Breastfeeding: 22 answers to the most common doubts of mothers

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Philippe Gloaguen
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There are so many questions that can crowd the mind of a nursing mother. We tried to clarify with the help of Chiara Losa, pediatric nurse and IBCLC breastfeeding consultant who works at the breastfeeding clinic of the Buzzi Hospital in our city. Other experts answered questions where reported.



Read also: breastfeeding, questions and answers

In this article

 



 

Quantity and quality of milk

  • Some days I have "empty" breasts: is it because I have less milk?
  • My milk seems transparent to me, is it because it is less nutritious?
  • I've been under a lot of stress lately and seem to have less milk. It's possible? Is it still nutritious for my baby?
  • When does the menstrual cycle usually arrive while breastfeeding? Does anything change for the baby's nourishment?
  • How can I make my milk more nutritious?
  • I have started weaning, but at night my baby still wants to breastfeed, and even more often than before. It's normal? Does that mean my milk has become less nutritious and needs it more often to get through the night?
  • Are there food supplements to promote milk production? What are they and where are they located?

 

Breastfeeding and breast appearance

  • My baby is four months old and breastfeeding. Since I left the hospital, one breast has remained larger than the other. It's normal? Depends on what?
  • After breastfeeding my baby, my breasts appear "emptied" and I would like to have an operation to "do it again". How long do I have to wait for the operation? And if I were to get pregnant again after the operation, would there be problems with breastfeeding again?

 

A little help for mom?

  • A friend advised me to use nipple shields: when can they really be useful? And are the classic ones or the silver ones better?
  • I have a strong dry cough, my doctor prescribed me a syrup but on the internet I read that it is not recommended while breastfeeding. What should I do?

 



Breastfeeding and lifestyle

  • I smoke and I can't stop: are there any consequences for the baby if I smoke just before breastfeeding?
  • Can i get tattoos while breastfeeding? And can you dye your hair, or do straightenings and perms?

 

Breastfeeding management 

  • Breastfeeding on demand or at fixed times? But when it's on demand, does that mean she can actually breastfeed at any time of the day or night? Doesn't it reach timetables by itself?
  • If the baby does not wake up by himself, how often do I have to wake him up to breastfeed him?
  • Could giving the addition at night help make the baby sleep more?
  • What foods should I avoid to avoid colic in the newborn?
  • My baby is 14 months old and I would like to stop breastfeeding him, but he keeps looking for the breast in the evening. How to do?
  • I am still breastfeeding but I got pregnant: should I stop breastfeeding the first one?

1. Some days I have "empty" breasts: is it because I have less milk?

No: it is completely normal to feel this sensation, especially at particular times of the day, after the first weeks of breastfeeding.



At the beginning, in the first three to four weeks, there is one calibration phase in which the breast "learns" to produce the milk actually required by the baby. After this phase, in which the breasts tend to be tense or very tense, the sensation of continuous fullness is reduced and the breasts return to normal.

However, it can happen to feel a little more swollen in the morning, since at night there was a peak of prolactin which favored its production, and a more emptied in the afternoon or evening. But this does not mean that there is no milk in these moments.

Those who know how to manually express breast can use it for a small check: they will immediately realize that the milk is still present. But be careful: those who don't know how to do it should avoid trying their hand at it. There is the risk of not seeing anything come out precisely because it has not been squeezed in the right way. To learn how to do it, just ask an operator (midwife, pediatric nurse, consultant ...) who specializes in breastfeeding.

2. My milk seems transparent to me; is it because it is less nutritious?

No. For a start consider that mother's milk is never white and "milky" like that of a cow. The color of cow's milk depends on the high content of a protein called casein, which is present at much lower concentrations in human milk, especially in the first months of breastfeeding.

Human milk has quite one whitish color, with blue, greenish or yellowish shades. Only towards the sixth month, when the concentration of casein increases compared to other proteins, does it tend to become a little whiter. However, there is a strong variability from person to person, also according to the type of diet: when you eat red beets, for example, the milk could take on a pink color.

Beyond the color, it is important to point out that the milk is a live food, specific for each mother-child couple, and capable of changing its composition during the day and over time. For example, few people know that around the fifth / sixth month of a baby's life, the milk returns temporarily similar to colostrum, that is, very rich in antibodies, which help protect the child when he begins the phase of active exploration of the world and puts whatever he encounters into his mouth.

