Your most Googled breastfeeding questions answered by a lactation expert

Is it normal for one breast to produce less milk than the other? How can I improve my milk supply? Do I really need to buy a feeding bra or can I wear a regular one? What can I do if I have a blocked milk duct? Can I continue breastfeeding if I am pregnant? These are the most Googled breastfeeding-related questions, and we asked lactation expert Natascha Olivier to answer them.

Is it normal that one of my breasts produces less milk than the other?

Having an overachiever boob, and a lazy boob is perfectly normal, and nothing to worry about. Many women will notice that their breasts are never quite the same size while breastfeeding, and in some cases your baby may even prefer one breast to the other, or latch more easily on one of your breasts. If you are exclusively breastfeeding, start off by offering both breasts at every feed, especially during the early days. This ensures that both breasts are emptied, and thus stimulated to make more milk, ensuring a good milk supply. It also affords your baby the opportunity to fill up as much as they need at each feed, even if one breast may be producing less milk than the other. Also keep in mind that some moms may only have one functional breast, and usually are still able to exclusively breastfeed their baby.

How do I know when my baby has had enough milk at a feed? What signs should I look out for?

If your baby is nearing the end of a feed and is almost satisfied, you will most probably be able to observe the following:

• Your baby’s suckling will slow down, and may also become quicker and lighter, with longer pauses in between sucks.
• Your baby may fall asleep if she is still quite young, or she may unlatch and appear content if she is a little older.
• Her posture will most probably relax, with her body becoming a little looser, and her fists uncurling into relaxed hands.

Keep in mind that you should always look at your baby rather than the clock to know whether your baby is full. Exclusively breastfed babies rarely keep to a schedule, and the great thing about breastfeeding is that it is always available. If you are uncertain whether your baby is hungry or satisfied, you should always try offering the breast, as you cannot overfeed a breastfed baby. If your little one is satisfied, she will refuse to latch on, or will push your breast away. If she takes a few more sips, then you know that she wasn’t quite full just yet.

Please keep in mind that this advice is only applicable to healthy, full-term babies who are gaining weight as expected. If your baby is not gaining sufficient weight, falls asleep on the breast very quickly and stops suckling and swallowing, seems to choke on your milk, swallows a lot of air, leaks a lot of milk out of her mouth or nose, clicks while nursing, hurts you while nursing, or if your mommy instinct has you worried, please contact a lactation consultant to guide you and to get the support you need.

ALSO READ: How to get your baby to latch properly when breastfeeding

Do I really need a nursing bra or can I just wear my regular one?

While nursing bras are not essential, they are convenient and cater for your body’s unique changes during pregnancy and breastfeeding. Things to keep in mind when shopping for a bra to use during late pregnancy and breastfeeding include:

• Comfort and room for growth. Your breasts will change in size quite dramatically, growing throughout your pregnancy, feeling like they might explode during the first few days after birth, and then still increasing and decreasing quite a bit in size as your milk supply settles in. A comfortable, soft and stretchy material will accommodate these changes. The material should be breathable, and the bra should not have seams over the nipples to avoid any unnecessary irritation.
• Look for bras with wide shoulder straps, and a wide and supportive bottom band with multiple hooks to adjust the fit to comfort.
• Avoid bras with an underwire, as this can result in pressure on your breasts, which can potentially inhibit blood flow, impair breastmilk production, or lead to the development of blocked ducts and/or mastitis.
• Ease of access – for your baby of course! A hungry baby does not like being made to wait for breastmilk while you figure out whether you should pull your bra up, down or sideways. Also, if your bra bunches up underneath or around your breast during a feed, it may be difficult to empty your breast completely, putting you at risk for engorgement, plugged ducts and mastitis.
• Affordability, as you will need quite a few. On any given day you’ll probably be wearing one, have one on the washing line or in the cupboard, and 2-3 (or more) that have already been burped on or into – burp has a way of ending up in the strangest places…
• Ease of care. Your nursing bras tend to get dirtier, faster – so you’ll be washing them more frequently than “normal” bras. Try to wash them on a gentle or cold setting, and hang them to dry to make them last longer.

