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Talk through the different shapes and sizes of flanges available for our Spectra S1 and Ardo pumps

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Changing the flange on a milk collection kit for the Spectra S1 pump

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Changing the flange on a milk collection kit for the Spectra S1 pump

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Changing the flange on the milk collection kit for the Spectra S1 pump

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How to put together the milk collection kits for the Spectra S1 pump

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How to put together the milk collection kits for the Spectra S1 pump

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How to put together the milk collection kit for the Spectra S1 pump

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Click here to download the Neko Tiny user manual

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Four key areas for babywearing safety - Carrying Matters

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- supporting children, carers and society to be more connected through close contact.

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Hip Scoot Back Carry with a Zensling carrier

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Hip Scoot Back Carry with a Zensling carrier

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Including how to use the calypso pump, using shields and when to know you need a different sized flange.

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Videos to help expressing mums. At Ardo, we understand what it is like to be a new mum and feel overwhelmed by having a new born baby and the need to express. That is why we have produced a comprehensive range of videos to help you navigate your breastmilk feeding journey.

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New fitting guidance from a 2024 study

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Do I have postnatal depression? By Laura Shtaingos

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Do I have postnatal depression? Laura Shtaingos | Counselling for Parents in Sevenoaks

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What is postnatal depression and what causes it? Is there anything you can do to feel better?

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LennyTwin Carrier, Standard Size, herringbone weave 100% cotton - LITTLE HERRINGBONE OMBRE GREEN

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LennyTwin Carrier, Standard Size, herringbone weave 100% cotton - LITTLE HERRINGBONE OMBRE GREEN

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Danielle Anne Manton-Kelly on Instagram: "I share this every few months to reach parents with brand new newborns who might be having trouble with wind and colic. It’s fantastic to finally be able to share the whole thing! #colic #wind #newborn #newparent"

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12K likes, 112 comments - enchantednanny on June 15, 2024: "I share this every few months to reach parents with brand new newborns who might be having trouble with wind and colic. It’s fantastic to finally be able to share the whole thing! #colic #wind #newborn #newparent". 

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View this post on Instagram

A post shared by Danielle Anne Manton-Kelly (@enchantednanny)

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Sometimes there is just a straight up mis-interpretation of a baby behaviour. Newborn babies can really only do 2 core trunk movements - they can scrunch themselves inwards (flexing) or they can straighten /arch (extend), and they will do these movements for lots of reasons - to move position, to communicate they want to move, to say they want to swap sides, they want to feed, they want a nappy change, and on and on it goes. Several times I've seen a baby pulling knees up to start a breast crawl from the position they are in (they will then cry if they don't get to the breast), which was misinterpreted as wind.

That being said - babies do have wind, and lots of it, so I thought it might be good to talk a bit about it.

What is Wind?

We should start with this very basic question, because I usually hear 2 different things being described as wind. Some people will use "wind" to refer to air in the stomach which was swallowed during feeding i.e. the gas that gets burped up when you "wind" a baby after/during feeds. Other people will use it to refer to intestinal gas which is 'farted' out (flatus). Some people use the same word to refer to both, and some haven't really thought about whether these are 2 separate things. So let's just look at them very briefly.

Swallowing some air is pretty normal. We all swallow air, adults included and we normally release this later, often without really even being aware of it. Babies will also swallow air while feeding, although how much may depend on how well they are attached to the breast or bottle, speed of milk flow etc, so some babies will swallow more air than others. I find that a lot of people are worried about their baby swallowing air when in fact they are sealed well and just making normal feeding noises. In her 2017 article which addresses swallowing air while breastfeeding, Pamela Douglas refers to ultrasound scans of babies and says that

Large volumes of air are not normally observed in the stomachs of breastfeeding infants

so there is likely not as much air being swallowed during breastfeeding as you may be worried about. That being said, some babies struggle to make a seal for many reasons and can be taking in excess air - so if you are concerned about this, do see someone trained in assessing a breastfeed to check what is going on. Some babies also struggle to seal well on a bottle, and that may be due to the shape/size/texture of the bottle teat or may be for other reasons. Many IBCLCs can also help with looking your baby's seal on a bottle teat.

Once some air is in the stomach it can potentially move 1 of 2 ways. It can either be released up through the top of the stomach by burping, or some can potentially pass through to the intestines. The larger amounts of gas which is found in the intestines however is not likely to have come from being swallowed. The gas is more likely to have been created in the intestine itself. This gas is more likely created by bacteria in the large intestine digesting and fermenting food particles (sugars from milk) and producing gas as the result of that digestion/fermentation. This might seem problematic on first glance but is usually, in fact, a good thing as the bacterial colonies in our gut are a vital component to our health or lack thereof.

The microbiome

If you've read anything about the gut and/or gut health in the last 10 years you are almost certain to have read something about the gut microbiome / gut microflora / gut microbiota - which just refers to the microbial colonies in our gut. Adults typically have as many bacterial cells in their bodies than human cells, and the lion's share of those are in/around the gut, particularly the colon. These microbial colonies establish a balance of different strains and species of bacteria - competing for space and keeping numbers of different strains in check. This is why when you have antibiotics you are at risk of thrush. Antibiotics kill helpful bacteria as well as pathogenic bacteria, and when the helpful bacteria are gone/reduced they are no longer keeping the candida (thrush fungus) numbers in check. Candida colonies can then start to expand, causing thrush symptoms. Once well established our balance of bacteria is pretty stable and unique to us as individuals - like a bacteria fingerprint.

Having the right bacteria in out gut is vital to our health. Helpful strains help us to digest our food, they make vitamins for us that we are unable to make ourselves (Vitamin K) and they help to modulate our immune system. Bacterial colonies have evolved with us to work together and keep us in good health. Conversely when those microbiomes are out of balance, perhaps with more pathogenic bacteria in place then health is affected negatively. The gut microbiome has been implicated in research in a mutlitude of chronic health conditions, e.g. ME / chronic fatigue (Giloteaux et al 2016), chronic kidney disease (Wing et al 2015), anxiety & depression (Wong eat al 2016), obesity [ Ley et al. 2006b; Zhang et al. 2009], malnutrition [ Kau et al. 2011], diabetes [ Qin et al. 2012] IBS, Ulcerative colitis, Crohn's disease (CD) [ Frank et al. 2007] and cardiovascular disease (Hansen et al 2015).

So getting the right bacteria in place and creating a hospitable environment for the right bacteria is important.

Setting up the Microbiome

It is estimated that a 70kg adult male has 38000000000000 bacterial cells in his colon (Sender et al 2016). This is where a lot of the fermentation and gas production will happen. We are not born with these bacteria cells in place however. A baby is born with a virtually sterile gut and the needed bacteria colonise the body in the days, weeks and months following birth. Those bacteria come from the birth process (babies are designed to swallow mouthfuls of bacteria as they pass through the vaginal canal), the skin to skin contact we do after birth, from our family environments, and crucially - from milk. Babies born by C-section may be seeded with slightly different bacteria than those born vaginally, and of course will be exposed to antibiotics during the surgery. The type of milk a baby is fed will mean that different types of sugars are available to the bacteria for food and this alters the type of bacteria that will set up home in the baby's gut. The type of bacteria which colonise the baby, in turn, affects the type of gasses that are produced, and potentially whether that gas is linked with discomfort and crying or not.

An interesting 2001 study (Jiang et al) looked at the types of gases present in the stools of babies who were either breastfed, cows milk formula fed, or soy formula fed, and found differences between the 3. Six gases were quantified: hydrogen (H ₂ ), methane (CH ₄ ), carbon dioxide (CO ₂ ), hydrogen sulfide (H ₂ S), methanethiol (CH ₃ SH), and dimethyl sulfide (CH ₃ SCH 3).

They found that the breastfed babies produced the highest quantities of hydrogen (an odourless gas), and very low quantities of sulphur based gases like methanethiol or hydrogen sulphide. This, conversely means that both groups of formula fed babies produced much lower quantities of hydrogen and much higher volumes of sulphur based gases. This is significant not just because sulphur based gases both smell bad (and is why gas and poo smells very different in breastfed and formula fed infants), but the authors also note that,

these extremely toxic gases could irritate or damage the colonic mucosa.

They go on to say,

H 2 S and CH 3 SH are highly toxic gases that can damage or irritate the intestinal mucosa. ... The colonic mucosa of the adult rat (and human) has a specialized detoxifying system that rapidly converts these sulfur gases to thiosulfate (29). This detoxification presumably allows the mucosa to protect itself from what would otherwise be injurious concentrations of the sulfur gases. In our study, levels of fecal sulfur gases of formula fed infants were similar to the values reported in adults, in which fecal H 2 S release is 1400 ± 182 nmol/g dry weight and CH 3 SH is approximately 530 ± 75 nmol/g dry weight (30). It is possible that the detoxification system for the sulfur gases may not be fully developed in infants and that irritation by sulfur gases might cause discomfort and/or play a role in certain intestinal disorders of infants.

So this is interesting I think. Two points which I think are important for us to understand are:

1. All babies produce lots of gas, and when you think about what is happening it makes sense why. Babies need to very quickly get their gut colonised by bacteria to help it to function properly. It has to go from a either completely or virtually sterile gut to a gut teeming with bacteria. Those bacteria are competing for space, multiplying rapidly and usually being fed a sugar rich fluid. That sugar rich fluid is of course lactose in milk, but in addition to this breastmilk contains lots of special sugars called oligosaccharides which are there specifically to feed the right bacteria and help the gut get colonised with helpful bacteria. These sugars are digested by the bacteria and gases are produced. While the bacterial colonies are being set up there is going to be a lot of this gas production.

2. The milk diet that is given to the intestine will impact just what species of bacteria will thrive there, and that determines what kind of gases are produced and whether they smell bad or not and whether they might be toxic and harmful/painful or not. It's not he only thing that will impact the species of bacteria - but it is a significant one. This doesn't mean that all breastfed babies won't get some pathogenic bacteria in their gut. Bacterial strains are shared in families, passed in birth, in skin, in our family environments and may be why allergies are 'vertically transmitted' from parents to children. Many of us have our own gut problems, and may not have a perfect bacterial profile to pass on, nor was a perfect one passed to us, and we live in a world which is not very friendly to our good bacteria (chlorine in water, antibiotics in our toothpastes and foods etc). What we do know from these studies however is that breastfeeding really does make a difference. The special sugars in our milk really does make a difference to our babies gut and the bacteria that live there. Breastfeeding gives our babies the best chance at a diverse, healthy microbiome.

The vast majority of babies will pass gas and not find it particularly painful. They may grizzle at times, and may benefit from tummy massage or a soothing bath to help them pass gas and once they do they settle. We've probably all had a little trapped wind from time to time and we understand that it can be uncomfortable, but the gas itself is usually just normal amounts and part of being a baby.

Some babies, however, are uncomfortable more often than is normal, crying abnormally and sometimes alongside their discomfort you may see frothy poo, bubbling with gas which smells unpleasant. Colic is usually defined as a baby crying at least 3 hours a day for at least 3 days a week for at least 3 weeks in a row, and a number of studies have now identified differences in the types of bacterial species present in babies with colic and those babies without.

Babies with colic have less bacterial diversity in their guts and levels of Actinobacteria Bifidobacterium and Firmicute Lactobacilli bacteria specifically are inversely related to crying and fussiness - so less of these strains are correlated with more crying. The babies with colic also have more proteobacteria present (Dubois et al 2015). Some studies using probiotics (helpful bacteria) as treatment for fussing and crying have also had promising results, like a 2018 study (Sung et al) which used the probiotic strain Lactobacillus Reuteri on a large group of breastfed babies which found that it reduced crying and fussing within 21 days. They didn't have as dramatic a result in formula fed babies, but there have been enough studies that many formula manufacturers are adding probiotics to their products. The results of the study, of course didn't stop crying and fussing altogether - some crying and fussing is normal in babies. Just like the rest of us, babies will have good days and bad days, and good and bad times of the day and times when they need help and support more than others.

So what does all this mean? Well it means that babies really are gassy and that a lot of gas is very normal. It's part of normal digestion, normal microbiome development and normal human development. Gas and poos from breastfed babies should not smell bad, and that's because the milk is feeding the right kinds of beneficial bacteria and although that produces a lot of gas - that diverse, healthy microbiome can be really important in future health. So remember that the next time you are wondering about how gassy your baby is, and remember that a little bit of tummy massage can help everything keep moving along.

