Are you expecting your first child? A new mom on maternity leave? Or a veteran mother about to add another child to your family? No matter where you are in motherhood, you will likely have questions about breastfeeding. And we’ve got answers for you! Join us for Part Two as Crecia Montgomery, an International Board Certified Lactation Consultant (IBCLC) at IU Health West Hospital, continues to answer our questions about all things breastfeeding. Make sure not to miss Part One of our series, and stay tuned for Part Three next week!
Is there any guidance on when you would recommend supplementing with formula?
If a baby is unable to transfer adequate amounts of breastmilk by directly breastfeeding, supplementing may be recommended, says Montgomery. It is important to not only determine if the baby is actually not getting enough milk but also why the baby is not transferring before a decision is made on how to supplement feedings.
Montgomery says one of the most asked and hardest questions to answer from breastfeeding moms is, “How do I know that my baby is getting enough breastmilk?” Moms who choose to exclusively bottle feed are able to measure at each feeding how much their babies are eating. Direct breastfeeding moms must look for other signs to determine how well their baby is feeding. “I spend a great deal of time teaching new and experienced breastfeeding moms how to look at an overall picture of each day, which includes monitoring the number of feedings, keeping track of wet and dirty diapers, listening for swallows when the baby is nursing, observing breasts that are softer after the baby has nursed than what they were before the feeding began, and observing the baby’s behavior for satiety (does the baby seem relaxed and calm after feeding, etc.),” says Montgomery. “We also talk about the importance of keeping all appointments with the baby’s pediatrician to monitor the baby’s weight and achievement of appropriate developmental milestones. Many times a mother perceives that her baby is ‘not getting enough’ breastmilk more often than a baby who is actually not getting enough breastmilk.”
Montgomery continues by saying, “If a baby is not having adequate output and/or growth is not appropriate, we must find out why in order to be able to make recommendations about what to do.” As an example, you may find that a baby has been sleepy and not waking often enough to nurse. Encouraging more frequent breastfeeding sessions around the clock may be all that is needed. In some cases, the mom has an adequate supply, but the baby is having difficulty getting the milk out of the breast. Montgomery says the mom could be encouraged to pump and offer her own breastmilk as a supplement while the baby’s latch and feedings are assessed.
“The decision to recommend formula supplementation should be guided by the baby’s pediatrician in any and all medical contraindications to breastfeeding,” says Montgomery. Other circumstances are “when the baby is unable to receive adequate breastmilk from direct breastfeeding and/or pumping of their mom’s own breastmilk and access to pasteurized human donor milk is not available or declined.”
Are there certain positions or tricks you would recommend using for a gassy baby?
It can be hard to determine what is making a breastfeeding baby gassy, says Montgomery. While it is possible to be diet related, an often overlooked cause is a poor latch. “If the baby does not have a tight seal at the breast or they frequently lose that tight seal, air can be introduced and make its way to the baby’s stomach and cause distress,” she says. “Ensuring a good latch and optimal positioning in any chosen position can be helpful.” Feeding the baby more upright, with their head above their stomach may be helpful. Burping should occur mid-feeding between switching breasts and at the end of the feeding to help encourage any air accumulated from feeding to come out.
Also, Montgomery says some moms can have very forceful letdowns that cause a baby to gulp when swallowing until they learn to manage the rapid flow of milk. “Nursing in the laid-back position can use the effects of gravity to help slow the flow of mom’s letdown and also positions the baby above the breast which may make managing the flow easier as well,” she says.
If the baby is gassy despite a good latch and mom is concerned about a possible diet related cause, she should discuss this with the baby’s pediatrician who can make recommendations on eliminating certain foods from her diet. Over the counter gas drops should only be used under the advice and supervision of the baby’s pediatrician.
Do you have any Haakaa tips?
If you haven’t heard of the Haakaa, it is an alternative to traditional pumping or hand expression. Montgomery says a Haakaa can be used “when you want to gently remove some milk from the breast but are concerned about added stimulation during situations like engorgement and over-supply or when you desire to collect drip milk from the opposite breast during breastfeeding that would otherwise be lost in a nursing pad or in clothing.”
It is fairly simple to use. Montgomery recommends rolling the flange slightly when applying it to the breast, much like applying a nipple shield. This helps to latch it on deeper where it is more likely to stay put and not fall off. In addition to rolling the flange, compressing the bulb, and then releasing it once it is in contact with the breast should apply gentle suction to pull milk from the breast during letdowns. The more you compress, the stronger the suction, according to Montgomery. Since the Haakaa has no additional openings other than the flange, once it is applied well, milk cannot spill out and this can allow for the Haakaa to be placed at an angle or to the side if needed to keep from being in the way of the baby positioned at the opposite breast.
It is important to remember that the Haakaa and other similar devices may not be appropriate in every situation for every mom or baby. “Even though it is less stimulating than a traditional pump, it can lead to an increase in supply in moms struggling already with oversupply due to the basic principle of supply and demand,” says Montgomery. “Anytime we are removing milk from the breast, even gently, we are designed to replace it.” Also, she says if a baby requires the milk from both breasts at each feeding, it would not be the best idea to place the Haakaa on the opposite side until the baby has switched sides. Ideally, the baby is allowed to remove the milk directly from the breast during the feeding and not have to be given the expressed milk by another feeding method.
Support Groups/Services – Are there any breastfeeding support groups or services you recommend?
“Through our partnership with IBCLCs across the IU Health organization, we offer support to new moms through a variety of breastfeeding classes as well as one-on-one support from our experienced lactation specialists where moms can ask questions and get helpful tips for breastfeeding success,” says Montgomery. If you have any questions, please call the IU Health West Hospital Lactation Department at 317.217.3639.
Stay tuned for Part Three of our series where we will answer your questions on exclusive pumping and guidelines on storing milk!
About Crecia Montgomery (IBCLC)
Crecia Montgomery is an International Board Certified Lactation Consultant (IBCLC) at IU Health West Hospital. She is a 2003 graduate of the Indiana University School of Nursing. Her nursing experience includes pediatrics and labor and delivery prior to becoming certified in lactation, where she has worked since 2016. Crecia has three sons and one daughter, absolutely loves baseball, and is a huge San Diego Padres fan.
Indiana University Health
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