Author: Kathryn Stagg IBCLC

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Definition of an IBCLC

Kathryn Stagg IBCLC

Detective

An IBCLC will delve into their vast knowledge to try to work out what is going on. They will go away and research if necessary. They will share with their network of colleagues with permission if someone else has the knowledge that is needed. IBCLCs come from a huge variety of backgrounds with different specialisms.

Fuelled by rage against the system

Most IBCLCs are absolutely livid about the injustice of lack of breastfeeding support faced by women and birthing people every day in a capitalist society where baby milk companies are making money out of this situation. Every family deserves to have the feeding support they need. This can be peer support level or more specialist support for more complicated cases. They support everyone whether they breastfeed directly, pump, use formula or a combination of all of it.

They run on oxytocin

The next best source of oxytocin after breastfeeding directly is supporting someone else to breastfeed their baby. Lactation Consultants use this oxytocin and dopamine in order to keep on keeping on in a society that often works against them. It is addictive.

Baby observer

IBCLCs have a lot of training and knowledge around normal newborn behaviour and can usually explain why a baby is doing particular things. They pick up subtle cues and interactions which can tell a story. They have lots of tips to help new families cope and understand a baby’s cues and needs.

Milk maximiser

IBCLCs have all the tips to increase supply, give the parents the tools to understand if baby is getting enough milk and will celebrate every drop! Whether a baby is receiving all their milk or some of their milk IBCLCs will support you to increase or maintain.

Empowerer

IBCLCs support families to advocate for themselves and their babies around their care, to make evidenced based informed decisions around the health and well-being of their families. They encourage parents to question suggestions and decisions if they do not feel right.

Passionate and slightly obsessed

IBCLCs often become quite obsessed with finding out everything they can about breastfeeding and lactation and babies. They have to have 75 hours of continuing education every 5 years to stay certified , but most will have far more hours than this to quench their thirst for knowledge. More and more exciting information is being discovered all the time on milk composition and how the milk, breastfeeding, the baby and the mother all interact, so it is the gift that keeps on giving.

The long story

IBCLCs can support a family throughout their feeding journey, from establishing breastfeeding and milk production, to navigating the next phase, through introducing solids, returning to work and continuing to breastfeed into the toddler years and eventually stopping breastfeeding whenever the time is right. IBCLCs are there for the long haul.

What have I missed?

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Triple Feeding

Kathryn Stagg IBCLC

When babies are born a bit early, or a bit sleepy or a bit inefficient on the breast, they have higher risk of jaundice, low blood sugar and weight loss. They also may struggle to put on enough weight and regain their birthweight.

Often these issues can be overcome by concentrating on achieving a deeper latch, more frequent feeding, and by using breast compressions to increase the flow of milk. Compressions maintain active feeding for longer and increase the length of the sucking bursts. We should encourage baby to have a second go on the breast by waking with a nappy change and offering the other side.

However, it is sometimes clinically indicated that baby needs a little extra milk. Many of these parents start their breastfeeding journey topping up their babies with formula to make sure they are getting enough milk. But if their long term goal is to exclusively breastfeed, or even majority breastfeed, using formula will be detrimental to their future milk making potential. To protect their breastfeeding goals, it is important to encourage parents to pump whenever babies are getting milk from elsewhere. This expressed breastmilk can then be used for all or some of the top-up feeds, meaning less formula is necessary and milk supply is closer to the baby’s intake. The volume and frequency of top ups should be the minimum necessary to maintain an appropriate rate of growth.

The act of breastfeeding, top-ups and pumping is often called “Triple Feeding” because there are three parts. Doing all three parts, every feed can be very overwhelming and time consuming, so it is important to stress to parents that this is a temporary intervention. As soon as babies are breastfeeding more effectively they should be able to reduce and eventually remove the extra milk, or move to a more manageable combination feeding pattern. Triple feeding is not a long term solution.

Triple feeding is much less overwhelming if there is a helper to do the supplemental feeds. If no helper is available, do the best you can.

Triple Feeding Plan

*Wake baby, or pick up baby if they are showing early cues and waking

*Bring baby to the breast with a deep latch

*Watch for deep suck and swallows

*Use breast compressions to maintain active feeding and extend sucking bursts

*Once compressions are no longer stimulating deep sucks and swallows take them off and offer a cuddle. If baby wakes, offer the other side. If baby does not wake, wake them and offer the other side.

*Breastfeed baby on second breast with a deep latch and compressions if necessary.

*Once compressions are no longer stimulating deep sucks and swallows, pass baby to a helper if you have one, to top-up with expressed milk or formula, pacing the bottle feed.

*Pump for 15-20 mins with an efficient double pump, this milk can be used for future top-ups

NB If no helper is available then the baby will need to be breastfed and topped up and then pump as soon after the feed as possible.

