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. Make sure to change them when damp.
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. Colostrum is 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 ok to drink. Remember your milk is made from your blood.
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 each feed
24-48 hours -5-13ml colostrum each feed
48-72 hours-15-27ml colostrum each feed
72-96 hours-30-46ml each feed
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
After breastfeeding is established: How much breast milk in ounces does baby get? This varies greatly for every baby.
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?
Hold your breast with one hand in the form of a C or U. Hold back of baby's head and neck with your other hand. Sandwich your breast tissue/compress it. Line up your breast sandwich parallel across from babys mouth. 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 nipple up and back towards the back of their mouth. Try to get as much tissue in the back of their mouth as you can during the latch. Make sure both lips are flanged out and not tucked inside their mouth for a good seal. If you hear clicking or popping, relatch. Bring the baby up to you, don't lean down or stoop down to feed your baby, this will likely cause back pain. Lots of pillows or a breast friend pillow/boppy support pillow under baby to bring baby up to you.
Point baby's nose towards any problem area you have such as a clogged duct.
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 rest or nap, and fully empty breast milk via nursing baby or pumping, and antibiotic prescription. Your milk is safe to drink and most antibiotics are safe for breastfeeding. Ask your pharmacist.
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. Eating the following foods may assist in milk production: beets, whole wheat, flax seed, wheat germ, oats and oatmeal, chicken soup, any form of protein, and water.
Flange fitting for breast pump
Measure the nipple only from top to bottom with a ruler. You will most likely need a pump flange adapter peice that goes inside the size 24 flange to make the nipple hole smaller. 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:
Kellymom
Infant Risk Center
Dr.Jack Newman
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.
Updated 12/19/22
Latch
Crystel Corbin, RN, IBCLC
Call: 515-745-4485
Email: crystel@latchia.com
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