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Prenatal Information

Updated: 2 days ago

Prenatal Consult


Breast Changes February 6, 2021

You may notice your breasts are changing in their size, shape, and color. It is a good sign to see breast changes in relation to breast milk production. Wear a supportive bra, you may have to get sized every few months. Wearing underwire is ok while pregnant but while you are breastfeeding it can cause the risk of clogged milk ducts (with the milk not being able to move freely in the breast). You may notice breast leakage of yellow or white breastmilk in small amounts during your pregnancy, this is normal. If you need to wear breast milk pads inside your bra to protect your clothing that is fine. There are disposable pads and washable/reusable pads. Either is fine.

Your nipple and areola may turn a darker color and you may notice small white bumps on your areola. The white bumps are called Montgomery tubercles. They will excrete a fluid after delivery that smells like amniotic fluid and will draw the baby towards the breast and nipple. These glands will lubricate the areola(area around the nipple) and assist to prevent infection.

Your breasts may look fuller and more round and may be sensitive to touch. When you are showering, turn away from the water if your nipples are too sensitive. Wear a bra during the day and wear soft bras and clothing, nonrestrictive. It is ok to tell your partner that your nipples are sensitive and you do not want them touched during sex.

If your breasts are orange and dimple please call your doctor. Please call your doctor if you have recurrent mastitis after you deliver and request a diagnostic mammogram if needed.



Why breastfeed?

Your breast milk is perfect for your baby. Every drop is special and made specifically for him/her. Your baby will receive your immunity from being sick from various bacteria and viruses throughout the years. This does not mean they do not need to be vaccinated against deadly viruses. Your antibodies do not provide a full protection from these viruses.

Your milk will change throughout the day and months/or years to assist in the various growth spurts and development. For example: if your baby is 3 months old they will receive a larger amount of fat in their milk compared to a 12 month old baby who is consuming table foods and proteins and fats from formed food. A 12 month old baby will have a thinner consistency to their breast milk, with more water.

Breastfeeding may decrease ear infections in your child, decrease allergies, decrease the chances of diabetes in children. You may also have a decrease in breast cancer.

What's in breastmilk

In the beginning of your baby’s newborn life, your breasts excrete a concentrated milk called colostrum. This super concentrated milk contains everything your baby needs for nutrition and brain health in the first few days of life. This is also important for the baby’s gut. The baby’s GI tract is now lined with good bacteria and begins to push out the first bowel movement that is thick and dark, meconium. Breastfeeding may decrease your chances of breast cancer in your life. Breast Milk contains amazing proteins and macronutrients. Macronutrients are required for survival, water, fat, carbs, and proteins. Proteins include stem cells that are directed towards any damaged organ or cells. Fat and lactose are the main energy source. Micronutrients are needed to thrive “brain food.” This is one item that sets human milk apart from cows milk found in most formulas. These include vitamins, minerals, nucleotides and pre/probiotics. The proteins are distinct and protect against infection and inflammation. They support organ development, immune maturation, and a healthy microbial or good bacteria growth.

Colostrum contains: SIgA(the main antibody in human milk), lactoferrin(antibacterial and absorbs iron), lysozymes(3x more in human milk than cow's milk. Degrades and breaks down bacteria), erythropoietin stimulates red blood cell production and provide immunity, EGF epidermal growth factor maturity and healing in intestines, oligosaccharides(carbs and HMO’s{human milk oligosaccharides}). These are all critical for immune support. These heal, seal, and seed the gut with healthy bacteria.

Preterm infants: contains high amounts of triglycerides, brain food. Protein is also high.

Foremilk: the beginning of your milk excretion during a breastfeeding session. High amounts of lactose, for good brain growth.

Hindmilk- high fat, essential for weight gain.

Cow's milk aka formula contains beta lactoglobulin. This can cause allergies in humans and diabetes mellitus. Cow's milk has a predominant protein called casein. This is harder to digest compared to human milk. Human milk has prominent whey protein. This contains lactoferrin, lysozyme, immunoglobulins, lactalbumin, and serum albumin. This provides continuous nutrition.

Formula cannot help prevent sepsis(blood infection) in the newborn. Mothers milk is a natural preventative.


Birth to Breast

The first hour postpartum is called the golden hour. This is the most important time to do skin to skin and allow for pt to self lead to the breast. Studies have shown that the earlier the breast milk is removed from the breast, the better outcomes and milk supply will be overall. It also reduces stress in you and your baby by decreasing cortisol levels.

1.Skin to skin asap. Take off the babys wrap/blanket.

2. Allow the baby to lay between breasts, lay back with the baby.

3. Baby will lick and sniff, this includes baby's hands. Don't clean off the baby’s hands.

4. Baby will nibble on your nipple and swallow.

5. Milk transfer, baby is sucking and swallowing.


What's most important to establish a good supply?

#1. Start breastfeeding early! Within the first hour do skin to skin. Skin to skin often.

Get a hospital grade pump if/when you need to use it.

Nurse when the baby wants to eat, usually around every 2 hours in the beginning and during growth spurts.

Have good support from your spouse and family. Share your knowledge with them.

Know how and PRACTICE hand expressing milk. Press, Compress, and Release, Repeat. Youtube is a great resource.


