Hand expression

Even if you don’t want to collect and store colostrum, learning how to hand express colostrum at the end of pregnancy is so valuable. It is much easier to learn a skill when you’re well rested and have some privacy than when it’s an immediate or urgent need just after giving birth. 

Your body starts to produce colostrum as early as 20 weeks. Some people find they leak small amounts of it or that their bra is stuck to their nipples at the end of the day. If you’re interested in collecting and saving colostrum during pregnancy, experts generally recommend waiting until 37 weeks. Your OB provider can help you create a timeline that works for you!

Hand expression can take some practice to master, and you may find that each breast needs a slightly different touch or technique. We love this short video that shows some different ways to express those precious drops. The best way to save colostrum is in very small syringes that are about 1-3 mLs in size. You can label and freeze the syringes until you’re ready to thaw and use them.  

Who does it help?

Colostrum collection can benefit many parents. Those who have experienced low supply or who have risk factors for low supply may want extra colostrum on hand to avoid excessive newborn weight loss or reduce the risk of jaundice. 

Those with gestational diabetes or who take beta blockers may want to collect colostrum to use in case of low or unstable blood sugar instead of using formula. 

Parents of multiples, babies who have IUGR, and babies with diagnosed genetic or physical differences may also benefit from having extra colostrum saved. There are a variety of reasons why it can come in handy. Talk to your provider or a lactation professional about the pros and cons. 

For some people, hand expression causes temporary but uncomfortable cramping, so it’s always a good idea to check in with your OB provider beforehand to see if there are any activities you should avoid that may cause contractions. Again, it’s generally recommended to wait until 37 weeks to try hand expression or colostrum collection.

Helpful tips

The best time to practice hand expression or collect colostrum is when you’re relaxed and not in a rush. Often people find that being warm and post shower/bath is a great time. Some gentle breast massage can help warm things up as you get started. Once a day is generally enough for practice until you get the hang of it. You may consider expressing more than once a day if you are actively collecting and storing. Keep in mind that at first, you may see just a hint of clear wetness or nothing at all.

If you’re collecting colostrum you’ll want to:

• Wash hands and have clean spoons, container/syringe ready
• Express for few minutes on each side collecting drops (aim for 10 drops and measure how much this is to make future collection easier, for example 10-15 drops might equal 1 mL)
• Date and store your colostrum in the freezer

Now that you have a little bit more information about hand expression and colostrum harvesting, you can make an informed decision about what is right for you!

Read more

All about colostrum

Breastfeeding basics

Deanna Barnes works in Chicago in advertising technology sales and lives with her husband of twelve years and her three kids: Avery (age 8), Bennett (age 6), and Greyson (age 3).

We sat down to talk about her breastfeeding experience and how it changed with each baby. From setting breastfeeding goals early to pumping all across the country, this resourceful working mom knew from the start that she wanted to breastfeed each baby for 12 months. Here’s her story. 

Can you tell me a little bit about your breastfeeding journey?

I knew I wanted to breastfeed. I come from a Black mother who did not breastfeed – maybe it was her generation, but it wasn’t a focus. She knew she was going to formula-feed before she left the hospital. I breastfed all my children for a year, and as a working mom that definitely had its challenges. 

Two things to take away from breastfeeding:

1. Breastfeeding is not as intuitive as you would think. I needed help in the hospital with a lactation specialist. I needed help when I got home with a lactation specialist. It’s not intuitive. I can remember crying but pushing through.
   
2. Secondly, the first kid teaches you a lot. We really learned it all together. With my second and third, I had some great lactation specialists who said: “Every baby is a different dance partner,” and I just remembered that throughout the process whenever it got hard. 

Are there any moments that stand out when you think back on breastfeeding?

Those 3 a.m. quiet nights, nursing in a rocking chair while listening to a podcast. I remember just thinking, “This is really nice.” As many challenges as there were along the way, when it came time to end, I was very sad. 

There is no bond like the bond created when you’re breastfeeding. I knew I was going to miss that time together. That’s why I love the infant and newborn stage so much — you don’t get that back and it’s just the best time.

Was it challenging to care for other kids while also breastfeeding your second and third kids?

Oh yes. And don’t forget to throw a pandemic into the mix. When I had my first two, I was the working, parenting mom. I pumped in airplanes and Amtrak stations, in bathrooms and hotel gyms and cars. There was so much transporting of milk. I’ve had my milk dumped out by the TSA. There were many challenges. 

But when my third kid was born, I had to do all that and navigate a new job. I had a two-week orientation in New York with a three-month-old at home. So I pumped and used Milk Stork to ship all my milk back. It was a lot. I had alarms on my phone so I could pump at work, it required time management and planning. But if you’re a mom running a household, you’re used to all that planning. 

