Following childbirth, many women that wish to breastfeed [worry about their milk supply](../breastfeeding-am-i-producing-sufficient-milk). Milk production is regulated by the hormones [prolactin](https://nabtahealth.com/glossary/prolactin/) and oxytocin, which start working mid-way through pregnancy; however, once the baby is born, on-going production comes from consistent and regular removal of the _milk from the breasts_. Therefore, the single best way of _improving milk supply_ is to feed, or express, often. The first few days after delivery are critical for establishing milk secretion and this is the time at which many women who are struggling with [breastfeeding](https://nabtahealth.com/articles/is-breastfeeding-overrated/) decide to switch to [formula feeding](https://nabtahealth.com/articles/correct-position-for-formula-feeding-babies/). There are options for increasing milk supply and for those women who are struggling with [breastfeeding](https://nabtahealth.com/articles/is-breastfeeding-overrated/), it may be worth trying these before switching to an entirely formula-based diet. **1\. Seek professional help** ------------------------------ Prior to attempting pharmacological methods or herbal remedies try speaking to an expert. Your [gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) or midwife should be able to put you in touch with a [local](https://nabtahealth.com/product/at-home-lactation-consultation/) [lactation](https://nabtahealth.com/glossary/lactation/) specialist. These women are trained to offer advice and counselling. They can evaluate whether your breastfeeding challenges are physical (for example, poor positioning, latching difficulties, baby tongue tie) or emotional (usually due to fluctuating hormone levels after giving birth). Their role is to support and encourage, and it is essential that if they do not do this, you find somebody else, who does. **2\. Pharmacological galactogogues** ------------------------------------- A galactogogue is a substance administered to enhance milk supply. To date, there have been no drugs approved [solely to enhance](https://nabtahealth.com/articles/when-should-you-see-a-lactation-consultant/) [lactation](https://nabtahealth.com/glossary/lactation/). The medications that are prescribed are usually licensed for other purposes and used ‘off label’. That does not mean they are unsafe; as licensed drugs, they will have undergone extensive safety testing and, when prescribed to [assist with](https://nabtahealth.com/product/at-home-lactation-consultation/) [lactation](https://nabtahealth.com/glossary/lactation/), they are given at a significantly lower dose than that normally recommended. Domperidone is an antiemetic, sometimes given to infants with severe gastrointestinal reflux. Domperidone stimulates the release of [prolactin](https://nabtahealth.com/glossary/prolactin/), which is one of the hormones that regulate milk production. When given at a dose of 10 mg, three times a day, there is a modest _increase in milk_ production; generally of between 80 and 100 mL a day. There is an association between domperidone and cardiac arrhythmias and, in very rare cases, [sudden cardiac death](https://nabtahealth.com/articles/9-common-cardiac-defects-in-children/). Therefore, women with a history of heart complications should be advised against the use of this drug. It does not cross the blood-brain barrier, meaning there is no risk of neurological side effects, and the dose that passes into [breast milk](https://nabtahealth.com/articles/low-milk-supply-we-can-help/) is extremely low. Given for the first few weeks post delivery, it is moderately successful at enhancing milk supply, but longer term studies on its efficacy are lacking. Metoclopromide is an alternative medication sometimes used to stimulate milk production. Like domperidone, it’s primary usage is to prevent nausea and vomiting, but it also increases [prolactin](https://nabtahealth.com/glossary/prolactin/) levels. Unlike domperidone, it crosses the blood-brain barrier and can cause quite severe neurological side effects, such as tremor and bradykinesia (slowness of movement). Most studies on this drug have failed to find a significant _increase in milk production_. More of the drug passes into the breast milk, although levels are still well below those given therapeutically to infants with stomach complaints. The side effects and lower efficacy mean that, generally, domperidone is preferred over metoclopromide for improving [lactation](https://nabtahealth.com/glossary/lactation/). It is recommended that when medication is prescribed, women continue to feed and _pump milk regularly_ to further enhance their supply. **3\. Herbal galactogogues** ---------------------------- Perhaps the best known non-pharmacological method of _boosting milk supply_ is via the consumption of [lactation](https://nabtahealth.com/glossary/lactation/) cookies (or brownies, or lemonade, depending on personal preference). These can be homemade or shop-bought; however, the latter often come with a high price tag and indiscriminate ingredients, meaning their effectiveness may be questionable. It is the individual ingredients within [lactation](https://nabtahealth.com/glossary/lactation/) products that give them their proposed galactogogue properties. The most widely known herbal remedy for enhancing milk [supply is fenugreek](https://nabtahealth.com/articles/natural-methods-to-alleviate-period-pain/) seeds. As well as being a key ingredient in [lactation](https://nabtahealth.com/glossary/lactation/) cookies, these seeds can be consumed in capsule form or dissolved to make a tea. [Fenugreek](https://nabtahealth.com/articles/natural-methods-to-alleviate-period-pain/) seeds have been used extensively as a cooking spice across India and the Middle East for many years. They stimulate sweat production and, as the mammary gland is a modified sweat gland, it is proposed that they stimulate this gland to produce milk. The evidence for their efficacy is inconclusive and mainly anecdotal, although they do seem to have a mild galactagogue effect and many _[lactation](https://nabtahealth.com/glossary/lactation/) consultants_ will recommend them. A dosage of 1 – 6 grams a day is recommended and side effects are generally minor, [](https://nabtahealth.com/articles/diarrhoea-during-your-period-when-to-see-a-doctor/)[diarrhoea](https://nabtahealth.com/glossary/diarrhoea/) and flatulence being amongst the most common. At high doses, fenugreek can lower blood sugar levels, so it is suggested that women with diabetes mellitus do not use it. There are other herbal options which include shatavari root, malunggay leaves and silymarin (65-80% milk thistle extract). Malunggay is widely used as a galactogogue in the Philippines and thistle extract is another common ingredient in [lactation](https://nabtahealth.com/glossary/lactation/) cookies. However, the scientific evidence for their beneficial qualities is lacking. There are very few studies, and the results are variable and inconclusive. Herbal products do not need to undergo the same rigorous testing as other food and drink products. This means they are not regulated by government bodies and do not need to be tested on humans prior to being sold. The safety profiles of herbal products may not be as well established as conventional medication, however, many, including fenugreek seeds, have a long history of use in cooking and medicine, and therefore, are generally considered to be very safe and well tolerated. In conclusion, adequate support, on both an emotional and practical level as well as frequent feeding (or expressing) are the best ways of _boosting milk supply_. Medical and herbal products seem to show some beneficial effects, however, the scientific evidence for their usage is limited and often restricted to short-term studies. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of [fertility](https://nabtahealth.com/articles/causes-of-female-infertility-environmental-lifestyle-factors/), [pregnancy](https://nabtahealth.com/articles/dos-and-donts-in-early-pregnancy/), and [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#ea938b86868baa848b889e8b828f8b869e82c4898587) if you have any questions about this article or any aspect of women’s health. We’re here for you. Seek more advice from [at-home](https://nabtahealth.com/product/at-home-lactation-consultation/) [lactation](https://nabtahealth.com/glossary/lactation/) consultation and get to learn more **Sources:** * Asztalos, E V. “Supporting Mothers of Very Preterm Infants and Breast Milk Production: A Review of the Role of Galactogogues.” _Nutrients_, vol. 10, no. 5, 12 May 2018, doi:10.3390/nu10050600. * Bazzano, A N, et al. “A Review of Herbal and Pharmaceutical Galactagogues for Breast-Feeding.” _The Ochsner Journal_, vol. 16, no. 4, 2016, pp. 511–524. * Drugs and [Lactation](https://nabtahealth.com/glossary/lactation/) Database (LactMed) \[Internet\]. Bethesda (MD): _National Library of Medicine (US)_; 2006-. Fenugreek. \[Updated 2019 May 1\]. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK501779/](https://www.ncbi.nlm.nih.gov/books/NBK501779/). * Grzeskowiak, L E, et al. “Domperidone for Increasing Breast Milk Volume in Mothers Expressing Breast Milk for Their Preterm Infants: a Systematic Review and Meta‐Analysis.” _BJOG_, vol. 125, no. 11, Oct. 2018, pp. 1371–1378., doi:10.1111/1471-0528.15177.
