Lactation Frustrations Trivia Quiz

Answer: Latch

A good latch makes feeding easier for the baby, and less painful for her mother! Babies often need some help getting a good latch, though, especially when they're new. Mom can help with positioning by lining up her nipple with the baby's nose. The goal is a nice, wide latch with most of the areola in the baby's mouth -- not just the nipple! The baby's tongue should be positioned under the nipple.

A bad latch can be quite painful and can even cause bruising -- yikes! A new mom may suffer from sore or cracked nipples even without latching problems, though; her breasts are getting much more strenuous exercise than ever before. Nontoxic lanolin ointment can really help soothe the aches and pains in those tough first weeks of acclimation.

Answer: Tongue-tie

The lingual frenulum is a folded mucous membrane that runs from the bottom of the tongue to the floor of the mouth. Sometimes a baby is born with a frenulum that's too short, or attached too near the tip of the tongue, to allow the full range of motion. For the best latch and best milk flow, a baby should be able to extend his tongue out past his lower lip; otherwise breastfeeding will be less efficient and very often more painful for the mother.

There are a few strategies available for tongue-tie. Sometimes, the baby just needs a different nursing position or more help getting the right latch. Sometimes medical help is called for; the frenulum can be surgically severed to enlarge the tongue's range of motion.

Answer: The baby still feeds at the breast, not from a bottle

An SNS is basically a long, thin, flexible tube with a container of breastmilk or infant formula at one end. The other end of the tube is placed on the mother's breast, next to her nipple. When the baby latches on, she sucks from both the nipple and the tube at once. She's still nursing; she's just getting extra. The tube can be taped in position, or it can be held there by an accomplice. It can be tough to maintain the right amount of suction, especially if the initial nutrition problem was that the baby's suck reflex wasn't strong enough! To address this, some systems use a syringe at the top, so that an adult can help regulate the flow.

Mothers of newborns are often advised not to let their very new babies drink from a bottle if they intend to breastfeed. The worry is that the baby might get confused, since the bottle feels different from her mother's breast. In fact, the baby might prefer it if she realizes that she can get milk faster from a bottle! (Low-flow bottle nipples can help with that problem.) An SNS can be awkward, inconvenient, and sometimes even painful if the tube is pressed hard into the breast -- but it's also a great way to give a baby extra calories while still letting her practice her breastfeeding skills.

Answer: Letting the baby nurse more

Breastfeeding follows the laws of supply and demand: as the baby demands more milk, the breast responds with more supply. (This is how breastfeeding mothers of twins pull it off!) In the act of nursing, the baby's mouth stimulates milk-producing glands in the breast; breast pumps also provide this kind of stimulation. Emptying the breast of milk also prods the body into producing more. This is why it's recommended that mothers always offer their babies their second breast, even if they seem satisfied after nursing from the first; even a little stimulation will help supply in that breast, and the baby may still be hungry for lower-calorie foremilk. It's also a good practice to alternate which breast is the first one offered to the baby.

While drinking milk, sleeping, and meditating can promote maternal health and reduce stress -- which are important! -- they are not direct ways to increase milk production. In fact, as the baby starts to sleep for longer stretches, his mother's body will adjust to produce less milk overnight.

Answer: Fenugreek

Ground fenugreek seeds are sold in capsules, which may be taken up to three or so times a day. It can unsettle stomachs, so it should be taken with food, and shouldn't be taken when the milk is destined for a fragile premature infant. Despite this caveat, fenugreek is a fairly gentle herb: the primary complaint is that it makes mother and milk smell slightly of maple syrup. This is usually an easy price to pay!

With all these supply issues, I do want to make one thing clear: a lot of breastfeeding mothers worry about their supply when they really don't have to. If the baby nurses when he shows signs of hunger, if he's growing, if he's producing plenty of wet diapers (six or more in a day by the end of the first week) and dirty diapers (three or more in a day by the end of the first week), then he's probably doing just fine.

Answer: Plugged duct

Mastitis is inflammation of the breast, generally accompanied by tenderness and pain, fever, and even the aches and fatigue usually associated with the flu. In a nursing mother, mastitis usually happens in only one breast, and it often develops due to infection in a plugged duct: a place in the breast where milk is no longer able to flow freely. For a plugged duct or mastitis, the mother should get lots of rest, fluid, and nutrition -- and should keep nursing! The baby can drink the milk perfectly safely, while simultaneously helping Mom get healthy by draining her breasts and working to remove the blockage.

A mastitis sufferer should consult a doctor, nurse often, start each nursing session on the affected breast (without ignoring the other side, of course), massage with warm compresses, and most importantly, get someone to help with the baby and with the household.

Answer: After a morning shower

Milk supply follows a daily cycle. It tends to be highest in the early morning hours, and lowest in late evening before bed. Hot water on the breasts will stimulate milk production and flow, so it's a very good strategy to nurse the baby, hop in the shower, and then pump. Alternatively, some mothers combine pumping and nursing: they pump on one breast while the baby's nursing on the other! That was too much of a juggling act for me personally, but you can't beat it for coziness.

Answer: The nipple moves freely in the tube part of the funnel. The areola mostly stays in the cone part.

The widest part of the cone should make a good seal with the breast; if there's airflow around it, the pump won't be able to get any suction. That's a sign of a flange that's too large! Another sign of an overly large flange is if a significant part of the areola is being drawn into the tube; only the nipple is supposed to be pumped on.

A nipple that rubs against the sides of the tube, on the other hand, is a nipple that's going to chafe. A flange that's too small can quickly become painful. And, as if the pain weren't bad enough on its own, it also inhibits milk flow!

Flanges are typically made out of a clear plastic, so the user can check the sizing while she pumps. All breast pump manufacturers sell variously sized flange sets separately, so it's easy to get the right size -- and perhaps lay in an extra set or two to cut down on the amount of washing that's needed during the day.

Answer: Thawed breastmilk can be stored in a refrigerator for a few weeks.

Luckily for pumping mothers everywhere, breastmilk is remarkably forgiving for a precious and perishable substance. (White blood cells from the mother's immune system actually patrol fresh breastmilk, doing their part to ensure food safety for the little one.) It is wise to take a few prudent precautions, though:

Wash your hands before pumping, expressing, or otherwise handling. breastmilk.

Don't mix fresh warm breastmilk with chilled breastmilk, since you won't be able to control the temperature. Most especially, don't add liquid breastmilk to a container of frozen breastmilk!

Never re-freeze breastmilk that has been thawed. The freezing process destroys white blood cells, so thawed breastmilk should be used promptly.

Store breastmilk in bottles with tight-fitting caps, or in bags especially designed for the purpose. (As a bonus, such bags are also less likely to leak -- and a leaking bag of breastmilk is a heartbreaking thing for the mother who worked so hard to fill it.)

Answer: A few days to a week

A baby in the middle of a growth spurt may want to nurse every hour instead of every two or three hours; nursing at night will increase too. At the same time, the growing baby is usually fussier than usual -- maybe because she's missing out on sleep! During these times, it can feel like the baby is permanently attached, but this is usually a temporary situation. Besides, right after the intensive feeding phase of a growth spurt, most babies sleep more than usual for the next couple of days. That's an important recovery period for baby and mother!

When do growth spurts happen? The rule of threes is a decent predictor: three weeks, six weeks, three months, and six months. (That isn't the last one, of course, but after six months solid foods will provide some of the extra nutrition.) Every baby's different, though, and none of them know how to read a calendar -- so results will vary!