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Why are Babies So Gassy? How much is normal and how much is a problem? | Carol Smyth IBCLC & CBT

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Sometimes there is just a straight up mis-interpretation of a baby behaviour. Newborn babies can really only do 2 core trunk movements - they can scrunch themselves inwards (flexing) or they can straighten /arch (extend), and they will do these movements for lots of reasons - to move position, to communicate they want to move, to say they want to swap sides, they want to feed, they want a nappy change, and on and on it goes.

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Lullaby Trust

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To reduce the risk of sudden infant death syndrome (SIDS) the safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. However, we know that many parents find themselves co-sleeping whether they mean to or not. Wherever you're planning for your baby to sleep we recommend making your bed a safer place for baby. Our advice on co-sleeping with your baby will tell you how.

When not to co-sleep

Whether you choose to co-sleep or it is unplanned, there are some key risks you should avoid.
Co-sleeping with your baby is very dangerous if:
In these scenarios, it is always best to put baby in their own safe sleep space, such as a cot or Moses basket. Keeping the cot or Moses basket next to your bed might make this easier.
Never fall asleep on a sofa or armchair with your baby. The risk of SIDS is 50 times higher for babies when they sleep on a sofa or armchair with an adult. They are also at risk of accidental death as they can easily slip into a position where they are trapped and can't breathe.
Co-sleeping more safely

Keep pillows and adult bedding away from your baby or any other items that could cover their head or cause them to overheat. A high proportion of babies who die as a result of SIDS are found with their head covered by loose bedding.

Follow all The Lullaby Trust's other safer sleep advice to reduce the risk of SIDS such as sleeping baby on their back

To reduce the risk of accidents, do not bring other children or pets into bed with you.

Try to make sure or check that baby cannot be trapped, wedged or fall out of bed or get trapped between the mattress and the wall

Never leave your baby unattended in an adult bed

For more info on co-sleeping and safer sleep read our guide for parents
If you are bedsharing with your baby you should consider any risks before every sleep. It is easy for your situation to change if you are unwell or have drunk any alcohol, which means your baby will be safest in a separate sleep space such as a cot or Moses basket on that occasion.

Co-sleeping with your baby: FAQs

I am worried I might fall asleep while I breastfeed my baby at night, is this ok?

Click here to open this question

Breastfeeding reduces the chance of SIDS. If you feel you might fall asleep we would recommend you prepare the bed as described above so it is safer for baby if this happens.

Make sure you know the advice on when never to co-sleep so you know when to take particular care. It is really important that you do not accidentally fall asleep with your baby on a sofa or armchair. If you think you might fall asleep on a sofa or armchair, put the baby down in a safe place to sleep.

Should I co-sleep with my baby?

Click here to open this question

The safest place for a baby is their own separate sleep space, such as a cot or Moses basket. We would just advise you to read all the information on co-sleeping and how to reduce the risks, so you can make an informed decision for you and your baby.

However, there are some circumstances where we would strongly recommend against co-sleeping such as on a sofa or armchair, if anyone in the bed smokes or has drunk alcohol or your baby was premature or a low birth weight.

Can I co-sleep with twins or multiples?

Click here to open this question

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

Is it safer to co-sleep using a nest or pod than with a baby just lying on the adult bed?

Click here to open this question

No. We do not recommend that babies sleep on soft surfaces such as pods or nests. If you choose to co-sleep with your baby the safest place is a clear space on a firm flat mattress the same as we would advise with a cot.

Why do you advise against co-sleeping in certain scenarios?

Click here to open this question

It is estimated that around half of SIDS deaths occur whilst co-sleeping, and that most of these are in high risk situations. We do not know the cause of SIDS and why these deaths happen but we do know what some of the risk factors are and that removing those risks greatly lowers the chance of SIDS occurring.

For that reason we strongly advise against co-sleeping when there are risk factors such as a baby being premature or a parent having drunk alcohol.

What bedding should I use for my baby when we co-sleep?
The Lullaby Trust has worked with Public Heath England, Unicef UK Baby Friendly and Basis on two publications to support families with safer sleep advice and advice on co-sleeping more safely. We have also collaborated on a guide for health professionals to have more open and productive discussions with families about safer sleep and co-sleeping. These can be downloaded below.

Click here to open this question

Adult bedding should be kept well away from your baby along with any belts or cords from clothing. Keep adult bedding at your waist height and add an extra layer of clothing if you are cold

A baby sleeping bag is a good way of giving your baby their own bedding when bedsharing.

Baby sleeping bags should be well fitted, so the baby can't wriggle down inside. Most sleeping bags are fitted according to a baby's weight, rather than age.

You might also be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust:

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Some parents choose to share a bed (known as co-sleeping) with their babies. Read our advice on how to co-sleep more safely.

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BASIS infant sleep research in the UK

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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Responsive feeding is giving your baby a feed when they show you signs they're hungry and stopping when they show you they're full. This makes your baby feel safe and cared for, supporting a close and loving bond between you and helping their brain to grow.

Breastfeeding your baby meets their needs for comfort and nutrition all in one and has many benefits for mother and child but this isn't always an option for every family.

If you can't or choose not to breastfeed, and bottle-feed with formula or expressed breastmilk, you can still follow your child's needs and nurture them with affection through responsive feeding. This will help them to grow in a way that's healthy for them.

Feeding your newborn

It's normal for your newborn to want to feed frequently.

Newborn stomachs are very small, only the size of a marble and then only increase in size slowly, so a baby can get full quickly. They need to feed little and often. This isn't a sign you don't have enough breastmilk for your baby, giving them formula will reduce your own milk supply.

If bottle-fed babies take more than they need, their stomachs can be overstretched and may become bigger than they might have been, leading them to need more milk to feel full.

Feeding in the early days can seem overwhelming and tiring, especially if your baby feeds a lot at night.

You and your baby will find more of a rhythm with feeds as they get older.

Your baby will show you signs they are hungry before they start to cry.

sticking out their tongue

smacking their lips

sucking on their fists

turning their head to find milk.

Crying doesn't always mean a baby is hungry and needs a feed. Feeding a bottle-fed baby every time they cry can lead to overfeeding. Holding your baby or wearing them in a sling can help comfort your baby if they aren't showing any other hunger cues. Visit our baby behaviour and how to cope with crying for more support.

You cannot overfeed a breastfed baby, so you can feed your baby at the breast anytime, for your or their comfort.

How to bottle-feed responsively

When you bottle-feed make sure you hold your baby fairly upright, with their head supported - so they can breathe and swallow comfortably. Babies shouldn't be flat on their backs or left alone with a propped-up bottle when they are being fed, as they can choke.

Hold the bottle flat with a slight tilt so they're not overwhelmed with the flow. Start by stroking your baby's top lip so they open their mouth and draw the teat in. Let them take the lead.

Babies feed in bursts of sucking with short pauses to rest. When your baby slows down, lower the bottle slightly to stop the milk flowing, let your baby pause and decide if they want to draw it in again.

Giving your baby a break allows them to register how full they are and how much more they need - helping them to control how much they take.

Talk to your baby gently and look into their eyes. This helps them to feel safe and loved. In the early weeks, to help your baby feel more secure, keep feeding as a special time between you and your baby.
As your baby starts to feel full you might notice they:

push out the teat or don't pull it back into their mouth

start dribbling milk

turn their head or push the bottle away

fall asleep.

Once you think your baby has had enough, take the bottle away. Don't force your baby to finish a bottle however tempting it is to have that last bit of milk gone. Just like us, babies have different appetites and needs, so sometimes their feeds are longer and sometimes they are shorter.

Babies who are encouraged to keep feeding find it harder to regulate how much they eat and may gain weight too quickly as they grow. Responding to your baby and helping them take in as much milk as they need helps them grow in the way that's right for them.

It's difficult to overfeed a breastfed baby because they have to actively suck to get milk. You can breastfeed anytime for yours or your baby's comfort.

There is support available however you want to feed your baby including help to restart breastfeeding or to express breastmilk. Speak to your midwife or health visitor for more information.

Deciding how to feed your baby is a personal choice. The Health Visiting Team will support you to build a close and loving bond with your newborn.

Visit our 'Feeding your baby' page for more information on local support.

From six months, you can introduce solid food alongside your baby's usual milk feeds. At this age, most babies can sit up unaided, pick up food, put it in their mouth and swallow it rather than pushing it out again with their tongue. Remember your baby's tummy is tiny and fills up quickly, so offer milk feeds after food.

How much your baby takes is less important than getting them used to the idea of eating, alongside all the new tastes and textures they'll experience. Start with small amounts as most of their calories and nutrients will still come from breast or first-stage formula milk.

Your baby has a small tummy that fills up quickly so start with small portions and offer more if they're still hungry. Allowing your child to feed themselves as soon as they are able, will allow them to eat at their own pace. The amount your baby eats depends on their appetite, which can vary from day-to-day. Some days your baby might be more interested in milk feeds and some days solid foods.

Signs an older baby is full:

closing their mouth

turning head away or pushing food away.

Visit our 'Introducing solid foods' page for more information starting your baby on solid foods.

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Tell us what you think of our animations Kent Health Visiting Team would appreciate your feedback on our responsive feeding campaign featuring the 'feeding your baby responsively' and 'responsive feeding from six months' animations by answering our five-minute survey. This survey is open to any member of the public.

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Buckle Carrier: Neko Tiny Front Carry and Feeding

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Perinatal Mental Health Community Service

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Perinatal Mental Health Community Service

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The Perinatal Mental Health Community Service (PMHCS) specialises in the assessment, diagnosis and short-term treatment of women 18 and above who are affected by a moderate to severe perinatal mental health illness in the preconception, antenatal and postnatal period

We are a multi-professional team consisting of consultant perinatal psychiatrists, registered mental health nurses, psychologists, therapists and assistant psychologists, nursery nurses, peer support workers, occupational therapists and occupational therapy assistants, social workers and pharmacists.

In the first instance, before referral, advice should be sought from a midwife, health visitor or GP, as many women can be offered appropriate initial support and treatment in primary care. However, if more specialist support, advice, interventions or treatment is required, a referral to the perinatal mental health service can be made.

PMHCS can provide specialist mental health assessment and treatment for women and their families in pregnancy, and for women with babies up to 2 years of age who are experiencing moderate to severe perinatal mental health problems. The perinatal mental health difficulties may be new, or linked to previous mental ill health.

There are some known diagnoses that can increase the risk of a mum experiencing perinatal mental health difficulties. These include:

Bipolar affective disorder

Previous episodes of post-partum psychosis

Moderate to severe postnatal depression or anxiety

Previous or current mental health issues prior to or during pregnancy

Previous birth trauma/PTSD

Strong family history of mental health problems in the perinatal period

It is important to identify and support those at risk of developing mental health problems associated with pregnancy and child birth, or those who have pre-existing conditions by providing them with the specialist care that they may need as soon as possible. Pre conception advice is also provided.

Referrals, assessment and support

PATH perinatal panel signup form

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Perinatal Mental Health Community Service (PMHCS)

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The Perinatal Mental Health Community Service (PMHCS) specialises in the assessment, diagnosis and short-term treatment of women 18 and above who are affected by a moderate to severe perinatal mental health illness in the preconception, antenatal and postnatal period We are a multi-professional team consisting of consultant perinatal psychiatrists, registered mental health nurses, psychologists, therapists and assistant psychologists, nursery nurses, peer support workers, occupational therapists and occupational therapy assistants, social workers and pharmacists.

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Free Talk therapy for those living in Swanley, Dartford, Gravesham and Swale over the age of 16

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Free Talk therapy for those living in Swanley, Dartford, Gravesham and Swale over the age of 16

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Kent and Medway Mental Health Services & Support | Vita Health Group

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Vita Health Group’s NHS mental health services and support stretches across Kent and Medway, Dartford, Gravesham, Swanley & Swale

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Tandem Babywearing, or Carrying Multiples - Carrying Matters

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- supporting children, carers and society to be more connected through close contact.

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Images showing a wide latch with the lower lip coming on nice and low

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Knowing it's time to feed

If possible, try to feed your baby when you are both relaxed and comfortable.

Your baby will let you know they are hungry by doing things like:

sucking their fists

licking their lips

wriggling and opening their mouths, as if they're searching for your breast

Encourage your baby to feed fully from each breast. This will help them get the fattier milk that comes towards the end of the feed.

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If possible, try to feed your baby when you are both relaxed and comfortable. Your baby will let you know they are hungry by doing things like: sucking their fists licking their lips wriggling and opening their mouths, as if they're searching for your breast Encourage your baby to feed fully from each breast.