Obviously, the milk for a one-week-old baby will be different from that for a one-year-old baby, but it never happens, as is often said, that at some point it becomes water: it simply calibrates its composition for the different nutritional needs of the baby. baby.

3. I have been very stressed lately and seem to have less milk. It's possible? Is it still nutritious for my baby?

More than the quantity of milk, a state of high stress can affect the milk ejection reflex, that is, the mechanism of active expulsion of milk outside the mammary gland, which becomes weaker. This may make it seem like there is less milk, but in reality it is not, at least in the short term. In the long run, however, this condition could lead to a reduction in milk production.

The situation is different if it is not just a question of stress, but of extreme fatigue associated with malnutrition: in these conditions, little milk can actually be produced.

4. When does the menstrual period usually arrive during breastfeeding? Does anything change for the baby's nourishment?

The return of menstruation in the nursing woman is a very subjective event.

In general, the more frequent feedings are and the more often they occur at night, the more likely it is that the return of menstruation will be delayed. That said, not all breastfeeding women go without menstruation for months: some may return even 40 days after giving birth, as happens to women who are not breastfeeding.

The return of menstruation it does not affect the nutritional value of milk in the least product. It is true though that there may be a slight change in flavor, so much so that some babies - but not all - find it a little harder to take the breast in those days or in the previous days.

A clarification for women who are breastfeeding and do not have menstruation: be careful not to consider this fact as a natural contraceptive. If it is true that breastfeeding amenorrhea is a factor that contributes, on large numbers, to distance pregnancies, it is also true that on the single woman there is no absolute efficacy in terms of contraception.

5. How can I make my milk more nutritious?

The milk produced by each mother in the different stages of her baby's life is already nutritious, in the sense that it already has the nutritional characteristics appropriate to the baby's age. So there is nothing to be done to make it more nutritious, and above all there is no need to do anything.

What can happen is that perhaps a reduction in milk production linked to the passage of time is exchanged with a variation in its nutritional qualities, but this is not the case: simply, the one-year-old baby will suck milk adequate to his needs, which are other than that of a two month old baby.

6. I have started weaning, but at night my baby wants to breastfeed, still and even more often than before. It's normal? Does that mean my milk has become less nutritious and needs it more often to get through the night?

No, this phenomenon, which is completely normal, has nothing to do with the "quality" of the milk, but instead has to do with the mother-child relationship. The little one, who perhaps loves her complementary feeding very much, is telling his mother that he still needs her and her milk anyway.

7. Are there food supplements to promote milk production? What are they and where are they located?

The market is full of supplements proposed to promote the "physiological production" or "secretion of milk", in the most varied forms: herbal teas, capsules, products to be dissolved in water and so on, in general based on herbs such as milk thistle, fennel, galega, anise, fenugreek.

The American Academy of Medicine on breastfeeding does not recommend its use, because there is no solid scientific data in favor of its effectiveness, and because in some cases it could have side effects on the baby (cases of drowsiness or hay asthma have been reported Greek caused by the use of these products).

The only sure thing that causes milk to be produced is the emptying of the breast: the more and better it is emptied, the more milk it produces. Otherwise, the residual milk inside the breast stimulates it to produce a substance that tells it to produce less, the lactation inhibiting factor.

To favor this mechanism, however, one must work on the attachment and position of the baby and the frequency of feedings, possibly with the help of manual squeezing or extraction with a breast pump, but not on the use of supplements.

That said, if drinking an allegedly "pro-lactation" herbal tea - one cup, not liters! -mum feels more serene and peaceful, she feels pampered and safe, there is nothing wrong with that. She may also feel that she is producing more milk, but what is actually happening is that she may change the milk ejection reflex. If she is less stressed and more serene she will release more oxytocin, which will promote the ejection reflex, so starting the feed may be more satisfying for the mother and baby.

Also read: 10 foolproof ways to increase breast milk production

Breastfeeding and health


He answers these questions , gynecologist of the Buzzi Children's Hospital in our city, and contact person for breastfeeding of the local company Fatebenefratelli Sacco.

