Everything You Wanted To Know about Breastfeeding

Interview with breastfeeding counsellor Julie Cottle

Lena:             Hello. This is Lena of MaternityAcupressure.com and today I have the honor to…this call’s about breastfeeding with Julie Cottle of NaturalTransition.com. Julie is a naturopath and she’s doing a lot of things with new mothers and also mothers that want to become pregnant woman who try to conceive. In addition to naturopath she’s a natural fertility consultant and also a breastfeeding counselor.

In addition to her website NaturalTransition.com she’s running her own clinic in Sydney, Australia. The clinic’s name is Avena Natural Health Care. Julie, thank you for discussing about breastfeeding issues with us today.

Could you please tell us a bit about yourself? How did you become a naturopath in the first place?

Julie:              It was something that I stumbled upon after I finished high school. I was just looking into things to do with my life and decided that natural therapy was something that I was very interested in. Throughout the four years of my studies I became very interested in reproductive health care. Once I had my own children I became much more interested in mothering and mother care and baby care.

Lena:              At that time did you have children during your studies?

Julie:              I had no children. I finished my course and within a few months I got pregnant and started my family. From there my interest in motherhood, breast feeding and fertility grew with my family.

Lena:              You have been a breast feeding counselor for six years already. You have definitely helped a lot of mothers with their breast feeding issues.

Julie:              I certainly hope I have over that time. Yes, I became a breast feeding counselor when my son was little. I had some breast feeding problems myself and I was lucky enough to be told while I was pregnant that breast feeding was not an easy thing to do and to reach out for help before I needed it.

That’s something that I did through our local Breast Feeding Association which is quite a large organization here in Australia. Through the Breast Feeding Association I received lots of help from lots of different mothers, lots of support, and was able to get through the very difficult situations that I was presented with. I also felt that during that time that I needed to continue my studies.

Breast feeding was something that really interested me. I felt that it was something that was very important for the child’s health as well as the mother’s health. I studied breast feeding counseling and have been working with the Association to help as many mom’s as I can to successfully breast feed their babies and to get over the hurdles that I encountered during the breast feeding time.

Lena:              Great. We’re looking forward to the advice you’re going to give us. We have received a lot of questions about breastfeeding to MaternityAcupressure.com. The first thing is really how to get started. Sometimes a baby just naturally starts to suckle and everything just starts so smoothly.

Their mother’s milk supply is there and everything. Sometimes the baby doesn’t know how to suckle and the mother is, especially first time mothers, not very confident with breastfeeding. When the baby’s born, immediately, how do you get started with breastfeeding? The first few hours and maybe days after birth?

Julie:              It’s very important, if possible, to feed as soon as possible after the baby’s born. If the birth goes very well and you’re able to feed your baby as soon as it’s born, that’s ideal. Usually a newborn baby will just latch on quite naturally to the mother’s breast.

Some of them do need maybe  half to one hour after the birth to wake up a little bit if you’ve had pain relief during the labor but generally they’re ready to feed and happy to feed straightaway. That’s the best time for them to create a good latch on to the breast without you having to interfere with the process too much. Sometimes things go wrong during birth. You may need to have a cesarean or you may have needed to have a lot of pain relief.

It might be difficult for you to feed your baby straightway but as soon as possible after the birth is the best way to go. That way also your breast aren’t too full of milk. They’re still nice and soft. There’s colostrum there, the milk colostrum, which is a very nutrient rich milk that’s got lots of sugar in it and helps the baby’s energy levels to rise very quickly.

That won’t make your breasts overly full so it makes it very easy for the baby to latch on and have a good first experience with breastfeeding before it can become a little bit more difficult when the breasts become full and engorged after the first one to four days. Another very important thing to consider when you’re first getting started is to ask for help when you need it.

If things aren’t going along as we had hoped there’s no need to fuss out on your own. You need to ask for a midwife to help you or if you’re really struggling ask for a lactation consultant to come and help you in the hospital to make sure that that process is working properly before you get sent home.

Lena:              Thanks. Actually that is fantastic that it’s kind of like nature has thought about that, that the breasts doesn’t become very full right after birth so it’s also easier for the baby to learn how to suckle where the breasts are still soft. They’re not big and much harder.

Julie:              Yeah.

Lena:              I’ve heard that actually the baby’s born with a lot of energy sources and also they have enough of fluids for the first three days. Even if they don’t get a lot of milk during the first three days they still can survive if they can just get a bit of colostrum.