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Jack Newman Clinic Breastfeeding Videos showing swallowing and breastfeeding compressions.

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Breastfeeding Videos – International BreastFeeding Centre

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A set of videos which shows how breastfeeding works, how to know if a baby is getting milk, what is a good latch, using a lactation aid, using breast compressions, tongue tie, tongue tie release, vasospasm.

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Mastitis, abscess, engorgement and milk bleb protocol from the Association of Breastfeeding Medicine

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Mastitis, abscess, engorgement and milk bleb protocol from the Association of Breastfeeding Medicine

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Beware! some graphic images of breast abscess

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How to put on your Joy and Joe stretchy wrap

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How to put on your Joy and Joe stretchy wrap

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The T.I.C.K.S. Rules for Safe Babywearing Keep your baby close and keep your baby safe. When you are wearing a sling or carrier, don’t forget the T.I.C.K.S! T - Tight - Slings and carriers should be tight enough to hug your baby close to you, as this will be most comfortable for you both... I - In v…

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Ergobaby Carrier, Swaddler, Wrap and accessory instructions

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Colostrum Collection in Pregnancy: When to start and how to do it

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Colostrum Collection in Pregnancy: When to start and how to do it

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Does my pump fit?

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Nipple tunnel diameter varies slightly by brand (Figure 1), with 24 or 25 mm the standard diameter of most pumps. One sign a different size nipple tunnel is needed is pain or discomfort during pumping, even near the pump's lowest suction setting. Because the left and right nipples may vary in size, some parents get the best results when they use one size on one side and another size on the other side.

If pumping is comfortable with good milk flow, you probably have a good pump fit. If there is discomfort, even on low suction settings, watch your nipples during a pump session and see how they compare with Figures 2a, 2b, and 2c.

Depending on the pump brand, larger or smaller nipple tunnels may be available for purchase separately.
How Often Are Larger or Smaller Nipple Tunnels Needed?
More often than you might think. In one U.K. study, 36 mothers with babies in the NICU pumped with a standard 25 mm nipple tunnel, and the researchers noted that because they reported discomfort, the opening was too small for 28%. The authors wrote: "If the [opening] is too small, pressure is highest on the nipple tissue, which can cause sore nipples and ineffective drainage."2

In a U.S. NICU study, a different brand of pump with a 24 mm standard nipple tunnel was used. When both milk flow and comfort were assessed, a much higher percentage of mothers had better results with a larger diameter nipple tunnel. "[W]e found that 51.4%-or about half-of the 35 mothers who served as subjects in the research initially required either the 27 or 30 mm shield in order to achieve optimal, pain-free nipple and areolar movement during milk expression. As lactation progressed, 77.1%-or slightly more than three quarters-of the mothers eventually found they needed these larger shields."3
Pump Fit Can Change with Regular Pumping.
A 2019 U.S. randomized crossover study compared the effects of nursing, hand expression and pumping on the nipple sizes of 46 lactating women1. The researchers found that unlike direct nursing and hand expression, with pumping, nipple length and diameter increased in size. Two U.S. lactation consultants used an engineer's template to measure mothers' nipples before and after pumping and also found that pumping causes nipples to increase in size. They wrote: "Pre- and post-pumping measurements taken with a circle template reveal that nipple size can increase 3 to 4 millimeters."4 So even if parents are fitted well when they start pumping, it makes sense for them to check their pump fit over time to see if it has changed and whether they need a larger diameter nipple tunnel.
Signs a Larger or Smaller Nipple Tunnel Is Needed Consider a larger nipple tunnel if:
* You feel discomfort, even on low suction settings.

* Your nipple rubs along the tunnel, despite efforts to center it.

* Your nipple blanches, or turns white.

* Your nipple does not move freely in the nipple tunnel.

* You notice slow milk flow or less milk expressed than expected.
Consider a smaller nipple tunnel if:
* You feel discomfort, even on low suction settings.

* More than about 1/8 inch (3 mm) of the areola is pulled into the nipple tunnel.

* Your nipple bounces in and out of the tunnel.

* You have difficulty maintaining an air seal.

Major breast-pump brands, such as Ameda, Medela, and Spectra offer fit options ranging from 20 mm to 36 mm. Another product that can sometimes help make pumping more comfortable is Pumpin' Pal, which provides an angled nipple tunnel. Contact a lactation supporter for help in finding the best fit for you. See also the blog post HERE for other reasons pumping might feel uncomfortable.

References

1 Francis, J., & Dickton, D. (2019). Physical analysis of the breast after direct breastfeeding compared with hand or pump expression: A randomized clinical trial. Breastfeeding Medicine, 14(10), 705-711.

2 Jones, E., Dimmock, P. W., & Spencer, S. A. (2001). A randomised controlled trial to compare methods of milk expression after preterm delivery. Archives of Disease in Childhood. Fetal and Neonatal Edition, 85(2), p. F94.

3 Meier, P. (2004). Choosing a correctly-fitted breastshield. Medela Messenger, 21, p. 8.

4 Wilson-Clay, B., & Hoover, K. (2017). The Breastfeeding Atlas (6th ed.). Manchaca, TX: LactNews Press, p. 80-81.

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Getting a good pump fit is vital, especially when you pump often and the breast-pump part your nipple is drawn into (the nipple tunnel ) is composed of rigid plastic, as is true of most pumps.

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Tula Mini Instructions

1. Before use: Instruct and practice the safe opening and closing of the waist belt buckles with your child.

2. Place the waist belt around your child's waist.

3. Buckle and adjust. (Make sure you hear a "clicking" sound to ensure proper closure of the buckle)

4. Put doll or toy inside the built-in inner pocket either on the front or on the back of your child.

5. Assist in placing the should straps over their shoulders.

6. Buckle chest/back strap to hold the shoulder straps in place.

7. To remove the toy carrier: Unbuckle the waist and chest/back strap by squeezing the male part of the buckle and withdraw it from the female buckle. Remove toy carrier.

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Tula Mini Instructions 1. Before use: Instruct and practice the safe opening and closing of the waist belt buckles with your child. 2. Place the waist belt around your child's waist. 3. Buckle and adjust. (Make sure you hear a "clicking" sound to ensure proper closure of the buckle) 4.

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How to use a bottle like breastfeeding.

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Finger feeding is a technique the main purpose of which is to prepare the baby to take the breast when the baby is unable to latch on. See our blog on the baby who does not latch on. Though finger feeding can be used to feed a baby and thus avoid artificial nipples, this is not what it is meant to do really. Furthermore, if the baby is actually taking the breast (latching on) and requires supplementation, this supplementation should be given with a lactation aid at the breast not by finger feeding. See the blog on the Lactation Aid and the video clips. Too often finger feeding is used to feed the baby when a mother has sore nipples, and the baby is taken off the breast. This is seen as not interfering with breastfeeding while, at the same time, the "nipples are given a rest". Taking a baby off the breast for any reason, including sore nipples, should be a last resort only. See the blogs What is a good latch, Sore Nipples which contains information on the all purpose nipple ointment (APNO). See also the information on Candida Protocol.

Finger feeding may be used if:

1. The baby refuses the breast for whatever reason, or if the baby is too sleepy at the breast to breastfeed well. Good flow of milk to the baby will tend to wake the baby up, as, for another example, to wake up a sleepy baby during the first few days of life and there are concerns about intake.

2. The baby does not seem to be able to latch on to the breast properly, and thus does not get milk well. (However, if the baby is latching on, even not well, then it is better to use a lactation aid at the breast to give extra milk).

3. The baby is separated from the mother, for whatever reason. However, in such a situation, feeding the baby with an open cup is probably a better method of feeding the baby. Since finger feeding should be used primarily to help a baby take the breast when he is reluctant or temporarily unable, the best technique is not finger feeding if the mother is not present to breastfeed him.

4. Breastfeeding is stopped temporarily (there are very few legitimate reasons to stop breastfeeding. However, in this case too, an open cup would be better. See our blog on medication and 2 blogs on maternal illness 1 and 2.

5. Your nipples are so sore that you cannot put the baby to the breast. Finger feeding for several days may allow your nipples to heal without causing more problems by getting the baby used to an artificial nipple. However, see the first paragraph above about taking the baby off the breast. Cup feeding, even a baby only a few hours old (see photo below), is also more appropriate in this situation and takes less time.

6. Taking a baby off the breast should be a last resort only but too often is recommended as a first resort. Proper positioning and a good asymmetric latch will help sore nipples far more than finger feeding. And our "all purpose nipple ointment", described in several blogs, including this one, will help as well. This so called "nipple holiday" is not advisable and if suggested within the first few days of life may be a terrible mistake. Taking the baby off the breast does not always result in painless feedings once you start again and sometimes the baby, fed away from the breast, will refuse to latch on.
This newborn is being cup fed with his mother's expressed colostrum. Why is a bottle better? It is not.
It is true that finger feeding is much more similar to breastfeeding, if done properly, than is bottle feeding. In order to finger feed, the baby must keep his tongue down and forward over the gums, his mouth wide (the larger the finger used, the better so using a baby finger to do finger feeding is not a good idea), and his jaw forward. Furthermore, the motion of the tongue and jaw is similar to what the baby does while feeding at the breast. Finger feeding is best used to prepare the baby who is refusing to latch on to take the breast. It needs to be done only for a minute or two, at the most, just before trying the baby on the breast if the baby is refusing to latch on. See video clip Finger feed to latch.

What does this video show? Finger feeding is a useful technique to help a baby who is reluctant to latch on to latch on. Finger feeding calms an upset baby and wakes up a sleepy baby. Once the baby is sucking well on the finger, it is time to move the baby over to the breast. Do not try to force the baby to take the breast. As seen in the video, it took a couple of tries to get the baby to latch on. Letting the baby come off the breast if he has not latched on works better than trying to force him into the breast when he resists staying there, does not work at all, but only makes things worse. The baby did not take the right breast because he had already fed on the right and the flow of milk was slower than ideal even with the lactation aid. The baby took the left breast because he had not yet fed on the left so that the combination of flow from the breast and flow from the lactation aid in combination with an asymmetric latch gave him what he needed. This baby was born 8 weeks prematurely, is now 2 months old in the video and has never in his life latched on though the mother was producing all the milk the baby needed. Why was the baby not latching on? See these two blogs on the premature baby: 1 and 2. A third blog on the premature baby is also available on our website.

If the mother is not present to feed the baby or if the baby still doesn't latch on after the finger feeding is attempted, then feeding the baby with a cup is better than finger feeding which can be slow.
Please Note: If the baby is taking the breast, it is far better to use the lactation aid tube at the breast, if supplementation is truly necessary (See information sheet Protocol to Increase Breastmilk Intake and Lactation Aid). Again, finger feeding is not a good method of supplementation in the latching baby.
FINGER FEEDING (BEST LEARNED BY WATCHING AND DOING).
See also the video clip Not Yet Latching; Finger feed to Latch (same as the video above). The video shows the information below much better than words.
1. Wash your hands. It is better if the fingernail on the finger you will use has been cut short, but this is not necessary.

2. It is best to position yourself and the baby comfortably. The baby's head should be supported with one hand behind his shoulders and neck; the baby should be on your lap, half seated. It may be easiest if he is facing you. However, any position which is comfortable for you and the baby and which allows you to keep your finger flat in the baby's mouth will do. See the video clip Finger feed to latch

.

3. You will need a lactation aid, made up of a feeding tube (#5 French, 93 cm or 36 inches long), and a feeding bottle with an enlarged nipple hole, filled with expressed breast milk or supplement if breastmilk is not available. The feeding tube is passed through the enlarged nipple hole into the fluid.

4. Line up the tube so that it sits on the soft part of your index, thumb, or middle finger. The end of the tube should line up no further than the end of your finger. It is easiest to grip the tube, about where it makes a gentle curve, between your thumb and middle finger and then position your index finger under the tube. If this is done properly, there is no need to tape the tube to your finger.

5. Using your finger with the tube, tickle the baby's upper lip lightly until the baby opens up his mouth enough to allow your finger to enter. If the baby is very sleepy, but needs to be fed, the finger may be gently insinuated into his mouth. Pull the baby's lower lip out if necessary by exerting some downward pressure on the baby's chin. Generally, the baby will begin to suck even if asleep and as s/he receives liquids s/he will then wake up.