8. Is it true that breastfeeding protects the mother from developing tumors? Which?
“Yes, it's true: many studies now confirm that breastfeeding decreases the mother's risk of getting sick breast or ovarian cancer in the course of life "he replies. And the effect is all the more significant the longer you breastfeed.
“The protective effect - specifies the specialist - concerns all women, but in particular those that already have risk factors for the development of these diseases, for example in women with mutations in the BRCA1 and BRCA2 genes. In fact, it has been seen that during breastfeeding the breast undergoes very particular maturation processes, which prevent the cell growth anomalies associated with the mutations of these genes ".
To underline the importance of breastfeeding as a protective factor against cancer, the American Institute for Cancer Research has included it among its recommendations on prevention. The others are: maintaining an adequate weight, eating healthily, exercising, preferring a diet rich in plant-based foods, reducing the consumption of salt, alcohol and red meats.

9. If you seem to feel something abnormal in your breast while breastfeeding - for example a lump that wasn't there before - who should you contact and what tests should you do to check?
The first thing to do is to talk to your family doctor or trusted gynecologist. "If further investigations are considered appropriate, the exam to be taken according to the international medical community is thebreast ultrasound, if possible with a expert operator of breastfeeding breast ultrasound" he claims .
MRI and mammography, on the other hand, give less reliable results in this particular moment of life.

10. If there are no particular problems, is it still advisable to have a breast checkup while breastfeeding? What kind?
"If there are no particular risk factors, for example we are talking about a young, healthy woman, with no familiarity with breast cancer, there is no reason to schedule a check-up during breastfeeding" replies the gynecologist.

“If, on the other hand, there are risk factors that involve periodic checks, it is certainly advisable to continue to do them even while breastfeeding. Again, the exam to take is thebreast ultrasound, with an expert operator ".

11. My baby is four months old and breastfeeding. Since I left the hospital, one breast has remained larger than the other. It's normal? Depends on what?

Let's start from the fact that the two breasts, initially, are never identical. Sometimes the asymmetry is very evident, other times minimal, so much so that the woman does not even notice it. Unless during breastfeeding this asymmetry is accentuated, because the breasts work in a distinct way, so there can be differences if the baby suckles more or better on one side, draining that breast better.

To rebalance things, you can try to stimulate the baby to breastfeed a little more from the breast he tends to neglect, but it must be said that in any case there are no problems for the efficiency of breastfeeding. As for the appearance of the breast, once breastfeeding is over it will return to about the same as before, so if the difference between the breasts was minimal, it will return like this. It is true, however, that at that point the mother, who has become accustomed to seeing them different during breastfeeding, will probably notice her more.

12. After breastfeeding my baby, my breasts appear "emptied" and I would like to have an operation to "do it again". How long do I have to wait for the operation? And if I were to get pregnant again after the operation, would there be problems with breastfeeding again?

It's true: after breastfeeding the appearance of the breasts may change and be a little softer. For a breast surgery it is necessary wait at least 40 days (it takes so much for the complete involution of the milk production system).

After this period you can hear the surgeon and evaluate with him the different types of surgery. Breast augmentation does not generally give contraindications to any subsequent breastfeeding, but it is important evaluate the placement of the prosthesis and the scar. If this ends at the point, under the aerola, where the nerve endings pass from which the reflex for the production of oxytocin starts, there could be interference with the reflex of ejections of the milk.

However, it must be said that today surgeons are generally very careful not to make scars under the areola for these reasons.

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13. A friend advised me to use nipple shields: when can they really be useful? And are the classic ones or the silver ones better?

Like all tools, the nipple shield can have advantages, if used appropriately, but also disadvantages, especially if used improperly.

The first thing to say is that it is a tool that should never be used "because a friend told me", that is, by word of mouth. If it is indeed appropriate to use it, it should be recommended by a trained lactation practitioner, and its use should be kept under control to evaluate how things are going.

When to use it? In reality, the cases in which we know its real effectiveness are few. For example for the passage to the breast of a very young child who comes from intensive care, where he was fed perhaps with his mother's milk, but always with a bottle. Or if the child has a very short frenulum, which cannot be cut. Or, again, if the mother has flattened or introflexed nipples and other strategies have not yielded satisfactory results.

When the nipple shield is used, it does not have to be forever: it is to facilitate the first stages of breastfeeding with particular complications, but gradually it must be removed.

The disadvantages are that very often, in the presence of a nipple shield the child does not attach properly. This means less breast emptying, which in the short term could lead to engorgement, mastitis or abscess and, in the long run, to a reduction in milk production. It is no coincidence that the use of nipple shields is often associated with a mixed breastfeeding: there are very few exclusive breastfeeds at six months when using this tool.

Many mothers use nipple shields - lately especially the silver ones, more expensive than the others - to control any breast pain, due for example to a fissure. In reality this is not a scientifically approved claim, as there are no valid scientific studies to support it.