What specific issues did you face along the way?

Like I said earlier, it’s just not intuitive! I didn’t intuitively understand the latching part and it was so painful. But I had lactation specialists who taught me all kinds of different methods. That education aspect is important. We’re so vulnerable at that stage and open to everything. My biggest challenge was just knowing what to do, understanding supply and demand, etc. I feel so fortunate that I got that education because I know a lot of people don’t. 

Did you ever have a moment where you thought, I can’t make it to 12 months? 

Never. I had a freezer of milk. I feel very fortunate that I had enough supply. Every body is different, but I never had to supplement. I did everything possible so that I could make it to a year. And if there was a challenge, I always thought, “Ok how can I fix this?”

Do you have any messages for people who are preparing to breastfeed? Either for the first time or for another child. 

Every kid is a new dance partner! Remember that, so you don’t put so much pressure on yourself. You have the kid who falls asleep on the boob and the other one who drinks drinks drinks. And don’t succumb to the pressure. If you feel you’ve reached the end of your journey in three months, kudos! If it’s one day, that’s great. Three months is better than nothing. One day is better than nothing. 

It’s a lot to be a mom and take care of a little being. So do what works for you. In the end, the baby wants you happy and healthy and mentally stable first. Make the decisions you need to make to feel mentally stable and present. 

Read more

• Breastfeeding Bootcamp
• Breastfeeding how-tos

Myth #1: Avoiding peanuts and other allergenic foods while pregnant can help prevent food allergies for your baby

Fact: According to the National Institute of Allergy and Infectious Diseases (NIAID) Guidelines for Diagnosing a Food Allergy, expecting mothers should not restrict their diets in order to prevent a food allergy. There is new evidence from the landmark LEAP study to show that, in infants with severe eczema and/or egg allergy, avoiding or delaying introducing peanuts was linked to an increased risk of peanut allergy. 

This myth comes from outdated recommendations causing confusion. In 2000, the American Academy of Pediatrics advised allergy-prone moms to avoid peanuts and tree nuts during pregnancy to help prevent their babies from developing food allergies. Now we have more information and based on current recommendations, expecting mothers should not restrict their diet to prevent a food allergy for their baby.  

Myth #2: Eating peanuts and other allergenic foods while breastfeeding can help prevent food allergies for your baby

Fact: In the 2019 Guidelines from the American Academy of Pediatrics (AAP), there was insufficient evidence to show that eating allergenic foods while breastfeeding might be able to  prevent your child from having food allergies.  

“No conclusions can be made about the role of breastfeeding in either preventing or delaying the onset of specific food allergies.” – American Academy of Pediatrics (AAP), March 2019.

Myth #3: My baby isn’t at risk for food allergies if they don’t have a family history

Fact: Over 50% of children with food allergies do not have any family history or a direct family member with a food allergy. Also, babies aren’t born with food allergies — they develop them over time. So in fact, all babies are at risk of developing a food allergy. 

Reviewed by the Ovia Health Clinical Team

Content provided by Ready, Set, Food!. Ready, Set, Food! is a complete guided system that gently introduces your baby to the top 9 most common childhood food allergens, including peanut, egg, and milk. 

Read more

• Food allergies vs. food sensitivities
• Does breastfeeding prevent food allergies?

You’ll burn calories

When you feed your baby, your body’s working overtime! Experts estimate that it takes about 25% more energy to make your breast milk for each day. That’s a serious increase — even from pregnancy — and you’ll feel the hunger and thirst. It’s important to eat well and get enough energy on board! It’s also estimated that protein requirements specifically go up by at least 15 grams. Pro tip: keep taking your prenatal vitamin and talk to your provider about other supplements you may need while breastfeeding!

Hearing a baby cry could make your breasts start to leak

When your baby latches onto your breast, their sucking triggers release of the hormone oxytocin, which stimulates milk production. This release of breast milk, called the let-down reflex, usually happens after Baby has been sucking for about 1-2 minutes. Some people feel the let-down reflex as a tingling or a warmth and others don’t feel anything at all! But other stimuli can trigger the production of oxytocin too, including emotional ones like looking at a picture of Baby, thinking of them, or hearing a recording of them. Sometimes hearing any baby cry, not just your own, can trigger your let-down reflex. This can be awkward or messy, but it’s just your body’s way of knowing what to do when a baby needs milk!

You might get cramps

Not only does Baby’s sucking cause the release of oxytocin so that your milk can flow freely, but oxytocin also creates uterine contractions. Some people don’t really notice these cramps. Others might feel them kick in like clockwork while nursing in the early days after delivery. Although they can be painful, these cramps (also called afterpains) are helpful. When you’re pregnant, your uterus — a super strong muscle — has to grow much larger to make room for Baby, and the contractions that cause cramps also help to squeeze your uterus back to its pre-pregnancy size. 