**1\. Low milk supply** ----------------------- Some women find themselves unable to produce an adequate [breast milk supply](https://nabtahealth.com/articles/low-milk-supply-we-can-help/) to meet their babies’ needs, but fortunately, there are some evidence-based options to help them increase their production. It’s important to note, however, that truly low milk supply is actually pretty rare among breastfeeding women, so before you try every tip on our list, be sure that it is really an issue for you. **2\. Focus on nursing** ------------------------ A great place to start trying to increase your milk supply is by setting aside a weekend (or a time when you have a partner or friend around to help) to take a “[nursing vacation](https://www.leadinglady.com/blogs/our-moms/what-is-a-nursing-vacation).” This means that instead of focusing on your to-do list, you focus entirely on your baby. Get as much skin-to-skin time as you can, and let your baby feed as much as he or she wants. This contact can not only increase your supply, it also gives moms much-needed rest and bonding time with baby. **3\. Feed more frequently** ---------------------------- The more you feed your baby (and empty your breasts), the more milk your body will produce. If your milk supply is low, you should consider letting go of plans to get your baby on a schedule or reduce nighttime feedings, in favor of [feeding your baby](https://nabtahealth.com/articles/3-rules-for-feeding-your-baby-solids/) whenever he or she is hungry. By doing so, your body should react by producing more milk. **4\. Pump** ------------ Again, removing more milk from your breasts is the goal here. Pumping or hand expression may be a good way to encourage breast milk production, but it’s also important to know what you need to do with the milk you are removing in this case. You should check with your [](https://nabtahealth.com/articles/when-should-you-see-a-lactation-consultant/)[lactation](https://nabtahealth.com/glossary/lactation/) consultant to see if your baby needs the pumped milk on a regular basis as a supplement (if there are any issues, like weight gain) or if it’s okay to store the milk for later use. While supplementing your baby’s diet is recommended in some cases, it’s important not to do so if it isn’t necessary because it can decrease your baby’s interest in nursing (because he or she may feel full from the supplement instead). **5\. Massage before feeding** ------------------------------ Unlike hand expression or pumping, massaging your breasts before feedings isn’t intended to remove any milk at that time. Instead, a pre-feed massage can increase the amount of [milk your baby](https://nabtahealth.com/articles/3-ways-to-boost-milk-supply/) is able to remove during a feeding. Again, if your baby takes in more milk, your body will likely try to keep pace by producing more. One massage method worth trying is the “massage-stroke-shake” approach. **6\. Herbal remedies** ----------------------- Herbs and medications, also called galactagogues, may also help you increase your milk supply. There isn’t much data to support whether or not these supplements work well, but that’s likely because there aren’t many good studies about them. If you choose to go this route, it’s important to be careful which ones you choose because all options are not of the same quality and some may have side effects. You should talk to your doctor or [](https://nabtahealth.com/product/at-home-lactation-consultation/)[lactation](https://nabtahealth.com/glossary/lactation/) consultant to help you decide. **7\. The bare necessities** ---------------------------- Cut back on pacifiers, bottles, and supplements that your baby can suck on and that replace the breast. These can all be distractions that can interfere with your milk supply. If you’ve been supplementing your baby’s diet with something like formula, be sure to [consult a pediatrician](https://nabtahealth.com/articles/when-should-your-pediatrician-send-your-child-to-an-ent/) to see if your baby really needs it. **8\. Relax!** -------------- It’s difficult to let go of stress and to focus on taking care of yourself when there is so much to do and think about. However, stress can keep your milk from letting down normally, so it’s important to try to relax. Even if your biggest stressor is the very fact that you have low milk supply, it’s important to remind yourself that any milk you produce is better than no milk at all. Take some time for yourself so that you can be your best self for your baby. **9\. Get checked out** ----------------------- As you navigate low milk supply, you may find that nothing is working to increase your _breast milk production_. If that’s the case, and you haven’t already discussed these issues with your doctor, it may be time to see if there are any underlying medical conditions. Conditions like undiagnosed [thyroid](https://nabtahealth.com/articles/how-thyroid-disease-can-affect-your-pregnancy/) disorders, [diabetes](https://nabtahealth.com/product/diabetes-nutrition-session/), and [polycystic ovarian syndrome](https://nabtahealth.com/articles/does-polycystic-ovary-syndrome-cause-infertility/) can all cause low milk supply. **10\. Cut out hormonal meds** ------------------------------ Did your milk supply start getting low after you started taking birth control again? Certain types of birth control can interfere with your milk supply, so if this is true for you, consider choosing another birth control method and cutting out hormonal medications. **Sources:** * Riordan and K * Wambach. Breastfeeding and Human [Lactation](https://nabtahealth.com/glossary/lactation/), 4th edition. Powered by Bundoo®
Baby-led weaning is one way to start solids with your baby. It involves skipping the spoon and allowing your baby to self-feed solids that are prepared in graspable and dissolvable forms, such as sticks of cooked meat or ripe fruit cut into wedges or sticks. While research suggests that baby-led weaning encourages self-regulation, [development of feeding skills](https://nabtahealth.com/articles/9-ways-to-make-night-weaning-work-for-you/), and leaner babies, there isn’t much research to assess its nutrient adequacy. Some research suggests that lower calorie foods such as fruit and vegetables are more common in this feeding approach, which may be associated with baby’s weight status. More recent research points to inadequacies of [iron](https://nabtahealth.com/glossary/iron/) in the diet of baby-led weaners and their spoon-fed counterparts. More research on nutrient intake is needed to help guide optimal food selection to support normal growth and development. #### In the meantime, here are [five nutrients parents](https://nabtahealth.com/articles/qa-with-dr-jen-lincoln-what-about-weaning/) of baby-led weaners should pay attention to, and why: [Iron](https://nabtahealth.com/glossary/iron/)—[Iron](https://nabtahealth.com/glossary/iron/) requirements are particularly important during the first year of life when baby’s brain is developing, his body is growing, and [iron](https://nabtahealth.com/glossary/iron/) stores are being built up. Around the time of introducing solid food (6 months), [iron](https://nabtahealth.com/glossary/iron/) requirements shoot up to 11 mg/day (from 0.27 mg/day), making [iron](https://nabtahealth.com/glossary/iron/) an important consideration when choosing foods to feed your baby. If you are breastfeeding your baby, [iron](https://nabtahealth.com/glossary/iron/)\-rich foods will play a central role to your baby’s overall growth and development. Try to offer two servings of [iron](https://nabtahealth.com/glossary/iron/)\-containing