Moving away from triple feeding and topping up

Before moving away from triple feeding regime, certain criteria must be met:

*Baby should be gaining weight appropriately with the top ups in place before thinking about reducing, and also be having appropriate wet and dirty nappies

*Baby should be able to latch well with deep sucks and swallows, developing longer bursts of sucking, especially towards the beginning of the feed. They should be maintaining active feeding for more than a few minutes

*Baby should be feeding at least 8 times in 24 hours and mainly waking themselves for feeds, more frequently is to be expected.

Once the baby is beginning to be more alert and breastfeeding is improving we can begin to gradually reduce the extra milk. Regular weight checks are necessary.

Frequency of feeding

Exclusively breastfed babies will often want to feed more frequently than every three hours. If babies are waking “early”, they can be brought to the breast. But we should not need to top up more frequently if weight gain is appropriate.

Reduce the volume of the top ups

Baby can be offered a third or fourth go on the breast before a top up is offered, called switch nursing. Each time a baby latches triggers another let down of milk and they will take more milk. This should mean a smaller top-up, or perhaps no top up.

Babies can be encouraged to settle on the breast. Both breasts are offered first, a smaller top up given in the middle, and then baby can be brought back to the breast to settle, taking some more milk directly.

Removing top ups

A baby will often be more settled in certain parts of the day. Mornings especially are a time when they tend to feed well and the parent may naturally have more milk.

Take a 4 or 5 hour period in the morning and just breastfeed, putting baby back on the breast as many times as it takes to settle. Top ups continue the rest of the day. Then extend or add another stretch of exclusive breastfeeding.

During night feeds, baby should begin to settle more easily without the need for extra milk.

Pumping

As the need for top-ups decreases, pumping can be reduced. Either pump whenever babies get extra milk, or pump the total 24hr top-up volume baby is taking over however many pumping sessions it takes to express that volume.

Kathryn Stagg IBCLC, June 2024

Breastfeeding

Nursing Manners

Kathryn Stagg IBCLC

Nursing manners

Some older babies and toddlers try lots of different behaviours when they are feeding. Things like pinching, twiddling the other nipple, kneading, grabbing hair, putting hands in your mouth, biting, coming on and off, feeding standing up and all sorts of acrobatics. Some of these are cute. Some hurt!

Its important to remember that although all of these behaviours are normal, if you are finding something intolerable, it is a 2 way relationship! You really don’t have to put up with it!

Start early! If your child starts to do something you don’t like, work on it immediately. It’s true a lot of behaviours are temporary as they are just exploring, but you don’t want them to keep doing it if you can’t stand it!

Distraction – if it is something their hand is doing, give them something else to play with; a toy, necklace or scarf perhaps. Or move their hand to a part of the body which is less sensitive (I’m thinking not the nipple!!)

Offer alternatives. Try offering to do something else. Maybe take them off and offer a toy, play, go out, give them a teether to chew, a snack or drink instead. If they want to nurse again, offer the other breast as sometimes the faster flow reduces the behaviour

Use some gentle discipline. If unwanted behaviours continue, take them off and explain simply that they can’t feed if they do that as it hurts or you don’t like it. Offer them an alternative or if they want to continue feeding then they must not do it. Even quite young toddlers can understand this concept, although they might not like it! But boundaries a important. This is actually a great way to introduction the concept of body autonomy. It is your body after all!

Use a code word – some people have concerns about the way their child asks to breastfeed. Maybe they yell BOOB! or start to help themselves by undoing your bra or pulling your top down. Maybe they just scream. Developing a baby sign or code word can make this easier to deal with. They can still make their wished to feed clear but in a respectful and gentle way.

If your child is asking to nurse very frequently in the daytime and you are struggling, there are some things you can do. Distract! Give other options of things to do. Go out. Change of scenery. Nurslings generally aske to feed a lot less if they are busy. Offer a snack or drink. They can be hungry or thirsty, although toddlers like to feed for all sorts of other reasons of course. Nap on the move. If your child tends to feed to sleep then doing a car/buggy/sling nap can break this cycle. Use language like “after …” not just No. No is rejection. After lunch or after we get home means they will still get to breastfeed, just not right now. Validate and acknowledge their feelings. Understand that not breastfeeding is challenging, they may be cross with you, they may need some extra support with this. That does not mean you have to do it. “I understand that your really want some milk right now, but we are in the supermarket buying some yummy food to eat. You can have it as soon as we get home. Here have a biscuit to keep you going” You may end up with screaming but remember they are only letting you know they are not happy about this. And that is ok.

Kathryn Stagg IBCLC 2023

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Breastfeeding, Holistic Sleep

The 4 month baby

Kathryn Stagg IBCLC

Ah the 4 month baby.