Bigger breasts don’t mean more milk production

Though you might assume otherwise, milk glands are what matter when it comes to milk production, not breast size. The larger the breast size, the more fatty tissues that exist, but it doesn’t change the milk glands at all, so someone with an A-cup can actually make the same amount of milk as someone with a double D, they just have less fatty tissue compared to glandular (milk-making) tissue. Even if your bust is on the smaller side, you’re just as likely to be able to make plenty of milk for Baby as someone with a larger size!

Your nipples may get uncomfortable 

This isn’t a fun fact, but it’s the truth. While you might hope that breastfeeding will be nothing but smooth sailing, things can be somewhat sore for the first few weeks or longer. Getting Baby to latch onto your breast at all, let alone correctly, can take time, and those initial 8-12 feeding sessions a day with a newborn can leave your nipples feeling sensitive and sore. The discomfort can range from slight tenderness to cracked and bleeding skin as you and your baby learn to latch successfully.

Fortunately, most people find that their nipples do feel comfortable in just a few weeks, and as Baby grows and their mouth gets bigger, you might find even more comfort, as they latches on more expertly. In the meantime, you can use nipple salves or balms like lanolin, nipple shields, or warm or cool compresses to provide some relief. Even if those early days are a bit tender, it’s important to get Baby to latch on correctly and have enough time feeding at your breast. 

However, certain types of breast pain could be evidence of infection or other problems. And since every person’s experience with breastfeeding is different, do speak to your healthcare provider if you have any questions about what’s normal in terms of discomfort and what might help you feel better. If nipple tenderness or soreness has turned to nipple pain while feeding, that might be a sign that you could use some expert help. A board certified lactation consultant is a great place to start!

Your milk will change over time

The nutritional composition of your milk will change over time to keep up with Baby‘s nutritional needs. The first few days after they is born, instead of what you might usually think of as milk, you’ll actually produce a fluid called colostrum that is rich in protein and antibodies. It will help your baby’s new digestive system function properly, pass along immunity, and help them gain weight. In just a few days, this colostrum will transition to mature milk, first thin and watery and then thicker and creamier. As you continue to feed your baby over the coming months, the composition of this milk will continue to change, providing just the nutrients that Baby needs at that particular time.

Your milk comes from many holes, not just the obvious one

If you had to guess the spot where breast milk comes out, you might guess that it’s right in the center of the nipple. In reality, milk comes from many openings in the nipple. Called milk duct orifices, these tiny holes usually number from around four to twenty per breast. Babies who are correctly latched onto the breast will have their mouths covering the entire areola, not just the tip of the nipple, so they can drink the milk from these multiple holes without a problem and without too much mess.

You can breastfeed with body modifications

Many folks with breast implants can still breastfeed successfully. Implant incisions made through the armpit or underneath the breast tend to interfere with breastfeeding the least, whereas incisions around the areola can potentially increase problems with feeding like reduced nipple sensitivity or blocked milk ducts. And implant placement below the pectoralis muscle usually leaves the milk glands intact for future feeding.

If your body mods include nipple piercings, the hole created as a result shouldn’t interfere with feedings either. As mentioned above, breastmilk comes from many holes at once, so extra holes won’t cause a problem. Just make sure that you remove your nipple jewelry before breastfeeding. And keep in mind that newer piercings have an increased risk of infection, so they should be fully healed before you attempt breastfeeding.

Your libido

Although your breasts will look and feel different as they take on the responsibility of feeding baby, the way your partner views your breasts might not change much. Chances are your breasts may still be a turn-on even though your perspective on your breasts — and sex in general — may be ice cold. For some people, breastfeeding hormones decrease libido or make it feel like your breasts shouldn’t be looked at or touched sexually. It’s important to honor your feelings and communicate with your partner about potentially new, and likely temporary, boundaries for your body.

You might get turned on

Speaking of getting turned-on, arousal during breastfeeding can be a common, if confusing, occurrence. The fact of the matter is that the nipple is an erogenous zone, and erogenous zones usually feel good when stimulated; this doesn’t stop just because you’ve had a baby. Rest assured knowing that even if it’s taboo to talk about and many people experience this physical response. Most importantly, the physical arousal you feel is totally separate from how you feel emotionally towards your baby, so there’s really no need to be weirded out.

Have you added a bump picture in Ovia? Try the feature by tapping here! 

