When The MILC Group first started out we ran a series that we called "JJs Nip Tips." They were named for an adorable chunky baby who we spent a lot of time with. JJ is now a rambunctious preschooler and we wanted to take a moment to pull together a list of our favorite Nip Tips and post an adorable updated pic of our chunky mascot. 

1. Breastfeeding isn't just about food. It is about love and closeness and more!
2. If you have breastfeeding questions, don't wait to ask for help. Have a list of local resources on hand before you deliver your baby.
3. A good latch is a good thing. Wide open relaxed mouth...lips flanged out...chin deeper into the breast than the nose. These are a few quick nip tips.
4. Don't forget that the best way to build your milk supply is to breastfeed your baby frequently. 
5. Breastmilk has a mild laxative effect that helps to prevent constipation. 
6. A supportive bra is one of the most important breastfeeding tools you can buy. Invest in a good one!
7. Breasts come in all shapes and sizes. Yours are perfect for your baby.
8. Remember, when baby is being fussy they are not trying to manipulate they are trying to communicate.
9. Finding a group of breastfeeding friends can be great for you and baby.
10. Make sure to take some time for yourself. A few quiet moments with a lovely cup of something warm can help to relax and rejuvenate you.
11. Nursing in a carrier can make things easier for babies on the go.​

If you need breastfeeding support you can contact The MILC Group here:
www.TheMILCGroup.com
210-960-MILC/210-960-6452

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Low milk supply seems to be a main concern for today's breastfeeding mother.  I do remember mothers asking, "how will I know that my baby is getting enough?" and, "how much milk does my baby need?" back when my first child was born (19 long years ago).  The difference I suppose was that we were satisfied with the answers we were given and we never pumped to see how much our body was presumably making.  We relied on observing our baby. Today's mother seems to want more answers and to know exactly how much milk she is making.  Here is a brief overview of Low Milk Supply. 

When should we be concerned that our milk supply might be low?  

• Insufficient Weight Gain
  
• Babies are expected to gain approximately one (1) ounce per day for the first two months and then half an (.5) ounce per day until around six months of age.  Remember however that all growth charts are just guidelines to follow.  They were developed to help monitor the growth and development of a large amount of babies especially in poor areas to watch for anything going wrong.  Now we utilize them for every baby but often we put too much stock into those numbers instead of looking at the whole child.
  
• Lack of  bowel movements
  
• The first several days of life a baby's bowel movements are what we call meconium.  Usually by day four, the baby is transitioning to bowel movements that are lighter in color and moving towards yellow or brown and mustardy.  If baby is still having meconium bowel movements at day five, you should contact your health care provider.  During the first few weeks of life, a baby should have frequent bowel movements.  If a newborn baby goes more than 24 hours without a bowel movement, you should contact your health care provider.  After three weeks of age, the bowel movements may space out more.  As long as baby is happy and healthy there is no cause for concern. 
  
• Lethargic Baby
  
• Some babies are very relaxed.  Relaxed and lethargic are quite different.  We want to see a baby being "active and alert" at the breast when feeding.  Your baby should be moving actively, looking around, making noises, etc.  If your baby seems inactive or overly sleepy you may wish to contact your health care provider.
  

What can cause a low milk supply?
Maternal Concerns
*Note that the majority of maternal issues would be present from the onset of the breastfeeding relationship.

• Breast Surgery
  
• Breast reductions and augmentations would be the top of this list however biopsies, injuries and surgeries of other types fall into this category.  If you have had any of the above at any time you should consult with your OB/GYN and an International Board Certified Lactation Consultant (IBCLC) to discuss how these may effect breastfeeding for you and what you can do to improve your chances of being able to provide a full or partial milk supply to your baby.
  
• Insufficient Glandular Tissue (IGT)
  
• These breasts have less milk making tissue and so mothers who have IGT may need to supplement.
  
• Thyroid Problems
  
• Can cause issues with milk release.
  
• Diabetes
  
• Milk production can be affected if insulin requirements are not well managed.  Mothers who are diabetic can reduce their child's risk of developing both type 1 and type 2 diabetes in adulthood by breastfeeding.
  
• Polycystic Ovary Syndrome & Other Fertility Issues
  
• If a mother had issues preventing her from becoming pregnant without assistance these issues may also affect lactation.  
  
