Q&A with International Board Certified Lactation Consultant Madeline Given

Q&A with International Board Certified Lactation Consultant Madeline Given

Breastfeeding comes with plenty of questions, and the Internet can have a lot of contradictory advice. We sat down with Madeline Given, BCHN, IBCLC, RWP to answer some of your most common breastfeeding questions.

1. I have pain when breastfeeding. How do I know if it's normal or not?

While it can be common, actual pain should not be a normal or accepted part of breastfeeding. Nipples may feel sensitive and sore in the initial days due to all the new activity, and breasts may feel tender depending on the stage of milk production you’re in. 

If you’re feeling toe-curling pain that isn’t changing or subsiding at all with time, or noticing any scabbing, cracked nipples, bleeding, etc., please seek the help of a lactation consultant. The most common reason for breastfeeding pain is poor latch. An IBCLC can help correct positioning, latching, and alignment, which should all help immensely with initial nipple pain. 

2. How do I know if my baby is getting enough milk? 

Sometimes breastfeeding success requires a little detective work. You can look for clues that your baby is receiving enough milk in the early stages by paying attention to diaper output, doing frequent weigh-ins or weighted feeds, and learning your baby’s breastfeeding satiety cues. 

Babies who have drunk their fill will typically turn away from the breast, appear to have relaxed arms and hands, act sleepy, and stop sucking altogether. But we never want to just rely on these outward cues, as other birth factors could mimic these signs. If weight gain is truly a concern, I would suggest purchasing an infant scale to monitor your baby’s weight more closely. Ideally, you would connect with a local IBCLC who would bring their high-accuracy scale to your home and weigh your baby before and after a feeding to better understand their actual milk intake.

In the first week, your baby should have at least one dirty diaper for each day of life (i.e. one on day one, two on day two, etc.). By day four, stools should be yellow and seedy, and there should be 3-4 dirty diapers a day. Once your mature milk starts coming in, you should expect more like 5-6 we diapers in a 24-hour period. 

If you’re pumping and offering your baby expressed breastmilk between the ages of one and ten weeks old, I typically recommend offering at least 150-200 ml of milk, per kilogram of weight, per day.

3. What can I do to support the nutrients in my milk? 

It’s well-documented that levels of Omega-3 fatty acids like DHA (think baby’s brain development!) are transferred to your baby through breastmilk, so maternal diet does affect nutritional levels in your breastmilk! You can get your own levels tested through Needed’s at-home testing kits here. You can also test your breastmilk’s DHA levels through Lactation Lab. Once you get your results, you’ll be able to adjust your Omega-3 intake — I often recommend adding on an extra capsule of Needed’s Prenatal Omega-3+ to your routine while breastfeeding.

Studies show that maternal supplementation of many nutrients has a positive effect on breastmilk levels. Nutrients like Vitamin K, Vitamin D, Vitamin C, Choline and many of the B vitamins increase in breast milk when mama increases them in her diet or supplement regimen. I encourage all postpartum mothers to stay on Needed’s Prenatal Multi in order to ensure they are not only replenishing their own vital nutrients after birth, but also so that their baby’s receive the most optimal breast milk possible. 

4. I want to start working out again, what can I do to make sure my milk supply doesn’t tank?

The evidence suggests that a healthy exercise routine does not affect milk supply. That said, in the early stages of postpartum, recovery and healing should be your number one priority for at least the first six weeks, if not longer. Then, start with what you know, and don’t overdo it. And above all, be sure to work in extra electrolytes like Needed’s Hydration Support — crucial minerals for when you’re working up a sweat!  

5. I’m going back to work and nervous about being able to pump enough milk - what can I do to start to build a freezer stash?

Many mamas, depending on milk supply and baby's feeding preferences, end up creating a bit of a freezer stash with just the use of a silicone Haakaa pump, which is essentially a letdown or excess milk catcher that you wear on one breast while feeding on the other. 

You don't need much of a supply stash built up to return to work while successfully continuing to feed your baby breastmilk. Our culture is big on the "huge freezer stash!" to feel comfortable and ready to head back to work. But realistically, if you are able to pump at work, then you'll ideally be pumping several times throughout the day, which you can then give to your baby the following day, and so forth. 

Begin to experiment with pumping and bottle feeding prior to returning to work. If you feel more full after some feedings than others, choose those feedings to pump after. This will allow you to gradually collect some “leftover” milk to freeze without feeling like you have to pump around the clock or in between feedings. 

