Frequently Asked Questions
Where are you located?
Our clinic is located at 130 Thompson Road, London ON, N5Z 2Y6, Unit #14 in the Thompson Medical Centre and we proudly serve the London-Middlesex-Elgin and Oxford communities in person.
Our location is accessible. If you require assistance bringing your baby into the clinic, please let us know in advance, and text 226-342-5003 when you arrive to the clinic.
Virtual services, classes, and webinars available worldwide in English. French services coming soon. Stay tuned!
What are your fees?
Click HERE for a full listing of our services and fees.
Do you offer any discounts?
If you are a teenaged mother or a woman living in a shelter, the fee is $35 for an in-person or virtual visit. Contact us HERE, we are here to help.
Are lactation services covered by OHIP or other health insurance?
The answer is complex. Our services may be covered through your private or workplace health insurance depending on the package your employer has offered you. We will provide you with a receipt for your service that you can submit to your insurance provider, but we cannot guarantee you will be reimbursed by them.
Breast pumps are considered a medical device that are covered by many insurance companies. We do not sell breast pumps but if you have purchased one, submit the receipt to your insurance provider as you may be eligible for reimbursement.
Currently, OHIP does not cover lactation services. We are working towards getting some coverage through a pediatrician group. Stay tuned!
What payment methods do you accept?
Visa, Mastercard, American Express, Debit, Cash.
Who will my appointment be with?
At this time, your appointment will be with me. I am starting an internship program later this year for aspiring IBCLCs. Anyone who works with me, whether directly with clients or the office administrative staff are committed to the Birthwise values statement.
What are your qualifications?
• I have been a working Registered Nurse in the province of Ontario since 1995 with experience in many fields including Family Health and Maternal-Newborn health.
• I am an International Board-Certified Lactation Consultant (IBCLC). I have additional training in the areas of oral function and oral restrictions, oral habilitation of the breastfeeding dyad, maternal-infant gut microbiome, breast pumps and flange fitting, safe bottle feeding, tummy time and more.
• I am a mother of six and grandmother of two.
• I have informally helped numerous friends and family care for and feed their babies over 3 decades.
What is an International Board Certified Lactation Consultant (IBCLC)? What do they do?
An International Board Certified Lactation Consultant (IBCLC):
• Is the only internationally certified medical professional in the clinical management of breastfeeding.
• Is a valuable member of the maternal-child health care team who works in collaboration with other health care providers to help families meet their breastfeeding goals.
• Has advanced training and education for anticipating, preventing, diagnosing, and providing therapy for breastfeeding issues.
• Helps families restore breastfeeding when issues arise throughout their breastfeeding journey.
• Provides comprehensive diagnostic exams of mother and baby and suggests lactation therapies based on current evidence and clinical experience.
• Provides emotional support for families struggling with feeding problems.
• Adheres to the International Board of Lactation Consultant Examiners (IBLCE) standards of practice, code of ethics and works within a defined scope of practice.
• 95+ hours of lactation specific education.
• 500-1,000 hands-on clinical hours (Canada) *500 hours internship under direct supervision of an IBCLC mentor or 1,000 hours counted from paid or volunteer independent practice from the IBLCE Recognized Breastfeeding Support list.
• 14 post-secondary health sciences courses or IBLCE recognized healthcare professional.
• Passing grade (76% or higher depending on exam year) of the 4-hour IBCLC exam.
• Maintain accreditation through continued education credits and earn recertification every 5 years.
• Anyone, regardless of experience or education can call themselves breastfeeding counsellors, breastfeeding support, lactation counsellors or even lactation consultants. Only practitioners who have completed rigorous training and have met the requirements of the IBLCE are permitted to use the credential IBCLC®.
What do you do during a visit?
What to expect at a Birthwise Lactation visit:
• A conversation about how you want to feed your baby
• A relevant medical/surgical history and details about your birth story will be taken (initial visit)
• Functional oral assessment of baby (to identify any tongue, lip, or cheek-ties and suck dysfunctions)
• General assessment of your baby (to identify any issues that many affect suck, positioning or latch)
• Maternal breast/ chest assessment (with consent and only as needed)
• Weighted feed*
• Observation of a full feed and guidance of latch and position
• Pumping or hand expression observation/ guidance (if necessary)
• Treatment suggestions for nipple damage and/or breast pain (if necessary)
• Paced bottle feeding demonstration (if necessary)
• Other supplementation demonstration (if recommended after assessment)
• Oral and bodywork exercises to do at home
• Education about normal infant behaviours- feeding, crying, sleep, developmental milestones
• Referrals to other health care professionals (if necessary)
• A customized written plan based on your goals and unique lifestyle
• Love and acceptance
* Weighted feeds are a valuable tool for determining milk transfer from your breast to your baby, especially when weight gain is an issue. Your baby will be weighed several times during your visit. The first will be a naked weight so we can plot their growth. The following weights will be before and after your baby feeds from each breast and they will be fully clothed.
How do I prepare for an in-person clinic visit?
When you book your appointment, you will fill out a consent form and some information to help us get started and prepare for your visit.
