What would you like to know about breastfeeding?

For this second part of our two-part series on breastfeeding, we encouraged readers to share their questions. NCH lactation consultants Karen Dickert, R.N., BSN, IBCLC, RLC, Teya Drews, R.N., BSN, IBCLC, RLC and Colleen Rohrbacher, R.N., BSN, IBCLC, RLC helped answer them.

Q: Does eating cabbage actually help dry up your milk?
A: No, eating cabbage will not dry your milk up. Cabbage is often used as a natural anti-inflammatory when moms are engorged. It is recommended that mom keep cabbage refrigerated (the coldness will feel soothing to engorged breasts). She can take a leaf, breaking the veins of the cabbage to help release the anti-inflammatory properties, and place them in her bra until wilted.

Q: Is it true that a baby can have nipple confusion between breast, bottle and pacifier? I know they discourage using bottles and pacifiers but is that evidence-based thinking or just anecdotal?
A: Typically bottles and pacifiers are not recommended until breastfeeding is well established (two to three weeks). The wave like tongue movement in a breastfeeding infant becomes more of a compression with bottle or pacifier sucking.  And babies are so smart!  Even in the first few days they can differentiate between different textures (bottle nipple vs. mother’s nipple), and flow (colostrum is thick and sticky, vs. a bottle which  flows fast and freely). Once breastfeeding is established, babies are able to differentiate between the two and confusion is less evident. 

Q: What should expecting moms consider when choosing a pump? 
A: There are several breast pumps on the market which can be very confusing. A double electric breast pump will fit most moms’s needs. Mom who exclusively pump however, may choose to rent a hospital grade pump to maximize their milk supply. Moms who are not planning on returning to work often find a manual pump will fit their needs. Many insurance companies will cover the cost of a breast pump though most moms do not need to use a breast pump unless they are separated for several hours from their babies (like returning to work). Consumer reviews can be helpful in choosing a pump.

Q: When pumping, how do you choose the right breast shield size? Especially if you’re having trouble letting down and if you’re a very large cup size naturally? We can read all the literature and suggestions that come with the pumps, but sizing is a very personal experience.
A: As a rule, if you measure the nipple diameter your pump flange size should be 2 to 4 mm larger in size. For example, if your nipple measures 20 mm your pump flange size adding 2 to 4 mm would be 22 to 24 mm. Therefore, a 24 mm pump flange would be recommended. Each manufacturer makes several sizes of pump flanges. If when pumping your flange is causing friction on the nipple, you may need to increase size. On the other hand, a flange size that is too large may not empty you well when too much breast tissue or areola is being pulled into the flange.

Q: How often should you replace breast pump parts?
A: Each manufacturer has different suggestions. Please refer to your owner’s manual. On a side note, many insurance companies will send monthly replacement pump parts to your home free of charge.

Q: I’ve heard that a mom’s body knows what sort of antibodies to produce in their milk from baby’s saliva. As an exclusively pumping mama, I’ve also heard that kissing babies forehead lets my body know the same. Is it true that for babies who are bottle fed breastmilk that it’s best practice to put some baby’s saliva on your nipples so your body knows what to produce for baby? 
A: Baby’s saliva does send signals to the breast while breastfeeding for production of antibodies. Although there is no research to suggest applying saliva to the nipples will produce the same effect, it is a widely used practice.

Q: I was an older mom at 40. I may have asked all the wrong questions, but breast feeding didn’t work for us. I tried pumping, and all kinds of suggestions. Does age have anything to do with your ability to produce?
A: Many factors (both infant and maternal) can affect the ability to produce milk. Advanced maternal age can delay the onset of lactation but not necessarily decrease the ability to produce it.  However, older mothers may not be as sensitive to the hormone prolactin, which is one of the key hormones in milk production. 

Q: I’ve always wondered what women did many years ago when formula wasn’t around and breast feeding didn’t work out or their milk never came in. 
A: In these cases, moms would use a “wet nurse” to feed her baby. This is a woman who was employed to breast feed another woman’s child. The term wet nurse has been replaced by what we modernly call “cross nursing,” where moms may nurse each other’s babies. 

Q: I breast fed all three of my children for different lengths of time because back then employers didn’t have to have a place to allow you pump. Even when I could pump, I still had to supplement with formula. It didn’t seem like I could pump enough to solely feed with breast milk. Not sure if I was doing something wrong or just didn’t have the time to do it often enough. My kids are now 25, 20 and 17 and each is thriving just fine despite the differences. 
A: Moms often have problems with decreased supply when they return to work. This is why we developed Baby Café. We recommend moms reach out to a lactation consultant or other mothers for assistance with increasing supply or to talk about helpful tips for returning to work.  

Q: I always wondered if there were proven health benefits of breastfeeding (six months, one year, etc.) I think we all just did the best we could. 
A: As milk is the primary source of nutrition up to one year of age, breastmilk would be the ideal food of choice for baby. Around six months to one year, baby starts additionally taking solid food. Breast milk still gives the baby vitamins, minerals and nutrients he or she needs but additionally contains immunologic factors and antibodies that can protect the baby from illness during the breastfeeding relationship. Breastfeeding over six months also lowers mom’s risk of developing heart disease, type 2 diabetes and breast, ovarian and uterine cancers.

Q: Are there any baby wearing slings that make breastfeeding in public easier? My newborn days are over, but it was always so uncomfortable breastfeeding in public because the only thing available at the time was the super awkward cover. 
A: Public breastfeeding rooms are certainly more available now. We have two at NCH with a third coming very soon. If those rooms are not available and mom wants to cover up (it is not necessary unless she desires to), there are many breastfeeding covers on the market. A lot of moms also can find breastfeeding clothing or wear a scarf to cover up. Slings also offer the option of tucking baby close to mom which can make breastfeeding easier. Moms in our support group really like the Boba wrap.

Q: Back when mine was little, I was told to eat oatmeal everyday…and I did. I pumped enough milk to feed a small village. Do they still recommend oatmeal?
A: Yes! Whole grains such as oatmeal, along with other foods are said to be “lactogenic” or milk producing. Other foods that are considered to be lactogenic are dark, leafy greens such as spinach, broccoli or kale, fennel, garlic, nuts and seeds (especially almonds), flax seed, brewer’s yeast and malt (like in Ovaltine).

Although breastfeeding can be very natural and instinctive, several factors can effect lactation. Some moms decide not to breastfeed, or many discontinue breastfeeding based on individual reasons. Ultimately, the decision to breastfeed or not can only be determined by you. The lactation consultants at NCH are here to support you in your decisions and guide you on your breastfeeding journey.

Breastfeeding is a beautiful bond between mom and baby. As lactation consultants at NCH, we are honored to be a part of such a special time in your lives. Many moms need assistance and issues may arise during your breastfeeding journey. Please know we are happy to help you be successful in your breastfeeding goals.