6. Insert your finger with the tube so that the soft part of your finger remains upwards. Keep your finger as flat as possible, thus keeping the baby's tongue flat and forward. Usually the baby will begin sucking on the finger, and allow the finger to enter quite far. The baby will not usually gag on your finger even if it is in his mouth quite far, unless the baby is not hungry or he is very used to bottles.

7. Gently pull down the baby's chin, if his lower lip is sucked in.

8. The technique is working if the baby is drinking. If feeding is very slow, you may raise the bottle above the baby's head, but usually this should not be necessary. Try to keep your finger straight, flattening the baby's tongue. Try not to point your finger up, but keep it flat. Do not apply pressure to the roof of baby's mouth.

9. The use of finger feeding with a syringe to push milk into the baby's mouth is, in our opinion, too difficult for the mother to do alone and definitely not more effective than simply using a bottle with the nipple hole enlarged and the tube coming from it. The idea of finger feeding is not really to feed the baby! The idea is to train the baby to suck properly so that pushing milk into his mouth defeats the whole purpose of finger feeding.

If you are having trouble getting the baby to latch on to or to suckle at the breast, remember that a ravenous baby can make the going very difficult. Take the edge off his hunger by using the finger feeding technique for a minute or so. Once the baby has settled a little, and sucks well on your finger (usually only a minute or so is necessary), try offering the breast again. If you still encounter difficulty, do not be discouraged. Go back to finger feeding and try again later in the feed or next feeding. This technique usually works. Sometimes several days, or on occasion a week or more, of finger feeding are necessary, however.

CUP FEEDING

See photo above, and this video. This baby in the video is already 4 months old and has been essentially bottle fed from birth. He is not at first liking this new way of feeding, but improved with time.

Cup feeding (and similar vessels like spoon, etc) is a method of feeding baby that has been around for a very long period of time. It should be used to feed a baby who is not yet taking the breast and is better than a bottle. This should not be used to supplement a baby who is taking the breast (see the information sheets Lactation Aid and The Baby Who Does Not Yet Latch).

1. Sit baby upright on your lap with baby's head supported while you have one hand behind his shoulders and neck

Use a small medicine cup or shot glass when first learning how to cup feed

2. Place the edge of the cup gently on baby's lower lip or gum

3. Bring the liquid to baby's lower lip so baby will lap it up like a pussycat. Do not pour the liquid in baby's mouth

4. It is important to maintain the level of the liquid as best as possible so baby can continually lap it up.

5. Go slowly as the two of you learn how to do this. Eventually, this can become a very fast and efficient way of feeding until baby learns to take the breast, and this is a good method to use to avoid artificial nipples and teats.

If you are leaving the hospital finger or cup feeding the baby, make an appointment with the clinic within a day or so of discharge, or get other good hands-on help quickly. The earlier the better. Once the baby is taking the breast, s/he may still require the lactation aid to supplement for a period of time; because although the baby may take the breast, the latch can still be less than ideal, and the suck may still not be efficient enough to ensure adequate intake.
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don't know what this means, please email us to ask!

©IBC, updated July 2009, 2021

Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.

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International BreastFeeding Centre | Finger feeding and cup feeding

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Finger feeding is a technique the main purpose of which is to prepare the baby to take the breast when the baby is unable to latch on. See our blog on the baby who does not latch on .

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User manuals - Mamaruga - Creative Babywearing

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Dracomum Hatchling Carrier instructions 

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Dracomum Hatchling Carrier instructions 

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Babywearing is common around the world and has been practiced for decades. Despite its commonality, one of the largest factors in reported injuries is user error. It is important to understand how to safely use your TwinGo Carrier. Please review all warnings and instructions before using your carrier.

Dual Carry

This video demonstrates how to assemble and load two children in the TwinGo Carrier.

When will my baby be ready? Dual Carry is ideal when at least one baby meets ALL 3 criterion to be worn on your back:

1. Development: Baby must have well-developed head/neck control when awake and asleep.

2. Size:Baby must be tall enough his head is outside the carrier and his legs must be long enough to comfortably straddle the panel of the carrier

3. Age:Baby must be 4+ months corrected age in good health

Please read: Is my baby ready for Back Carry in the TwinGo?
Waist Belt Sizing & Fitment Instructions for Dual Carry
Single Front Carry

This video demonstrates how to wear a baby on your front in the Base Carrier.

This video demonstrates how to install the Backpack Shoulder Straps and wear the carrier in the Front Carry Position.

This video demonstrates how to install the shoulder straps, crisscross them and load a baby in the Front Carry position.
Single Front Carry
When will my baby be ready?
The front carry is ideal for babies starting at 10 lbs, or starting at 7 lbs with the use of the TwinGo Infant Insert.

Single Back Carry

This video demonstrates how to put a baby on your back. This method is used for both single-child and double-child methods.

This video demonstrates how to take a baby off your back. This method works for both single-child and double-child methods.
Single Back Carry

When will my baby be ready?

1. Development: Baby must have strong and consistent head/neck control when awake and asleep.

2. Size:Baby must be tall enough his head is outside the carrier and his legs must be long enough to comfortably straddle the panel with knees extending over the edge of the carrier

3. Age:Baby must be 4+ months corrected age in good health

Please read: Is my baby ready for Back Carry in the TwinGo?

Storing Your Carrier

This video demonstrates how to fold the carrier into its own pocket for convenient storage.

About Product Testing & Compliance

TwinGo LLC is a proud member of the Baby Carrier Industry Alliance. The TwinGo Carrier is tested to the following safety standards: EN13209-2:2015, ASTM F2236-16, and CPSIA. The carrier was tested as two separate single carriers worn on the front, back and as a tandem carrier. A total of 5 separate ASTM 2236 tests were conducted and a total of 5 separate EN13209-2 tests were conducted. We invested a lot of resources in research, development and testing.

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Babywearing is common around the world and has been practiced for decades. Despite its commonality, one of the largest factors in reported injuries is user error. It is important to understand how to safely use your TwinGo Carrier. Please review all warnings and instructions before using your carrier.

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Do you have a new baby carrier you would like to learn to use? This page is a collection of "using your carrier" resources, general babywearing resources, and troubleshooting tips. This is a great place to get started with babywearing! Click on any of the links to get started! How to Use your Baby Carrier...

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Babywearing Educational Blog - Babywearing with Comfort, Simplicity, and Joy

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Do you have a new baby carrier you would like to learn to use? This page is a collection of "using your carrier" resources, general babywearing resources, and troubleshooting tips. This is a great place to get started with babywearing! Click on any of the links to get started!

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DOWNLOAD INSTRUCTION PDF --- RECOMMENDED VIDEOS HERE With thanks to Babywearing Consultant Roamy Hunt - South East Slings, UK ---

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No buckle, no snaps - the Neko Tai combines the feeling of a woven wrap with the ease and support of a structured carrier.

Neko Tai BABY SIZE- suitable from newborn, 3.5kg/8lbs up to apprroximately 2-years

Jaquard weaved fabric. (% 60 combed cotton %40 bamboo)

All belt and shoulders are jaquard weaved fabric. Very soft and cushy

Fully adjustable pannel width and height.

Width measures (min-max) 20cm -40 cm

Height measures (min - max) 20cm - 42 cm

Elastic head support line

Shoulder fabric width 25 cm, lenght 195 cm

Supportive belt foam

Belt measures (min - max) 60cm -180 cm

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No buckle, no snaps - the Neko Tai combines the feeling of a woven wrap with the ease and support of a structured carrier. Neko Tai BABY SIZE- suitable from newborn, 3.5kg/8lbs up to apprroximately 2-years Jaquard weaved fabric. (% 60 combed cotton %40 bamboo) All belt and shoulders are jaquard weaved fabric.

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Instructional VIDEOS Archives - Isara Blog

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Instructional VIDEOS about how to adjust ISARA for each type of carry

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Izmi Carrier and Stretchy Wrap instructions

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Izmi Carrier and Stretchy Wrap instructions

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Cheeky Rascals Limited is a company registered in England & Wales (registered number: 3933118) whose registered office is at Liss Mill, Mill Road, Liss, England, GU33 7BD. VAT number: GB GB689097664. ©2021. All rights reserved.

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Minimonkey Mini, Carrier and Twin Carrier instructions

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Minimonkey Mini, Carrier and Twin Carrier instructions

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All presented below

Instructions Baby Carrier

Our newest model, the Minimonkey Baby Carrier.

Instruction video

Instructions Sling Classic

This product has been out of our assortment for a while. If you are looking for the instructions, click on the button below.

Read the instructions

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Although the Minimonkey products are very intuitive and easy to use, it always helps to have a look at the instructions, videos and tips 💡

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Newborn Nappy Kit Information #16 TEMPLATE A

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Tongue exercises for pre and post procedure

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Tongue exercises for pre and post procedure

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Nipple eczema/dermatitis by Wendy Jones

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Nipple eczema (dermatitis) and breastfeeding – Breastfeeding and Medication

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Suck Training Exercises for the Older Infant

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Suck Training Exercises for the Older Infant

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Suck training exercises for the older baby

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Paced Bottle Feeding For The Breastfed Baby

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Thrush and Medication by Wendy Jones

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Thrush and Breastfeeding – Breastfeeding and Medication

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I’m hearing of some really weird treatment of topical thrush in the recent few days and weeks.

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Maya Bolman gentle breast gymnastics for engorgement

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Maya Bolman gentle breast gymnastics for engorgement

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In light of the unfolding tragedy in Israel, Lahav is collecting and distributing human milk to those in need. You can make a financial contribution to Lahav here.

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Cow's Milk Protein Allergy and Lactose Intolerance 

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Cow's Milk Protein Allergy and Lactose Intolerance 

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CMPA is an allergy to the beta-lactoglobulin protein in cow’s milk. Learn about this and lactose intolerance in this article.

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IS THRUSH CAUSING MY SORE NIPPLES? Introduction Common reasons for ongoing nipple pain Approaches to try to help resolve painful nipples or breasts If you

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Mastitis & Blocked Ducts - How Do I Clear a Blockage? | Carol Smyth IBCLC & CBT

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Mastitis & Blocked Ducts - How Do I Clear a Blockage? | Carol Smyth IBCLC & CBT

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Mastitis means inflammation of the breast. “Mast” (to do with the breast) and “itis” (inflammation). Inflammation can be on a spectrum from mild inflammation to very severe inflammation and in the same way inflammation of the breast is a spectrum from mild engorgement on the mild end, through blockages, through mastitis right up to abscesses on the extreme end.

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Selection and Use of Galactagogues - La Leche League International

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Galactagogues (foods, herbs and medicines that may help milk supply)

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Galactagogues (foods, herbs and medicines that may help milk supply)

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Frank J. Nice, RPh, DPA, CPHP and Mary Francell, MA, IBCLC

Many breastfeeding mothers worry about making enough milk for their babies. Sometimes these concerns are unfounded and LLL Leaders can reassure mothers by asking about diaper (nappy) output, latching, audible swallows and weight gain and by referring them to many of our resources for further information. Leaders can provide parents with information on supply and demand, and how frequent, effective breast emptying with breast compression and massage is the first milk supply management strategy. But if there truly is a milk supply issue unrelated to management, mothers often turn to galactagogues-teas, supplements and foods that can support milk production. Pharmacist and author Dr Frank Nice discusses popular galactagogues that parents may take to try to help their milk supply.

Galactagogues may be considered to increase a milk supply when non-medical interventions do not help. Some prescription (synthetic) galactagogues typically increase prolactin levels and thus help with milk production when low prolactin is at fault, but some also help to initiate the breast milk let-down (milk ejection reflex). Multiple mechanisms may come into play and we don't have clear information on how many herbal galactagogues work.

Synthetic galactagogues

Synthetic galactagogues include domperidone and metoclopramide (dopamine antagonists), and miscellaneous agents such as metformin. These three drugs are the most commonly used synthetic galactagogues due to their relative efficacy and safety in breastfeeding women. However, there are a number of caveats. Metoclopramide (Reglan) can have significant side effects, including depression. Metformin may help milk supply in women who have blood sugar issues, but there is no strong evidence of its efficacy. Domperidone is widely available by prescription and even over the counter in many countries. However, it has not been approved for use by the Food and Drug Administration [FDA] in the United States (USA) because the drug manufacturer did not apply for FDA approval. Clinical trials are currently underway which may change that in the future. Parents should always consult with a breastfeeding specialist such as an International Board Certified Lactation Consultant (IBCLC) if they have concerns about low milk supply, and their physician before taking any synthetic galactagogue.