Julie:              The only need a little bit. That’s why this special milk is very rich in sugar. It’s just a little bit of energy to keep them going until the mature milk comes in. it also has a lot of immune factors in it which helps the baby adjust to life outside the mother as well.

It helps them deal with the bunch of germs that they’re going to come in contact with within the outside world. It’s important for the baby to get that milk if they can? If they do miss it for whatever reason, say your baby is born and has to go into special care in a humidicrib or something like that, they can certainly get by without it and you don’t really need to worry too much about your milk supply during that time. If the baby can get that milk as soon as possible it’s great for the baby.

Lena:              Because the initial amount of milk is quite small during the first one, two, or three days, you don’t need to be worried about your milk supply during the very first days. Do you still need to breast feed the baby as long as she or he wants to suckle even if there isn’t too much milk?

Julie:              Absolutely. It’s the best time for you to be getting the baby onto the breast as much as possible. As I said before, because it’s a good time for them to latch on without having to worry about being the engorgement so they can develop good feeding habits during that time.

It’s a good process for the baby learning how to breast feed as well as the mother learning how to breast feed. If you can do it when there’s less pressure during the early days, before the milk comes in, that’s the easiest time for that to happen. That will help the baby to establish a good suck and good feeding patterns for later on.

Lena:              So just let the baby feed as long as she wants to?

Julie:              Absolutely. Yes. Whenever and for however long the baby seems to indicate that they want.

Lena:              Even during the first few days.

Julie:              Yes.

Lena:              So how about the breast feeding positions and the holds. How do you hold the baby in the right way that you help the baby to suckle and actually feed herself?

Julie:              I guess the most common hold is the cradle hold which is when you’re holding the baby across your chest. To do that you would put the baby on its side with its mouth in line with your nipple. You always bring the baby up to the breast at the level of your chest. You don’t bring the breast to the baby.

You try and support the baby behind the shoulders and make sure that you support the neck as well. Be careful not to push the baby’s head to the breast. Just put them close and allow the baby to take the nipple into his mouth by himself. If the baby’s attached properly there should be no real pain associated with it.

In the very early days it might be very sensitive because you’re not used to this sensation but if it hurts beyond the first maybe 15 seconds or so then the baby’s probably not attached properly and you need to take baby off and try and put him back on again in a way that’s comfortable for you.

Some little tips so that you can…a little checklist to see on why you think the baby’s attached properly might be that you can see that the mouth is covering, has got the nipple but also some of the areola, which is the dark area around the nipple, is drawn into the mouth. So not just the end of the nipple but quite a lot of the breast tissue as well.

You want the baby’s chin touching the breast and you want the nose just clear of the breast or maybe just touching the breast but not pushed into the breast. The most important thing to consider when positioning the baby on the breast is that it’s comfortable for you. If it feels comfortable for you and there’s no pain involved then it’s fine. You don’t need to worry about any of the other tips or tricks that I just gave you.

Lena:              So you told us that if you’re feeling pain when the baby starts to suckle you should take the baby off. I know that they can suck very tough. You cannot just take the baby off. Do you have any tips how to actually get the baby to move their hold?

Julie:              Yeah, they can have quite a strong suction.

Lena:              Yes.

Julie:              Yeah, you just get a finger. Make sure that your fingers are nice and clean when you’re dealing with newborns, that you just prop the finger in between the lips and the nipple. That will help break the suction and you can remove the baby without damaging your nipples too much.

Lena:              I guess there is a line between feeling a little bit sore and pain. I remember when I started to breast feed my daughter. During the first few days it did feel a bit painful during the first few seconds. I guess my nipples get used to that. I guess it’s also a question of getting used. Your skin and your breast area just gets used to breast feeding.

Julie:              Yes, that’s right. If the pain continues throughout the feed then there’s definitely something wrong. If you can feel the baby kind of chewing on your nipple then that’s also a sign that you need to take them off the breast and try to get them back on again.

If you can see any deformity in the nipple when you take the baby off, sometimes you might see like a white line or you see that the nipples kind of out of shape, that’s also a sign that the baby’s not sucking correctly and it will cause pain if that’s the case. It’ll be quite strong pain as well. If  you need to take pain killers while you’re breast feeding then you know that your baby’s not sucking properly and that you need help to correct any positioning and attachment problems that you may have.

Lena:              Taking pain killers while breast feeding…is there any…just a quick question…is there any pain killer that you can actually take while you’re breast feeding?

Julie:              Nothing any stronger than just a simple paracetamol tablet.

Lena:              Will that get into breast milk or not?