foods each day; if offering plant-based [iron](https://nabtahealth.com/glossary/iron/) sources, give a source of vitamin C (orange juice, tomato sauce, etc) at the same time to maximize [iron](https://nabtahealth.com/glossary/iron/) absorption. Good sources of heme [iron](https://nabtahealth.com/glossary/iron/) (animal-based and naturally well-absorbed in the body) are: chicken liver, oysters, beef liver, beef cuts and ground beef, turkey (dark meat), tuna canned in water, turkey (light meat), chicken (light and dark meat), fresh tuna, crab, pork, shrimp, and halibut. Good sources of non-heme [iron](https://nabtahealth.com/glossary/iron/) (increase absorption by adding a source of vitamin C): ready-to-eat cereals, oatmeal, soybeans, lentils, beans (kidney, lima, black-eyed peas, navy, black, pinto), tofu, spinach, raisins, molasses, and commercially prepared white and wheat bread. [Zinc](https://nabtahealth.com/glossary/zinc/)—[Zinc](https://nabtahealth.com/glossary/zinc/) is a key nutrient for growth and appetite. Children with poor [zinc](https://nabtahealth.com/glossary/zinc/) intake may grow slowly, and have a poor appetite causing inadequate food intake. [Zinc](https://nabtahealth.com/glossary/zinc/) is also tied to immunity and plays a role in keeping your baby healthy. Include [zinc](https://nabtahealth.com/glossary/zinc/)\-rich foods as your baby transitions to solid food, such as red meat like beef and lamb, poultry like chicken or turkey, crabmeat, lobster, fortified ready-to-eat breakfast cereals, a variety of beans, different nuts (when older), whole grains and foods made with whole grains, and dairy products. Fat—Babies need quite a bit of fat in their diets to sustain their rapid growth in the first year of life, especially when considering how easily their tummies fill up. Every calorie counts! In fact, babies need about 50 percent of their total calories from fat, which is an amount naturally found in breast milk and infant formula. However, when babies start solid food, their fluid intake naturally decreases over time, making fat sources from solid food an important inclusion. Fat sources include plant oils, avocado, nut butter, butter, whole milk (wait until a year old) and yogurt [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/)—If you’re breastfeeding, your baby should already be getting a [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) supplement; [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) is included in the panel of nutrients in infant formula. As your baby transitions to solids, keep an eye out for foods that include [vitamin D](https://nabtahealth.com/glossary/vitamin-d/), either naturally (fatty fish such as salmon, cooked mushrooms, or eggs) or fortified with [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) (milk or [vitamin D](https://nabtahealth.com/glossary/vitamin-d/)\-fortified orange juice). As you reach the one year milestone, milk or milk alternatives fortified with [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) will help your baby reach his requirements, though you may still need supplementation to assure your baby is getting enough. DHA—Docosahexaenoic Acid (DHA) is an omega-3 fatty acid essential for the development of the retina and the brain. Breastfed babies will receive DHA through mother’s milk, provided that mom has a good diet including DHA food sources (found below); many infant formulas include DHA. By 9 months, start offering solid foods that are [good sources of DHA](https://nabtahealth.com/articles/qa-with-dr-jen-lincoln-what-about-weaning/), including 1-2 servings of low-[mercury](https://nabtahealth.com/glossary/mercury/) fish each week, including salmon, trout, shrimp, tilapia, pollock, and canned light tuna. Other sources of DHA include fortified eggs, DHA-fortified milk, and DHA-fortified orange juice. Consider a DHA supplement if your toddler won’t eat fish or other sources of DHA. **Sources:** * A Review of Studies on the Effect of [Iron](https://nabtahealth.com/glossary/iron/) Deficiency * The Journal of Nutrition. Castle JL and Jacobsen MT * Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School * Jossey-Bass, 2013. Development and pilot testing of baby-led introduction to solids * BMC Pediatrics. Zeigler et al * Dry cereals fortified with electrolytic [iron](https://nabtahealth.com/glossary/iron/) or ferrous fumarate are equally effective in breast-fed infants * J Nutr * 2011; 141: 243-248. Powered by Bundoo®
You worked hard to make breastfeeding work and you are on a roll. Your baby is thriving and your confidence in nursing is solid. But now you’re tired! Your baby is still waking up several times at night, and you can’t get back to sleep. Many families in this position decide it’s time to wean, if only to get better sleep. But there is a middle ground. Breastfeeding is not an all-or-nothing proposition. If you are struggling with frequent night-waking, you may want to consider night weaning as [opposed to full weaning](https://nabtahealth.com/articles/qa-with-dr-jen-lincoln-what-about-weaning/). This way, your baby still gets all the benefits of breastmilk and you can hopefully get some much-needed sleep. There is a right time and a wrong right time to wean: babies under the age of 6 months are too young to wean from nursing at night because they still need the calories. Sucking at the breast also has proven protections against SIDS. But if your baby is more than 6 months old and you want to try night weaning, here are some good tips. #### [Strategies for Successful](https://nabtahealth.com/articles/tips-for-baby-led-weaning/) Night Weaning Whatever the age of your baby, there are a few things to keep in mind when night weaning: Make sure your baby is nursing plenty during the day. It can be easy to get distracted and forget to nurse as often as it takes to satisfy your baby’s caloric needs. Your milk is calorie-dense and very hydrating. Prepare your baby by telling her that she is not going to nurse until the sun shines. Teach her about day and night. Even if your baby isn’t speaking yet, she may still understand you. Routine and consistency are important. Have a set bed time and bedtime ritual. This could be bath time, baby massage, reading or telling a story, and nursing. Be sure your baby is eating nutritious solids. If your baby is already eating solids, make sure to provide as much nourishing and filling food as possible during the day. Plan to cluster nurse just before bedtime. Your [milk is fattier](https://nabtahealth.com/articles/5-nutrients-for-baby-led-weaning/) if you nurse in clusters. In the evening, your milk has more melatonin to help your baby sleep more. Avoid night weaning when your baby is sick or teething. This is a time when your baby needs attention twenty-four hours a day, and sleep disturbance comes with the territory. It is also best not to wean during a big change such as a move, a parent returning to work, or during holidays and vacations. Many babies who once slept through the night will wake more when routines change, when mom returns to work, during travel, or when there are visitors. #### Offer lots of skin-to-skin contact while night weaning. Have a sippy cup with water available. You may be surprised to know how thirst-quenching your milk is, so your baby may actually be thirsty. Avoid pumping at night to relieve fullness. This will encourage your body to continue making milk at night, so you’ll just be pumping instead of nursing. This negates your plan to be able to sleep more. Hand-expressing can help to relieve fullness without over-stimulating your breasts. **Sources:** * Cohen Engler A, Hadash A, Shehadeh N, Pillar G * Breastfeeding may improve nocturnal sleep and reduce infantile colic: potential role of breast milk melatonin * Eur J Pediatr * 2012 Apr;171(4):729-32.Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome? Powered by Bundoo®