Please try not to feed your baby within 60 minutes of our visit. A large part of our visit involves us observing a feeding and providing guidance as necessary. If your baby has a full tummy, this will be difficult, if not impossible. Having said this if your baby cannot wait, please go ahead and feed them.
If you are pumping or supplementing, please bring your pump, bottles, and expressed milk or formula with you to the appointment. If you are taking any herbs or using any nipple creams, bring those too. If you are using a nipple shield or really anything to do with your feeding, just bring it so we can get a clear picture of how things are going.
You do not need to bring your breastfeeding pillow.
The clinic is accessible so bring your stroller and load it up! And bring your partner or any other person who is helping you with feeding too. Our clinic is small but there is enough room for you and one other person (and of course your baby/ babies😊)
How do I prepare for a virtual visit?
When you book your appointment, you will fill out a consent form and some information to help us get started and prepare for your visit. We will be in touch to schedule a time for a phone call to complete the entire intake questionnaire before our virtual visit.
Depending on the reason for the consult, you will be sent a list of 2-4 pictures/ short videos to take and send back before our visit. Clear instructions for how to take the videos or pictures will be sent.
Please try not to feed your baby within 60 minutes of our virtual visit. A large part of our visit involves us observing a feeding and providing guidance as necessary. If your baby has a full tummy, this will be difficult if not impossible. Having said this, if your baby cannot wait, please go ahead and feed them.
Please ensure the room you are in is well lit.
The visit works best when you have someone to help by being the “camera person” while you focus on the baby. If this isn’t possible, not to worry, we will work around it.
Please use the flash on the phone camera.
Wi-Fi: if you have poor connectivity, ensure other devices in the home are set to airplane mode during our visit and you are as close to the router as possible.
Depending on the reason for the consult, you may need to rent a gram sensitive scale or purchase a low-cost scale. We will sort this out during the intake call.
How do I prepare for a home visit?
When you book your appointment, you will fill out a consent form and some information to help us get started and prepare for your visit.
Please try not to feed your baby within 60 minutes of our visit. A large part of our visit involves us observing a feeding and providing guidance as necessary. If your baby has a full tummy, this will be difficult if not impossible. Having said this if your baby cannot wait- please go ahead and feed them.
I am unfortunately allergic to cats and dogs and ask that they are secured in a separate room during our visit.
Please do not worry about being out of your pyjamas or your house being clean when I arrive. All I need is a clear space on a table or a counter to place my scale, and I will be bringing a large bag on wheels with the equipment I use for assessments and/or to help with feeding. I will take off my shoes and bring slippers with me. I will be masked during our visit but it is not necessary for you to be.
I am fully vaccinated and boosted against COVID-19 as well as all other standard vaccinations. I get my flu shot every year. I will reschedule your appointment if I am feeling sick. Your family’s health is my priority.
Please tell me any cultural or religious practices you would like me to observe when I enter your home.
How do I prepare for a pumping consult?
When you book your appointment, you will fill out a consent form and some information to help us get started and prepare for your visit.
Please bring your pump, flanges you are using or have tried and any other pumping related equipment you are or have used.
We have flanges ranging from 10mm-44mm in our clinic for you to try during your consult. We will measure you and then try as many as necessary until we find the one that moves the most amount of milk, in as little time as possible. We will know we have found the perfect one when you say, “That feels like nothing at all!” Or “All I feel is a gentle tugging.”
If you can try not to pump or hand express for an hour or two before your appointment, that would be ideal. If you find you are uncomfortably full, go ahead and pump or hand express to comfort.
Are you fully vaccinated?
I am fully vaccinated and boosted against COVID -19 as well as all other standard vaccinations. I get my flu shot every year. I will reschedule your appointment if I am feeling sick. Your family’s health is my priority.
Any staff or interns working with me will also be required to be fully vaccinated against COVID-19.
What happens after our visit?
Click HERE for our handout “What Happens Next?”
How many visits will I need?
That is difficult to answer without knowing your specific situation. Some issues can be fixed in just one visit, others are more complex, and they are fixed a bit at a time, with progress seen over several visits. We work efficiently to ensure that you leave your appointment feeling supported and with a plan that gets you on the path towards meeting your feeding goals in as few visits as possible.
What is considered exclusive breastfeeding?
The World Health Organization (WHO) defines exclusive breastfeeding as “Exclusive breastfeeding (EBF) is the situation in which an infant receives only breast milk from his/ her mother or a wet nurse for the first 6 months and no other solids or liquids with the exception of drops or syrups consisting of vitamins, minerals, supplements, or medicines.”
Our position is this definition does not say the breast milk comes directly from nipple into baby’s mouth. Therefore, breast milk from hand expressing, pumping, or using donor milk and feeding via cup, syringe, finder feeder, tube at the breast or bottle is considered exclusive breastfeeding.
When you are making the feeding choices that are best for your family, we will always tell you all the options and the benefits of each one so you can make a fully informed decision. We trust you to know what is best for your unique life.
I give my baby formula. Are you going to shame me?