Julie:              No, it doesn’t. You need to check any medication that you would be taking with your midwife. I know here in Australia we have some very good help lines set up throughout hospitals that you can call and find out whether the medication you’re taking is safe for breastfeeding. I hope in other countries around the world they may have similar things setup but it is always important to check with a doctor or other health professional before you take any medications when you’re breastfeeding.

Lena:              So when you are breastfeeding how do you tell when the baby’s really actively suckling and getting breast milk?

Julie:              You can feel a drawing sensation from usually quite deep within the breast. You can also see the baby swallowing, making swallowing motions. You see the jaw moving and the ear is wiggling. If you can feel the drawing sensation and see those signs then it’s a pretty good indication that the baby’s sucking.

Lena:              What if the baby’s unable to suckle?

Julie:              If you feel that your baby’s unable to suckle it’s really important that you ask for help from somebody as soon as possible. If you’re in the hospital get a midwife or a lactation consultant to come and sit with you and your baby to help you and to troubleshoot any problems that you may have.

If you’ve had your baby at home get a midwife to come in and help you. In most countries around the world you can pay a lactation consultant to come and visit you and speak with you and watch you feed and help you with any troubles that you may have. It’s very important to get a health professional to help you as soon as possible if you feel that the baby’s unable to suckle.

Lena:              Have you ever come across with a case that baby’s tongue is too short? I’ve heard someone to say that they’ve heard such a case that they actually had to make a tiny operation. You know the flesh that actually keeps the tongue…

Julie:              Oh yes.

Lena:              You have heard of it?

Julie:              Yes. Tongue tied babies. There are different things that you can do to help a baby feed if they do have that condition. It can be quite a process and you need to work with somebody quite closely to help you through that. It’s certainly no reason why the baby can’t breastfeed but it does make it more difficult for the baby and the mother to create good breast feeding habits so if you are aware that your baby has that problem then you need to get help from somebody who knows what they’re doing as soon as possible.

Lena:              So how about when… this is a question that I received from one of our customers and she asked that what  do you do when baby seems to want to nurse but just dibble dabbles and gets frustrated and seems to take a long time for the getting settled for breast feeding.

Julie:              There could be a couple of reasons for that. The most common ones would be if the milk was not available for the baby. Sometimes they can come on to the breast and they can suck a little bit and get frustrated because there’s no milk coming out or it could be the milk is coming out too quickly and they’re having trouble coping with it.

You would be able to tell the difference between the two because if the milk’s coming out too quickly and the baby’s having trouble coping with the volume that’s coming out. You’ll see milk coming out the side of the mouth and the baby just gasping for breath and really struggling to take the milk in. if there doesn’t appear to be any milk around the baby’s mouth then it’s likely that the baby’s not getting any milk coming out when he wants it.

You actually need to try and encourage the milk let down reflex. It’s basically taking the milk from the milk ducts into the nipple to make it available for the baby. It’s the reflex that forces the milk out the nipple. You need to be very calm and comfortable to allow that process to happen so anything that you can do to help yourself relax is very important.

The more upset that you get about the situation the more difficult it’s going to be for that let down reflex to work properly. Also you can use heat and massage to help make that milk available for that baby as soon as possible. You can also try hand expressing a little bit so just pinch from the outside of the area, all of the dark area around the nipple and towards the nipple.

Just gently pinch that a little bit making like a milking motion with your thumb and forefinger. That will help bring some milk down into the nipple so that it will be available for the baby to take as soon as they latch on rather than them having to work hard for it and get frustrated because it’s not there.

Lena:              Okay, good. Thank you. We’re going to later on talk about more techniques of how to increase your milk flow but this is good advice you’ve given to get baby to actually make sure that there is milk for him or her when they’re breast feeding. About the length of these periods when you breast feed. How long should these early nursing periods of breast feeding last?

Julie:              To start off with it can be very variable. I know myself I’ve had two children and they’ve both been very different. My first child took an hour and a half to feed. That was an hour and a half every few hours that I would have to sit down and feed him. At about probably six weeks it was down to 40 minutes.

My second son I was very concerned about because he would finish his breast feeds within five minutes and I was thinking he couldn’t possibly have managed to get what he needed from a five minute nursing period but everything was fine. He had all the signs of a well fed baby and there really wasn’t any need for concern. He was just a fast feeder.

He had strong jaws and my breasts were obviously very good at delivering the milk to him at that point. All babies can be very different. I guess the easy answer for that question would be for as long as the baby wants.

