Dear Lactation Consultant:

As a new breastfeeding mom I am overly concerned about what I eat, whether it gets into my breast milk and how it will affect babies (yes, I have twins!) I live in an agricultural area so the food I eat is extremely fresh but recently I read something about a high accumulation of nitrates affecting certain vegetables. Can you give me any information on this and whether I should avoid any foods, particularly vegetables? I am doing so much to provide for my 3 month old twins and I want to continue to provide them with the best.

Angela Cortes Webster
Santa Maria, CA

Dear Angela:

First of all, hats off for providing breastmilk to your twins and finding the time to keep up on important topics such as nitrates, as long as it is not impacting on your sleep!

Dear Lactation Consultant:

My baby is breast feeding well and our pediatrician said at the 8 week visit that it is time to introduce a bottle or he may never take the bottle. I enjoy reading the Q & As on your website so I thought I would pose this question to you. Can you give me some advice on whether it is necessary to introduce a bottle and if so, which bottles and nipples do you recommend? Also, I do not have a pump, so any recommendation on pumps would also be helpful.

Thank you,

Prudence Arnold
Austin, TX

Dear Prudence:

At eight weeks, I have to agree with the pediatrician-it might be extremely difficult to introduce a bottle to your baby, as he is very comfortable at the breast and may not take to a silicone nipple. There are many factors to consider when introducing a bottle and I will discuss them for you.

Dear Lactation Consultant:

My pediatrician doesn’t believe in starting solids before 6-8 months and since my totally breastfed baby is in the 90% for weight and height I’m in total agreement with the pediatrician. My mother, on the other hand, disagrees and we have been battling for months now. I apparently was not a good sleeper until she added rice cereal to my diet at 2 ½ months and since my baby doesn’t sleep through the night she is insistent it is because I am ONLY breastfeeding and that if I would just add a little rice cereal, my baby would sleep better. I was not breastfed and so my mother was adding the cereal to a bottle of formula. Although the idea of some blissful sleep does sound appealing, it just doesn’t sound like the appropriate way to go. What do you think?

Leila Cranston
Oak Brook, IL

Dear Leila:

Your pediatrician is absolutely correct. The American Academy of Pediatrics does not recommend introducing solids before 6 months and there are several clinical reasons for this. When your baby was born, she had big cheeks with very thick fat pads in them, known as bucchal cheeks. They help to create the suction needed for breastfeeding. At around 6 to 8 months this fat reduces and there is left a pouch between the cheek and the gums on both sides of the mouth. This enables the baby to move food around in her mouth. The baby can at this point chew, liquefy and experiment with the food in her mount. Until this point, more food is pushed out of the baby’s mouth than remains in it. I’m sure if you have younger siblings you can remember your mom taking the spoon and scraping the food as it came out of the mouth and dripped down the chin and putting it back into your siblings’ mouth. It was because they were not yet coordinated to chew, liquefy and swallow.

Dear Lactation Consultant:

A friend of mine is adopting a baby in a few weeks. She has been working with a lactation consultant in an attempt to produce breast milk for the baby but so far it does not look very promising. I just finished nursing my twins and am more than willing to breast feed her baby but she seems reluctant to that idea. You always seem to have good advice so I am wondering what you would recommend in this situation.

Sincerely,

Ricki White
Sherman Oaks, CA

Dear Ricki:

You are extremely compassionate and selfless to offer your time and your breast milk to your friend and her new baby, but I do understand her hesitation. She has probably waited a very long time for this baby and the thought of someone else breastfeeding might be more than she can handle.

Dear Lactation Consultant:

My maternity leave is just about over and I am really depressed about returning to work. I always knew the route I would take: get married; have a baby; take a little time off; go back to work. It is a no-brainer for me because we need two salaries to live the lifestyle we decided to maintain. I am a professional who has always loved what I do. Now all that has changed and all I want to do is be a SAHM. I don’t want a stranger raising my child so we can have the home we have always dreamed of living in, yet I really look forward to coming home to that house in the suburbs. So I will shortly put on suit and heels and get back into work mode. I’m sure I am not the only new mom who feels like this so thanks for letting me vent.