Herbs and food

Many herbs and foods have been used traditionally for their lactogenic (milk-making) properties. The list is quite extensive and includes alfalfa, almonds, anise, asparagus, barley, basil, beets, black seed, borage, caraway, carrots, chaste tree fruit, cherries, chicken broth/soup/stock, chickpeas (garbanzo beans), coconut, coriander seeds, cumin, dandelion, dill, fennel, fenugreek, flax seeds, garlic, ginger, goat's rue, green beans, hibiscus, hops, lemon balm, lentils, lettuce, malunggay (moringa), marshmallow root, millet, molasses (blackstrap), mung, mushrooms, nettle, oat straw (oats), papaya, peas, pumpkin, quinoa seeds, red clover, red raspberry, rice, sage, seaweed soup, sesame seeds, shatavari, spinach, sunflower seeds, sweet potatoes, thistles, turmeric, and vervain. Fenugreek is one of the most widely known and recommended herbal galactogogues, although there is some anecdotal evidence that it can actually decrease milk supply in some mothers.

The specific foods thought to enhance a new mother's milk supply vary by culture. In Korea, seaweed soup is fed to mothers after birth, while new parents in India eat dal (split lentils). Lactation cookies made with oats are popular in the United States. Parents in the Phillipines, Africa and other parts of the world eat malunggay (moringa) leaves and other parts of the plant both cooked and raw. These foods tend to be nutrient dense and so can help replenish a mother's nutrient stores regardless of whether or not they help increase breast milk.

Most knowledge of herbal use comes from the systematic collection of data in Germany by the German Commission E Monographs. While a number of research studies have been done on various combinations of herbs, few have been replicated, so we don't know much about their effectiveness or side effects from long-term use. Herbal recommendations are generally based on anecdotal evidence of their use in various cultures.

Not all mothers have access to off-label drugs or desire to take prescription medications to increase milk supply. Galactagogue herbals are regulated by the FDA in the USA as foods and not medicines, as long as only "affects body function" claims and not "medical" claims are made. The European Union's Committee on Herbal Medicinal Products offers three different pathways to bring herbal products to market, including one for traditional use registration. In China, herbal products are readily available through a well established system of traditional medicine. Many other countries have their own system for herbal medicine regulation.

Because there is often easier access to these types of galactagogues, it is important for consumers to be well informed and have a real need for treatment before taking any herb. Some herbs have side effects and can be contraindicated for mothers with underlying medical conditions. Parents should always check with a health professional and herbalist, or physician who practices integrative health before taking lactogenic herbs.

If at all possible, using galactogenic foods along with effective breastfeeding management is the preferred way to help maintain and increase milk supply. Food equivalent amounts of these herbals and many others can be found in the resources below.

LLL Leaders cannot recommend individual herbs or medications

LLL Leaders can provide information on galactagogues, but are not allowed to "prescribe" or advise mothers on which of them to take or eat. A mother may have a medical condition or be taking a medication that could interact adversely with the galactagogue, so we must always recommend that parents consult an individual who is knowledgeable about their's and their baby's medical conditions and the use of herbs beforehand. The resources below may be useful resources for a nursing mother interested in exploring lactogenic herbs or foods.

Dr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for 45 years. He holds a Bachelor's degree in Pharmacy, a Master's degree in Pharmacy Administration, and Masters and Doctorate degrees in Public Administration. Dr. Nice has worked for the US Public Health Service, the National Institutes of Health and the Food and Drug Administration and has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition, The Galactagogue Recipe Book, and Recreational Drugs and Drugs Used To Treat Addicted Mothers: Impact on Pregnancy and Breastfeeding. Mary Francell and her husband Howard are the parents of three adult children. She has been an LLL Leader for over 25 years and is a contributing editor for Leader Today. Mary is an International Board Certified Lactation Consultant (IBCLC) in private practice in Bellingham, Washington, USA and currently serves as Associate Area Professional Liaison for LLL of Washington, USA.

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Selection and Use of Galactagogues - La Leche League International

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Pharmacist and author Dr Frank Nice discusses popular galactagogues that parents may take to try to help their milk supply.

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How do you treat a milk blister? * KellyMom.com

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How do you treat a milk blister? * KellyMom.com

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What is a milk blister? A milk blister, or blocked nipple pore, is also called a bleb or nipple blister, or simply "milk under the skin." It occurs when a tiny bit of skin overgrows a milk duct opening and milk backs up behind it.

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New Mastitis protocol from Association of Breastfeeding Medicine

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New Mastitis protocol from Association of Breastfeeding Medicine

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Breastfeeding the Baby with Faltering Weight

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'Faltering Weight' is used to describe a baby whose weight gain is less than expected. If your baby has faltering weight they will need to be assessed and you may need specialist support from either a midwife or health visitor with additional training and expertise in supporting breastfeeding, a local breastfeeding peer supporter or an IBCLC (internationally board certified lactation consultant).

In short:

The NICE Guideline states that:

it is common for infants to lose some weight during the early days of life

this weight loss usually stops after about 3 or 4 days of life

most infants have returned to their birth weight by 3 weeks of age.

NICE thresholds for concern include:

a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile

a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles

a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

when current weight is below the 2nd centile for age, whatever the birthweight

Historically, babies and young children who have not gained weight or not grown at the expected rate, have been termed as 'failure to thrive' and various different ways of managing this situation would be tried, depending on the view of the medical professional working with the family, and any the local policies in force to govern this.

Recently the term 'Faltering Weight' has been used instead, to describe a baby whose weight gain is less than expected, because the word 'failure' was seen as suggesting a judgement on the family. 'Faltering Growth' is now used to describe a baby or child whose growth rather than weight was less than expected.
National NICE Guidance
In 2015, the National Institute for Health and Clinical Excellence (known as 'NICE'), who provide guidance, advice, quality standards and information services for health, public health and social care, commissioned a NICE Guideline entitled 'Faltering Growth: recognition and management of faltering growth in children'. This guideline was published in September 2017 and covers 'recognition, assessment and monitoring of faltering growth in infants and children. It includes a definition of growth thresholds for concern and identifying the risk factors for, and possible causes of, faltering growth. It also covers interventions, when to refer, service design, and information and support.'

In the UK, normal healthy term babies are weighed according to the NICE Postnatal Care Guidelines and according to local practice, by the midwifery team at birth, then again by the midwifery team within the first week of life - usually about 5 days - and then again at around 10 days (by the Health Visitor at the 'Primary Visit') and around 3 weeks by the Midwife as they discharge the baby and mother from their care. Things may be slightly different for babies who are born preterm or who are unwell, and the timing of later weights is more variable.

Weights are recorded on the electronic systems used by hospitals, in the paper patient records, and in the Personal Child Health Record (PCHR) often known as the 'red book' - though in some areas the covers are no longer red. There is a table to record the weight and also other measurements, alongside the date, and there are weight and growth charts to plot the measurements against the age in weeks or months to make a graph showing weight and growth over time.

The weight charts for children from birth to four years of age which are used in the modern 'red book' are known as the UK-WHO Growth Charts, and were first added to the PCHR in 2009. The new charts are based on the World Health Organisation (WHO) Child Growth Standards, which describe the optimal growth for healthy, breast fed children. Previous UK growth charts were based on data from studies on breast and formula fed children, so did not reflect normal weight fluctuations of breast fed children in the first few weeks - which is what we're aiming for, of course.

The NICE Faltering Growth Guidance outlines thresholds at which babies are to be diagnosed as having faltering growth, and makes evidence-based suggestions about the management of the baby's feeding from there.

As an Infant Feeding Specialist, I often support families whose babies have been found not to have gained weight as expected. Sometimes this weight issue is picked up at day 3 or 5 when the babies lose a larger than desirable amount of their birth weight, sometimes it is picked up after a few weeks when baby has not got back to birth weight, and sometimes much later.

The NICE Guideline tells the reader that we should be aware that:

it is common for infants to lose some weight during the early days of life

this weight loss usually stops after about 3 or 4 days of life

most infants have returned to their birth weight by 3 weeks of age.

Checking for an underlying cause to your baby's faltering weight.

If your baby, in the first few days, loses more than 10% of her birth weight, your medical professional should first perform a clinical assessment of your baby, looking for evidence of dehydration, or of an illness or something else which might account for the weight loss. They should then ask you the right questions to gather a detailed feeding history, using the information provided in the NICE guideline on Postnatal Care to guide their questions.

Depending on whether the medical professional found something obvious to explain the weight loss, via either the clinical observation or the detailed feeding history, and whether the medical professional is appropriately skilled to conduct the observation of feeding and make useful suggestions to improve milk transfer from mother to baby, where applicable, they might then do a direct observation of the baby feeding.

If there isn't an obvious cause for the weight issue from the feeding history or clinical observation, then your health professional should ensure an observation of baby's feeding is done, crucially this must be conducted by a person with appropriate training and expertise - so if you are in this situation please seek out some expert and experienced breastfeeding support locally if possible, or remotely via telephone or social media if that is not possible. This might be from a

midwife or health visitor with additional training and expertise in supporting breastfeeding

local breastfeeding peer supporter

IBCLC (internationally board certified lactation consultant) who might also be a peer supporter, midwife or health visitor, or may be in private practice.

The guidance says that medical professionals should perform further investigations (for example blood tests or hospital in-patient stays to monitor) only if they are indicated based on the clinical assessment.
Feeding Support for a baby with faltering weight
The NICE guidance on faltering growth says that the mother of a baby who has been found to be weight faltering should be provided with feeding support, using the information in the NICE Postnatal Care Guideline.

If babies lose more than 10% of their birth weight in the early days of life, or they have not returned to their birth weight by 3 weeks of age, the NICE Faltering Growth guidance asks that the medical professional working with the family consider making a referral should be made to paediatric services (in the hospital), particularly if there is

evidence of illness

marked weight loss

failure to respond to feeding support

If no immediate referral if made because the infant is otherwise well, then a decision should be made about when to reassess your baby if she is not referred to paediatric services at this point.
How often will my baby be weighed if they have faltering weight?
If a baby loses more than 10% of their birth weight in the early days of life, then her weight should measured at appropriate intervals depending on the level of concern, but no more frequently than daily.
Example 1 - 5 day old baby needing improvement in feeding technique
A baby who is weighed by their midwife and found to have a weight loss by day 5 of over 10%, and whose clinical observations are acceptable but feeding history and feeding observations demonstrate that there is some improvement to be made in feeding technique: in this case the mother and baby should be supported to make those changes and the midwife call back in one or two days to check progress by weighing again.
Example 2 - an older baby with slow weight gain
In a situation with an older baby, where weight gain has slowed but clinical observation shows a baby who is otherwise healthy, but the feeding history or observation of feeding show an area for improvement, then again the mother should be supported to improve milk transfer to baby, and perhaps a plan should be to weigh again in a week or even longer, depending on the severity and the age of the baby.
Thresholds for concern
The NICE Guideline for Faltering Growth suggests using the following as thresholds for concern in infants and children (a centile space being the space between adjacent centile lines on the UK WHO growth charts):

a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile

a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles

a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

when current weight is below the 2nd centile for age, whatever the birthweight.

Supporting breastfeeding in babies receiving supplementary feeding with formula milk
The Guidance cautions that we should be aware that supplementary feeding with infant formula in a breastfed infant may help with immediate weight gain, but often results in breastfeeding ending before the mother planned, and sometimes in the allergic sensitisation of the baby.

If supplementation with an infant formula is given to a breastfed infant, we should support the mother to continue breastfeeding, advise her to express her breast milk to promote milk supply and then feed the infant with any available breast milk before giving any infant formula.
Underlying causes linked to faltering weight
In the case of faltering weight in an otherwise healthy baby which does not respond to interventions to improve feeding technique, the NICE Faltering Growth guidance suggests that medical professionals might consider investigating for:

urinary tract infection (follow the principles of assessment in NICE's guideline on urinary tract infection in under 16s)

coeliac disease, if the diet has included gluten-containing foods (follow the principles of assessment in NICE's guideline on coeliac disease)

and then perform further investigations only if they are indicated based on the clinical assessment.

Other factors that might be associated with faltering growth include

preterm birth

neurodevelopmental concerns

maternal postnatal depression or anxiety

The NICE guidance suggests that in faltering growth, a range of factors may contribute, and it may not be possible to identify a clear cause.