Lena:              That’s amazing that it can vary so much between the baby siblings. Your two sons had so different nursing periods when it comes to how long they last. That’s actually a good answer for anyone. It’s kind of like you just need to be confident enough to trust yourself and see that when your baby seems to be happy and content and know that the way to increasing them you’re feeding enough.

Julie:              That’s right. There are some signs that you need to look for to make sure that the baby is actually getting enough milk. The most important one being how many wet nappies the baby’s having in a day and also the color and smell of the urine.

If the urine is very yellow and concentrated and it has a very strong urine smell then that is a sign that the baby’s not getting enough milk and then in that case you would need to try and actively increase the amount of time that the baby is spending at the breast. If there is a lot of urine, you’re having to change a lot of wet nappies and it’s a nice pale straw yellow color and it doesn’t have any odor about it then your baby is getting plenty of milk and you don’t need to worry at all.

Lena:              How much is a lot of nappies?

Julie:              If you’re using disposable nappies it’s quite difficult to tell nowadays with these disposable nappies but…

Lena:              Yeah, they’re so good.

Julie:              Nice and heavy. About four really nice and heavy disposable nappies in a day. If you’re using cloth nappies we say six to eight wet cloth nappies. I find it’s easier to assess the urine in a cloth nappy so if you are concerned about your baby’s well being and whether or not they’re getting enough milk just try putting the baby in cloth for a 24 hour period and seeing how many nice wet nappies that you’re getting and that way you can look at the color and assess it more readily that way. Six to eight wet cloth nappies in a 24 hour period.

Lena:              That’s a good tip on how to really estimate that your baby’s getting enough milk. Just to buy these not disposable nappies.

Julie:              Yes.

Lena:              To see the amount of urine that she has been passing.

Julie:              It’s amazing how much they can soak up.

Lena:              Another question that new mothers often make that how often should I breast feed? I guess it’s about the same answer that how long should breast feed…that how often should I breast feed my baby?

Julie:              Yeah. Again, it’s very variable. Some babies will want to feed every two hours and some babies want to feed maybe every four hours. Some babies start off and they’re very sleepy and they sleep for long periods of time and they may want to go six hours in between feedings. We don’t actually recommend that you let them go any longer than four hours without a feed.

If your baby is very sleepy you need to try and wake them up in four hours. If they’re trying to feed very frequently say every two hours it’s a really good idea to allow them to do that early on because it helps to establish a good supply.

After the first six to eight weeks when you’ve got a good supply then you can try to stretch the feeds out if you feel that it’s detrimental to your health and well being. In the first six to eight weeks if it’s at all possible it’s important to let the baby feed as often as possible even if that’s every hour and a half or every two hours.

Lena:              Well, yeah, you really just have to focus on breastfeeding even if it’s every 90 minutes. You barely get any sleep but I guess it is worth it.

Julie:              It can be very difficult to start off with. Very, very, difficult.  You need to give yourself basically nothing to do during that first two months of establishing a supply. Some mothers find it very, very easy but most mothers do find it very, very difficult. If at all possible you need to get yourself a good support team around you and really plan for that time to be all the feeding and just coping with the demands of the baby and really not expecting too much of yourself during that time.

Lena:              Speaking of establishing the milk supply, when I got my daughter in the hospital the nurse actually came, it was the night time, she actually came in every two hours and woke me  up so I…I had to wake my baby up to breast feed. I think that was, at that time, I felt like I was very tired of course. Now I understand that it was a very good strategy of them to help me to establish my milk supply for my daughter.

Julie:              Yes, that’s right. It can be an incredibly difficult time. You just need to keep in mind that it’s only for a short period of time and it won’t always be like this. If you can just get through that first two months chances are everything’s going to be just fine.

Lena:              Even the first few days, weeks you just focus on trying to get the milk supply out just by breast feeding as often as possible so you won’t face the challenge of too little milk later on.

Julie:              That’s right. Rest is very important in building a supply as well. You need to be making sure that you’re not worn out otherwise your energy’s going to go towards doing the things that you’re trying to do rather than making milk to allow your body to build up a good supply by getting plenty of rest and really looking after yourself during that time too.

Lena:              So the way to cope with frequent feeding is just you mentally prepare that before you get your baby and just to try and have a support team around, your partner, husband, your mother, your sister, your friends. Just tell them that you really want to breast feed and you might feel very tired because of that and you wish them to help in any ways they can.