Sincerely,

Vanessa Kaffner
Sacramento, CA

Dear Vanessa:

Thank you for your honesty. I empathize with you. Your generation has not been given the option of making choices. You just knew what had to be done from the very beginning. Whether you have a career and are the bread winner in the family, share the financial responsibility or without your salary, that house will remain a dream, returning to work is not a choice.

Dear Lactation Consultant:

I am 6 months pregnant and will be going back to work when my baby is 3 months old. It is my hope to breastfeed for a full year (assuming all goes well), which means I will be pumping while I am at work. I am confused as to the type of pump to use to maintain my milk supply. Can you advise me?

Candi Hazelcorn
Brooklyn, New York

Dear Candi: 

You have many options available today, which is quite a change from even 10 years ago. The first thing I would recommend is to check with your health insurance company to see if they will reimburse for a pump. If they will, is the coverage for a rental or a purchasable pump (aka expendable good)? If you can get reimbursement, that will help with your decision. Also, many corporations have lactation and/or pumping programs, which you should know about before you have the baby. Then you might be provided a pump. Check all this out now so you aren’t dealing with it once the baby is born.

Dear Lactation Consultant:

I am going back to work next week. I wasn't supposed to return until my baby is 4 months old, but due to some uncontrollable problems at the office, I have no choice but to go back at 6 weeks postpartum.

I have a great milk supply, my son is breast feeding like a champ and his dad gives him a bottle daily without any difficulty, so we are ready to return to work and continue breast feeding.  Rationally and intellectually that's it!  But I was not prepared for this and I am a nervous Nelly.  We have hired a babysitter until we get into day care at work and she has already spent a week with the baby. I have so many questions and concerns.  Where do I begin?

Monika Levin
Valley Glen, CA

Dear Monika:

Take a deep breath and realize that you have done everything to prepare yourself for this day.  You have probably been thinking this through since before your baby was even born.  It's just that the day has now come sooner than expected and your heart is beating faster as Monday arrives.

Print a list of important names and numbers for your babysitter, including all cell and work numbers, numbers of neighbors, friends, relatives, the pediatrician and any emergency numbers (you do live in earthquake country). Also, make sure a neighbor you are comfortable with has a copy of that list as well.

Dear Lactation Consultant:

My sister-in-law is a former drug addict and began a methadone maintenance program knowing she wanted to get pregnant.  She is due in 3 months and is planning on breast feeding.  Her doctor has given her his blessing.  She has begun to interview pediatricians and she has informed me she will find a doctor for the baby who will agree to allow her to breast feed.

My question to you:  Can you give me any information on whether she should breast feed and what danger, if any is there to my very first niece? My sister-in-law is a good person who did some pretty stupid things in her past but is working hard to stay clean and is going to be a great mom, so I just need to know from a breast feeding specialist if she is really looking out for the safety and welfare of the baby.  You always seem to give excellent advice with back-up when appropriate, which is why I am turning to you.

Thank you,

Nervous Aunt-to-be
Wilmington, DE

Dear Nervous Aunt-to-be:

I can certainly understand your anxiousness and concern for your sister-in-law and your unborn niece and they are both very lucky to have you there for them.

I recently reread a study done in 2007 that basically approved breastfeeding for new mothers on methadone maintenance.  “The American Academy of Pediatrics classifies Methadone as a drug usually compatible with breastfeeding and reports no adverse signs or symptoms in breastfed infants of methadone maintained mothers.”  (This comes from the AAP Committee on Drugs. "The Transfer of Drugs and Other Chemicals Into Human Milk"; Pediatrics 2001; 108: 776-789 and revised from the original article published in 1994: Pediatrics 1994 93: 137-150. This is readily available as a PDF for you to read by clicking Here.)

Dear Lactation Consultant:

When my mother was pregnant with me in the mid 1970s, she was told NOT to breast feed because she had many allergies and her doctor told her she would most likely pass those allergies on to her baby.  Surprise!!! I am also an allergy ridden person, both to foods and to pollens, etc.  I know that doctors today believe that breast feeding can help my children against becoming allergic.  I am 3 months pregnant with twins and hoping to breast feed them.  I know a lot has been learned in the 37 years since I was born.  Can you share some insight?