How does the breast milk change

Retrograde milk flow- the baby’s spit and backwash flows back into the nipples to tell the mom that the baby is sick, in return causes an immune response. Studies have shown that kissing the baby’s head or that instinctual kiss on their lips can cause this same response. Your milk will then change to fit the baby’s needs.


Milk can come in different colors

Milk may white, green, orange, rusty brown, black, light blue, yellow, pink or light red. These are all ok.

Pink- fresh blood from cracked nipples or irritation. Eating beets may cause this.

Green-lots of iron, vitamin supplements can cause this, and sports drinks.

Orange- carrots may cause this from beta carotene, also common color for colostrum.

Black- when taking antibiotics this may be seen.

Rusty/brown- “rusty pipes syndrome”-blood, certain medications, or inflammation.

SUPER HOT PINK do not feed, call your OBGYN or PCP.



Approximate intake for the baby for the first week

First 24 hours- 2ml up to 7ml colostrum

24-48 hours -5-13ml colostrum

48-72 hours-15-27ml colostrum

72-96 hours-30-46ml

AFTER THE 6th DAY-- Intake of 8-12 feeds per day, both breasts offered

OUTPUT--Minimum of 6-8 urine output/wet diapers per day

Minimum of 4 stools per day

After breastfeeding is established: How much breast milk in ounces does baby get? This varies greatly for every baby. Approximately baby’s weight in lbs x 2.5 = 24 hours worth of oz. baby consumes.

14lbs x 2.5= 35 ounces of breastmilk in a 24 hour period. Please Note this is after breastfeeding is established.

Baby should gain 4-7oz per week or 1 oz per day, regaining birth weight by 2 weeks is a goal.


Engorgement may happen day 3 postpartum, it is important to remove the milk. Offer the breast offer and stay skin to skin whenever possible. Vibration with a vibrating toothbrush or whatever you have that vibrates does help with clogged milk ducts. Use your hands to gently massage the breast milk down to the nipple. Hand excrete when necessary. It is good to massage your breasts before and during your pumping sessions or breast feeding sessions. Warmth will assist with let down or low supply. Cold will help with engorgement. Clean,cold cabbage leaves will decrease inflammation and excess milk if your breasts are very uncomfortable and full of milk/surplus. DO NOT USE cabbage if allergic to sulfa. 10-15 min at a time for cabbage. You can reapply 2-3x per day if needed.

You may notice lumps or fullness in your armpits after 3 days postpartum, it is important to remove the milk by nursing, hand expressing, or pumping. Nursing your baby is more effective at pulling the milk out of your breasts.


How should I breastfeed?

Asymmetrical with baby’s full body facing your body, baby's belly should be touching your belly or skin, baby's mouth wide open at 140 degree angle, pointing the baby’s nose towards your nipple.

Point baby's chin towards any problem area you have such as a clogged duct. Make sure you and baby are comfortable and there are no blankets or pillows near the baby's face. Bring the baby up to you, don't lean down or stoop down to feed your baby, this will likely cause back pain.


Complications

Mastitis- inflammation of the breast tissue due to bacterial infection and continued milk in the breast. You may have flu-like symptoms with fever 100.1 or higher, chills, body aches, redness of breast, red streaks on breast tissue. Contact your doctor for an antibiotic. You may need to use warmth/heat, rest or nap, and fully empty breast milk via nursing baby or pumping, and antibiotic prescription.

If you have several bouts of mastitis please discuss this with your doctor including the need for a diagnostic mammogram.


Nursing strikes may happen around 7 months old, keep offering the breasts, lay with the baby and allow them to latch when they are ready.




Your milk supply

Please make sure you drink plenty of water while breastfeeding. Please eat enough food. Many cultures believe that eating the following foods will assist in milk production: beets, whole wheat, flax seed, wheat germ, oats and oatmeal, chicken soup, and water.

Stay away from: Parsley, thyme, peppermint, mint, and sage in large quantities.

Flange fitting for breast pump

Measure the nipple only from top to bottom with a ruler. If your nipple is 20mm you'll most likely use a 24mm flange. You’ll go UP to the closest size. Never let your nipple or skin rub up against the inside of a pump flange. This causes too much friction and skin breakdown and nipple cracking/soreness.


Websites:

https://youtube.com/watch?v=OhF-qpaaOHQ&feature=share

Kellymom

FYI:

It is ok to ask for help!

It is ok to not want any visitors after delivery or at your home while you are getting used to breastfeeding. This is your baby, and your partners’. Establish boundaries! It is Legal in all 50 states to breastfeed in public. Know your state’s laws, they are clearly defined. Do not feel that you need to feed your baby on the toilet, a closet, or away from your family. The baby eating is a biological need and a biological norm.

It is ok for babies nose to be touching your skin, babies can breathe through their noses.

It is ok for baby’s hands to massage your breasts, please allow them to move their hands around and they may fiddle your nipples to increase the speed for let down.




Latch

Crystel Corbin, RN, IBCLC

Call: 515-745-4485

Email: crystel@latchia.com

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Follow on Facebook @LatchBreastfeedingIBCLC

Instagram @LatchBreastfeedingSupport



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