When a mom’s milk lets down while nursing, it means that the cells that make and store the milk are contracting and releasing their contents so the baby can start eating. While it may seem like more is better when it comes to a good let down, this isn’t always the case. Known as an overactive letdown, this occurs when a very forceful letdown releases a lot of milk at once. For some babies, this can actually make those first moments of nursing really difficult to handle. Think of it as drinking from a fire hose! Babies of moms who have overactive let down may sputter or gag at the breast as they try to handle all the milk coming their way. They may pull off frequently as they try to self-regulate the flow of milk. This can [lead](https://nabtahealth.com/glossary/lead/) to swallowing a lot of air during feeding, which in turn may cause excess gas. It can also cause pain for mom as the baby is constantly pulling off and trying to re-latch. Babies may also seem fussy at the breast and may have green stools related to the fact that they ingest a lot of foremilk and end their nursing sessions early. Moms with overactive let down may also have milk oversupply — another blessing and a curse — so these babies may show very rapid weight gain. However, if a baby is not nursing well because of the overactive letdown, weight gain may actually go down. Overactive let down can also [lead](https://nabtahealth.com/glossary/lead/) to a sensation of pain for mom. Some women describe it as a sharp or shooting pain that usually doesn’t involve the nipple. Any mom who is having breast pain should be examined to make sure mastitis or plugged ducts are not the culprits, but sometimes it may just be related to a really forceful letdown. The good news is there are some things you can do to manage their overactive letdown. One trick is to stimulate a let down by pumping or simply doing a hand massage before the baby latches, and then have a washcloth (or bottle) ready to let the milk spray into. Once the let down has passed, let baby latch on as the milk flow will now be slower and easier to handle. A nursing baby in a position that is more “uphill” can help slow the flow of milk somewhat and let the baby have more control. Positions such as the football hold, cradle hold with the baby propped up more on pillows, and laid-back nursing positions can be good ones to try. It may seem instinctive for a mom to keep pressing her baby’s head back onto the breast when he pulls off. This can actually cause more problems, however, because the baby needs to be able to breathe and self-regulate. If they keep feeling forced on the breast, they may become resistant to nursing and stop feeding well. Luckily, over time some women do notice that their overactive let down seems to settle down somewhat, and as a baby gets older, she often is able to work with it more easily. As with any breastfeeding problems, seeing a [lactation](https://nabtahealth.com/glossary/lactation/) consultant can be key if the techniques mentioned here don’t help mom and baby. **Sources:** * The Breastfeeding Answer Book * La Leche League International * 3rd revised edition. Powered by Bundoo®
A study recently published in the journal Social Science & Medicine reignited the debate over the benefits of breastfeeding (or breast milk feeding) versus formula feeding when it seemed to find that the benefits of breastfeeding are “overstated.” Dr. Cynthia Colen, an assistant professor of sociology at Ohio State University and [lead](https://nabtahealth.com/glossary/lead/) author of the study, attempted to find out whether previous studies showing benefits of breastfeeding weren’t reliable because of flaws in their design. When comparing all children in Colen’s study, those who were breastfed showed superiority in all outcomes measured except asthma (which is surprising considering several other studies have shown breastfeeding protects against asthma). However, when excluding extraneous factors (such as race and [socioeconomic](https://nabtahealth.com/glossary/socioeconomic/) status) by looking at individual families where one [infant was breastfed](https://nabtahealth.com/product/the-breastfeeding-box-2/) and the sibling was formula-fed, she concluded that breastfeeding might be no more beneficial than formula feeding for 10 of the 11 long-term health and well-being outcomes studied in children age 4-14. In her study, Colen used data from the 1979 cohort of the National Longitudinal Survey of Youth (NLSY), a nationally representative sample of young men and women who were between ages 14 and 22 in 1979, as well as results from NLSY surveys between 1986 and 2010 of children born to women in the 1979 cohort. The outcomes measured included asthma, body mass index, behavioral compliance, hyperactivity, math ability, memory based intelligence, obesity, parental attachment, reading comprehension, scholastic competence, and vocabulary recognition. Although the results of this study are interesting, the preference toward [breast milk for infant nutrition](https://nabtahealth.com/articles/covid-19-vaccine/) is unchanged. Several news media outlets ran stories following the release of Colen’s article, stating that breastfeeding’s benefits have been dramatically “overstated.” However, an enormous amount of research points toward the benefits of breastfeeding for both the mother and infant. For the infant, breastfeeding is associated with a reduced risk of acute otitis media (ear infection), [atopic dermatitis](https://nabtahealth.com/glossary/atopic-dermatitis/) (eczema), gastrointestinal infections, lower respiratory tract diseases, asthma, obesity, childhood leukemia, and sudden infant death syndrome (SIDS). For the breastfeeding mother, breast and ovarian cancer risk is reduced. In terms of cost, breastfeeding is free. Breastfeeding promotes a growing bond between mother and infant. Regarding Dr. Colen’s study, only a few pediatric medical outcomes (asthma, body mass index, and obesity) were explored. The rest were neurobehavioral in nature. Still, the study highlights the notion that choice of nutrition is not the only factor involved in child health and development. While the benefits of breast milk are undeniable, other variables in a [child’s environment](https://nabtahealth.com/articles/involving-dad-with-breastfeeding/) are also important. This should come as good news to mothers who are unable to breastfeed. Reviewed by Dr. Sara Connolly, December 2018 **Sources:** * Colen CG, Ramey DM * Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons. Social Science & Medicine * January 2014. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J * Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries * Evidence Report/Technology Assessment No * 153 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No * 290-02-0022) * AHRQ Publication No * 07-E007 * Rockville, MD: Agency for Healthcare Research and Quality * April 2007. New Mother’s Guide to Breastfeeding, 2nd Edition * American Academy of Pediatrics * 2011. Section on Breastfeeding, American Academy of Pediatrics * Breastfeeding and the use of human milk * Pediatrics * 2012: 129(3): e827. Powered by Bundoo®