Thank you.

Carla Post
Studio City, CA

Dear Carla:

You are correct in that over the last 50 years much has been learned about the relationship between breast feeding and allergy development and using formula and the increased rate of certain allergies.

We now know that human milk does protect against the development of allergens in most infants and babies because it provides complete nutrition with species-specific proteins.  By breast feeding, if there is a family history of food allergy (mother or father’s side), if mom avoids those foods in her diet, she is providing a barrier in the breast milk to the gut to prevent absorption of antigens in a typically immature immune system.  The prevention of early food allergy is apparent in that less than .5% of exclusively breast fed infants/babies show signs of food allergies.  This does not mean your baby will never develop allergies, but rather that you will be able to slow the onset of any allergies until your child is older (and from personal experience, this makes a tremendous difference in treatment and tolerance.)

Dear Lactation Consultant:

I will be flying several times in the next few months for business and would like to know if I can pump on board planes and also, if I can carry pumped milk with me on the planes. I really do not want to have to toss any of my very precious milk.

Thank you for an answer.

Elana Krauss
Evanston, IL

Dear Elana:

The Transportation Security Administration (TSA) regulations regarding transporting breast milk changed in 2007 and were recently modified again this summer. While it is subject to inspection, you should have no difficulty getting it through security.  I would recommend that you make a copy of the TSA policy printed with this answer and carry it with you just in case anyone questions you.

(You can read about the 2007 TSA regulation changes HERE, and see the 2008 revised regulations HERE.)

Unfortunately, when it comes to pumping in airports and on planes, that’s a very different story.  The TSA has no regulations to cover this and most airlines/airports have no policies of their own. You might want to contact the airline in advance of your travel to see if they will accommodate you.  I had a client who recently was able to go to the first class area in the airport to pump while waiting for her delayed flight. Courtesy of American Airlines.

Dear Lactation Consultant:

I love my in-laws but I am not looking forward to the pressure I anticipate from them when it comes to breast feeding. They are older, from another country, did not breast feed their five children and already I am hearing talk about buying a scale so we know how much weight the baby is gaining since we will not be able to see what the baby is getting from my breasts.  What should I do so I don’t insult them?

Marina Maravilla
Glendale, CA

Dear Marina:

Yours is a very common concern and I understand your anxiety.  I often find asking your pediatrician or lactation consultant to spend a few minutes with your in-laws to discuss their interest in their grandchild’s feeding, which hopefully will make them more comfortable.  Take them to a prenatal breastfeeding class with you, if you do not feel they are imposing on your private time.

Dear Lactation Consultant:

I am so confused. I just came out of my local Babies R Us unsuccessful in my intent to purchase a breast pump.  There are so many available that I didn’t know which one to get. Prices vary greatly and I know some manufacturers tend to be more reliable than others, but I am totally confused. I know I want an electric pump, but other than that, I am lost as to which is the best.  What would you recommend?

Jane Penshaw
The Woodlands, TX

Dear Jane:

I don’t blame you for your confusion.  What you need to do is ask yourself the following questions:

• 1. What is the purpose for pumping?
  •     a; are you returning to work or school and will need to be pumping at least several times a day, all week long?
    
  •     b; will you be pumping so baby gets a bottle a day and perhaps an occasional extra one?
    
• 2:  What is your budget?
  
• 3:  Have you contacted your health insurance to see if they will cover any part of the pump cost?  Some companies will reimburse you for rental pumps only.  Other companies will reimburse for “expendible goods” (purchased pumps), so you definitely want to check on this before investing.
  
• 4:  Does your employer have a lactation program?  More and more companies have programs that include pump rentals. In Los Angeles, for example, The Dept. of Water and Power has a program where they will give the employer or spouse a rental pump to use as long as she is working and breastfeeding.  What a great deal!