6. Is there anything I can do nutritionally to support my supply? 

Protein needs is one of my favorite topics to discuss with pregnant and breastfeeding mothers. Most women are not getting enough (20-30 grams a meal can feel like a lot!), but sufficient protein intake is required for optimal milk production. 

I also love recommending Needed’s Hydration Support for electrolytes. Breastfeeding is the time to prioritize not just how much water you’re drinking every day, but the quality of it. By re-mineralizing your water, you can help to support healthy breast milk production and your own overall health too.

For galactogogue support, turn to time-honored herbs like moringa, fenugreek, nettle leaf, and fennel seed, either in tea or capsule form (I like Motherlove).

7. What’s the difference between foremilk and hindmilk and how do I know if my baby is getting the right amount of each?

La Leche League International (check them out if you haven’t!) puts it well: “Foremilk is the milk available when your baby starts feeding, hindmilk is the milk your baby gets at the end of a feed.” It’s often incorrectly believed that foremilk contains significantly less fat than hindmilk, when really it has more to do with how long your milk has been collecting up near the ducts and how empty your baby leaves your breast at the end of each feeding. Some babies breastfeed with great efficiency and speed, while others take their time, making it impossible to know how much fat they’re receiving based solely on time at the breast. I find that as long as your baby is latching well and sucking effectively, allowing them to determine the length of the feeding is the best way to ensure they get just what they need from you.

8. What is a nipple shield and is there any risk to using one in the long term?

I typically only recommend the use of a nipple shield for the short term and as a last resort. While they can absolutely work wonders for a sore and frustrated mama in a bind, they are best used under the guidance of an IBCLC, ensuring that all other measures have been taken into account first. There is a risk for some of developing clogged ducts or mastitis from using a nipple shield too long, and there are reports of decreased milk production possibly due to lack of direct nipple stimulation. If you choose to use a nipple shield, make sure you choose the correct size (yes, there are several options!).

9. My baby has started to bite - is there anything I can do to discourage this?

You will see a plethora of suggestions surrounding this online, and there’s definitely no one-size-fits-all approach. Trying to get to the root cause of why your baby might be biting is a helpful place to start. Are they possibly teething? Try offering a safe, cold toy or frozen damp washcloth to chew on prior to nursing sessions. Are they bored or experimenting? Try providing a calm and quiet environment, offering lots of snuggly attention during breastfeeding, and then giving plenty of positive feedback if they refrained from biting. Keep in mind that some babies might chomp down if the milk supply is waning or coming out slower than they’d like. The same goes for a fast letdown or flow — they may try to slow it down by clamping down. Ultimately, know that it’s okay to calmly end the nursing session and take a break for a few minutes if you’ve done some trouble-shooting and the biting continues. 

10. I’m scared of getting mastitis. Is there anything I can do to prevent it?

Breastfeed (or pump) regularly. When you remove enough milk on a consistent basis, you are at a decreased risk for clogged ducts, which are one of the most common causes of mastitis. Avoid tight-fitting bras and other clothing that puts pressure on your chest, which could lead to clogged ducts, and refrain from sleeping on your stomach. Keep your nipples clean and consider air drying in between feedings to prevent bacteria from building up, especially if you have any cuts, cracks or injury to your nipples or breast tissue. Above all, staying on your Prenatal Pre/Probiotic is an excellent way to prioritize the health of your own microbiome, which will go a long way in supporting your body as it wards off infection and inflammation. And always stay hydrated!

If you feel like something is starting to brew, continue to feed on demand, but don’t overfeed or overpump. Try an anti-inflammatory, apply cool compresses to the inflamed areas, and gently massage any clogged areas. Key word here is gentle!

11. Where can I go to find a lactation consultant?

While your local hospital may offer referrals or even in-hospital support groups that you can venture back into, nothing beats a home visit from a supportive IBCLC. If you’re looking locally, try searching to see if your city has a La Leche League group, run by lactation consultants. Otherwise, my favorite place to look for in-person or telehealth help is The Lactation Network — they’ll connect you with a nearby IBCLC and check your insurance to see if they can get your visit fully covered. 

Madeline Given is a functional perinatal nutritionist and IBCLC. She is passionate about helping women heal their fertility, achieve better birth outcomes, and prepare for postpartum through preventive and intentional care. I currently serve women through my online private practice at Madeline Nutrition, where I offer one-on-one consults and packages. I live in Southern California with my husband and two sons, ages 6 and 3.

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