[PCOS](https://nabtahealth.com/glossary/pcos/) is the most common hormonal condition to affect women of reproductive age. It can have a detrimental effect on fertility, as women with the condition [struggle to conceive](https://nabtahealth.com/pcos-and-pregnancy/) and are at greater risk of experiencing pregnancy complications, including [miscarriage](https://nabtahealth.com/glossary/miscarriage/). It is also thought that [PCOS](https://nabtahealth.com/glossary/pcos/) can affect a female’s ability to breastfeed, with some studies showing that women with clinically diagnosed [PCOS](https://nabtahealth.com/glossary/pcos/) are less likely to commence breastfeeding than those who do not have the condition. The issue seems to be with initiation of breastfeeding, as once it is successfully established, women with [PCOS](https://nabtahealth.com/glossary/pcos/) are no more likely to stop breastfeeding than their counterparts. If you have [PCOS](https://nabtahealth.com/glossary/pcos/) and are having difficulty establishing breastfeeding there are steps you can take to make the process easier. The [advantages of breastfeeding](https://nabtahealth.com/benefits-of-breastfeeding/) for both mother and child, are extensive and far-reaching; benefiting the child’s health for the foreseeable future, and, as such, support should be given to all women who are finding the process challenging. #### **Reasons why [PCOS](https://nabtahealth.com/glossary/pcos/) might make breastfeeding more challenging** Women with [PCOS](https://nabtahealth.com/glossary/pcos/) often have lower levels of [progesterone](https://nabtahealth.com/glossary/progesterone/), particularly if they do not ovulate regularly. [Anovulation](https://nabtahealth.com/glossary/anovulation/) is one of the main [clinical symptoms of](https://nabtahealth.com/what-is-pcos/) [PCOS](https://nabtahealth.com/glossary/pcos/). [Progesterone](https://nabtahealth.com/glossary/progesterone/) is required for normal breast development. It has been suggested that women with [PCOS](https://nabtahealth.com/glossary/pcos/) have insufficient glandular breast tissue, meaning that the breasts cannot undergo the normal physiological changes necessary during pregnancy. Women with [PCOS](https://nabtahealth.com/glossary/pcos/) are often hyperandrogenic, meaning they produce high levels of [androgens](https://nabtahealth.com/glossary/androgen/). Specifically, levels of Dehydroepiandrosterone‐sulphate (DHEAS) have been shown to be elevated in pregnant women with [PCOS](https://nabtahealth.com/glossary/pcos/). DHEAS is a weak androgen, however, it can undergo conversion to more potent [androgens](https://nabtahealth.com/glossary/androgen/), including [testosterone](https://nabtahealth.com/glossary/testosterone/). One of the sites for this conversion is the mammary glands, which suggests a potential build-up of [testosterone](https://nabtahealth.com/glossary/testosterone/) in the breast tissue of women with [PCOS](https://nabtahealth.com/glossary/pcos/) during pregnancy. [Androgens](https://nabtahealth.com/glossary/androgen/) suppress [prolactin](https://nabtahealth.com/glossary/prolactin/) receptors and inhibit [lactation](https://nabtahealth.com/glossary/lactation/). [Prolactin](https://nabtahealth.com/glossary/prolactin/) is essential for breast growth and milk synthesis. [Prolactin](https://nabtahealth.com/glossary/prolactin/) efficiency can also be compromised by high insulin levels. [](https://nabtahealth.com/treating-the-associated-symptoms-of-pcos/)[Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is a common symptom of [PCOS](https://nabtahealth.com/glossary/pcos/) and many women with the condition have higher than normal levels of circulating insulin. Aside from having a direct effect on milk synthesis through the proliferation of mammary gland cells, insulin also contributes to the high androgen levels seen in women with [PCOS](https://nabtahealth.com/glossary/pcos/). #### **The counterargument** One large cohort investigation looking at almost 5000 women, of whom 6.5% had [PCOS](https://nabtahealth.com/glossary/pcos/), identified that there was a positive association between obesity and breastfeeding. Obese mothers were less likely to initiate and subsequently persevere with breastfeeding. Many of the women with [PCOS](https://nabtahealth.com/glossary/pcos/) were overweight, but any [lactation](https://nabtahealth.com/glossary/lactation/) issues were attributed to them having a high [](https://nabtahealth.com/what-is-body-mass-index-bmi/)[BMI](https://nabtahealth.com/glossary/bmi/), rather than their [PCOS](https://nabtahealth.com/glossary/pcos/) status. Certainly there are explanations for why obesity may be linked to lower breastfeeding rates. Women who are obese are more likely to require interventions during labour and delivery, which lowers the likelihood of them breastfeeding. They may experience mechanical difficulties with the baby latching due to their increased size. Obesity is also a driving factor for [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/) and [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/), and, as described above, these are two of the proposed causes of low breastfeeding rates and/or [lactation](https://nabtahealth.com/glossary/lactation/) difficulties. Thus, it remains unclear whether women with [PCOS](https://nabtahealth.com/glossary/pcos/) struggle to breastfeed because of their condition, or because of their associated symptoms. Furthermore, it must be considered that for some women breastfeeding is challenging. This may be entirely irrespective of any coexisting medical conditions. Perhaps the reason why breastfeeding is difficult does not really matter and we should instead look for solutions to the problem. #### **Why it is important** The [World Health Organisation](https://www.who.int/nutrition/publications/globaltargets2025_policybrief_overview/en/) recommends that all babies are exclusively breastfed for the first six months of life. Breastfeeding is singularly the best way of satisfying all your baby’s nutritional needs and should be a resource that is freely available and accessible for all. It is for these reasons that all women who are struggling to breastfeed should be given sufficient help and support to overcome the barriers they face, whether these are medical, physical, emotional or a combination of the three. Such support might include, speaking to a [lactation](https://nabtahealth.com/glossary/lactation/) specialist, as well as taking pharmacological or herbal supplements (galactogogues) to help. For a detailed summary of these approaches, click [here](https://nabtahealth.com/3-ways-to-boost-milk-supply/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#d5acb4b9b9b495bbb4b7a1b4bdb0b4b9a1bdfbb6bab8) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Joham, Anju E., et al. “Obesity, Polycystic Ovary Syndrome and Breastfeeding: an Observational Study.” Acta Obstetricia Et Gynecologica Scandinavica, vol. 95, no. 4, 18 Jan. 2016, pp. 458–466., doi:10.1111/aogs.12850. * Kochenour, N K. “[Lactation](https://nabtahealth.com/glossary/lactation/) Suppression.” Clinical Obstetrics and Gynecology, vol. 23, no. 4, Dec. 1980, pp. 1045–1059., doi:10.1097/00003081-198012000-00008. * Marasco, Lisa, et al. “Polycystic Ovary Syndrome: A Connection to Insufficient Milk Supply?” Journal of Human [Lactation](https://nabtahealth.com/glossary/lactation/), vol. 16, no. 2, May 2000, pp. 143–148., doi:10.1177/089033440001600211. * Sir-Petermann, T., et al. “Maternal Serum [Androgens](https://nabtahealth.com/glossary/androgen/) in Pregnant Women with Polycystic Ovarian Syndrome: Possible Implications in Prenatal Androgenization.” Human Reproduction, vol. 17, no. 10, Oct. 2002, pp. 2573–2579., doi:10.1093/humrep/17.10.2573.