• Retained Placental Fragments
  
• Can occur even after cesarean birth. 
  
• Breastfeeding Mismanagement
• Most often IBCLCs find that milk supply has been reduced due to what we call breastfeeding mismanagement.  This can mean that either baby was not being put to the breast often enough (early scheduling or sleep training) or baby was at the breast but with poor positioning and thus unable to nurse effectively.

Infant Concerns

• Prematurity
  
• Premature babies may be smaller or have weaker jaws and may need assistance transferring milk in the beginning.  Usually these babies will become more efficient as they grow.
  
• Oral Concerns
  
• Tongue Tie and/or Lip Tie are the most common however there are other oral irregularities that can affect breastfeeding. Congenital malformations such as Cleft Palate and/or Cleft Lip can also make breastfeeding challenging and cause mom's supply to drop if baby is unable to nurse effectively.
  
• Muscle and Neurological Issues
  
• As with prematurity these babies may need help until they are able to develop their oral muscles more or may need continued assistance but can transfer a portion of their food at the breast.  Remember that breastfeeding is more than food.  The closeness and comfort for many babies will help them to grow and develop and provide comfort to both mom and baby.
  
• Chromosomal Disorders
  
• Down's Syndrome is among the most common.  Many Down's Syndrome children are able to breastfeed with little assistance but perseverance from their amazing mothers. 
  
• Heart Conditions or other illness
  
• These babies may be too weak to transfer milk effectively.  
  

What can we do?
With any of these concerns the first step would be to work with an experienced Health Care Provider (HCP).  This can be your OB/GYN, Pediatrician and/or an International Board Certified Lactation Consultant (IBCLC).  Who you work with depends on which issue you are dealing with.  While seeking out a professional who can assist you and working on a care plan you will want to:

1. Make sure baby is being fed.
   
2. Make sure you are protecting your milk supply by pumping and/or hand expressing in addition to breastfeeding.

Ways to Increase Milk Supply

• Increasing Milk Removal
  
• Breastfeeding more frequently, pumping more frequently and in general increasing the removal of milk from the breast.  Breast compressions may also assist with this.
  
• Assist Baby in Gaining Oral Strength/Developing Orally
  
• Working with an IBCLC you can develop a care plan to work with Pediatric Dentists, Pediatric Ear, Nose and Throat Doctors, Speech Therapists, Occupational or Physical Therapists, Chiropractors and/or Cranio Sacral Therapists to aid baby in gaining oral strength and function.  By doing this you will find baby is able to stimulate your breasts to make more milk.
  
• Bring Mother's Health into Balance
  
• Your OB/GYN or other HCP can work with you to check maternal hormone levels, thyroid function, etc. to bring mother's health into balance to assist her body in being able to produce more breastmilk.  This includes checking for retained placental fragments which must be removed.
  
• Utilizing Galactagogues
  
• Galactagogues are any substance that increases milk production.  These include herbs, foods and prescription medications.  A list of common galactagogues is below.   
  

Common Galactagogues

• Goat's Rue - Often used for IGT and Breast Surgery situations
  
• Shatavari - Often used for hormonal support
  
• Fennel - Often used for milk release problems
  
• Alfalfa
  
• Fenugreek
  
• Barley
  
• Brown Rice
  
• Oatmeal
  
• Domperidone (Motilium) - Often used to increase Prolactin
  
• Metoclopramide (Reglan, Maxeran) - Often used to increase Prolactin
  
• Metformin (Glucophage) - Often used to stabilize blood sugar
  

There are many great Low Milk Supply Resources.  Following is a list of just a few:
http://www.mobimotherhood.org/
http://www.lowmilksupply.org/
http://kellymom.com/hot-topics/low-supply/
http://www.llli.org/nb/nbmilksupplyissues.html

If you have questions or concerns about your milk supply we will be happy to meet and discuss those concerns with you either prenatally or after baby arrives.  www.TheMILCGroup.com  210-960-MILC/210-960-6452

Ginger and I are so blessed to meet a huge variety of women in all stages of their breastfeeding journey.  We are proud and humbled to be able to support them and to hopefully provide them some guidance along the way.  Today I was reminded of something so very important.  Breastfeeding is so much more than feeding at the breast.  