It may be that the cold of this silver "hat" gives a momentary relief, and there is nothing wrong with keeping it a few minutes a day or a day every now and then, but continued use could be counterproductive, for the reasons that we said above and also why the fissure itself is likely to get worse: it is difficult to think that a wound can heal well if it is kept in a humid and closed environment.

Read also:
Breastfeeding: what to do if your breasts hurt

14. I have a strong dry cough, my doctor has prescribed me a syrup but on the Internet I read that it is not recommended while breastfeeding. What should I do?



Text by Valentina Murelli
The Internet is not always a good source of information on the topic of "breastfeeding drugs", and unfortunately not all doctors are actually up to date on this issue. To resolve this situation, the Ministry of Health has published an official document on the use of drugs for women who are breastfeeding. The document emphasizes the fact that for many situations, effective and safe drugs are also available for the nursing mother (and therefore for her little one) and offers doctors a guide to orient themselves among the various possibilities.

What to do, however, if you find yourself with a prescription for a drug and you are in doubt that it might not be good for your child? One option is to call the Poison Control Center of the Pope John XXIII Hospital of the city (green number 800.883300 active 24 hours a day) which has a specific service on drugs during pregnancy and breastfeeding.

As for the Internet, a good official source is the Drug Agency's Del Paesena Drug Service in Pregnancy and Lactation. Another good source, however in English, is the Lactmed site of the American National Institutes of Health.

15. I smoke and I can't stop: are there any consequences for the baby if I smoke just before breastfeeding?

Obviously, the ideal would be not to smoke, both because nicotine - in addition to negatively influencing the milk production mechanisms - passes into breast milk, which for example increases the risk of colic, and also because the secondhand smoke to which it is exposed the child is dangerous.

If you really can't quit, the following tips for reducing the impact of smoking on your baby can be:

  • reduce the number of cigarettes and choose a nicotine-reduced brand;
  • smoking after feeding, and after the cigarette wait at least an hour and a half for the next feed: so it takes nicotine to break down.
  • going to smoke away from the child, preferably outdoors, covering the head and clothes with clothing (a scarf, an apron) that can be removed before picking up the child again;
  • wash hands and face before taking the baby back.
Read also: Smoking parents: children with higher cardiovascular risk

16. Can I get tattoos while breastfeeding? And can you dye your hair, or do straightenings and perms?

The answer to all the questions is yes, there is no data that indicates a danger of these practices for the breastfed child. As far as tattoos are concerned, however, it is necessary to make sure that they are performed by serious professionals, able to implement all the necessary measures to reduce the infectious risks.

Read also: Tattoos and piercings: what risks are there and how to do them safely

17. Breastfeeding on demand or at fixed times? But when it's on demand, does that mean she can actually breastfeed at any time of the day or night? Doesn't it reach timetables by itself?

More than breastfeeding on demand, Chiara Losa likes to talk about breastfeeding guided by mother and baby. It is the couple that calibrates, and little by little they can find their own fairly regular balance. But it must be said that, especially in the first weeks, the frequency of feedings can also be very high, especially at night.

Trying to impose fixed times on a baby at these stages can be counterproductive, because these fixed feedings may not be sufficient for the baby's needs (who will not grow adequately) or may not be effective, because it is forced to latch on. a moment when he is not hungry, and therefore will suckle reluctantly. The consequence will be a reduction in milk production.

18. If the baby does not wake up by himself, how often do I have to wake him up to breastfeed him?

There is no one answer that is valid for everyone: each mother and child couple is unique and must adjust to their own balance and needs. In general, however, it can be said that if during the day the child is able to show clear signs of hunger, the mother can rely on him and her requests.

The baby's hunger signals I'm:

  • smack the tongue against the roof of the mouth,
  • make the gesture of sucking;
  • to turn the head here and there in search of the breast, or to make the woodpecker with the head;
  • sucking fingers, hand, wrist;
  • crying (which, however, is already a very late signal, which comes when the child is desperate from hunger)

If these signals are well present, and the requests are actually met, that child will not have to wake up every two or three hours to attack him: they can easily be allowed to pass even four or five hours. After that it might be time to wake him up, and it could be the mother herself who feels the need, to empty a breast that is swelling a lot.

Some children, however, are not very able to show these signs right away, or they may be very sleepy. In this case, it may be appropriate to wake them up for two / three hours to offer them the breast.