Do natural herbs to promote lactation, like fenugreek, actually work? What else can I take to boost my milk supply?

While galactagogues, or substances that promote lactation, may improve your breastmilk supply, it is important to note that all supplements and medications may have side effects. So while fenugreek taken at the correct dosage does have its place, it may also result in various unwanted side effects such as gastrointestinal complications including nausea, gas and cramps, and diarrhoea in both mom and baby.

It is also important to note that the amount of breastmilk that you have is based on supply and demand. This simply means that the more frequently and the more completely you empty your breasts, the more breastmilk they will produce, and therefore the more breastmilk you will have. Steps to boost your breastmilk supply should therefore first and foremost focus on the following:

• Ensuring good positioning and a deep latch every time that your baby latches. Make sure that you are comfortable, and that your baby is well positioned and supported. For a deep latch, it may be useful to start with your nipple slightly above your baby’s mouth and closer to her nose. Wait for your baby to open her mouth wide, and then pull her entire body close to you to ensure a deep latch, with her chin firmly on your breast, and her nose free to breathe comfortably. The cross-cradle position or the football position allow you to support your baby and bring her in quickly at the right time using one arm, while allowing you to handle your breast with your other hand.
• Breast compressions encourage your baby to stay on the breast for longer to continue nursing, and thus increases her intake, as well as boosting your supply. Start with breast compressions as soon as your baby’s suckling and swallowing slow down, especially in small, premature, weak or sleepy babies. Breast compression is basically hand expressing milk into your baby’s mouth while she is latched on. These compressions maintain a continuous flow of breastmilk to your baby, encouraging her to continue suckling and to swallow the milk in her mouth.
• Offering both breasts at every feed, especially in the early days, can also help to establish your supply. Once your baby gets sleepy on the first breast, you can burp her and/or change her nappy, and then offer the second breast. Even if she only takes a few sips of the second breast at every feed, this adds up to quite a bit over an entire day.

As mentioned before, breastmilk is based on supply and demand. If you do not regularly and completely drain your breasts, then no galactagogue, herb, supplement, lactation bar, boobie biscuit (try our recipe by clicking here), medication or anything else will significantly increase your milk supply. The most important component to a good supply is to empty your breast frequently and completely. If you are concerned about your supply and/or the tips above do not work, please get in touch ASAP. The sooner you get help, the easier and more stress free your breastfeeding journey will be.

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Can I continue breastfeeding if I’m pregnant again?

If you fall pregnant while still breastfeeding, you may be concerned about the health and growth of your unborn baby. Research in normal, healthy pregnancies indicates that continuing to breastfeed has not been shown to disadvantage your unborn baby, to deprive them of nutrients, to influence their growth, or to trigger early labour.

Your nipples may be more sensitive and tender during pregnancy, and you may need to pay attention to your child’s position and latch. If your child is old enough to understand, you can ask them to nurse gently, and for shorter periods. Breathing exercises and other distractions can help you to overcome the tenderness during feeds.

Continuing to breastfeed in a normal, healthy pregnancy is thus a personal decision. If you are expecting multiples or have a high-risk pregnancy, you should consult your healthcare professional for an individualised discussion about this topic, taking all of the risks and benefits into consideration.

What can I do if I suspect I have blocked milk ducts?

A blocked or plugged duct refers to a milk duct in your breast that is obstructed, resulting in a painful, lumpy, red, and sometimes warm area of your breast.

To assist in the management of the plugged duct, breastfeed frequently, at least every 2 hours. A warm compress and gentle massage shortly before breastfeeding may assist your milk flow. Taking a hot shower or submerging your breast in a warm bath or basin with warm water may also help. Offer the affected breast first and ensure good positioning and latch for optimal milk flow. Breast compressions and massage may be useful in moving the plug, and breastfeeding on all fours, or dangle feeding, may also help.

If your breast still feels full after a feed, hand express or pump to aid in milk drainage, and apply a cold compress after feeds to minimise inflammation and pain.

Ensure that you get sufficient rest, drink enough, and eat well to strengthen yourself and your immunity.