No. Never. Formula is a good source of nutrition and when used properly as supplementation, is a step forward towards breastfeeding. In some cases, for example if mom is struggling with milk supply issues, formula is necessary (if donor milk is not an option) for the growth and health of their baby.
During our discussion about your feeding goals, and through our assessments, we will determine what place formula has in your feeding plan. Is it temporary or will it be used throughout your breast/chestfeeding journey? Regardless of the answer, you will find no judgement from us.
We will teach you about safe formula preparation and storage, paced bottle feeding or other ways of supplementing with formula as needed (cup, tube, syringe).
I have chosen to exclusively pump. Will you help me?
Of course! We offer a full pumping consult and flange fitting so you don’t have to buy to try.
There are many challenges with exclusive pumping, we will help you avoid them and find a plan that helps you in your effort.
I took a course called “Pumping is breastfeeding. Period.” I completely agree.
Are you going to make me triple feed?
First, we will never make you do anything. There are no “one-size-fits- all” approaches to infant feeding that work. Every step of the plans we come up with will truly be a joint effort between us and you, with your input being key and your choices respected.
We will always be honest with you and give you evidence-based suggestions to help with whatever issues you may be having. But the final plan is always based on what you can realistically do, keeping the relationship between you and your baby and your mental well-being at the forefront.
Triple feeding (feeding at the breast, pumping or hand expressing after the feed and then bottle feeding) is an effective short-term method of establishing or maintaining milk supply and getting calories into baby while we sort out why a baby is not transferring milk well. It is not sustainable long-term. We would never suggest it long-term, and we would never make you do it even for one day if it was not an option for you.
Do you think every feeding problem is because of tongue-ties?
No. The presence of a tongue-tie does not always mean there is a problem with feeding, reflux, sleep problems etc. It is how the tongue functions that we are interested in.
Every baby we see has a full functional oral assessment. Yes, we are looking for oral ties (tongue, lip, cheek) but we are also assessing how your baby’s tongue moves and works. We are also looking at your entire baby- is there tightness somewhere in the body that is affecting how the tongue and jaw move? What is happening with the baby’s reflexes? If we correct those things, will we get more movement from the tongue, and will that help the other issues?
There are many other reasons a baby may not be feeding well or have symptoms like reflux or is very fussy. It may be because of a tongue tie but not always. A full assessment will help find the answers.
Do all tongue-ties need to be released?
If it is affecting the function of the tongue and/or causing other health problems for your baby, yes, it should be released completely (both the anterior-tie if present and posterior-tie) by a qualified provider at the right time for your baby.
There are many cases when we should improve the strength and coordination of the baby’s suck or address tension in baby’s body before we address the tongue tie. Sometimes there are no issues except for the tight tongue-tie, and it can be released sooner.
These cases are complex, if you are unsure, book an in-person visit for a full assessment and referral to a qualified release provider.
When a tongue-tie is present that is affecting your baby, we work closely with a team of people to get them the best care possible. We care about you and your baby. And we make sure anyone we refer you to does too.
My nipples/ breasts/ body hurts. Can you help me?
Yes! If it hurts, something isn’t right. Book an appointment and let’s figure out why and make it stop without compromising your feeding goals. It’s important we get this right as this is one of the top 3 reasons women who wanted to exclusively breastfeed give for early weaning.
If you are in pain and the next available appointment time is too far away, please send us an email and we will get back to you within 24 hours, and try to find a temporary solution, or get you in sooner.
My breasts are huge/ engorged/ hurt/ baby can’t latch onto my nipple. What can I do?
Many of us are told that engorgement is a “normal” part of breastfeeding and to be expected in the first days and weeks after our babies are born. That is simply not true. A feeling of fullness is normal around day 3-5 or even up to day 14 but not engorgement which is excessive swelling and painful.
Engorgement happens when too much fluid and blood get into your breasts causing painful swelling and inflammation that traps milk, stalls milk production and if left untreated, can affect milk supply. The breasts are not swollen with milk. It is a mix of fluid, blood, and some milk.
Engorgement symptoms can include: both breasts are swollen, and painful, there may be some pink/red/ warm areas and you may have body aches and/or feel like you have a fever. This does not mean you have an infection/mastitis. They are normal symptoms of early inflammation but not necessarily infection.
Engorgement usually happens in the first few weeks after your baby is born or if you have slept for longer than normal between feeds. The good news is, with early assessment and treatment, you will have relief fairly quickly. To keep the engorgement from coming back, we need to figure out why it happened in the first place.
If you are engorged, it is so important for you to know that neither you nor your baby have done anything wrong. But you do need an appointment as soon as possible to find out what is going on, protect your milk supply, make sure baby is getting enough to eat and to correct any issues early in your breastfeeding journey.
Please CONTACT US. We will get back to you asap and/or BOOK an appointment.
If it is outside office/ clinic hours, IN THE MEANTIME, follow these steps for temporary relief:
THE GOAL: soft, comfortable breasts that make plenty of milk for baby.