Julie:              Yes. All of those things are really good tips. I think it’s a very important time for them to be able to except help from other people. It’s something that many people have trouble doing. If there’s one time in your life that you’re going to say yes I can take help from somebody then I think that’s a really good time to do it. Let people come over and help you look after your other children and help you do your dishes and look after your house and cooking meals. If you’re lucky enough to have those people around you say yes to everything.

Lena:              Oh my, gosh, now it sounds so tiring and exhaustive but I don’t recall it in that way for those first few weeks. I don’t know whether you forget or it’s actually not that bad. I don’t know which way it is.

Julie:              Yeah.

Lena:              You have two sons. How do you feel about the first few weeks?

Julie:              I remember them being quite different actually. The first one I felt was a little bit easier because I had the time just to do nothing basically. I had my baby in my arms 24 hours a day and that was okay because I had nobody else really to look after.

The second time it was more difficult because I had my two year old to look after as well the baby. I had to get quite creative with ways of allowing myself that rest time and also making sure that I was giving time to my older child. I did find with my second son that first couple of months was incredibly difficult.

Luckily, I didn’t have any issues with undersupply but I did have some breast feeding issues that were quite difficult to deal with and it did need extra attention and it did take a lot out of me. I did find that quite difficult, but the first one I didn’t really have much trouble with.

Lena:              Okay. What type of advice would you give for mothers who have twins?

Julie:              Seek out other people who have twins and find out as much as possible about what to expect from the satiation while you’re pregnant before you’re actually faced with the situation. I know here in Australia we have the Multiple Births Association which is a group of mothers that have twins and you can go and get advice from them, spend time with them and ask them lots of questions. There are people on telephone hot lines that can help you if you need help with anything.

You can also get help and advice from staff at your hospital or from infant health nurses. I guess for people who have twins it’s probably twice as difficult as it is for a mother that just has one newborn, so the need to accept help and to be prepared for a rocky establishment period is even more important than other mothers.

Lena:              How about mothers with premature babies?

Julie:              Mothers with premature babies; it can be very difficult for a mom with a premature baby. It’s a highly emotional time I guess and often a mother will have to leave her baby in the hospital and she will be sent home. She may have to come in to the hospital to feed her baby every four hours or so she may need to come into the hospital to express milk to be fed to the baby.

It can be a very difficult time and each situation is really quite unique. You need to work with a lactation consultant or with your midwife again to help you through that time and to help you know what the best thing to do is.

You can definitely breastfeed a premature baby. You can express the colostrum and express the milk to be fed to a premature baby at a later date if they have to be tube fed or having to be kept in a humidicrib for an extended period of time before you’re allowed to breastfeed them.

Lena:              After you have breastfed a baby you usually burp the baby, so how do you do that in a right way?

Julie:              A lot of people believe that you don’t necessarily need to burp a baby. Babies, often if you just pick them up they will release any trapped gas, so many babies don’t actually need burping. If you feel that your baby does need burping a good way to do it is just to put the baby upright, maybe leaning on your shoulder and just gently patting them on the back. If they need to burp they will.

Lena:              I guess when you’re breastfeeding the lactation is doing good and the babies suckling correctly he doesn’t get too much air into his stomach right?

Julie:              That’s right.

Lena:              There was someone who asked that she has a three week old baby and the baby has trouble bringing up his wind and the thing might be that there might be no wind to bring up.

Julie:              That’s right.

Lena:              Okay. There’s another one who asks a question. She writes that after I breast feed my baby she has a tendency to throw up the milk even though I burp her. She wants to know whether that’s normal or it is related to how she positions her after breastfeeding.

Julie:              For many babies it can be very normal for them to bring up a bit of milk after a feed. For some babies it can seem like they’re brining a lot of milk after a feed. If the baby is brining up the milk straight after the feed then it’s generally because they’ve just got too much milk in their stomachs.

It takes a long time for the valve that keeps the stomach contents down to actually mature to the point where they can work properly. If baby’s getting a lot of milk very quickly then that can just come up. Generally the rule is that if it’s not a problem for the baby, if it’s not causing the baby any distress then it’s nothing really to worry about too much.

If it’s happening maybe an hour after a feed and it smells very sour and it smells vomity that can be more of a sign of reflux and that can actually be burning the baby and causing pain for the baby. In that case it’s a good idea to see a pediatrician and to get some help with that. It’s very common for babies just to bring up some milk after a feed. My second son did it for a long time. It’s very messy, but it’s not really a problem.

Lena:              The volume probably looks more than it is. Like one of the questions was that she has a daughter that she says she will eat until she vomits. I think that this might be just that she throws up some milk and it looks like she’s vomiting.