Reviewed by the Ovia Health Clinical Team

Read more

• How often should a baby breastfeed? 
• How breast milk changes as your baby grows

Sources

• Lisa Marasco. “Common breastfeeding myths.” llli.org. La Leche League International, November 4 2012. Retrieved July 18 2017. http://www.llli.org/nb/lvaprmay98p21nb.html.
• Jahaan Martin. “Nipple Pain: Causes, Treatments, and Remedies.” llli.org. La Leche League International, July 17 2016. Retrieved July 18 2017. http://www.llli.org/llleaderweb/lv/lvfebmar00p10.html
• Mayo Clinic Staff. “Breast-feeding tips: What new moms need to know.” Mayo Clinic. Mayo Foundation for Medical Education and Research, November 23 2016. Retrieved July 18 2017. http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047138.
• Mayo Clinic Staff. “Post-partum care: What to expect after a vaginal delivery.” Mayo Clinic. Mayo Foundation for Medical Education and Research, March 24 2015. Retrieved July 18 2017. http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233.

1. Take care of yourself and your baby during pregnancy

Taking good care of your own health and your baby’s health by getting proper prenatal care will set you up for success and may help avoid having a baby preterm. Preterm babies can have more problems breastfeeding than full-term babies — that definitely doesn’t mean it’s not possible to breastfeed a preemie, just that it can sometimes be more challenging! Prenatal care also gives you the opportunity to regularly talk about preparing to breastfeed and the questions you may have!

2. Take a breastfeeding class

Breastfeeding classes, available in person and increasingly online, can do so much to help you learn more about all the ins and outs of breastfeeding — including basics like how to hold your baby and get a good latch, how to care for your breasts, how often your baby needs to eat and how these needs will change over time, how to recognize signs of hunger, and how to work through and get help with any challenges that you face along the way. Being taught by an expert can help you feel confident and prepared to begin breastfeeding. 

3. Make sure you have breastfeeding support from your care team

Talk with your healthcare provider about your plans to breastfeed, and learn more about if the place you’ll deliver your child, whether at a hospital or a birth center, is prepared to help support you. Many hospitals have special designations and certifications that confirm their commitment to support breastfeeding families. This means that the hospital will encourage lots of skin-to-skin time, will keep you and your baby together in your room, and won’t offer anything to your baby other than breastmilk unless you request it or if it’s medically necessary. They may also be able to offer suggestions of breastfeeding friendly pediatric providers.

4. Talk to friends and family who have experience breastfeeding

Ask your friends and family about their breastfeeding experiences. Keep in mind that everyone’s experience is different, so try not to compare yourself to anyone else or expect that you’ll have the exact same experience. But it can be incredibly valuable to talk with loved ones who have gone through it before, and to know that you can reach out to them if you have questions or need moral support. That midnight text to reassure you that you’re doing a great job or what you’re experiencing is normal can be such a win on your breastfeeding journey.

5. Seek out a supportive community

If you don’t have friends and family who’ve had the experience of breastfeeding, or if you find that they’re not being particularly supportive of your goals or choices, it can be hugely helpful to find a supportive community. Most cities and communities, and often even hospitals or community health centers, have breastfeeding groups in which new parents share their experiences and offer support along the way. You can find many supportive communities online too. 

6. Get breastfeeding essentials 

Breastfeeding doesn’t require much to get started, just a few staple items, most of which are widely available in stores or online. Three good quality nursing bras are a must, since you’ll find they need frequent washing! They come in a handful of styles, so you may want to experiment with a couple and see which style you’re most comfortable in. A nursing pillow may also be helpful depending on where you’ll nurse most frequently and the size of your breasts. And at some point you’ll likely need a breast pump. Most pumps will come with some starter essentials like storage containers, bottles, and nipples — so be sure to check out what’s included with yours!

7. Give yourself a goal

Everyone’s breastfeeding goals are different, but sometimes setting them in advance can help you get through difficult days and can motivate you to continue when it gets challenging. That being said, the goals you set before your child is born (especially if this is your first and you haven’t breastfed previously) don’t always line up with the reality of your experience once you’re breastfeeding. If it makes sense to reconsider your goals at any point, you can definitely do that. Always reach out for support on your toughest days — breastfeeding changes quickly and you may find more joy from one day to the next!

8. Seek out professional support 

Even if you do a lot of preparation prior to breastfeeding, it’s normal to face challenges, have questions, or need reassurance once you get started. Fortunately, there are a lot of people who can help you. Certified lactation consultants are experts in helping folks who are breastfeeding with all of this — and you should be able to find one in your area or even one that you can work with remotely by video. Your child’s healthcare provider or even your own OB provider may also be able to be of help too. You deserve all the help and support you need along your breastfeeding journey. 