1. Take some deep breaths, focusing on the exhalation slow and steady through your nose.
2. Remember that you just got through your pregnancy and birth, and you will get through this too. You are strong!
3. Avoid deep massage and vibrating massage. These things may feel good while you are doing them, but they only make the swelling worse. This isn’t a muscle in your shoulder with a knot in it you are trying to massage out; this is tender fragile milk making cell tissue that is easily damaged when pressed too hard.
4. Medication: It is safe for you to take extra strength ibuprofen to reduce the swelling and extra strength acetaminophen for the pain as long as you have never been told that it is contraindicated for you. Follow the dosage instructions on the bottle or speak with the pharmacist.
5. Wear a well fitting, supportive bra or tank top with bra support. A tight bra will put pressure on the breasts making the swelling worse. A loose bra will cause the breasts to hang and make the swelling worse on the bottom parts.
6. Heat is not recommended as it makes swelling worse. But sometimes a warm shower or some warm compresses (not on nipple) for a few minutes are needed to help to get the breasts leaking and soften things enough to be able to latch baby or for you to be able to start hand expressing.
7. Light lymphatic massage: This is very gentle finger brushing to get the fluid and blood moving.
8. Reverse Pressure Softening: If your breasts are so swollen your nipples are flattened and baby is slipping, can’t grasp the nipple, try reverse pressure softening to make the nipple protrude a little more so they can latch.
9. Feed baby on cue with optimal positioning and a deep latch. Feed baby at the breast whenever they are hungry. It is normal for a newborn to want to feed every hour in the first days and week after they are born. Ensure baby is feeding a minimum of 8x/24 hrs with no more that 3hrs from beginning of one feed to beginning of the next. If baby is falling asleep after only a few minutes at the breast or bobbing on and off or feeding for longer than 30-40min at a time, please let us know and we will try to get you in for an appointment as soon as possible.
10. If baby is not feeding well or you are separated from your baby and are pumping:
• Hand express every 2-3 hours, even through the night. Visit https://firstdroplets.com/ for expert advice about hand expressing from a well known, very skilled and experienced resource.
• Hand express before pumping. If you put a pump flange on a swollen nipple and areola, it may damage the tender milk ducts laying right beneath the nipple. By hand expressing slowly and gently first, you will soften the area well enough to pump. A note about pumping: please ensure you are using the correct flange size for each nipple; it may be different than what you will need in a few weeks because of the extra fluid and blood. Double pump with a high-quality electric pump on a vacuum setting that is comfortable for you and only for about 15min.
11. Ice: Apply ice packs or bags of frozen vegetables wrapped in a towel for 10-20 min after every feed or whenever you need to. Avoid using cabbage; it is the cold that feels good and you can get that from the ice packs or bagged frozen veg without danger of Listeria infection.
12. Be patient: The following steps will bring you relief, but this is like waiting for butter to soften on the counter. It won’t be instant; the relief will come in degrees and waves.
13. Repeat steps 6-11 as often as baby feeds or at least every 2-3 hours.
I think I have mastitis. What should I do?
Contact for guidance.
I think I have a plugged duct. What should I do?
This is usually a sign that something is off with milk production and/or removal. Especially if it happens more than once. Plugged ducts/nipple pore blebs can be very painful, if possible you should book an appointment to be seen in person for a full assessment, therapy and prevention plan.
If you are in our service area, please book the first available appointment. If the “in the meantime” steps below are not helping, call/text/ email and we’ll try to get you in sooner.
If it is outside office/ clinic hours, IN THE MEANTIME, follow these steps:
Milk ducts: Visualize the milk ducts in your breasts like an intricate cobweb, with tiny little lines that branch into other ones and go in all directions. Or like a maze. And there are so many milk ducts it would be impossible to count them. That is what the milk ducts in your breast look like. They are not straight lines from the milk making cells directly to your nipple pores.
It is normal for your breasts to feel lumpy and sometimes even have some discomfort after your baby is born. It is also normal to be sweaty and feel hot after baby is born. It has to do with the hormones from being pregnant and giving birth. Make sure if you are feeling around your breast, you are doing it with the long pads of your fingers, not the tips of your fingers and digging in. You are sure to find all kinds of lumps if you do it the second way and all that digging may actually cause the “plugging”.
It is impossible that a single duct could become plugged with a tiny little clump of milk. And it is also impossible, since the ducts are not in a straight line, that anyone could massage, or squeeze or dangle feed a plug out.
What is actually happening is that in an area of your breasts, the ducts have become congested, swollen, and narrowed. Imagine a traffic jam on a busy highway.
Mom symptoms: tender area/ full area or lump, no redness, fever or general body aches, may have some relief after pumping/ feeding but it doesn’t last, one or both breasts may be continuously engorged, nipple blebs
Baby symptoms: may be frustrated or fussy at the breast, may cough, spit, gulp or clamp down while feeding, may be gassy, have explosive, watery, frothy, mucousy green poops, may vomit after feeding or have reflux-like symptoms
Causes: oversupply, imbalance of the healthy bacteria in your breasts’ microbiome, excessive pumping especially with an incorrect flange size, using a pump that puts excess pressure on your breast tissue, using a nipple shield*
*Please note: using a nipple shield is sometimes necessary short-term in order to help baby latch at the breast. If the choice is between not breastfeeding/ no nipple shield or breastfeeding with a nipple shield, we should always choose using the nipple shield with a good plan for how to stop using it.