Julie:              Yes.

Lena:              Yeah.

Julie:              That can happen. I found with my second son that I had to hold up him upright after a feed. If I kept him upright for a good period of time after he was fed, rather than feeding him and laying him down he didn’t bring up near as much milk as he would otherwise. That might help for some people as well.

Lena:              Yeah. Also, it’s a bit frustrating especially when you’re just bringing up your milk supply and then you get your baby fed and then she or he just vomits everything.

Julie:              Yeah.

Lena:              “I don’t have anymore milk. What could I do?” It can be very frustrating at that time.

Julie:              Definitely. As you say it always looks like more than it actually is. If you get yourself a third of a cup of water and tip it on the floor you’ll be surprised at how much it actually looks when it’s tipped out on the floor. It’s really just a small amount.

It’s also a sign that you have a pretty good supply usually if baby’s stomach’s not being filled up then it’s not going to be ejecting extra milk. Be happy that you’ve got a good supply.

Lena:              That’s a good reminder. How about collection and storage of breast milk? When do you begin to express breast milk?

Julie:              I recommend that mother’s don’t try and express or store breast milk for the first eight weeks while you’re building up your supply unless there’s a real need for it like some women need to go back to work and the only way they can continue to breastfeed their baby is if they are expressing or if you’ve got a premature baby in the hospital that you’re expressing for. Obviously, you need to express for that purpose.

If you’re expressing just to get a supply stored up in the freezer so that somebody else can feed the baby, it’s a good idea to wait until your supply’s fully established and wait until that eight week mark. Then you can start expressing.

The other thing to consider there is that usually when you feed express milk to a baby most people use a bottle to give it back to the baby. The suck that a baby uses on a bottle teat is very different to the suckle that they use to breast feed, so sometimes it can change the way the baby is actually breastfeeding. That can introduce attachment problems.

I just think that for the first two months if you can just try and keep it as interference free as possible then that will give you the best chance of getting through that establishment period with as few problems as possible.

Lena:              This is a bit different from expressing breast milk. Many new mothers are encouraged to use pump to increase a milk flow, so do you still kind of recommend just to breast feed your baby more instead of using breast pump?

Julie:              Yes, definitely. If you feel like you’ve got problems establishing your milk supply, you haven’t got enough milk, then the best remedy for that is to feed your baby more often. It might mean that you need to wake your baby up and feed them more often.

If the baby won’t feed more often and it’s the only way that you can get extra stimulation to your breast then expressing might be useful in that situation, but it’s always better to use the baby to try and to build your supply rather than the pump because you’re getting hormonal stimulation from the baby which you don’t get from using a plastic pump.

This whole interplay of hormones that come along while you’re breastfeeding that help to build up the milk supply and those feelings of love that you have for your baby will really help build up that milk supply. It’s very difficult to get that stimulation from using a plastic pump.

Lena:              Yeah. Definitely we should not forget that breastfeeding is not about a physical thing. We are still the mind and body. It’s one thing actually. Everything is connected to each other.

After around six to eight weeks period most moms it’s actually good to start expressing milk so you can actually maybe take off for a couple of hours or even four hours and leave your baby for someone else and they have the milk, your breast milk to feed the baby. What type of methods of milk expressions do you recommend for moms?

Julie:              There’s a few different things that you can use. You can  use hand expressing which is really good once you’ve got a good supply and you’re finding that the milk comes easily, you can just use your thumb and your forefinger to milk the breast starting from the outside of the area and drawing towards the nipple. You need to make sure that you’re moving around, that you’re accessing all milk ducts so maybe start at the top and work around like a clock.

You also need to make sure that you massage from right back under the arm. Use the palm of your hand and kind of push the milk in towards the areola area, so that the milk becomes available for the baby. The advantage of hand expressing is that it’s much more gentle on the nipple. Sometimes the plastic breast pump can aggravate the nipple a little bit. It can cause pain for some people.

I find that hand expressing is more gentle that way. If you’re doing larger amounts of expressing then using a hand pump or even using an electric pump can be very useful. Hand pumps are great because they’re usually reasonably inexpensive. You can just have one sitting there just in case you need it. Many mothers will have them but never use them but it’s good to have one if you feel like you might need it.

If you’re going to be doing large amounts of expressing, say you need to go back to work or you need to make it a very regular thing that you’ll be leaving the baby with somebody else, an electric pump can be very useful. You can buy them now. They are quite expensive if you’re not going to use them very often, but if you are going to use them, they are quite useful.