Dear Lactation Consultant:

My baby is 3 weeks old and has become extremely fussy over the last week.  She gets very hungry, latches well, but after 3 or 4 minutes starts wriggling and pulling.  I take her off because she is hurting me and relatch her but she’ll continue to do herky-jerky nursing (I hear her swallowing so I know she is getting milk) for about another 3-4 minutes, then she pulls off and cries uncontrollably.  I have tried burping her, sometimes as long as 10 minutes and sometimes I will get a burp (dry) but most of the time she spits up a lot.  After calming her (this usually takes about 10-20 minutes) she goes to the other breast without fussing, for about 15 minutes.  She usually falls asleep, but I feel it’s important to burp her and the burp is usually spit up. She does go back to sleep after that.  Her poops are always green and she poops at every nursing.  She only takes cat naps and wants to eat every hour to hour and a half.  We are going to see the pediatrician next week but I thought I’d ask you first because you have been so helpful when I have called you with questions in the past. I’m glad you have the blog up and running now so I don’t always have to call you.

Sincerely,

Susan Sweet,
Great Neck, New York

Dear Susan:

First of all, you never have to feel guilty for calling me with questions, but I also like the blog because it is a way to share common concerns with all our readers. From what you are describing and from other questions we have discussed before (foamy poop, blood in her stool)  it sounds like your baby may have a true dairy protein allergy.  Although not always the case, it is usually hereditary, so if there is a family history of such an allergy, it would make my assumption more likely.

Dear Lactation Consultant:

I have a real problem. I have checked out your website and I feel you are the kind of person I can talk to about it. Please do not judge me like so many others have. I am pregnant with baby #3. I am a smoker and did not breast feed my other 2 children because I was told by their doctor that it was bad for them. But thinking I might want to try this time. I took a breast feeding class where I learned it would be healthier for the baby to be breast fed than not to be. I asked the pediatrician and he said absolutely not so I was wondering if you had anything to back up the breast feeding teacher’s comment. I emailed her but she has not gotten back to me yet.

Kay Lewis
Brooklyn, NY

Dear Kay:

There is plenty of evidence that breastfeeding is even more important for babies of smoking moms since the breastmilk can improve some of the ill effects of second hand smoke. The protection provided by breastmilk will hopefully prevent against asthma, pneumonia, ear infections and even SIDS, all of which babies of mothers who smoke are of greater risk of. Your baby will develop appropriate immune responses to protect her and these responses can only be gotten from breastmilk, not from formula.

Dear Lactation Consultant:

I am expecting my second child any day now and although I successfully breastfed my first for one year, my one major problem was chronic mastitis. There were no lactation services in my local area but I have since moved and there will be help available this time, yet I am still very nervous. Last time my doctor kept giving me antibiotics, which after a while were not even working and I am afraid they may have had an effect on my son as well. I really do not want a repeat of this situation this time. What do you think I should do to prevent a repeat?

Lynn Rice
Saskatchewan, Canada

Dear Lynn:

Take a deep breath and be thankful you are now living in an area where you will be able to get lactation assistance. It can mean all the difference to you and you should try not to worry.

I have a few questions to ask you that might shed some light as to why you had recurring mastitis:

Dear Lactation Consultant:

I am due to have my baby in about a month and everything I have been taught in my breast feeding class, (which, by the way, I did not take in the hospital I will be delivering at because I was warned by friends not to,) encourages putting the baby to the breast immediately after it is born, unless there is a medical reason not to. When we went on the hospital tour, we were told that the baby goes to the nursery after delivery and that I will not be able to breast feed until we are in our post-recovery room. What can I do to keep my baby in the delivery room so I can breast feed?

Amee Ashton
Washington, D.C.

Dear Amee:

You are asking for an answer I am often asked, but one which is difficult to reply to without repercussions, as every hospital has their own policies when it comes to how long the baby can stay with you after delivery. If the hospital is baby-friendly, there is no issue, as the baby will remain with you for at least an hour, but otherwise it be anything from what you might experience to 15-20 minutes to a full hour. Working in Los Angeles, where most hospitals allow babies to breastfeed immediately after birth, it is indeed frustrating to hear of your situation. Research has shown over and again that encouraging good breastfeeding, which includes getting off to a good start quickly after delivery, putting the baby to the breast skin to skin and allowing the baby to remain that way for as long as possible will lead to success at the breast when the baby has become interested after they recover from the labor experience, which may be as long as 72 hours later.