In general, however, it is recognized that in the first months of life a baby breastfed on average 7 to 12 times. And someone even more often.

19. Could giving the addition at night help make the baby sleep more?

The dry answer to this question is yes: an addition of formula milk in the evening or at night can make the baby sleep more, because with formula milk the gastric emptying frequency is higher and the baby wakes up less.

On the other hand, it is necessary to be aware of the fact that the evening or nocturnal addition interferes with the mechanisms of milk production, considering that the peak of prolactin, the hormone that promotes it occurs precisely at night. Consequently, the use of additives leads to a reduction in milk production, which could be a risk for breastfeeding management, especially in the initial calibration phase.

20. What foods should I avoid to avoid colic in the newborn?

In general there are no foods contraindicated in breastfeeding, or foods to avoid a priori in the hope of reducing the risk of colic. Which, moreover, are often not such, while it is a simple state of restlessness of the child, which worsens in the evening for various reasons, and can be relieved by cradling, cuddling, maybe putting it in a swaddle.

That said, some foods the mother eats may cause the baby to have some intestinal upset, but only if this is already in itself intolerant to that food. The classic example concerns dairy products, in the case of children intolerant or allergic to cow's milk: in these cases, the pediatrician will make a diagnosis of intolerance or allergy and advise the mother to avoid dairy products for a while, and then try to reintroduce them gradually.

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21. My baby is 14 months old and I would like to stop breastfeeding, but he keeps looking for the breast in the evening. How to do?

For the answer to this question, you can read the article How to stop breastfeeding, 10 anti-stress tips (and without medicines) with advice from perinatal psychologists Antonella Sagone, IBCLC consultant, e Alessandra Bortolotti, president of the Del Paeseno Maternal Breastfeeding Movement.

22. I am still breastfeeding but I got pregnant: should I stop breastfeeding the first one?

Generally no, but in some particular situations some operators may still advise you to stop.

A position on this issue was taken, in 2022, by an official document of the Technical Table for the Promotion of Breastfeeding of the Ministry of Health and the Del Paesena Society of Perinatal Medicine. The conclusions clearly say that

"For most women, the coexistence of pregnancy and breastfeeding is considered safe for the mother, embryo, fetus and infant".

However, the document points out that in some situations, professionals could prudently discourage the continuation of breastfeeding, and to be precise:

  • if the mother has a non-optimal nutritional status, for example because she suffers from malabsorption diseases;
  • if there is severe fetal growth retardation;
  • if there is a history of recurrent miscarriages or previous prematurity;
  • if the pregnancy is twins or there is a risk of premature birth.

In reality there is no scientific evidence of a real danger of breastfeeding for the fetus in these conditions, but the document still considers the individual advice to stop it legitimate.

Read also: Breastfeeding, 10 rules to breastfeed well and for a long time

Questions and answers

My milk is transparent: is it because it is less nutritious?

Human milk is rather whitish in color, with shades of blue, greenish or yellowish. Only towards the sixth month, when the concentration of casein increases compared to other proteins, does it tend to become a little whiter. However, there is a strong variability from person to person, also according to the type of diet. Beyond the color, it is important to underline that milk is a live food, specific for each mother-child couple, and capable of changing its composition during the day and over time.

I am breastfeeding, but I can't stop smoking. Are there any dangers to the baby if I smoke before breastfeeding?

Obviously, the ideal would be not to smoke, both because nicotine - in addition to negatively influencing the milk production mechanisms - passes into breast milk, which for example increases the risk of colic, and also because the secondhand smoke to which it is exposed the child is dangerous. If you really can't quit, the following tips for reducing the impact of smoking on your child can be: reduce the number of cigarettes and choose a nicotine-reduced brand; smoking after feeding, and after the cigarette wait at least an hour and a half for the next feeding: that is how long it takes for nicotine to break down.

Breastfeeding: Does giving the addition at night make the baby sleep more?

The dry answer to this question is yes: an addition of formula milk in the evening or at night can make the baby sleep more, because with formula milk the gastric emptying frequency is higher and the baby wakes up less. On the other hand, it is necessary to be aware of the fact that the evening or nocturnal addition interferes with the mechanisms of milk production, considering that the peak of prolactin, the hormone that promotes it occurs precisely at night. Consequently, the use of additives leads to a reduction in milk production, which could be a risk for breastfeeding management, especially in the initial calibration phase.

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  • breastfeeding
  • artificial milk
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