Reviewed by the Ovia Health Clinical Team

Read more

• How to find a supportive breastfeeding community
• 5 positions every breastfeeding mom should try

Sources

• “Breastfeeding your baby.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, March 2019. Retrieved July 16 2020. https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/breastfeeding-your-baby.
• “Preparing to Breastfeed.” Office on Women’s Health. U.S. Department of Health and Human Services, August 27 2018. Retrieved July 16 2020. https://www.womenshealth.gov/breastfeeding/learning-breastfeed/preparing-breastfeed

The basics

For the first few months, babies need about 24-32 ounces of formula in 24 hours. If you’re combo feeding, they will likely drink less than these amounts. There is a lot of room for flexibility, which can make things confusing. You can directly breastfeed and then top up with formula, you can breastfeed with an at-breast supplementer, you can mix bottles if you’re pumping, or you can breastfeed all day and do formula all night. There isn’t a right and wrong way to do it — just what works best for you and your baby. And don’t be afraid to experiment! As long as your baby is making enough diapers and growing steadily, you can try on some different methods of combo feeding.

Supplementing because of low milk production

Sometimes adding formula isn’t a family’s first choice, and there are a lot of emotions that come with this adjustment. Everything you’re feeling is okay. If you’re struggling with low milk production, breastfeeding has likely been time consuming and painful, which may have taken the joy of feeding away from you. Sometimes adding formula allows you to start fresh. Know that formula is an amazing medicine and food supply in so many ways. 

If you decide to continue to breastfeed in addition to formula feeding, any breastmilk you provide can still be beneficial for comfort and antibodies. If you’d like more information, check out The Low Milk Supply Foundation.

Supplementing to share responsibility

Some families introduce formula supplements after a period of full breastfeeding because they want to be able to share the responsibility for feeding with a partner, or if they’re going back to work and don’t plan to pump. For these families, it’s a good idea to ease into supplementing one feed at a time, so the breastfeeding parent’s body can start to lower milk production while, hopefully, avoiding painful engorgement, clogged ducts or mastitis. In these cases, it can also be helpful to introduce a bottle part-way through a feed the first few times. This will allow Baby to get some breastmilk before getting formula, so that by the time they get a bottle, they won’t be quite so hungry and may be happier and more willing to try new things than they would if they were hungry and fussy.

Tips

• If your little one doesn’t take to the taste of formula right away, you are not alone. Formula just tastes a little different than breast milk, and some breastfed babies are suspicious of the change in taste when they first try it. It is possible and perfectly healthy to mix pumped breast milk with formula to give your little one a flavor that’s a bit more like what they’re familiar with.
• Babies are smart – if they can smell that the breast they’re used to being fed from is nearby, they may not be as willing to explore the bottle, so it can be helpful for the first few bottles offered to come from someone other than the breastfeeding parent.
• Adding regular pumping to the routine can help maintain your milk supply when supplementing if you wish.
• If you plan to maintain a breastfeeding relationship and are worried about how combo feeding will impact that, there are a few things you can try! Paced Bottle Feeding, comfort nursing, and some contact naps or breast sleep can help to keep baby happy at the breast.

Infant feeding is complicated and rarely is it all or nothing. Combination feeding can be a great way to maintain the benefits of breastfeeding, to help your baby grow, and/or to make infant feeding work for your family.

Reviewed by the Ovia Health Clinical Team

Read more

• Breast milk and formula at a glance
• Switching from breastfeeding to formula feeding and vice-versa 

Sources

• “How to combine breast and bottle feeding.” NHS choices. UK.GOV, February 10 2016. Retrieved October 26 2017. https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/combining-breast-and-bottle.aspx.
• “Mixed Feeding.” Australian Breastfeeding Association. Australian Breastfeeding Association, August 2017. Retrieved October 26 2017. https://www.breastfeeding.asn.au/bfinfo/mixed-feeding.
• “Mixed feeding: Combining breastfeeding and bottle feeding.” NTC. NTC, January 2016. Retrieved October 26 2017. https://www.nct.org.uk/parenting/mixed-feeding-combining-breast-and-bottle-feeding. 

1. Prepare for uncertainty 

While we can probably all agree that accepting “uncertainty as the only certainty” is easier said than done, most of us worry less about uncertainty when we feel prepared. Writing a birth plan helps channel any anxious energy into something productive. Use your sense of accomplishment from creating your rock-star birth plan to help you conquer your fear of childbirth.

2. A birth plan helps you get to know your provider better

Talking early (anytime after 25-30 weeks) and often about your childbirth and postpartum plan helps you confirm that you have chosen the right provider for you. The right provider for you is someone who listens to you and who you can trust. When you trust your provider (or provider team), you can feel more confident that they have your best interest at heart.