As far as the new [COVID-19](https://nabtahealth.com/covid-19/) virus is concerned, at present we have a lot more questions than answers. Hardly surprising given that at the start of the year barely anybody had heard of the virus. Whilst researchers and healthcare professionals work tirelessly to better understand a condition that has caused global chaos and uncertainty, all we can really do is follow current guidelines and make the best decisions for our families and loved ones. The [benefits of breastfeeding](https://nabtahealth.com/benefits-of-breastfeeding/) cannot be denied. The United Nations International Children’s Emergency Fund (UNICEF) and World Health Organisation (WHO) categorically state that exclusive breastfeeding for the first six months gives your child the best possible start. But what about if you are ill yourself? The predictions suggest that many of us will, over time, be diagnosed with COVID-19 and this will include [those who are pregnant](https://nabtahealth.com/i-am-pregnant-should-i-be-worried-about-the-recent-covid-19-outbreak/) or breastfeeding. #### I have recently been diagnosed with COVID-19, should I stop breastfeeding? First the good news, there is currently no clinical evidence that the virus passes into breast milk. Next, the caveat……this virus is new, studies to date have been preliminary and whilst analyses performed thus far have found no transmission via breast milk, case numbers have been small. This is probably why guidance from organisations such as WHO and the Centers for Disease Control and Prevention (CDC) with regards to breastfeeding following a COVID-19 diagnosis, is only just becoming available. The main mode of virus spread is via respiratory droplets. These are the particles we release when we cough or exhale. Thus, it would seem that the biggest risk to your breastfed baby will probably come from the close contact and sharing of airborne droplets that comes with breastfeeding and not from the milk they are drinking. Advice from the WHO states that: “The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19”. [WHO, April 2020.](https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1) #### What precautionary steps can I take to minimise the risk of passing the virus to my child? Talk to your family and health care professionals about the benefits and risks of breastfeeding. Be aware that as time passes, our knowledge will develop and, as such, the advice from WHO and CDC may change. To date, the advice is: * If you feel well enough, breastfeed your infant. If not, consider expressing milk. * Wash your hands thoroughly (for at least 20 seconds) before feeding your baby or touching any bottles or breast pumps. * If you have access to a medical mask, wear it whilst feeding your baby. Consult [WHO guidelines](https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks) for how to safely wear and discard your mask. * Try to avoid coughing or sneezing whilst feeding your baby. If you do cough or sneeze, use a tissue to catch any particles, discard it immediately and wash your hands again before continuing the feed. * If you do express milk, ask someone who is well to feed your baby. Make sure all equipment is thoroughly cleaned and sterilised before and after use. Additionally: * You do not need to wash your breast before every feed. However, if you cough or sneeze directly onto your chest, wash it promptly with soap and water for at least 20 seconds. * There is no defined period of time to wait before breastfeeding after COVID-19 infection. If you are well enough, you should continue to breastfeed throughout. If you are not well enough, you can start as soon as you feel better. If [lactation](https://nabtahealth.com/glossary/lactation/) is difficult, consult a specialist for help and support. #### Why are these guidelines different to those given to the general population? On first appearances, these guidelines appear to directly contradict most of the advice we are being given elsewhere. [Social distancing](https://nabtahealth.com/what-is-social-distancing/) is a concept many of us are now implementing. Adults and older children are strongly recommended to avoid crowded places and maintain a distance of at least 1.5 metres from other people. This is considered to be the best approach for minimising transmission of the virus. In contrast, mothers are recommended to continue breastfeeding, even if they are COVID-19 positive, and ensure as much skin-to-skin contact as possible with their infant. On the basis of the evidence available to date, the reasons for this are twofold: 1. The benefits of breastfeeding far outweigh the risk of transmission. Breastfeeding reduces the risk of [neonatal](https://nabtahealth.com/glossary/neonatal/) mortality and has additional [health benefits for the nursing mother](https://nabtahealth.com/benefits-of-breastfeeding-for-the-mother/). 2. To date, children are at low risk of COVID-19 infection. The majority that get it, experience only mild symptoms, or are [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/) #### Staying positive Breastfeeding can be difficult at the best of times; add a global pandemic to the mix and things really get tough. Remember that nothing needs to come between the bond you have with your child. There is no need for you to completely socially isolate yourself from your baby. In the early days of the virus, some new mothers in China were advised to separate from their babies for 14 days (the predicted incubation period). This was rapidly found to be far more detrimental than beneficial in terms of bonding and initiating feeding. Babies and young children have, to date, not been severely affected by COVID-19. Of course you do not want your child to fall ill, but maintain good personal hygiene and you will reduce the chances of this happening. Allow yourself time to recover. Even if your symptoms seem mild, this new virus is a big deal. There is a lot that remains unknown and until it is better understood, erring on the side of caution is wise. Ask family and friends for help. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#ff869e93939ebf919e9d8b9e979a9e938b97d19c9092) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Chen, Huijun, et al. “Clinical Characteristics and Intrauterine Vertical Transmission Potential of COVID-19 Infection in Nine Pregnant Women: a Retrospective Review of Medical Records.” The Lancet, vol. 395, no. 10226, 7 Mar. 2020, pp. 809–815., doi:10.1016/s0140-6736(20)30360-3. * “Coronavirus Infection and Pregnancy.” Royal College of Obstetricians & Gynaecologists, [www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/](http://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/). * “FREQUENTLY ASKED QUESTIONS: Breastfeeding and COVID-19 For health care workers”. World Health Organization, [https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0\_1](https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1). * “Pregnancy & Breastfeeding.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Mar. 2020, [www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html](https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html). * Rasmussen, Sonja A., et al. “Coronavirus Disease 2019 (COVID-19) and Pregnancy: What Obstetricians Need to Know.” American Journal of Obstetrics and Gynecology, 24 Feb. 2020, doi:10.1016/j.ajog.2020.02.017. * “When and How to Use Masks.” World Health Organization, World Health Organization, [www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks](http://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks).