Treatment: The goals are to widen the milk ducts, ease the congestion and get the milk flowing easily and stop this from happening again.
NO DEEP OR VIBRATING MASSAGE: it may feel good in the moment, but it only makes the swelling worse and can cause serious damage to your tender milk making cells and other breast tissue. You would not massage a swollen ankle; this is the same.
Temporarily stop taking any herbs or supplements you are taking to increase milk supply.
1. Take some deep breaths, focusing on the exhalation slow and steady through your nose.
2. Remember that you grew a human and brought them into the world, and you will get through this too. You are strong!
3. Medication: it is safe for you to take extra strength ibuprofen to reduce the swelling and extra strength acetaminophen for the pain as long as you have never been told they are contraindicated for you. Follow the dosage instructions on the bottle or speak with the pharmacist.
4. Wear a well fitting, supportive bra or tank top with bra support. A tight bra will put pressure on the breasts making the swelling worse. A loose bra will cause the breasts to hang and make the swelling worse on the bottom parts.
5. Heat is not recommended as it makes swelling worse. But sometimes a warm shower or some warm compresses (not on nipple) for a few minutes is comforting
6. Light lymphatic massage: this is very gentle finger brushing to get the fluid and blood moving.
YOUR BREAST NEEDS REST. Just like adding more cars to a traffic jam highway does nothing to ease the congestion, neither does adding more and more milk to your congested milk ducts help with the pain.
7. Ensure baby is getting a good deep latch every feed.
8. Feed from the breast without the plugging whenever baby is hungry.
9. Feed from the breast with the plugging only as much as the baby needs. You may have to rest this breast even more by only feeding from it every other feed.
• Feed one: breast without plugging first. Only feed from breast with plugging if baby is still hungry and only until baby stops actively feeding. Do not pump or hand express afterwards. Allow this breast to rest. Put some ice on it to reduce the inflammation and swelling.
• Next feed: breast without plugging first. Only feed from breast with plugging if baby is still hungry and only until baby stops actively feeding. Do not pump or hand express afterwards. Allow this breast to rest. Put some ice on it to reduce the inflammation and swelling.
• Next feed: breast with plugging first only until baby stops actively feeding. Then switch to the other breast.
*This is more complicated if you have low milk supply. With a person with a plentiful supply, block feeding like this may cause a decrease in supply we can most likely fix after the plugging has resolved. I understand if you don’t want to take that chance. Please book an appointment with an IBCLC to come up with a plan that works for you.
10. If baby is not feeding at the breast and you are pumping:
• Use a high-quality electric pump (not a wearable) and properly sized flanges for each nipple.
• Pump one: Only pump from the breast without the plugging for roughly 15 min or a couple of minutes after you see the last sprays. Hand express the breast with the plugging only for comfort- not to empty.
• Pump two: Only pump from the breast without the plugging for roughly 15 min or a couple of minutes after you see the last sprays. Hand express the breast with the plugging only for comfort—not to empty.
• Pump three: Double pump both breasts for roughly 15 min or a couple of minutes after you see the last sprays.
11. Ice: apply ice packs or bags of frozen vegetables wrapped in a towel for 10-20min after every feed or whenever you need to. Avoid using cabbage, it is the cold that feels good, and you can get that from the ice packs or bagged frozen veg without danger of Listeria infection.
12. Sunflower Lecithin is safe to take while breastfeeding 10mg per day when you have plugging then 5mg per day for prevention. Lecithin helps to break down the fat in milk and make it less clumpy and sticky. Soy lecithin may come from a GMO crop field.
13. If available, ultrasound therapy may provide some relief. This must be done by a physician or a specially trained therapist.
14. If you also have a nipple bleb. If the cause of your plugging is “mammary dysbiosis” (fancy word an imbalance of the bacteria in your breasts microbiome- a thick film forms along the sides of your milk ducts making them more and more narrow and easier for the milk to get backed up causing the plugging. A nipple bleb is that film or inflammatory cells that you can see it because they are at the opening of your nipple. Do not unroof. This may cause even more trauma. Take all the steps above and see your healthcare provider to get a steroid cream that will reduce the swelling and is safe to use when breastfeeding.
YOU SHOULD FEEL RELIEF WITHIN 24 hours of resting your breast. If you the pain does not get better or worsens after a day or so of resting your breast, see your healthcare provider and request an appointment for an ultrasound image of your breast to see if more needs to be done.
See the Academy of Breastfeeding Medicine Clinical Protocol #36 – The Mastitis Spectrum Revised 2022
When I pump my nipples/breasts hurt. Can you help me?