You’re over the first few weeks, breastfeeding is beginning to be a bit easier, baby is starting to stretch out their feeds a little at night, they are becoming more efficient in the day, the smiles are coming thick and fast. Life is good. I’m nailing this….

Then BOOM! 4 months hits. OMG. What is this about? Have I broken my baby?

I make it no secret that I find this age incredibly challenging myself, when I’m supporting families. Let me share with you my list of gripes.

The 4 month baby:
* I will only feed for 3 mins & 21 seconds to ensure this is not long enough to settle me to sleep.
* During these 3 mins & 21 seconds I shall come off the breast multiple times to smile, look at the lights, see what’s on TV, ooh there’s a cat …
* My parent has to find another way to settle me to sleep. No, I hate the buggy. Rocking, no don’t be silly, ah the sling. But I will resist, resist, re….. zzzz
* Now I am asleep I will spend only 20 mins asleep before something wakes me up.
* I will then want another nano-feed to recover from the indignation of having succumbed to a nap.
* Now what, entertain me parent! No don’t put me down. No I don’t want that, I want that. Actually I don’t want that, can I have the first thing? No that’s rubbish too, what else can I do? I would like to go over there but I can’t. No don’t put me down. Oh actually I can practice my rolling, yay aren’t I clever? Oh I want to roll back. I can’t roll back, roll me back. Now! Ah that’s better. But I want to go over there. I will roll. Now I cant get back! Put me back! Maybe I better have another nano-feed to recover.
* What do you mean its bed time? Oh no, I will resist, resist. I want to play. Ooh look at that cat. Aw I love you mum. This breastfeed will. not. make. me…. sleeep…. zzzz
* Oh why am I in my cot? Help! Where are you? Oh you’re just there. Need a feed. to. go back. to….. sleeep……zzzz
* Oh I’m sleepy, I want to roll over, that’s nice I’m on my front…..
I DON’T WANT TO BE ON MY FRONT, I can’t get back, turn me over NOW!! Ah that’s better. Better have a feed to. help. me. back. to……. sleeep…….zzzzz
.
Repeat ad infinitum. Its a good job I’m cute! 

Breastfeeding, Holistic Sleep

Stopping Breastfeeding

Kathryn Stagg IBCLC

So hopefully we all know that breastfeeding well into toddlerhood and beyond is recommended by the WHO and that it is normal to do so (although this message still seems to be a bit slow to filter through to some!).

But sometimes breastfeeding just isn’t working for the parent. Maybe they have aversion, maybe they’re feeling totally exhausted and touched out, maybe they’re uncomfortable with still breastfeeding, maybe they just need to stop!

Breastfeeding is a two way relationship and anyone who says a parent is breastfeeding their toddler for them hasn’t breastfed a toddler. It is INTENSE! They often seem to want to feed all day.

So the first step is try getting into a loose routine. A lot of parents find feeding first thing in the morning, mid morning before or after nap depending on whether they still feed to sleep, mid afternoon before or after nap and bed time works well. (They may still be having night feeds as well, I have written a separate blog on gentle night weaning, here. I wouldn’t try to do both at once!) You may find just cutting back a bit like this and taking a bit more control makes it more doable anyway and that then you feel you can keep going for a bit.

But if you still want to gradually wean then the easiest feed to drop is usually mid morning, especially if you go out to groups a lot as you can distract whilst out and baby will tend to fall asleep on the way home in sling, car or buggy. Have lunch ready for when for wake up.

Then once you’ve done that, try stopping the mid afternoon feed. Again get ready with drink and snacks to combat the post nap grumps if they happen.

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Once you’re down to morning and bedtime, a lot of people actually enjoy it again and hang on to those two feeds for a while. Once you’re ready to drop the first thing in the morning feed just get up straight away and have breakfast (although I left this feed until last as I preferred to stay in bed at 6.00am having a nice breastfeed than get up and make breakfast!).

For bedtime feed you can switch around the order of the bedtime routine. So instead of feeding to sleep or feeding as the last thing to settle, you can try feeding them first, then do teeth, pyjamas, story and cuddle to sleep instead. This breaks the feed/sleep cycle and will make it much easier to stop the feed completely. You may find babies are ok to cuddle to sleep instead. You may find that the association needs to be changed in a more gentle and gradual way. Try overlaying another sleep association alongside feeding. This can be a toy, blanket, song, arm, all sorts of things! Once this is established you can begin to remove feeding to sleep by gradually reducing the amount of time you breastfeed so they are not falling fully asleep and cuddle the last bit. This can take time but it is a very gentle transition that many parents find is far less traumatic for everybody.

Once you have weaned be very gentle on yourself as the drop in hormones can make you feel very down for a while. It takes your body a bit of time to function normally again. Lots of cuddles will get the oxytocin flowing and help everyone adjust.

Kathryn Stagg IBCLC – Oct2019