3. Choose who should attend the main event

Just as you need to know that your provider has your back, you want to make sure the right people are around you when contractions start for real. (Who knows, maybe you have always been waiting for the chance to be able to tell your MIL to take a hike?) A birth plan can be a tactful way to have these difficult conversations before you’re in labor. Nobody wants family drama in their delivery room!

4. Birth plan = partner’s prep

Even if your partner is an OB/GYN, that doesn’t mean they know exactly how to support you in the delivery room. Every birth partner needs to prepare, regardless of who they are. Researching, writing, and talking about a birth plan together can help ease your birth partner’s worries too. The last thing you want to be worrying about in labor is your partner worrying about you.

5. Let your knowledge help you reclaim your power

Learn about what is and isn’t normal during pregnancy, delivery, and postpartum. There is a reason why What to Expect When You’re Expecting was such a blockbuster success — expectant parents need information to prepare. So geek out all you want on crafting the mother-of-all birth plans — doing so will help you prepare for the main event. You’ll feel more confident, powerful, and in control because less will be new, unfamiliar, or unknown during your delivery and postpartum.

6. Establish open lines of communication

Many people who are afraid of childbirth worry that they will not have a voice in decision-making. When it comes to a good birth, over communication is the name of the game. Talking about your birth preferences early and often with as many people as possible will likely help reduce your anxiety. Think of your birth plan as your opportunity to tell your doctor and labor and delivery nurses what you do and don’t want to happen at your delivery. The more practice you get talking about complicated health information with healthcare providers, the more your self-confidence and power will grow. It is time to claim your seat at the table (or birthing stool in the delivery room as the case may be).

Worrying less during pregnancy is good for you and your baby. A June 2013 review in ​Obstetric Medicine​ also found that prenatal stress — like fears about childbirth — can have lasting physical consequences for both expecting parents and their babies, including low birth weight, premature delivery, and gestational diabetes. Writing your birth plan can help you meet uncertainty with acceptance, not anxiety. When your birth plan is flexible and comprehensive, both you and your birth team can turn to it as a good birth wishlist — a guide to what matters most to you as you enter the next chapter of your life as an expectant parent.

Read more

• Building a birth plan
• Finding an OB/GYN or midwife

If I am infected with COVID-19 during delivery, what will happen to my baby after delivery?

If you are suspected of or are confirmed to have COVID-19 during your delivery, your baby will likely undergo testing to confirm their infection status and will be isolated from other healthy infants while receiving their normal newborn care [1]. You and your baby may be encouraged to share a room (“rooming-in”).

Can I breastfeed and have skin-to-skin contact with my baby if I am infected with COVID-19?

There are currently no known cases where COVID-19 infections have been transmitted through breast milk [2, 3], so breast milk itself is safe to feed your baby. 

Experts believe that it is reasonable to directly breastfeed your baby with proper precautions, such as wearing a mask and washing hands thoroughly [4]. We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. The research into COVID antibodies in breastmilk is really encouraging and suggests that antibodies are passed through breastmilk after infection or vaccination for about 90 days.

Rooming-in and skin-to-skin contact are still recommended. While it is the birthing parent’s choice how to participate in these practices, there are many benefits, including better breastfeeding, temperature control, blood sugar, and parent-child bonding. Still, it is very important to wear a mask over your mouth and nose and to clean your hands frequently. And when you’re not nursing, the CDC recommends having Baby six feet away from you if possible.

Will I be separated from my baby if I have COVID-19?

Parents who are COVID-19 positive and coping well with their symptoms should NOT be separated from their baby after giving birth [6]. Parents and babies should stay together according to groups, including the American Academy of Pediatrics (AAP), ACOG, CDC and WHO. 

If you have concerns about your particular situation, please bring them up with your healthcare provider, and make sure you fully understand all the risks and benefits.

What about my postpartum appointments?

If you test positive for Covid-19 during the early weeks postpartum, many appointments, including mental health assessments, birth control planning and general questions, can all be done virtually. Mental health is a major postpartum concern and standard perinatal depression screeners can be completed at home. In-office visits may still be necessary for those with underlying conditions, wound infections, desire for an IUD or implant, or in the presence of other concerning symptoms. However, be sure to let your provider know you are sick. Ask your provider what option(s) are most appropriate for you, and don’t hesitate to call them if you have any concerns about your physical or mental wellbeing. General recommendations suggest that each person have a check-in by three weeks and a comprehensive 6- to 12-week postpartum appointment.

Should I get the COVID-19 vaccine if I am breastfeeding?

Guidance about vaccination may differ depending on which health organization you rely on. ACOG (the American College of Obstetricians and Gynecologists), recommends people who are trying to conceive, are pregnant, and breastfeeding get vaccinated against COVID [7]. As always, your OB or primary care provider is a great resource.