Yes! It should not hurt to pump. It should feel like a gentle tugging or like nothing at all. If you are having pain, most likely you are using the incorrect size flange for one or both breasts. (Did you know you may need a different size for each one? I have taken several courses on pumps, pumping and flanges, and my favourite line from one of them was, “your breasts are sisters, not twins”—ha! So true😊.) It may also be your pump or your pumps settings.
We offer a pumping consult and flange fitting. We have flanges in our clinic ranging from 10mm-44mm; so you don’t have to buy to try if you book an in-person visit.
I don’t think I am making enough milk. My baby is always hungry and never seems satisfied after breastfeeding. Can you help me?
Yes. First a few tidbits.
It’s important we get this right as this is one of the top 3 reasons women who wanted to exclusively breastfeed give for early weaning. The truth is most women’s bodies can make plenty of milk for their babies. It is also true that some women’s bodies, through no fault of their own, cannot. But the chances that you can and are making enough milk for your baby are good. (For women with true low milk supply/IGT. See the FAQ question for more information.)
What does a normal breastfeeding day look like?
• In the beginning, your baby may feed 8-15 times a day, some feeds lasting just a few minutes, some for 30-45 min. In countries where they don’t feed by the clock, more frequent feeds are common.
• These feeds are unevenly spaced. Some feeds might be within an hour of each other, some may be 3 hours apart. In the beginning, babies need to feed every 3 hours from beginning of one feed to the beginning of the next. That is 8 feeds in 24 hrs minimum to support their growth and hydration.
How many pee and poop diapers should I expect in 24 hours?
How much weight should my baby be gaining?
After a vaginal birth: Babies usually lose a bit of weight before they start gaining again on day 4. We like to see babies back to their birth weight after a vaginal delivery by day 14. They gain about 20-35g per day, until they are roughly 3-4 months old when their rapid growth slows down.
After a cesarian birth: We give babies a little more time; we like to see them back to birth weight by no later than 3 weeks or day 21. The reason we don’t panic if they are not back to birth weight by 2 weeks, but feeding is going well and they are having the right amount of pee and poop diapers, is because they are typically born with extra fluid in their body from the IV fluid during the procedure. Their weight loss includes losing all this extra fluid, and takes a bit longer. Baby may be taking in enough milk to support their growth and hydration but still peeing out the extra fluid.
Growth curves: Once baby has regained their birth weight we can plot their growth on a “curve” expressed in percentiles of 3rd-99.9th. So long as your baby follows their curve, their weight gain is fine. Babies come in all different sizes, just like us. A baby growing in the 25th percentile consistently, feeding well, meeting all their developmental milestones and generally content is just as healthy as a baby growing in the 75th percentile.
What is normal cluster feeding?
• Feeding several times over 3-4 hours, usually in the late afternoon or evening (but it can be at any time of the day or night). It may feel like one long continuous feed that doesn’t end for hours. This may go on for 2-3 days.
• Baby may be fussy and difficult to comfort or settle.
• Baby may fall asleep for only a few minutes before waking again and showing hunger cues.
When/why does normal cluster feeding happen?
• During growth spurts and developmental milestones, babies go through a huge transition from your womb to “life on the outside”. Then they go through more transitions as their brain develops and they are able to defy gravity and reach for things, roll over, sit, crawl, and walk on their own. Every time their world opens up by a little or a lot, it is somewhat disorienting and scary. So they cling to us and being in close contact with us helps them to feel safe in the world. Your breastmilk helps to fuel this brain and body growth, and also has ingredients in it that are comforting and soothing while they get used to the change.
• The first weeks and month after your baby is born is a time for getting to know one another. Your baby only has so many ways to communicate with you that they need something. As the bond and relationship between you and your baby develops, you will recognize their unique cues and respond. Be patient with yourself; learning your baby’s cues takes time.
• In the first weeks and month or so after your baby is born, you are building your milk supply. The best way to establish a good milk supply is to feed your baby on cue, as often as they cue and for as long as they are actively feeding at the breast (remember, feeds can be just a few minutes or up to 30-45min). Babies are like us, sometimes we just want a snack and other times we want a full meal with dessert.
• When baby is thirsty. Your breastmilk contains all the water your baby needs; sometimes they just need to quench their thirst.
• When baby is teething. Your breastmilk has pain reliever ingredients in it. Plus being close to you is comforting and soothing.
• When baby is sick. Don’t panic; babies get colds too. When you hold your baby close and kiss their little heads, your lips scan their bodies. If it finds a virus or bacteria that shouldn’t be there, your body will make the exact antibodies needed to fight it. Those antibodies end up in your breastmilk and then into your baby’s body when they feed- ready to fight off those unwanted invaders. Cool, eh?
• When there has been a change in the daily or family routine. Babies crave stability and need to be close to you to feel safe in times of change.
• Before a longer stretch of sleep. The milk you make during cluster feeding has more fat in it which helps baby to stay fuller a bit longer once they get through the cluster feed period.
Some tips for surviving the dreaded cluster feed:
• Know this will end. As your baby gets older and stronger, they will get more efficient at removing milk from your breast in shorter time periods. Investing your time and energy now to build a good milk supply will eventually pay off big time.
