maximize your milk supply. When giving supplement, try to mimic breastfeeding by using “paced” feeds, pausing to let baby regulate the feeding instead of encouraging “finishing” the bottle.

Q. How to increase milk production?
A. It’s important that a baby is gaining weight adequately. Use objective information based on the baby’s weight and growth curves. There are many tips to increase milk production, including pumping more frequently (frequency is more important than duration of each feed). It is important to assure that women who are concerned about low supply make sure they are pumping or feeding at least 8-10 times a day and not going longer than a 6-hour interval between feeds.  

Many women feel that eating certain foods helps supply (oatmeal, brewer’s yeast, flaxseed), (actually no scientific data here for most things but okay to try). Staying hydrated may help supply (again - little science) and medications (called galactogogues) in certain circumstances. Some women suffer from the opposite, too much milk production which can lead to pain, plugged ducts and infection.

Q.  Is it true that moms with smaller breasts produce less milk?
A. Not true! The size of a breast is related to the fat component.

Q. Can you breastfeed if you've had prior breast surgery?
A. Most women with breast implants successfully breastfeed. It is more worrisome for milk supply if the doctor used an incision that encircles the areola, as this particular incision can affect milk ducts and nerves. Fortunately, most surgeons don't use that incision for breast implants. Breast reduction can cause significant risk for low milk supply so please discuss with both your OB provider and the baby's care provider to monitor your milk supply and the infant's growth closely and be open to supplement if the baby's growth is concerning.

Q: How long should you breastfeed your baby?
A: Most organizations in the U.S. (AAP, ACOG, AAFP) agree that exclusive breastfeeding is recommended for around the 1st - 6 months of life with continued breastfeeding with complementary foods through the first year and as long as, is mutually desired. The WHO goes further recommending continued breastfeeding through 2 years. There are proven health benefits for the infant from breastfeeding through a year (U.S. studies) and both infant and maternal benefits from breastfeeding appear to be stronger the longer you breastfeed. Remember, there are health benefits for the mother too!

Q. What are some tips for pumping at work?
A. First, talk with your employer and see if there’s a private room or space that you can use (preferably a quiet space that has outlets, as some pumps require power). There is actually a worksite requirement - the Fair Labor Standards Act, that requires that your employer provides a safe /none-bathroom site for pumping).      

Depending on your daily duties, establishing a schedule is important. Storing your expressed milk is also an important step in the pumping process at work. The ideal place would be a fridge, however not everyone has access to one. Breast milk can be kept at room temperature for up to 4 hours and in an insulated cooler with ice packs for up to 24 hours.

Q. What does state law say about breastfeeding in public?
A. Texas law states that mothers have the right to breastfeed in any place, however it does not mean they have legal protection. Breastfeeding moms can be asked to excuse themselves to the restroom or leave a business entirely, and there is no legal recourse under the current law.

Q. How to make breastfeeding work while traveling?
A. Planning ahead, bring your essential items and dress in comfortable and easy clothing (that could mean nursing tops or shirts that you find it’s easy to nurse in).

Q. How to breastfeed with multiples?
A. While it is more difficult, breastfeeding multiples is doable! Some tips would be to get help early on, and to establish a schedule. Monitoring infant growth is important.

Q: What should you do if you’re having a hard time breastfeeding your baby?
A: Yes, get help! We are lucky to have excellent resources in Houston! See a lactation consultant. An IBCLC is a certified lactation consultant who has done many hours of training and passed a certification exam. We also are lucky to have free community lactation support either through a local WIC agency or The Lactation Foundation here in Houston.

To learn more or to find a physician near you, visit www.UTPhysicians.com or call 888-488-3627.

This article is sponsored by UT Physicians.