Will my milk supply be impacted if I get COVID-19? 

Many anecdotal reports suggest that a temporary dip in milk supply can result during or after a COVID-19 infection. This is similar to many other illnesses. Prioritizing rest, and eating and drinking enough, is essential. Supply may take time to rebound, but most nurslings do well being fed on demand. If you are exclusively pumping,  you may need to dip into your freezer stash for a short period of time. Note that some people also experience nipple pain after feeds related to COVID-19 infection, which is believed to be the result of vasospasm. Warm compresses immediately after nursing or pumping can be helpful with this pain. It’s always okay to reach out to a lactation professional for support along your feeding journey!

Reviewed by the Ovia Health Clinical Team

Your COVID-19 guide

Read more

• COVID-19, labor, and delivery: Your questions answered
• COVID-19

Signs your baby is hungry

Even before your little one can talk, they’ll communicate a lot. Signs of hunger follow some pretty clear patterns for babies, ranging from early signs of hunger (when your little one may still be in a good mood) to active signs of hunger (when they’ll be working even harder to get your attention) to late signs of hunger (when they’ll be feeling more desperate to let you know that they are really, really hungry).  

Early signs of hunger include:

• smacking lips, licking lips, or making sucking sounds with lips and mouth
• opening and closing mouth or sticking out tongue
• bringing fists to mouth
• sucking on fingers, hands, feet, clothing, toys, or anything nearby (especially as a newborn)

It’s often easier to feed your baby during this early stage because even though they’re hungry, they’re also still feeling calm. And making time for skin to skin contact (where you hold your baby, just dressed in their diaper, against your bare chest) with your newborn, and then onward in the first few months of your baby’s life, can help you notice these signs early. When your baby is on your chest in this way, it’s a lot easier to catch these early hunger signs and even active hunger signs.  

Active signs of hunger include:

• “rooting” or turning head and opening mouth when something brushes their cheek, essentially searching for breast or bottle with their mouth (especially as a newborn)
• trying to get ready to feed, by laying back or pulling at your clothes
• fidgeting and squirming 
• hitting you on chest or arms repeatedly
• breathing fast
• fussing

During this stage of hunger your little one is starting to become more actively hungry, and they may become more worked up and agitated as they get hungrier. 

Late signs of hunger include:

• crying
• moving head from side to side 
• acting frantic

When your baby is at this stage, they’re definitely doing all that they can to communicate that they’re hungry and not happy about it. If your child is in this later stage of hunger, sometimes they can be so worked up it can be hard to get them to settle down enough to feed easily. So do what you can to try and calm your baby first. Once they feel soothed and a bit calmer, they’ll likely be able to feed more easily. 

Why it’s so important to respond to your baby’s hunger cues

Certainly, once in a while you won’t be able to feed Baby quickly enough and they’ll move into full blown frantic crying mode. But it’s important to do what you can to respond to your baby’s hunger cues as early as possible. When you do your best to be responsive, and respond to your little one’s hunger cues with warmth and affection, it’s called “responsive feeding.” Responsive feeding helps lay the groundwork early for your child to develop healthy eating habits — including recognizing signs of being hungry and being full — and eventually feeding themself in a healthy way. Responding and being receptive also encourages bonding and helps your child feel secure — think about how good you feel when you clearly communicate something you need and then have your needs met promptly! Fewer tears makes for a more enjoyable mealtime for both you and your baby.

Signs your baby is full

And once Baby is happy and eating away, it’s also important to recognize when they’ve had enough. Some signs that your baby is full include: 

• releasing breast or bottle from their mouth; letting breast or bottle drop away from their mouth; spitting out breast or bottle
• starting and stopping feeding often or unlatch from the breast often
• pulling away or turning head away from the breast or bottle 
• closing mouth
• relaxing their body
• relaxing hands and opening up their fists
• getting distracted or fidgeting
• slowing down their feeding
• falling asleep 

You’ll be a pro in no time 

Just like any other part of parenting, it can take a little while to learn all these signs. But soon enough, recognizing all your little one’s signs will feel like second nature. You’ve got this!