• Make sure baby has a good deep latch. This is the basis of an efficient, satisfying milk transfer.
• Take breaks if you can. Have another adult around to spell you off while you step outside or plug in your earbuds or have a snack for a few minutes.
• Get out of your home whenever you can. The days can feel really long when your full-time job is feeding your baby. A change of scenery can do wonders and break up the day.
• Plan ahead. Have a cluster feed survivor kit with comfort items that are just for you. Special treats, special comfy socks, whatever helps you to relax and lean into the feed. Make sure you are in a comfortable feeding spot with your feet up. Have plenty of water and anything else you need to get you through this challenging time.
• Try non-nutritive sucking with a clean finger (a large finger not your pinky) pointed pad side up towards the roof of your baby’s mouth or a pacifier (long round nipple). Sucking is intensely comforting and pleasurable for a baby. It helps them to regulate their emotions and cope with changes. If this works, you will know what they craved was contact with your body. Perhaps another adult can take over while you go take that break.
• Decrease stimulation. Sometimes babies get overwhelmed by their surroundings. If they won’t make eye contact with you, are turning their head away and arching their bodies away, try dimming the light, turning off any devices, holding them close to your chest while you hum and rock or sway. It may take some minutes for them to settle.
• Try adding rhythmic movement to the feeds. Bounce on an exercise ball, rock in a rocking chair, wrap them up in your baby carrier in a way they can safely feed while snuggled in there.
• Try breastfeeding in the tub. Make sure you are not overtired in case you fall asleep. Have another adult around to take baby from you once they settle. Then add some more hot water and have a good soak. You deserve it!
• If you are certain you don’t have an “overactive let down”, try some gentle breast compressions while feeding to increase flow.
• Start a feeding, pee and poop log if you aren’t currently tracking. If you end up reaching out for help, it will be helpful to see what exactly is happening.
It is important to look at the whole picture when worrying about whether you are making enough milk for your baby. If they are having the right amount of pee and poop diapers a day, feeding a minimum of 8 times per day on non-cluster feed days and are content after the feed, have no problems with latch, have no signs of dehydration and weight gain is not a concern, you are likely making enough milk. We trust you to know if something isn’t right; book an appointment to be sure if necessary.
When cluster feeding is not normal and it’s time to BOOK a lactation appointment.
Please be reassured, with early assessment and help, this can almost always be fixed and save your breastfeeding journey.
• The cluster is not just for a few hours here and there. It is all day and all night, every day.
• Feeds consistently take longer than 45 min. Almost every feed or several feeds per day.
• You are unsure baby is getting a good deep latch, your nipples are sore, cracked, damaged and/or any shape other than round after baby unlatches.
• Breastfeeding is painful.
• Baby comes off the breast hungry, there is no break. Or baby feeds and fusses at the breast before falling asleep and you are unsure whether they even got anything.
• Baby is rarely content and every feed feels like a battle or like you are wrestling a cat.
• Baby is either gaining more weight than expected or not enough or gaining slowly, not able to keep or stay on their growth curve.
• Baby coughs, gulps or chokes at the breast.
• You are concerned your baby has a tongue, lip or cheek tie.
• Not enough pee and poop diapers in 24 hrs. Red orange crystals in the diaper after day 4. Meconium stool after day 4. (If this is combined with signs of dehydration, either get a same day appointment with baby’s doctor, paediatrician or nurse practitioner or go to your local emergency department).
• Baby is having explosive/green/frothy poops.
• You have tried everything and the only time your baby is satisfied after a feed is if you supplement.
• You are still concerned about your milk supply.
• You feel if this continues, you are going to stop breastfeeding when before the cluster feeding started, you were committed to exclusive or partial breastfeeding.
I’ve been told I have low milk supply/IGT/won’t make enough milk for my baby. Can you help me?
I’m so sorry this has happened to you. Give me a call so we can talk more about it.
Sometimes our bodies just take a little time to “wake up;” sometimes there is an underlying problem that, if corrected, can help you produce more milk.
Sometimes people don’t know what they are talking about and there is some other issue going on. Reach out, let’s talk and sort out what is and isn’t happening.
If you do have true low milk supply/IGT, I promise that we will work very hard to help you achieve the best possible feeding relationship with your baby. Making More Milk by Lisa Marasco and Diana West is an excellent book. I have a copy I would be happy to lend you if you would like to stop by the clinic and pick it up.
Please note I cannot provide specific advice without a full assessment and signed consent form. But we can chat and decide whether an appointment is necessary.
I don’t think I can do this (breastfeed). What should I do?
Come see us. We understand how lonely, overwhelming, discouraging, and frustrating breastfeeding can be sometimes. Let’s have a visit and see if there is something that can be done to make this easier for you (often it’s just a little tweak in position and latch). Let’s talk this through together so when you come to any decisions, you made them fully informed and feel good about your choice. Know that we respect any decisions you may come to. We’ve been there ❤️
I am trying to support my breastfeeding/ chestfeeding/ exclusively pumping partner/ daughter/ sister/ friend. What kinds of things can I do to be helpful?