Let me back up to say that having a baby is hard!  Getting pregnant for some women is a huge undertaking.  Many women wait years to see those two lines appear on the pregnancy test while others are lucky on the first try.  What I have found during my time working with women who are breastfeeding or trying to breastfeed is that if getting pregnant was a challenge then they are hoping that the labor will be easy.  If the labor is a struggle or doesn't go as expected then they hope that breastfeeding goes better.  Many women arrive at the beginning of their breastfeeding journey with all of their hopes pinned on this going well.

I was once attending the birth of a client who had struggled to get pregnant with her first baby.  Her doctor recommended an induction of labor and she and her husband had agreed.  During the induction her water broke on its own.  I remember the joy she showed that something had happened on its own and that she wasn't "broken."  It was so eye-opening to see her joy in something that many women take for granted.  

Today while working with a lovely first time mother and her baby she spoke of her birth experience and described it as "traumatic."  I voiced for her what I have witnessed, that when a mother's birth experience doesn't go as planned breastfeeding often becomes more important.  She was choked up while she nodded her head in agreement.

It is difficult for loved ones to understand.  So often we hear loving partners, friends and relatives telling a mother whose birth did not go as planned that, "at least you have a healthy baby."  Yes she has a healthy baby but is she ok?  Is she emotionally ok?  So many mothers have their feelings discounted because their baby is "healthy" and so what more can she ask for.  

Why can't she ask for more?  Why is it not alright for her to want an easy pregnancy, a smooth birth and a perfect postpartum experience?  There is no reason that she can not ask for that.  We should help to support her at whatever point along the way that we encounter her.  

This brings me back to Ginger and I and to her breastfeeding experience.  Breastfeeding is so much more than just feeding at the breast.  Breastfeeding is love.  Breastfeeding is comfort for the mother and baby.  Breastfeeding is about bonding.  Breastfeeding is about empowerment and seeing our baby growing from the food that we provide.  Breastfeeding is about our experience as mothers.  

The next time that you hear a mother speak of her struggles with fertility or her traumatic birth experience I hope that you will provide support and when she gets to the part about breastfeeding....remain a positive voice.  Support her.  Love her.  Provide her with resources if she needs them and above all else honor her experience.

Last summer Ginger and I had the pleasure of attending a wonderful workshop at the Texas La Leche League Conference.  We attended the daytime session led by Jaye Simpson, IBCLC and thoroughly enjoyed hearing in-depth information on "Structure and Function" as it relates to the anatomy of the infant and what could be contributing to breastfeeding difficulty.  That evening we attended a hands-on clinical session where we observed techniques and put them to work evaluating an infant.  We attended many other wonderful sessions in lactation education; however, the sessions taught by Jaye had the most impact on our work.  I would say that this information was so empowering and helped us to become even more confident in our evaluations of infants during our lactation consultations.  

This knowledge coupled with our years of additional training and experience would lead me to say that here in San Antonio we may be the lactation consultants doing the most thorough examinations of babies and catching oral and physical issues that other practitioners miss. This may be because they are either rushed through visits (often not by choice when the practitioner works in a hospital with limited time resources) or because they lack the extensive training that we have received.  Ginger and I continue to seek out courses that further our education and we are excited to team up with other lactation professionals in Central Texas to educate ourselves more fully on how different practitioners working together can get a baby nursing more effectively, gaining weight better and nipping (no pun intended) oral or physical issues in the bud before they effect a baby's later development.  

On our website www.TheMILCGroup.com we have compiled a short list of wonderful resources for parents who are seeking information regarding a possible tongue tie, lip tie or other oral issue in their baby.  We include practitioners who our clients have found helpful as we want all of our clients to have the best possible experiences.  We do suggest that parents seek out the guidance of a lactation professional to help them to decide what kind of practitioner will best serve their needs.  

If you suspect that your baby has an oral issue and would like to meet with us for a full evaluation you can contact us by phone at 210-960-MILC/210-960-6452.

For those parents not located in San Antonio, South Texas or the surrounding areas, we suggest that you seek out the support of your local La Leche League Leader or IBCLC to find resources to assist you with your breastfeeding issues.  We are always happy to support families who are not located near to us in finding the support that they need.