Opiates include prescription medications like oxycodone, hydrocodone, and codeine. These medications are prescribed to many breastfeeding women for a variety of reasons. This is including pain control after undergoing a cesarean section. But is it really safe to breastfeed if you are taking one of these medications? The short answer is that breastfeeding does not usually need to be stopped if a mother is taking one of these drugs. #### However, there are a few facts that a nursing mother and her [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and pediatrician should be aware of. The first is that all opiates pass into breast milk, but the amount that transfers varies depending on the drug. Because of this, the overall goal should be to use the lowest dose needed for pain control for the shortest amount of time. [Nursing mothers](https://nabtahealth.com/articles/benefits-of-breastfeeding-for-the-mother/) who need to take oxycodone after a C-section, for example, can use other methods to help control their pain. They can use drugs such as taking ibuprofen, acetaminophen, and using heat packs in addition to taking opioids. Combining multiple ways to control pain can lower the amount of narcotic medicine she needs to take. This can help prevent her own tolerance and dependence, which can then [decrease the amount in her breast milk](https://nabtahealth.com/product/at-home-lactation-consultation/). Different opiates carry different recommendations for how much a [breastfeeding mom](https://nabtahealth.com/articles/benefits-of-breastfeeding-for-the-mother/) should take in a 24 hour period. For example, the maximum recommended dose of hydrocodone is 30mg per day. According to LactMed, the maximum dose in a 24 hour period for oxycodone is 30mg. However, the American Academy of Pediatrics (AAP) actually recommends breastfeeding mothers not use this drug at all. Instead take morphine or hydromorphone. Despite this recommendation, many nursing mothers do take oxycodone post-operatively without any effect on their babies. But it is something to consider when deciding on a pain medication. #### To explain more….. Codeine is an opioid that has recently made headlines in the United States, with an unfortunate report of the death of newborn. The mother had been taking the drug and had a rare genetic variant that led her to metabolize the drug very quickly. This was leading to very high levels of the opioid in her breast milk. Because of this, the [FDA](https://nabtahealth.com/glossary/fda-2/) has recommended that breastfeeding mothers are not prescribed this medicine, especially since other effective, safer narcotics are available. In any mother who needs to take opiates for pain control, the goal should be the lowest dose for the shortest amount of time. This has to be kept in balance with pain control, since uncontrolled pain can actually interfere with a milk let-down and [successful breastfeeding](https://nabtahealth.com/product/at-home-lactation-consultation/). All babies who are exposed to narcotics should be monitored for side effects. These are like as being extra sleepy or sedated, especially if these drugs are used for longer than four days. What about the mother who is using opioids illicitly or who has chronic narcotic usage and is using exceedingly high doses? This group of women requires special attention, as do their babies. Mostly for women who are in a supervised methadone maintenance program. However, the AAP states that continuing to breastfeed is acceptable as long as they test negative for other illicit drugs. For the mother who is actively abusing narcotics, breastfeeding may be discouraged given the risk to the baby, but it is an individualized recommendation. **Sources:** * The Academy of Breastfeeding Medicine * Clinical Protocol #15: Analgesia and anesthesia for the breastfeeding mother, revised 2017. The American Academy of Pediatrics * Policy statement: breastfeeding and the use of human milk * March 2012. Powered by Bundoo®
 #### What is maternal health and why is it so important? Pregnancy and childbirth are exciting, scary, life-changing events. They can be joyful experiences, and they can be fraught with anxiety, and physical and emotional challenges. Maternal health is about the wellbeing of women and their babies during pregnancy, childbirth, and the postnatal period. Women should feel comfortable and confident in the medical care and attention they receive each stage of their pregnancy journey. Lack of awareness about the potential complications associated with pregnancy and childbirth can [lead](https://nabtahealth.com/glossary/lead/) to devastating outcomes. Most maternal complications are preventable with prompt support by trained maternal health professionals. The goal for maternal health is always positive outcomes for both mother and baby. #### What are maternal health services? A pregnant woman will usually meet some or all the following skilled healthcare practitioners during and after her pregnancy: * Doctor or General Practitioner (GP): Provides basic pregnancy care. Doctors with added expertise may share pregnancy care with a hospital. * [Obstetrician](https://nabtahealth.com/glossary/obstetrician/): A doctor qualified in specialist antenatal and postnatal care for women and their babies. Obstetricians deliver babies and manage high-risk pregnancies and births. * Midwife: Medically trained to care for women during pregnancy, labour and after childbirth. Often a pregnant woman will be cared for by a team of midwives. * Doula: Some women choose a Doula as a companion for support during pregnancy and labour. A Doula is not a medically trained professional. * [Lactation](https://nabtahealth.com/glossary/lactation/) consultant: Helps mother and baby establish breastfeeding and overcome difficulties with latching, low milk supply, and sore nipples. * Maternal and child health nurses: Monitor the child’s development and growth from newborn until around 3.5 years old. #### Antenatal checks, tests, and screenings Routine antenatal checks and tests are an important part of a woman’s pregnancy care. As the pregnancy progresses, blood tests, urine samples and ultrasound scans are accompanied by scheduled check-ups to assess the mother’s health and wellbeing, and the baby’s development. Screening and scans during pregnancy typically include a full blood count, infectious disease screen, urine culture, dating scan, screens for genetic abnormalities, [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) screening, and Group B strep screen. It’s a personal choice to have all the antenatal tests. A mother’s healthcare team will recommend that she has all tests and scans as scheduled for a complete picture of her health and her baby’s development. The tests are also designed to pick up any medical problems and identify possible genetic conditions affecting the baby. This will enable the mother and her doctors to make informed decisions about further testing or actions. #### What are maternal health concerns during pregnancy? Major maternal health problems can [lead](https://nabtahealth.com/glossary/lead/) to serious illness or death for both mother and baby. Complications can include excessive blood loss during labour, infections, [anaemia](https://nabtahealth.com/glossary/anaemia/), high blood pressure ([hypertension](https://nabtahealth.com/glossary/hypertension/)), obstructed labour, and heart disease. Maternal mental health is also an important consideration. Pregnancy and childbirth are different for every woman. Access to the right healthcare before, during and after pregnancy will reduce the risk of complications. #### – Before pregnancy Medical history and pre-existing conditions: The healthcare team should be made aware of any medical conditions, medications, or family history that may affect the mother’s health, or the unborn baby’s health during pregnancy. #### – During pregnancy The mother should attend all recommended check-ups and screenings. The maternal health team will monitor and treat pregnancy-related health issues including [anaemia](https://nabtahealth.com/glossary/anaemia/), urinary tract infections, [hypertension](https://nabtahealth.com/glossary/hypertension/), [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/), mental health conditions, excess weight gain, infections, [hyperemesis gravidarum](https://nabtahealth.com/glossary/hyperemesis-gravidarum/) (severe and persistent vomiting). #### – After pregnancy The postpartum period usually refers to the first six weeks after childbirth. While there’s (understandably) lots of focus on the new arrival, postpartum health is just as important: * Physical recovery: Allow time for physical recovery from a vaginal birth or C-section. Mothers should prepare for perineal pain, vaginal bleeding (lochia) and uterine [contractions](https://nabtahealth.com/glossary/contraction/). * Postpartum or postnatal depression: Take care of emotional health. It’s normal to experience the ‘baby blues’ when hormones dip a few days after giving birth. Prolonged low moods and feelings of helplessness should be raised with the healthcare team. * Rest is best: Try to sleep or rest when the baby sleeps. Rest will help with recovery. * Eat regularly: Eat regular, healthy meals. What a mother eats, her baby eats. * Hydrate: Drink water, lots of it. Hydration will aid milk supply. * Feeding routines: Get support establishing feeding routines, whether breast-feeding or bottle-feeding. * Physical exertion: Avoid heavy lifting for the first 4 to 6 weeks after delivery and especially after a C-section. Exercise should be gentle walks with the baby. Try not to do any physically demanding activities (no running up and down the stairs and definitely no gym sessions!). * Vitamins: Continue taking antenatal vitamins #### What are postpartum complications? Postpartum complications to be aware of include mastitis, postnatal depression, excessive bleeding (hemorrhage) after giving birth, infection or sepsis, [hypertension](https://nabtahealth.com/glossary/hypertension/), pulmonary [embolism](https://nabtahealth.com/glossary/embolism/), cardiomyopathy, and cardiovascular disease. Postpartum mothers should be counselled to recognise the signs and symptoms of a problem. Contact a doctor at once at any sign of high fever, flu-like symptoms, a red and swollen breast, a headache that doesn’t improve with medication, chest pain, shortness of breath, seizures, bleeding through one maternity pad in an hour, and a red or swollen leg painful to touch. #### What happens at a postpartum check-up? Postpartum maternal checks are about the mother’s health. At your postpartum check-ups your doctor will check your abdomen, [vagina](https://nabtahealth.com/glossary/vagina/), [cervix](https://nabtahealth.com/glossary/cervix/), and [uterus](https://nabtahealth.com/glossary/uterus/) to make sure you are healing well. They will talk to you about when it is safe to have sex again and birth control (remember that even if you don’t have your periods while you breastfeed you can still become pregnant). And your doctor will also talk to you about your emotional health, whether you are getting enough rest, eating well and how you are bonding with your baby. Use these check-ups to raise any concerns you might have with your recovery and emotional wellbeing. #### Getting started with Nabta Health Nabta’s marketplace and resources are designed to support mothers at every stage of their maternal health journey. From at-home tests to prenatal courses; on-demand Doulas to hypnobirthing courses; maternity pads to nursing bras; prenatal yoga to postpartum care packages… Nabta’s team of healthcare and wellness experts has carefully selected products to meet a woman’s maternal health needs.