To prevent recurring plugged ducts, keep the following in mind:

• Breastfeed frequently, and make sure that you empty your breasts. Beware of the following:
  • Skipping feeds, feeding infrequently, or feeding in a hurry
  • Overusing a dummy, or using a nipple shield
  • Returning to work
  • Limiting your baby’s time at the breast and/or scheduling your feeds
  • A poor latch, a tongue or lip tie, a distracted or sleepy baby
  • Feeding multiples
• Limit pressure on your breasts, such as that caused by a tight bra or clothing, a wrap or baby carrier that puts pressure on your breast, sleeping on your tummy, carrying a nappy bag, etc. These can result in poor milk flow and plugged ducts.
• Inflammation from injury, allergies and infections can increase your risk of plugged ducts.
• Although difficult to avoid, fatigue, stress and a weakened immune system may put you an at increased risk of plugged ducts.

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What should I do if I want to breastfeed but my milk is taking a few days to come in? What do I do in the meantime?

The first breastmilk that your breasts will make after the birth of your baby (and often already a few days or weeks in advance) is called colostrum. It is a dark yellow, thick, and very concentrated fluid filled with everything that your baby needs during her first few days. Colostrum is only produced in small quantities of a few millilitres at a time, perfect for your newborn’s tiny tummy. From about days 2 to 5 after your baby’s birth your colostrum slowly changes to your mature breastmilk, which is whiter and more fluid, and is required in larger quantities, perfectly matched to your baby’s growing stomach capacity.

Usually this process of producing first colostrum, and then transitioning to mature breastmilk happens naturally and without much external input. Sometimes, however, this process takes a little longer, and you may need some assistance. This may be due to a slower start at breastmilk production (due to a caesarean section, gestational diabetes mellitus, maternal blood loss, a medical condition, pain, etc.), or due to inadequate breastmilk removal (due to mother-infant separation, a small and/or sleepy baby, scheduled feeds, a poor latch, a tongue or lip tie, etc.).

It is important to understand that the process of lactation is specialised and individualised. The best advice is to prepare during pregnancy by attending a detailed breastfeeding workshop (usually not part of a basic antenatal course) to know what to expect, to learn the skill of hand expressing, and to know who to contact for support (and when) if things to not go as planned.

Should things not go according to plan, the most important goals are:

• To feed your baby, preferably with your own breastmilk (at the breast or expressed), and
• To establish, maintain and protect your milk supply.

Steps to make this happen include the following:

• Room in with your baby, and spend as much time as possible skin-to-skin, allowing your baby free access to your breasts.
• Offer the breast as frequently as possible, at least every 2 hours.
• Ensure good positioning and a deep latch at every feed, and start breast compressions as soon as your baby’s suckling and swallowing slows down. Offer the second breast after winding your baby and/or changing her nappy.
• If you are concerned about not having (enough) breastmilk, or your baby struggles to latch, you can start hand expressing as soon as possible, catching the colostrum in a syringe or on a teaspoon, and feeding this expressed breastmilk to your baby. Try to hand express your breasts for 10 to 15 minutes every 2 hours. Take a five-hour break overnight to sleep and recharge, and then continue expressing every 2 hours. After 24 hours you can add a good quality electric pump for 10-15 minutes after the hand expressing for optimal stimulation.

Since each case and breastfeeding relationship is different, contact a lactation consultant as soon as possible to work out an individualised step-by-step plan for you and your baby, and then take it an hour at a time, little by little. A delay in your milk production, or a baby that struggles to latch are not the end of your breastfeeding journey, it may just be time to adjust the plan (and your expectations) a little, but exclusively breastfeeding is still very possible in most cases!

Natascha Olivier is a registered dietitian (you can visit her website here or find her on Facebook and Instagram), certified lactation consultant, wife, and mother of 2 beautiful girls. She is passionate about evidence-based, practical nutrition in infancy, childhood, pregnancy and maternal health, and the family setting – her special interest is in breastfeeding, childhood nutrition, and family nutrition. Natascha is also a South African Certified Lactation Consultant and supports moms and families on their journey from pregnancy, to breastfeeding, and into the amazing adventure of introducing little ones to family foods. You can email Natascha on lactationdietitian@gmail.com or call her on 072 606 4320). Keep an eye on her social media for dates of upcoming workshops.