Here in Australia you can hire them so there may be similar schemes in other countries as well or you can hire them from different hospitals or the pharmacy.

Lena:              Yes. Is there any best times for expressing breast milk? Is it after the feed or in between the feeds?

Julie:              It’s very different. It depends on the need for the milk. If you’re expressing just to get a little stored away to put in your freezer and feed your baby if baby needs it then I would recommend just expressing after a feed.

The reason is because expressing can interfere with the process of supply and demand. The idea being that after that first six to eight weeks of establishing your supply, the milk supply is now dependant on the baby’s appetite rather than the hormonal stimulation that you’re getting.

The amount of milk that you’re making is exactly what the baby’s drinking by exactly what you’re taking out of your breasts. By expressing, you’re actually telling your breasts that you need to make more milk than the baby is actually drinking at that point.

Just taking the excess after a feeding is a good way to do it if you’re just trying get a little bit to store away but if you need a complete feed then you need to wait probably about an hour and a half to two hours after you have fed your baby to get a good volume of milk out.

If you’re expressing regularly for work or for regular outings out then you need to try and do it at the same time that your baby would be feeding. If you are at work and you can organize your breaks to allow expressing; if you could do that at about the same time that you would be feeding your baby if you were at home, then that helps to mimic that supply and demand process.

Lena:              Wow. Thank you because this is actually the first time I hear someone saying that, that it depends on the use of expressed milk and of the situation of where you are; if you are going back to work or just having a short break and you just leave the baby for a few moments.

You’re truly giving us very, very good advice on breast feeding and you offer more of this type of information on your website NaturalTransition.com and you actually have a membership area there where people can ask questions when it comes to breast feeding or the period after you have got your baby.

It’s really good quality information there and I just refer you for listening this recording to visit Julie’s website NaturalTransition.com to get more information.

Julie:              Thank you.

Lena:              You’re welcome. How about storing the milk? I guess that also depends on how you’re going to use it but could you just tell us things you need to need to consider when you store breast milk and expressing it?

Julie:              Yes, this can be really quite technical actually. You do need to make sure that you’re storing the milk in a sterilized container. Some people will store milk in bottles or if it’s small amounts, you can use ice cube trays. If it’s larger amounts, you can use Ziploc freezer bags.

They’re quite useful because it’s very easy to pull them out of the freezer and defrost them but whatever you’re using you need to make sure it’s well sterilized, that there’s not going to be any bacteria introduced to the breast milk because breast milk’s alive. It’s alive food. It’s got its own cultures in it like yogurt. Adding any other extra bacteria to it will make your baby sick.

That’s quite important. There’s lots of different ways that you can store the milk; you can keep it in a freezer for approximately two weeks if it’s the freezer compartment of your refrigerator. If it’s in a deep freeze, you can keep it for six to 12 months.

Lena:              Six to 12 months?

Julie:              Yeah. It’s a long time.

Lena:              It is.

Julie:              We don’t actually recommend giving the baby milk that’s been expressed that long ago though. The reason is because the milk actually changes in composition as your baby grows bigger. Newborn milk is going to be very different to the type of milk that a six month old baby is drinking.

It has different amounts of protein and different fats and things in it. It’s best to give your baby the milk as close as possible to the age that they are. Try and use in within about a month rather than keeping huge amounts in the freezer and going back to it.

In the refrigerator you can keep the milk for three to five days if it’s under four degrees Celsius. If you are keeping it at room temperature, you can keep it for six to eight hours if you’re unable to refrigerate it properly.

If you’ve already frozen the milk you need to thaw it in the refrigerator if possible. You take milk out of the freezer and leave it in the fridge to thaw out that’s the best way to do it so you have less chance of introducing bacteria to it. You need to use it within four hours if you’re keeping it out at room temperature or at the fridge for 24 hours.

Lena:              Right.

Julie:              If your baby has already had say if you defrosted a half of a bottle of milk, if you defrosted a bottle of milk and the baby’s only drank half of it, unfortunately, you need to get rid whatever’s left over. You can’t put it back into the refrigerator and give it to them a couple hours later. You need to get rid of the whole lot.

Lena:              Okay, so, it’s because some saliva gets mixed with the milk, and the bacteria start to grow.

Julie:              Yeah, that’s right because it’s a live food the bacteria can grow very quickly in the milk. You need to be quite careful with the way that you use it.

Lena:              How do you sterilize the bottles? Is it enough just to boil water in a big kettle and then boil wherever you store the milk for a while? Is that enough or do you have to buy some sterilizers?