**1\. Bundoo: What should a parent of a 3-week-old expect in terms of eating? About how much will a baby eat at every feeding?** **Answer :** Feeding Your 3 Week old Baby: Dr. Kristie Rivers: By three weeks of age, your baby is growing and changing every day, including his or her appetite. If your baby is [breastfeed](https://nabtahealth.com/articles/who-can-help-me-learn-to-breastfeed/), he or she will still eat every 2-3 hours, nursing at least 15-20 minutes at a time. You may notice that your baby cluster feeds at times, meaning he or she eats more frequently, then goes for longer periods of time between feeds. A formula-fed baby can go a little longer between feeds, usually eating every 3-4 hours. Most formula-fed babies at 3 weeks eat around 3-4 ounces at a time. **2\. What do you look for in a healthy 3-week-old in terms of growth and development? Is there anything parents should know about growth rates?** **Answer :** At three weeks of age, your baby should be well over his or her birth weight. In fact, it is normal for babies at this age to gain 20-30 grams (2/3 of an ounce) per day. In addition to weight, your baby’s doctor will also look at the size of the head and plot it on the growth chart to makes sure the [brain is developing](https://nabtahealth.com/articles/brain-cancer-in-children/) normally. The average baby’s head grows about 3 cm in the first few weeks of life. **3\. As babies eat more, many begin to spit up. What is spit up exactly, and is this something parents should worry about? Can they do anything about it?** **Answer :** Spit ups are very common in infants. Sometimes the muscle at the bottom of the [esophagus](https://medlineplus.gov/esophagusdisorders/) is not tight in babies, leading to the milk coming back up after a feed. Other times, the baby is being overfed, so the stomach is filled up too much, and the milk has nowhere to go but back up. If your baby is gaining weight appropriately and doesn’t seem overly fussy, the spit up is nothing to worry about. However, if your baby is spitting up so much milk that he or she is not gaining the appropriate amount of weight or seems to be in pain during eating, he or she should be evaluated by the [pediatrician](https://nabtahealth.com/articles/infant-gas-when-to-call-your-childs-pediatrician/). **4\. Babies cry a lot at 3 weeks, but this is also right around the time colic starts. How will parents know if their baby has colic, as opposed to just regular crying?** **Answer :** Babies at this age cry for a variety of reasons, including hunger, sleepiness, discomfort from a wet/dirty diaper, or pain. However, once the problem is taken care of, many babies will settle. If your baby has bouts of crying lasting more than 3 hours a day with no obvious reason, this is likely due to colic. Babies with colic often have predictable periods of crying throughout the day and are often content at other times. As long as your baby is growing well and has a normal physical exam, you can be reassured that this fussy period will end at around three to four months of age. Powered by Bundoo®
Engorgement is a term that is sometimes incorrectly tossed around anytime a nursing mom says her breasts feel very full. This fullness can be a sensation she notices when her milk first comes in (usually a few days after giving birth) or if her breasts aren’t completely drained during a feed (such as if there is an improper latch or plugged duct). True engorgement, however, is above and beyond the breasts feeling full, as is often the case in the first few weeks of [breastfeeding](https://nabtahealth.com/articles/breastfeeding-between-here-and-there-east-and-west/). Engorgement is when the breasts are abnormally distended, either from swelling known as edema (this can happen when mom has mastitis, for example) or from milk not being properly removed from the breast. Engorgement can first and foremost be very uncomfortable and even painful for a woman. Her breasts can feel very heavy, hard, and tender to the touch. She may notice that her baby now can’t latch, and this is because the breasts are now so full that he can’t fit enough of the [nipple](https://nabtahealth.com/articles/can-i-breastfeed-if-my-nipples-are-pierced/) and areola into his mouth. Unfortunately, this can cause a vicious cycle of less milk being drained, which means her engorgement only gets worse. So what’s a mom to do if she succumbs to [engorgement](https://nabtahealth.com/articles/what-is-engorgement-and-how-do-you-make-it-better/)? Checking in with her [lactation](https://nabtahealth.com/glossary/lactation/) consultant would be her best bet, but here are some things to try at home: Soften the breasts and help with milk let-down. This can be done by applying a warm compress or breast massage before a feed. Another excellent technique known as reverse pressure softening can help a baby latch better to an engorged breast. You can find a great description of how to do this (with pictures to help guide you) from the [La Leche League](https://www.llli.org/). Continue removing milk. Keep nursing your baby, but if your baby can’t latch or is not feeding adequately, express milk either by using a pump or hand expression. Hand expression may be quicker and easier in the early days of nursing. If your baby won’t latch at all, express milk as often as they would normally feed to keep your milk supply up. If your supply is adequate (that is, you get a ton of milk in a short amount of time), then only express enough to make yourself comfortable. If you do more than this, you could cause oversupply and only prolong the engorgement! Feed on demand. Many moms who try to schedule feeds (either by spacing them out or stopping a baby who is still nursing) will end up with engorgement simply because they are not allowing their infants to drain their breasts enough. Watch your baby, not the clock! Stop what is causing it. If your baby isn’t latching correctly and can’t drain milk, engorgement can certainly occur and won’t get better until the latch is fixed. If left alone, your body will get the message to eventually stop making milk which can [lead](https://nabtahealth.com/glossary/lead/) to true low milk supply. This is why any new mom with engorgement that doesn’t get better over 12-18 hours should seek treatment from a [lactation](https://nabtahealth.com/glossary/lactation/) consultant to evaluate for these kinds of problems. Decrease the edema. Combined with reverse pressure softening, other techniques can help reduce breast swelling, which can prevent milk from draining properly. You can try to apply ice packs for 20 minutes at a time as well as take an anti-inflammatory such as ibuprofen. Any signs such as a fever, red skin, or flu-like symptoms should trigger a call to your doctor or midwife to make sure that you’ve not developed mastitis on top of engorgement, which can certainly happen. This is because if milk is not removed, bacteria that normally live on the skin can start to grow in the milk and cause an infection. **Sources:** * Riordan and K * Wambach * Breastfeeding and Human [Lactation](https://nabtahealth.com/glossary/lactation/), 4th edition. La Leche League International * My breasts feel extremely full and uncomfortable * What is happening and what should I do about it? Powered by Bundoo®