Reviewed by the Ovia Health Clinical Team

Read more

• An intro to breastfeeding
• Breastfeeding benefits for you and your baby

Sources

• “Signs Your Child is Hungry or Full.” Centers for Disease Control and Prevention. U.S. Department of Health & Human Services, October 1 2019. Retrieved July 13 2020. https://www.cdc.gov/nutrition/infantandtoddlernutrition/mealtime/signs-your-child-is-hungry-or-full.html.
• Kelly Bonyata. “Hunger Cues – When do I feed baby?” Kelly Mom. KellyMom.com, January 15 2018. Retrieved July 13 2020. https://kellymom.com/bf/normal/hunger-cues/.
• “Is Your Baby Hungry or Full? Responsive Feeding Explained.” healthychildren.org. American Academy of Pediatrics, September 1 2017. Retrieved July 13 2020. https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Is-Your-Baby-Hungry-or-Full-Responsive-Feeding-Explained.aspx.
• “Signs Your Child is Hungry or Full.” Centers for Disease Control and Prevention. U.S. Department of Health & Human Services, October 1 2019. Retrieved July 13 2020. https://www.cdc.gov/nutrition/infantandtoddlernutrition/mealtime/signs-your-child-is-hungry-or-full.html.  

Benefits of the breast pump

Juggling work and new parent status aren’t the only reasons to consider investing in a breast pump. It can also help to maintain your milk supply, relieve discomfort when the baby isn’t eating, and help them out if they can’t quite latch on yet. Using a breast pump on the opposite breast while feeding (parallel pumping) can also help collect milk for storage and promote an increase in supply.

Types of breast pumps

Even with these benefits, choosing a breast pump can be overwhelming because there are so many available options. When picking a breast pump, first decide what your main use for the pump will be.  

1. Double automatic breast pump

This is a good choice if you’re going back to work and you want to continue to breastfeed. or need to do all or most feedings with pumped milk. Typically covered by insurance, these are the backbone of many pumping routines, as they are often the most durable and efficient choice. Look for one with customizable settings and the ability to move around by using a battery pack. Some also have the capability to be even more discrete and flexible, with smaller motor housing and less visible flanges.

2. Manual pump

If you only plan to pump occasionally, a manual pump might best suit your needs. They are inexpensive (around $20 to $40) and can work just as well as an electric one. Manual pumps require require a bit more energy to pump what you need, but often have fewer parts to clean. Everyone who is pumping a significant amount should have a manual pump as back-up during times like electrical outages or forgetting parts at work.

3. Wearable pumps

New breast pump technology has allowed several companies to offer pumps that sit in your bra with no wires or tubing. They offer another level of convenience for many people and often have very few parts to wash. They do limit the possibilities for breast massage while pumping, may have a less powerful motor, and are more expensive ($200 to $500).

4. Multi-user or “Hospital Grade” pumps

Multi-user pumps are pumps that can safely be used by different people because the suction system and tubing are a closed circuit. These are commonly seen in hospitals, and thus have acquired the nickname “Hospital Grade.” They tend to be very large and expensive. Some have motors that may feel like they offer more powerful (or painful) suction. 

Every feeding journey is different, and choosing a pump depends on your goals and needs. Remember that you can always work with a professional if you’re worried your pump isn’t sized or working properly. 

Pumping accessories 

Pumps will include basic parts with purchase, but there are quite a few accessories to go along with pumping! If you’re pumping at work, a spare manual pump is a great idea in case you have an electrical malfunction. A hands-free pumping bra is also essential to maximize your time and milk output by using breast massage. 

Many people find they are more comfortable while using pumping cream or spray in their flanges before each session. Does your pump come with an optional battery pack for mobility? Milk storage bags, a permanent marker, and a reminder of when to replace certain parts (some as frequently as every month for everyday pumpers) are all essential in any pumping bag. 

How to get a breast pump

It varies depending on your insurance coverage, but in general, you can follow these steps to get your pump.

1. Find out the details

Call your insurance company to learn more about your breast pump benefits. Find out if you’re covered to rent or purchase a pump, if you need to provide a prescription or pre-authorization for the pump, and when you can get the pump (before or after giving birth).

2. Start looking for a pump

Once you have the info, you’re ready to start looking for a pump that works for you. Many breast pump manufacturers have a website where you can check to see if your insurance covers their pump. Your insurance might also direct you to a website where you can browse pumps that are covered under your plan, or your lactation or pumping professional might be able to help you find one.

3. Order your pump

When you find one that your insurance covers has features that work for you, you can take the (well-informed) leap and order a pump by phone or online from a durable medical equipment provider.

The bottom line

If you’re experiencing trouble pumping, here’s where to start:

• Be sure the flanges are the right size. 
• Make sure your parts (like duckbills) have been replaced on schedule, and that the battery is still working (it tends to wear out after a year). 
• Use your hands while pumping! Your body may just need some human touch. 

If you’re still having trouble, call a lactation consultant who has expertise in pumping. Pumping is breastfeeding, and they are there to support you!

Reviewed by the Ovia Health Clinical Team

Read more

• Finding a breast pump
• Pumping is Breastfeeding