Ask what she would find helpful.
If she is not the kind of person who is comfortable saying what she needs. See below … by no means an exhaustive list but these ideas will get you started.
Be there for feeds and/or pumping sessions. Feeding your baby can be lonely work. Especially in the first weeks and months when feeds can take 30min or more. Just be present, even for night feeds (maybe not all but for some, you will figure out a routine).
Set up a feeding “station.” Or two, or three😊 Comfortable chair, stool for under her feet, table for snacks, water bottle, supplies, charging cables, anything she may need and can’t get to once she starts feeding or pumping. Make sure it’s always stocked.
Bring her snacks, fill up her water bottle.
Skin to skin or holding baby while she rests or has an uninterrupted shower.
Paced bottle feeds
Help with pumping. I saw this quote once, but don’t remember where, so I cannot credit the author, “she is cooking dinner 4-12 x/day, can you do the dishes?” … meaning the pump equipment. Or how about all the dishes! Ha!
Bring over light, nutritious, cold, or easy to heat up meals.
Do a load of laundry, tidy up the kitchen, vacuum.
Encourage her, write her little notes, bring her a little bouquet of flowers (already in the vase and water!)
I think I have postpartum depression. What can I do?
I’m so sorry things are so difficult. It is important you find emotional support with someone you connect with as soon as possible. If you find yourself alone in the world, please reach out and we will give you some names of qualified professionals experienced in postpartum mental health and wellness.
Without knowing more about you, I cannot give you more helpful support. I wish I knew the perfect words that would reach your heart and let you know you are enough; you have worth and not to let go of the hope that things will get better. Even if I did, sometimes that isn’t enough. Perhaps you need more than a supportive presence, listening ears, connection, and holistic lifestyle changes.
I am not qualified to even suggest whether medication is necessary, but I can tell you that almost all depression/anxiety meds are compatible with breastfeeding and if you need them, you can take them safely after consultation with your doctor.
What is most important for you to know is getting help for these feelings is a sign of strength. Whether or not you are breastfeeding, taking care of your mental well-being is key to bonding and your relationship with yourself, your partner, and your baby. If you are breastfeeding, depression and/or anxiety can affect your milk supply, your perception of nipple/ breast pain and more. Please prioritize yourself, you are so important!
A few facts… you are not alone!
• 80% (4 in 5) of women feel the postpartum blues.
• 13% of women (1 in 7) experience postpartum depression.
• 10% of men (1 in 10) experience postpartum depression and struggle to support their partners.
Here are a few online resources: (please check your local and national mental health websites for more resources closer to you)
Signs of Postpartum Blues may include: (common in first few weeks postpartum)
• Crying for no apparent reason; Mild mood changes; Impatience; Irritability; Restlessness; Mild anxiety; Difficulty sleeping (not because of baby care)
*If you are unsure if you have the blues or depression, reach out to your Health Care Provider.
Signs of Postpartum Depression may include: (can appear anytime in first year or even two after birth)
• Sluggishness; Fatigue; Exhaustion; Sadness; Depression; Confusion; Hopelessness/helpless; Appetite/Sleep disturbances (unusual for you and not because of baby care); Poor concentration; Memory loss; Over-concern for baby; Lack of interest in baby; Uncontrollable crying; Irritability/anger; Guilt; Inadequacy; Worthlessness; Lack of interest in caring for yourself or your baby; Anxiety; Exaggerated highs/lows; Fear of harming the baby or yourself; “I don’t feel like myself”
Signs of Postpartum Psychosis: (rare, usually in first 3 weeks after birth)
POSTPARTUM PSYCHOSIS IS A MEDICAL EMERGENCY: CALL 911
• Severe insomnia, Hallucinations or delusions (may come and go), breaks with reality; Bizarre feelings and behaviour; Hyperactivity; Paranoia and suspicious behaviour; Rapid mood swings; Difficulty communicating, odd word choices, disorganized speech
WHAT I HAVE WRITTEN IS NOT A SUBSTITUTE FOR GETTING QUALIFIED TREATMENT BY A MENTAL HEALTH PROFESSIONAL. IF YOU (OR YOUR LOVED ONE) ARE:
• IN AN EMERGENCY OR CRISIS, OR RECOGNIZE SYMPTOMS OF POSTPARTUM PSYCHOSIS IN YOUR LOVED ONE: CALL 911
• HAVING SUIDICAL THOUGHTS: CALL 911 OR if you live in Canada, Talk Suicide Canada at 1-833-456-4566 24/7
• IN CRISIS OR NEED SOMEONE TO TALK TO: MAKE AN URGENT APPOINTMENT WITH YOUR FAMILY PHYSICIAN, NURSE PRACTITIONER, OR CALL THE NATIONAL HELP LINES LISTED WITH POSTPARTUM SUPPORT INTERNATIONAL LISTED ABOVE.
*Please be aware that the information provided is intended solely for general educational and informational purposes only. It is neither intended nor implied to be a substitute for an in-person assessment. Always seek the advice of your physician for any questions you may have regarding any medical conditions. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.