Input from someone who is expert and experienced in providing evidence-based information and support to breastfeeding families can use the feeding history and any direct observation of feeding to determine whether

ineffective suckling in breastfed infants

ineffective bottle feeding

any feeding patterns or routines being used

the feeding environment

feeding aversion

parent/carer-infant interactions, how the parents or carers respond to the infant's feeding cues

any physical disorders that affect feeding might be contributing to the faltering growth in milk-fed infants.

What to do when your Breastfeeding Baby is found to have Faltering Growth
The NICE guidance recommends that you receive help in the community from a tells 'primary care team.' A primary care team includes your midwife or health visitor, and/or your GP.

Your primary care team may need access to the following healthcare professionals with expertise relevant to faltering growth,

an infant feeding specialist, plus a consultant paediatrician

paediatric dietitian

a speech and language therapist with expertise in feeding and eating difficulties

for older children perhaps a clinical psychologist or occupational therapist.

You may have a lead healthcare professional who coordinates your baby's care and acts as the first point of contact for you and your baby, if several professionals are involved.

In practice this may mean that your midwife or health visitor begins the process by performing a clinical observation of your baby, talking through feeding history and observing a feed, or possibly calling in someone more experienced in supporting breastfeeding issues (or with the time to do it) to observe a feed, then making some initial suggestions to improve milk transfer to your baby which may include

improving the positioning of your baby at the breast

discussion of normal feeding behaviours

description of feeding cues

some enhanced methods for optimising milk transfer such as breast compressions or expressing your milk both to boost supply and also to have milk to supplement your baby with.

Together you would then agree a plan for the next day or two, or for the next week if the baby is a little older or issue not as severe, and organise a time and date to return to re-weigh your baby to assess whether the improvements to breastfeeding management have met their target.
Re-admission to hospital
There is no justification for automatic re-admission of baby to the paediatric service at the hospital for normal faltering growth when someone competent is managing the case in the community and plans have been made for improvement and reassessment, unless something is on offer in the hospital which cannot be provided in the community, for example tube feeding the baby straight into its tummy, or an observation.

NICE guidance goes on to say that we should only consider enteral tube feeding for infants and children with faltering growth when there are serious concerns about weight gain and an appropriate specialist multidisciplinary assessment for possible causes and contributory factors has been completed, and other interventions have been tried without improvement.

If tube feeding is to be used in an infant or child with faltering growth, make a plan with appropriate multidisciplinary involvement for the goals of the treatment (for example, reaching a specific weight target), and the strategy for its withdrawal once the goal is reached (for example, progressive reduction together with strategies to promote oral intake).

In most cases, the infant is simply not receiving enough milk because breastfeeding has not got off to a good enough start, either in terms of technique for supporting baby to attach to the breast, or other aspects of management like frequency of feeding and so on, perhaps because the mother has not been equipped with quite the right information and support to prepare her. Another reason for might be that there is some simple reason for the baby not being able to transfer milk sufficient to meet its needs for growth, for example restricted oral function from a 'tongue tie', or some residual damage eg to neck or jaw during birth meaning it cannot get into an effective breastfeeding position.

The crucial messages therefore, are to provide good evidence based information to mothers about how to feed effectively and the signs that things may not be going so well (signs including nappy output and signs of good attachment at the breast), and to ensure all families can access expert and experienced breastfeeding support if anything does not go as planned, so that they can get back on track properly, without needed to supplement with infant formula as this is not supportive of continued breastfeeding.

It's a steep learning curve for new mothers, but the hard work is worth it!

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Breastfeeding the Baby with Faltering Weight

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'Faltering Weight' is used to describe a baby whose weight gain is less than expected. If your baby has faltering weight they will need to be assessed and you may need specialist support from either a midwife or health visitor with additional training and expertise in supporting breastfeeding, a local breastfeeding peer supporter or an IBCLC (internationally board certified lactation consultant).

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10 minute meditation for those weaning an older child 

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10 minute meditation for those weaning an older child 

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Using a breastfeeding pillow

​In this video, I talk about whether using a breastfeeding pillow is necessary (spoiler alert: it usually isn't) and how they can sometimes cause problems.

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Using a breastfeeding pillow ​In this video, I talk about whether using a breastfeeding pillow is necessary (spoiler alert: it usually isn't) and how they can sometimes cause problems.

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What Should I Do if My Baby Bites Me?

A baby may bite during a nursing session for many different reasons - distraction, teething, cold or ear infection (it's hard for your baby to swallow while breastfeeding with a blocked nose). Once it has happened, it may cause you to be tense or fearful at the next feeding. Here are some thoughts that may help you based on questions that arise at this time:

My baby bit me! Does this mean I have to wean?

Weaning is rarely the answer when a baby bites. It is important to identify the cause and work to correct it.

My baby is teething and bit me! What can I do?

Try the PACED approach:

Positioning - Review how your baby latches. As he has grown have you been less attentive to how he latches? Position so that the nipple is aimed to the roof of his mouth and wait for a wide open mouth before quickly hugging him close. Keep his bottom close to help angle his head back. When your baby is latched on correctly and nursing actively, getting milk from your breast and swallowing, it's physically impossible to bite.

Act fast - Try and watch for a hint that your baby is about to bite - usually after their initial hunger has been satisfied - when you feel your baby pausing and her jaw tensing, quickly break her suction, slide your index finger into her mouth and between her gums. Remove her from the breast. Pulling your baby straight off is a very natural and almost automatic response, but it may cause damage to your nipple.

Comfort - Your baby doesn't know it hurts you. He may be surprised and unhappy that you have stopped the feeding. Give a cuddle with a firm "no bite" and then offer a cold teether - a wet washcloth wrapped around an ice cube or a home-made ice water pop - or a commercial teether. Offer the breast again if baby is still rooting.

Expression/compression - Keeping milk flowing can help. Baby can't bite if she is actively sucking. If your baby seems to be slowing down (jaw tensing may or may not be present), do breast compressions to increase flow which will remind her to suck and swallow. You can also express a bit to start flow at the opposite breast and quickly move baby there to continue feeding.

Distract - Talk to your baby. Say his name. Play a game to get him to laugh for a quick release from the breast.

Since I began working, my baby has started to bite at the breast. Should I wean?

Not at all!

Review the PACED approach above for feedings at home.

Ask the caregiver to demonstrate how she is feeding your baby.

Observe for a paced manner, so that your baby is not clamping to stop a fast flow.

Make sure your baby is not allowed to tug and chew on the bottle nipple.

Make sure your baby is not being given a pacifier if you do not use one at home and/or not allowed to chew on one if one is given.

My baby has a cold and has started biting during feedings. Should I wean?

When your baby is ill, continued breastfeeding with all of the active antibodies is more important than ever!

Review positioning - Your baby may need to be more upright to allow congestion to drain more easily and for easier breathing. You may want to adjust your usual positioning to one where baby is in a more sitting position or even laying on top of your chest.

Consider wearing your baby to keep him upright and nursing him while wearing him.

Some mothers will run a humidifier in baby's room or run the shower in the bathroom. The increased humidity can open up your baby's airways for easier breathing.

If the baby is tugging at her ear, she may have an ear infection. See the pediatrician to check for an ear infection or more severe illness.

You can print to paper or to a PDF file. For best printing results, open the llli.org site in Google Chrome or Microsoft Edge. Although you can view the site well in any browser, printing from other browsers might not operate correctly. 1. Browse to the web document that you want to print.
2. Click the Print button that is displayed on the web page (not the Print command on the browser menu or toolbar).
This opens the browser print window. The window displays a preview of the document that will be printed. The preview might take a minute to display, depending on the document size.

3. In the Printer box, select the desired printer.
For example, if you are working on a Windows computer, and you want to print to a PDF file, select Save as PDF.
4. As required, configure the other options such as the pages to print.
5. Click the Print button.
If you are generating a PDF, click Save. You are prompted for the name and folder location to save the file.

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What Should I Do if My Baby Bites Me? A baby may bite during a nursing session for many different reasons - distraction, teething, cold or ear infection (it's hard for your baby to swallow while breastfeeding with a blocked nose). Once it has happened, it may cause you to be tense or fearful at the next feeding.

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The Tongue Tie Centre | Holistic and Functional Tongue Tie Practice

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London Pay what you can Tongue Tie Clinic

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London Pay what you can Tongue Tie Clinic

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The Tongue Tie Centre | Holistic and Functional Tongue Tie Practice

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The Tongue Tie Centre | Holistic and Functional Tongue Tie Practice

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The Tongue Tie Centre is a community interest organisation embodying a holistic and functional approach to tongue tie. All families are welcome irrespective of their financial means to pay.

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In the first hour, go directly from birth to skin-to-skin to breastfeeding, without interruption. Keep the connection to best supports attachment. An effective, comfortable "deep latch", with your nipple placed far back in baby's mouth may not come right away.

Attachment difficulty is common, for many reasons, and with 3 key steps and patience, attachment improves.

lots of skin-to-skin time
helpful positioning and handling techniques
last, but most important, a robust milk supply.

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In the first hour, go directly from birth to skin-to-skin to breastfeeding, without interruption. Keep the connection to best supports attachment. An effective, comfortable "deep latch", with your nipple placed far back in baby's mouth may not come right away. Attachment difficulty is common, for many reasons, and with 3 key steps and patience, attachment improves.

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Gentle post-frenotomy care and mouth work by Melissa Cole, MS, IBCLC of Luna Lactation & Wellness

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Post frenulotomy exercises - Luna lactation

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Post frenulotomy exercises - Luna lactation

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Gentle post-frenotomy care and mouth work by Melissa Cole, MS, IBCLC of Luna Lactation & Wellness

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Sleeping Tongue Posture Hold- Pain Free Post Frenotomy Care

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Sleeping Tongue Posture Hold- Pain Free Post Frenotomy Care

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Bibliography

By Kelly Bonyata, BS, IBCLC

Relactation
@
@ other websites
@
Induced Lactation and Adoptive Breastfeeding

@ other websites

Breastfeeding Without Birthing

Breastfeeding Your Adopted Baby or Baby Born by Surrogate/Gestational Carrier by Jack Newman, MD, FRCPC

Breastfeeding Your Adopted Baby from Breastfeeding USA

Breastfeeding the adopted child by Karleen Gribble, from the Australian Breastfeeding Association

World Health Organization

Induced Lactation by Barbara Wilson-Clay, BSE, IBCLC (at surrogacy.com)

Breastfeeding an Adopted Baby by Barbara Wilson-Clay, BSE, IBCLC

Breastfeed Your Adopted Baby by Teglene Ryan

My Adoptive Breastfeeding Journey by Teglene Ryan

Relactation and Adoptive Nursing by Anne Smith, IBCLC

Lact Aid's Online Library with information on adoptive nursing

Preparing to Nurse Our Baby; Learning about Adoptive Nursing

A Special Gift: Breastfeeding an Adopted Baby by Julie Bouchet Horwitz, from Mothering magazine Issue 104, January/February 2001.

Publications (most recent listed first)

Books
Relactation

Wambach K, Riordan J. Breastfeeding and Human Lactation, 5th ed. Boston and London: Jones and Bartlett, 2015.

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 8th ed. Atlanta, GA: Elsevier, 2015.

Schnell, A. Breastfeeding Without Birthing. Amarillo, Texas: Praeclarus Press, 2013.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010: 603-614.

Wiessinger D, West D, Pitman, T. The Womanly Art of Breastfeeding, 8th revised ed. New York: Ballantine Books, 2010.

Australian Breastfeeding Association. Relactation and Adoptive Breastfeeding. East Malvern, Victoria: Australian Breastfeeding Association; 2004 April.

Newman J, Pitman T. The Ultimate Breastfeeding Book of Answers. Harmony; 2006.

Department of Child and Adolescent Health and Development. Relactation: A review of experience and recommendations for practice (WHO/CHS/CAH/98.14). Geneva: World Health Organization, 1998.

Programme for Nutrition Policy, Infant Feeding and Food Security. Infant Feeding in Emergencies [Large PDF file] (EU/ICP/LVNG 01 02 08). Geneva: World Health Organization, 1997.

Adoptive Breastfeeding
Journal Articles

Banapurmath S, Banapurmath CR, Kesaree N. Initiation of lactation and establishing relactation in outpatients. Indian Pediatr. 2003 Apr;40(4):343-7.

Menon J, Mathews L. Relactation in mothers of high risk infants. Indian Pediatr. 2002 Oct;39(10):983-4.

De NC, Pandit B, Mishra SK, Pappu K, Chaudhuri SK. Initiating the process of relactation: an Institute based study. Indian Pediatr. 2002 Feb;39(2):173-8.