Julie:              No, you can boil the bottles in a big pot of water. Just try and keep them boiling for at least three to five minutes; three minutes will make sure there’s no bacteria in there if you can keep the water actively boiling while the bottles in there.

Yeah. If you use water that you’ve boiled from the kettle it will cool down too quickly and it won’t allow enough time to kill off any bacteria that may be lurking there.

You can use steaming as well. You can get electric steaming. Boiling or steaming is probably the healthiest way to do it. You can also get different tablets that you can use to sterilize things but that’s using chemical methods. You need to make sure that you rinse the bottles and the teats our quite thoroughly if you’re going to use those.

Lena:              The tap water, that’s not sterile either because in ordinary tap water there might be very, very small amount of bacteria. It’s still drinkable, but will that be okay for babies?

Julie:              It is true that there is some bacteria in tap water.

Lena:              Very small amounts.

Julie:              Yeah, you are probably better off using boiled water to rinse.

Lena:              Okay. How about when you boil the bottles, do you let the bottles cool down in the boiling water or do you pick up the bottles when the water is still very hot? Yeah.

Julie:              You can take them out of the boiling water and let them cool down and that’s fine.

Lena:              Then, you have to use something that is very clean as well when you pick them up.

Julie:              Yes. Yes.

Lena:              One more thing, what do you consider to be the room temperature that you can store the expressed breast milk for eight hours because that really varies around the world?

Julie:              It does.

Lena:              …other than Sydney, Australia

Julie:              Probably no more than about 30 degrees Celsius. If it’s getting hotter than that than you would need to reduce the amount of time that you could leave it out.

Lena:              Okay. It can be quite hot still so you can leave it for a few hours and not need to worry if the bottle is sterile that you put the breast milk in.

Julie:              Yes. Do your best to keep it in the coolest part of the kitchen. Don’t put it in full sunlight.

Lena:              Okay.

Julie:              Try and keep it nice and cooled off.

Lena:              Right. One last question about expressed milk before we go into milk supply and how to increase it, do you explain and advise your customers how they do bottle feed the babies and what is the best way to do it when you are offering the baby expressed breast milk?

Julie:              If you’re using bottles, make sure that they’re well sterilized. You may need to experiment with a variety of different teats. You can get teats that are better for breastfeeding babies. If you go into your pharmacy and have a look at what’s available you may need to buy a few different ones and see which suits your baby the best.

Some people if you’re dealing with a very young baby or a baby that will refuse a bottle you can actually give expressed breast milk in a small cup or you can use large syringe to syringe the milk into the baby’s mouth. Some people prefer to do that to reduce the chance of the baby learning that different sucking motion which they may then try to use on your breast which will then damage the nipples.

Lena:              When you are using the syringe, the baby doesn’t suckle at all. You just put the milk inside the baby’s mouth.

Julie:              That’s right and then they just swallow it.

Lena:              You have to be careful when you are using the syringe so you don’t press it too quickly or otherwise the baby might be suffering.

Julie:              Yeah, that’s right. Yeah. You can see what they can manage. I don’t really have any experience with that at all but I’ve heard that that’s a good way of doing it if you want to avoid using the bottle.

Lena:              I’ve never even heard of using a syringe. I’ve heard of a cup if you want to avoid bottle. Yeah, that might work better than a bottle probably when it’s a small baby. Better than a cup.

Julie:              Yeah, a cup.

Lena:              Yeah, a cup can be a bit challenging with a small baby.

Julie:              It could be yes, but again you need to be very careful of how much you’re putting in their mouth at a time. It’s really just pouring the milk into their mouth for them to swallow.

Sometimes babies might take bottles from their mothers if they’re breast feeding, so you may need to actually get somebody else to give the bottle. You may need to be completely out of the house or away from the baby for them to actually take it. It can be quite tricky to get some to take a bottle of expressed milk if mom’s close by with the real thing.

Lena:              Yeah, they sense that the mother is nearby. They really know. Babies really know.

Julie:              Yes. That’s right. If you’re expressing for a premature baby in hospital you can get a supply line which is basically a little bag attached to a tube that you attach to your breast. The baby can actually suck on the nipple and receive the milk from the tube. That way they can be learning to breast feed while they’re getting the expressed milk.

If you need to use something like that you can talk to the hospital staff that is helping you and your baby at the time and they will teach you how to use it and let you know if that’s appropriate for you.

Lena:              Exactly. Okay. Next thing is milk supply and how to increase your milk supply which is probably the hottest question when it comes to breast feeding.