Marquis GS, Diaz J, Bartolini R, Creed de Kanashiro H, Rasmussen KM. Recognizing the reversible nature of child-feeding decisions: breastfeeding, weaning, and relactation patterns in a shanty town community of Lima, Peru. Soc Sci Med. 1998 Sep;47(5):645-56.

Rogers IS. Relactation. Early Hum Dev. 1997 Oct 29;49 Suppl:S75-81.

Seema, Patwari AK, Satyanarayana L. Relactation: an effective intervention to promote exclusive breastfeeding. J Trop Pediatr. 1997 Aug;43(4):213-6.

Thompson NM. Relactation in a newborn intensive care setting. J Hum Lact. 1996 Sep;12(3):233-5.

Phillips V. Relactation in mothers of children over 12 months. J Trop Pediatr. 1993 Feb;39(1):45-8.

Bose CL, D'Ercole AJ, Lester AG, Hunter RS, Barrett JR. Relactation by mothers of sick and premature infants. Pediatrics. 1981 Apr;67(4):565-9.

Auerbach KG, Avery JL. Relactation: a study of 366 cases. Pediatrics. 1980 Feb;65(2):236-42.

Biervliet FP, Maguiness SD, Hay DM, Killick SR, Atkin SL. Induction of lactation in the intended mother of a surrogate pregnancy: Case report. Hum Reprod. 2001 Mar;16(3):581-3.

Cheales-Siebenaler NJ. Induced lactation in an adoptive mother. J Hum Lact. 1999 Mar;15(1):41-3.

Abejide OR, Tadese MA, Babajide DE, Torimiro SE, Davies-Adetugbo AA, Makanjuola RO. Non-puerperal induced lactation in a Nigerian community: case reports. Ann Trop Paediatr. 1997 Jun;17(2):109-14.

Hartmann P, Atwood C, Cox D, et al. Endocrine and autocrine strategies for the control of lactation in women and sows. In: Wilde C, Peaker M, Knight D, eds. Intercellular signaling in the mammary gland. New York, NY: Plenum Press; 1995: 203-225.

Nemba K. Induced lactation: a study of 37 non-puerperal mothers. J Trop Pediatr. 1994 Aug;40(4):240-2.

Banapurmath CR, Banapurmath S, Kesaree N. Successful induced non-puerperal lactation in surrogate mothers. Indian J Pediatr. 1993 Sep-Oct;60(5):639-43.

Amico JA, Finley BE. Breast stimulation in cycling women, pregnant women and a woman with induced lactation: pattern of release of oxytocin, prolactin and luteinizing hormone. Clin Endocrinol (Oxf). 1986 Aug;25(2):97-106.

De Leo V, Petraglia F, Sardelli S, et al. Use of domperidone in the induction and maintenance of maternal breast feeding. Minerva Ginecol. 1986 Apr;38(4):311-5.

Petraglia F, De Leo V, Sardelli S, Pieroni ML, D'Antona N, Genazzani AR. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol. 1985 May;19(5):281-7.

Auerbach KG, Avery JL. Induced lactation. A study of adoptive nursing by 240 women. Am J Dis Child. 1981 Apr;135(4):340-3.

Auerbach KG. Extraordinary breast feeding: relactation/induced lactation. J Trop Pediatr. 1981 Feb;27(1):52-5.

Kulski JK, Hartmann PE, Saint WJ, Giles PF, Gutteridge DH. Changes in the milk composition of nonpuerperal women. Am J Obstet Gynecol. 1981 Mar 1;139(5):597-604.

Kleinman R, Jacobson L, Hormann E, Walker WA. Protein values of milk samples from mothers without biologic pregnancies. J Pediatr. 1980 Oct;97(4):612-5.

Jelliffe DB, Jelliffe EF. Non-puerperal induced lactation. Pediatrics. 1972 Jul;50(1):170-1.

Slome C. Nonpuerperal lactation in grandmothers. J Pediatr. 1956 Nov;49(5):550-2.

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Relactation and Induced Lactation Resources * KellyMom.com

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By Kelly Bonyata, BS, IBCLC @ @ other websites @ Breastfeeding Without Birthing Breastfeeding Your Adopted Baby or Baby Born by Surrogate/Gestational Carrier by Jack Newman, MD, FRCPC Breastfeeding Your Adopted Baby from Breastfeeding USA Breastfeeding the adopted child by Karleen Gribble, from the Australian Breastfeeding Association World Health Organization

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10 hours womb sounds / Baby Einschlaf-Hilfe (Mutterleibs-Geräusche) (► SOUND DESIGN)

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Texas Department of State Health Services

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BASIS - Normal sleep development

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Popular beliefs about when babies should be 'sleeping through the night' are based on studies conducted in the 1950s and 1960s on groups of formula-fed babies. However, it is normal for babies - especially breastfed babies - to wake and feed throughout the night during, at least, the first year. Encouraging babies to 'sleep through' before they are ready to do so makes it difficult to keep breastfeeding and may encourage babies to develop mature sleep patterns out of sequence with their other circadian patterns, such as those controlling the regulation of temperature, hormone production, and the genes that control our biological rhythms.

Babies operate according to their own internal biological rhythms, and they are unaware of what their parents are reading or being told. Babies do not have a body clock when they are born. It often takes several months for a baby's day-night pattern of wake and sleep to become established, and for night-time sleep consolidation to happen. During this time many parents just need reassurance that their baby is normal, and that their baby's sleep patterns are developing as expected.

New-born babies may sleep for 18 or so hours a day, but often for only for 2-3 hours at a time. During the first-year overall sleep duration falls to around 15 hours a day, and the majority of sleep becomes concentrated during night-time as the circadian rhythms* develop.
Sleep variation
In a comprehensive systematic review (Galland et al. 2012) combined data from 34 studies relating to normal infant sleep duration. The chart below shows part of this data for babies aged up to one year. Data from each study & age range are represented by a dot which shows the average total sleep experienced. [The dotted line shows the amount of variation around that average.] It is clear that younger babies sleep longer overall, but there is also a lot of variation among individual babies, and within studies for this group.

Sleep is a developmental process, and our sleep needs change throughout our lifetimes. Babies' sleep patterns mature over the first several years of life, and the sleep architecture of newborns is very different to that of adults. Newborns sleep for 18-20 or so hours a day, but only for 2-3 hours at a time. During the first-year overall sleep duration falls to around 15 hours, and the majority of sleep becomes consolidated during night-time as circadian rhythms develop (Parmelee et al 1964).

*Circadian rhythms - biological processes which are roughly tied to the 24-hour day, and periods of daylight and dark. Processes regulated by our circadian rhythms include heart rate, temperature and our 'body clock', along with the production of hormones which make us feel sleepy or alert.*

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Perinatal Mental Health Information from Mind

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Perinatal Mental Health Information from Mind

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Mental Health Information from Maidstone and Tunbridge Wells Hospital

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Mental Health Information from Maidstone and Tunbridge Wells Hospital

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Thrush Information

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This information is also available in PDF format by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals. "I had been breastfeeding without problem for 5 months then suddenly developed terrible pains after every breastfeed. I hadn't changed anything and I was very confused. I noticed my baby's tongue was white. The doctor took swabs of my nipples and my daughter's mouth which confirmed we had thrush. It cleared up with treatment within a week" "I was told I had thrush when my baby was 4 weeks old but I could feel her clamping onto my nipple to slow my really fast flow. I went to see someone else who helped me to sort out my baby's attachment at the breast and the pain went without any medicines." "Who'd have thought such pain could stem from just an incorrect latch on. He fed for longer and it definitely didn't hurt as much afterwards. I'll keep on working to improve the attachment."
Thrush (Candida albicans) infection can affect a mother's breast while she is breastfeeding but it is being over-diagnosed at the moment. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

There is pain in only one breast/nipple

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

www.breastfeedingnetwork.org.uk/differential-diagnosis-of-breast-pain/

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

If you think you have thrush

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

If breastfeeding itself hurts check this information: www.breastfeedingnetwork.org.uk/if-breastfeeding-hurts-05-may-2015

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection

BREASTFEEDING SHOULD BE PAIN-FREE from the point of attachment (the moment the baby goes to the breast) onwards. (Pain from thrush begins after a feed). There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain.

Other causes of nipple pain:

attachment of the baby to the breast may need fine-tuning

eczema including reactions to breast pads or creams

tongue-tie in the baby

Reynaud's syndrome (associated with history of poor circulation and pain made worse when cold)

white spot which produces pin-point pain

bacterial infection which appears as a yellowy, thick discharge

vasospasm which is associated with less than perfect attachment of the baby at the breast and produces white nipples (particularly at the tip) after breastfeeds

www.breastfeedingnetwork.org.uk/if-breastfeeding-hurts-05-may-2015
Self-help measures

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally some mothers find reducing the level of sugar and yeast in their diet helps

IMPORTANT - To make sure that you get rid of thrush infection, both you and your baby need treatment. Usually once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.
If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.
Treatment

Ongoing attention to positioning and attachment because even the best latch can slip a little sometimes.

Miconazole cream applied to your nipples after every feed - sparingly and without washing off before the next feed

Miconazole oral gel applied gently to your baby's mouth 4 times a day a small amount at a time

If symptoms persist you may need fluconazole 150-400mg as a loading dose followed by 100-200mg daily for at least ten days. This is rarely necessary if your baby is less than 6 weeks old and could cause vomiting and stomach pains.
More detailed information can be found at www.breastfeedingnetwork.org.uk/thrush-detailed.
© Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network June 2020

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Thrush (of the breast/nipple) and Breastfeeding - Information for Mothers - The Breastfeeding Network

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This information is also available in PDF format by clicking here. The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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Covid and Dr Hale

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The InfantRisk Center has received numerous queries concerning the use of Covid-19 Vaccinations in pregnant and breastfeeding mothers. Below are recommendations from several groups.

Plain Language Summary:

Similar to other medications, pregnant and/or breastfeeding women have not been included in studies to determine how well COVID vaccines work or how safe they are. Based on what we understand from similar vaccines, we believe the risks that come with vaccination will probably be low. Therefore, while we wait for more information, each mother and provider should discuss what choice fits their situation best. The risk and benefit of the vaccine should be compared to each mother's individual risk for getting COVID-19 as well as how well she is expected to tolerate the disease.

The use of these new vaccines in breastfeeding mothers has not been studied, largely because none of them have been approved for use. That said, it is our opinion that most of the COVID-19 vaccines are probably going to be quite safe for breastfeeding mothers and their infants. In these situations, physicians and breastfeeding mothers in consult, will have to weigh the relative risks of the vaccine to that of the infection with Corona virus in that specific mother.

At this time, none of the new vaccines are live or infectious. All the mRNA vaccines thus far (produced by Pfizer and Moderna) are prepared by stimulating the human mRNA within the cell to build the "spike" proteins. In another set of vaccines, the structure of the spike protein from the virus is synthetically rebuilt by recombinant means and presented bound to another carrier protein to the patient in the injection. The body then creates antibodies to this "spike" protein.

The new mRNA vaccines(Pfizer and Maderna), give the muscle cell instructions to make a harmless piece of protein called the "spike protein." The Spike protein is the mushroom-like protein on the surface of the virus that allows it attach to the body's cells. Once the mRNA instructions are inside the muscle cells, the cell uses them to make a lot of spike protein. After this protein piece is made, it moves to the surface of the cell. Next, the cell displays the Spike protein piece on its surface. Our immune system quickly recognizes that the spike protein doesn't belong there and starts making antibodies. Thus, you become temporarily immune to the COVID-19 virus. The muscle cell then breaks down mRNA code and rids itself of these mRNA instructions.

At this time, we do not know how long this immunity will last. New data from the Pfizer vaccine suggest significant immunity to Covid-19 by 2 weeks.

At the end of the vaccination process, our bodies have learned how to protect against future infection. The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain this protection without ever having to risk the serious consequences of getting sick with COVID-19. Also, you're never exposed to a live virus in the vaccine.

As for breastfeeding, little or none of these vaccine components would ever reach the milk compartment, or even be transferred into human milk. Even if they were, they would simply be digested like any other protein by the infant. It is our opinion, that the present group of vaccines are probably going to be quite safe for breastfeeding mothers. The infant may even gain a small amount of maternal IgG in the breastmilk, which may even be beneficial.

Unfortunately, the safety of these vaccines will only be determined after significant use in patients.

For pregnant women, the Society for Maternal-Fetal Medicine (SMFM) has issued the statement below supporting the use of Covid-19 vaccinations in pregnant women. Below is a partial paragraph from their :

"In general, SMFM strongly recommends that pregnant women have access to COVID-19 vaccines in all phases of future vaccine campaigns, and that she and her healthcare professional engage in shared decision-making regarding her receipt of the vaccine. Counseling should balance available data on vaccine safety, risks to pregnant women from SARS-CoV-2 infection, and a woman's individual risk for infection and severe disease. As data emerge, counseling will likely shift, as some vaccines may be more suitable for pregnant women. mRNA vaccines, which are likely to be the first vaccines available, do not contain a live virus but rather induce humoral and cellular immune response through the use of viral mRNA. Healthcare professionals should also counsel their patients that the theoretical risk of fetal harm from mRNA vaccines is very low."

Their entire statement is available at this link. The above opinion is basically supported by years of safety data with most but not all vaccines, and from studies worldwide. At this point, since many of the new vaccines do not contain live viruses and are not infectious, the InfantRisk Center supports the opinion from the SMFM that most Covid-19 vaccines are probably safe for pregnant women. Ultimately, the risk of infection in that patient, must be weighted again the probable minimal risk of the vaccine.

The CDC has basically avoided answering this question, by the following statement:

suggests that pregnant women are potentially at increased risk for severe COVID-19-associated illness and death compared to non-pregnant women, underscoring the importance of disease prevention in this population. Given the predominance of women of child-bearing potential among the healthcare workforce, a substantial number of HCP are estimated to be pregnant or breastfeeding at any given time. Currently, there are no data on the safety and efficacy of COVID-19 vaccines in these populations to inform vaccine recommendations. Further considerations around use of COVID-19 vaccines in pregnant or breastfeeding HCP will be provided once data from phase III clinical trials and conditions of FDA Emergency Use Authorization are reviewed."

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COVID-19 Vaccine in Pregnancy and Breastfeeding

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The InfantRisk Center has received numerous queries concerning the use of Covid-19 Vaccinations in pregnant and breastfeeding mothers. Below are recommendations from several groups. Similar to other medications, pregnant and/or breastfeeding women have not been included in studies to determine how well COVID vaccines work or how safe they are.

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Supplementary nursing systems

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Nursing Supplementers - La Leche League GB

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If your baby needs a supplement of expressed breastmilk or formula, a nursing supplementer can help you enjoy the closeness of breastfeeding while your milk production increases. You can use a supplementer to: Stimulate breastmilk production while feeding infant formula or expressed mil, without usi…

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Domperidone - Information for Breastfeeding Parents
Domperidone (Motilium) is a drug that, as a side effect, increases breastmilk production by increasing prolactin (a hormone involved in making milk) secretion from the pituitary gland. Domperidone is generally used for problems with the gastrointestinal (GI) tract, or gut. It has not been released in Canada for increasing milk supply, but this does not mean it cannot be prescribed for this reason, just that the manufacturer does not support this use. There are many studies that show that domperidone works to increase milk supply and is relatively safe to use.
Metoclopramine (Maxeran, Reglan) is also known to increase milk supply, but it has frequent and unpleasant side effects (like fatigue, irritability, and depression). Domperidone has fewer side effects and is better tolerated by most people - this is because it does not enter the brain in significant amounts.
Note, even if you have "enough milk", increasing the milk supply also increases the flow of milk. This is helpful for many situations, including sore nipples, fussiness at the breast, and refusing to latch.
Domperidone should not be the only approach to address breastfeeding challenges. It should be used along with other strategies to increase milk supply and improve the breastfeeding situation. See the other information sheets at www.ibconline.ca, including "Protocol to Increase Breastmilk Intake" and "Late Onset Decreased Milk Supply or Flow".

Using Domperidone
Generally, we start with 30 mg (three 10 mg tablets) three times per day - a total of 9 tablets per day. In some situations we will go as high as 40 mg four times per day (or, for convenience, 60 mg once per day and 50 mg twice per day). The pharmacist may instruct you to take each does 30 minutes before eating, but that is because of its usual use for digestive problems. Taking domperidone on an empty stomach does allow it to be better absorbed, but it is not necessary to do this for it to work to increase breastmilk production. Spread the doses out throughout the day and take it when it is most convenient for you.
After starting domperidone, it often takes three or four days before you notice any effect. It usually takes about two weeks to get a maximum effect, but some find it takes even longer. It may also be important to remember that domperidone usually only begins to work three or four weeks after birth, but sometimes earlier. Sometimes the herbal remedies work best early on (see the information sheet, "Herbal Remedies for Milk Supply" at www.ibconline.ca).

Side Effects
As with all medications, side effects are possible. There is no such thing as a 100% safe drug. However, in our clinical experience, side effects in the breastfeeding parent are very uncommon. Some people may experience headache, dry mouth, abdominal cramps, weight gain/increased appetite, and alteration of menstrual periods (usually stopping them, if they have resumed; breakthrough bleeding is also possible). Most of those who experience side effects find they disappear after a few days.
The amount of domperidone that gets into the breastmilk is very small and side effects in the baby should not be expected. Domperidone is sometimes given to babies with reflux and the amount they get through the milk is a very small percentage of what they would get if they were treated with domperidone directly.

How Long to Take Domperidone
As a general recommendation, continue taking domperidone until your baby is well established on solid foods. Some people are able to stop domperidone sooner than this, if the breastfeeding challenges have resolved and things have been going very well for a least a few weeks. Some people continue domperidone for many months and some beyond a year. Worldwide experience with domperidone over at least 20 years suggests that long-term side effects are uncommon.

Stopping Domperidone
When you are ready to stop taking domperidone, you should gradually wean off it. This is to prevent a possibly significant drop in your milk supply and side-effects (like anxiety and loss of appetite) that may occur if domperidone is stopped suddenly.
To wean from domperidone, decrease your daily dose by one tablet per day per week (so, for example, if you are taking 30 mg three times per day, or nine tablets per day, you would first decrease to eight tablets per day). After seven days, if you see no decrease in your milk supply, decrease the daily dose by one tablet again. Continue in this way until you have completely stopped the medication.
If, at any point during the weaning process, you notice your milk supply decreasing significantly or your previous breastfeeding challenges (or new ones) arise, return to the previous effective dose. Try resuming the weaning process again after a couple of weeks.

You may hear about domperidone:
In 2004, the Federal Drug Administration (FDA) in the United States put out a warning against using domperidone because of possible heart-related side effects. However, these side effects occurred only when the drug was given intravenously to otherwise very sick patients, taking many other drugs.
In 2012, Health Canada endorsed a warning put forth by the company who manufacturers domperidone. This warning was about oral doses higher than 30 mg per day and the risk of heart-related side effects. However, the research cited to support this warning involved patients with an average age of over 70 years old, many of whom had pre-existing health conditions.
These warnings do not apply to the population to whom we prescribe domperidone (typically younger, healthy women) and we have continued to prescribe it to breastfeeding parents as we have for more than 30 years. We have treated thousands of people with domperidone and we are not aware of any one of them experiencing heart-related side effects due to domperidone. Also, as of 2015, Health Canada had never received any reports of serious heart-related adverse effects in anyone of childbearing age taking domperidone.

Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals. This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don't know what this means, please email us to ask!

©IBC, November 2016

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International BreastFeeding Centre | Domperidone, a medication to increase breastmilk supply

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Domperidone - Information for Breastfeeding Parents Domperidone (Motilium) is a drug that, as a side effect, increases breastmilk production by increasing prolactin (a hormone involved in making milk) secretion from the pituitary gland. Domperidone is generally used for problems with the gastrointestinal (GI) tract, or gut.

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Global Health Media Breastfeeding Videos

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Global Health Media Breastfeeding Videos

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Some great videos on all topics including hand expression

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Video Archive - Global Health Media Project

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Videos Archive - Global Health Media Project

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ALL-PURPOSE NIPPLE OINTMENT (APNO) - International BreastFeeding Centre

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An ointment to help with sore nipples, covering most of the causes of sore nipples except improving the latch. Contains ingredients to deal with inflammation, bacterial infection and "yeast, thrush" and Candida infections. Decreases nipple pain in most mother, but appointment with International Breastfeeding Centre (Newman Breastfeeding Clinic and Institute) is important to work on latching issues.

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Menstruation and Breastfeeding

Human beings have known for centuries that breastfeeding affects fertility, and this has been borne out in recent studies. The effects of breastfeeding on fertility vary greatly between individuals. In general though, the more often your baby is breastfed, the younger your baby is, and the less nutrition they get from other sources, the later your periods will resume.

The range of "normal", is enormous. Some women resume their menstrual cycles soon after giving birth, while other people do not resume menstruating until the baby is weaned (which can be months or years later, depending on how long the baby is nursed). Individual hormonal and physiological differences can play a part as can how frequently the baby nurses. Also, some people have a non-ovulatory period before 6 months postpartum, but do not menstruate again for many months.

According to The Womanly Art of Breastfeeding (p. 364-366), almost everyone who is fully breastfeeding their babies will be free of menstrual periods for 3 - 6 months or longer. This is called lactational amenorrhea. Fully breastfeeding means the baby relies completely on breastfeeding for nourishment and for all sucking needs. Frequent nursing inhibits the release of hormones that cause your body to begin the monthly preparations for a new pregnancy.

Experiencing a menstrual period does not mean that your menstrual cycle has returned permanently and without an accurate clinical test, you won't know whether or not you ovulated (released an egg and could potentially become pregnant). You are more likely to ovulate and resume regular periods if your baby is going for more than a few hours without breastfeeding (for instance, at night) and your baby is more than 6 months old.

Most breastfeeding mothers will resume their periods between 9 and 18 months after their baby's birth. Weaning your baby will almost certainly cause your menstrual cycle to return, but most people find that they do not need to wean in order for their cycle to gradually resume. If you want to use this knowledge for purposes of regulating your fertility you may find it helpful to read more about the "Lactational Amenorrhea Method." The book Breastfeeding and Natural Child Spacing by Sheila Kippley also offers factual information and support on coming to terms with the effect of delayed return of your periods on the timing of growing your family.

More information on this topic can be found at our resource page for Breastfeeding and Fertility.

Once your baby is not nursing for several hours at a time during daytime or at night, it is possible that you will ovulate. Therefore, you could become pregnant. If you suspect you are pregnant, you will want to check with your health care provider. Also, this would be a good time to consider a method of birth control that is compatible with breastfeeding (unless another pregnancy is desired). More information can be found at our resource page for Breastfeeding and Contraception.

DOES YOUR PERIOD DECREASE YOUR MILK SUPPLY?

It is common to have a drop in supply at certain points in your cycle, often from mid-cycle to around the time of your period. It can also be less comfortable to nurse at this time. This is due to the hormonal changes and is only temporary. Our book The Womanly Art of Breastfeeding states that:

"A daily dose of 500 to 1,000 mg of a calcium and magnesium supplement from the middle of your cycle through the first three days of your period may help minimize any drop in supply".

Birth Control
Breastfeeding and Fertility
Updated January 2021.

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Menstruation - Your Period While Breastfeeding

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Breastfeeding and your period hasn't resumed? Learn what happens to your period while breastfeeding and when your menstrual cycle can return.

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Lots of different suggestions for pain with a focus on nipples and conditions with some gross pictures (beware).

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Lots of different suggestions for pain with a focus on nipples and conditions with some gross pictures (beware).

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Nipples - Physician Guide to Breastfeeding

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This lengthy article goes into detail about many issues related to nipples and care during breastfeeding, including nipple pain, wound care, nipple growths and masses and many other topics.

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Reducing excessive supply or suppressing supply

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Reducing excessive supply or suppressing supply

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KellyMom.com - Breastfeeding and Parenting

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Too much milk: Sage and other herbs for decreasing milk supply - KellyMom.com

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This is best used only if you are in the process of weaning, though it may also be used in extreme cases of oversupply when the usual measures are not effective. Be careful with this if you are not in the weaning process! Don’t overdo it once you’re seeing some results. To use dried sage (Salvia officinalis) for reducing milk supply, take 1/4 teaspoon of sage 3x per day for 1-3 days. You can mix the sage in vegetable juice (for example, V-8), but it won’t mix well into other juices. You can also mix it into other foods. If you don’t like the taste of sage, try putting it into a tiny piece of sandwich and swallowing it whole - peanut butter or something else a bit sticky seems to work best for holding the sage in place. Tear off the corner of the sandwich containing the sage (it should be a very small section) and swallow it without chewing (that’s why you need a very small section).