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10 Tips for Breastfeeding in Public–With Confidence!

New mothers need to be out and about with their babies and often have lots of questions about breastfeeding away from home. Here are some easy tips to help you breastfeed fearlessly anywhere.

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1. Attend a breastfeeding support group or meet-up and see how other moms are breastfeeding confidently in public. Confidence is contagious!

2. Practice makes perfect! Practice your breastfeeding technique at home in front of a mirror or with a trusted friend or family member who can tell you what they see from angles that you can’t see. Maintaining the level of modesty that you desire gets easier with trial and experience.

3. Wear a bra that allows easy access with one hand. Being able to hold your baby and access your breast with one hand makes latching on a virtually seamless move.

4. Is latching on the most awkward part for you? Try leaving the room or turning your back while your baby latches on. When baby is nursing comfortably, return to what you were doing as if nothing happened. Smooth.

5. In a restaurant, sit with your back to the crowd. No one is likely to notice your quietly breastfeeding baby from behind. A roomy booth provides the most comfort and privacy.

6. A baby cradled close in mom’s arms looks like a sleeping baby. Most bystanders won’t even notice you’re breastfeeding. See someone looking your direction? Make eye contact and smile!

7. Pull your shirt up from the bottom rather than pulling your breast out over the top of your shirt. Wearing a shirt that it is a little loose will give you the most coverage all around.

8. Looking for more coverage? Wear clothes or undergarments (such as nursing camisoles) that are designed for breastfeeding moms. They offer strategically-placed access holes that allow you to breastfeed while remaining comfortably covered whether you want complete modesty or just to cover your post-pregnancy tummy. For an inexpensive alternative, cut slits into a regular tank top or camisole and wear it under any shirt you already own.

9. Breastfeed while carrying your baby in a sling, wrap, or other soft carrier. The fabric of the carrier will help keep you covered. Bonus: You can walk, do chores, or a million and one other things while you are wearing your baby.

10. Still feeling shy about breastfeeding in public?  A nursing cover or blanket thrown across your shoulder and your baby offers full coverage and can provide for complete modesty.

Remember: Anything that helps you feel comfortable and confident while breastfeeding in public is right for you. There are no rules! Do what works best for you and your baby and makes breastfeeding an enjoyable part of your everyday life.





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Frequently Asked Questions About Breastfeeding and Diet

Many mothers wonder how their diets may affect the quantity and quality of their breastmilk. With so much emphasis in both the popular media and the medical literature on the effects of processed foods, sugar, and artificial ingredients on health, women who have difficulty eating a more natural diet may worry that breastfeeding might not always be the safest or most nutritious choice. Maybe you have heard that you should change your diet while you are breastfeeding, or perhaps you have been told that it’s fine to eat “whatever you want.” Here are some answers to these questions. Please contact us via the website or Facebook page if your question does not appear here.

31st Annual Thunderbird Mid-summer Native American Festival

I have heard that the way we eat today puts us at higher risk for illnesses like diabetes and heart disease. What about my baby’s health? Is my milk still best for him?

Yes! Even if your diet contains more processed and convenience foods than is best for your health, your milk will still be the best available food for your baby.

It is clear from the research that breastfeeding is the single best way for a mother to safeguard her infant’s health: babies not breastfed have higher risk of diabetes, diarrhea, ear infections, rashes, allergies, childhood cancer, respiratory illnesses, asthma, and SIDS, (Bartick & Reinhold, 2010; Stuebe, 2009), and the protection offered by breastfeeding does not depend on the mother’s diet.

Formula, whether milk-based or soy-based, factory-produced or homemade, can never provide your baby with all the specific nutrients and immune factors essential for his health. Your milk changes composition in order to best meet your baby’s needs as he grows. Also, breastmilk contains immune factors to protect him against illness–no formula offers immune protection. While most infants can survive and grow on formula, some ingredients are associated with health problems. The proteins in formula are different from the proteins in your milk and are associated with increased risk for certain diseases like juvenile diabetes (Virtanen et al., 1994; Kolb & Wassmuth, 2000) and colitis (Host, 1994; Savilahti et al., 2010). The iron in formula is less available and harder to absorb than the iron in your milk, and it may cause undesirable changes in your baby’s gut bacteria (Balmer & Wharton, 1989; Mevissen-Verhage et al., 1985). When considering how to feed your baby, remember that milk from your breast is always fresh. Formulas, whether homemade or store-bought, carry the additional risk of contamination with disease-causing bacteria from processing facilities (Power et al., 2013) or farm animals.

Research has found little significant variation between the milks of mothers with different diets. For example the amounts and types of fats may vary (Cruz-Hernandez et al., 2013; Innis & Kuhnlein, 1988), but no diet has been found to result in breastmilk that is inferior to formula or inadequate to meet an infant’s needs. Humans are “omnivores” and have the ability to both stay healthy and produce high-quality breastmilk on diets that vary widely in both composition and quantity of foods. When your body makes milk, it produces the nutrients, non-nutritive elements, and immune factors your baby needs in the proper quantities (Hassiotou et al., 2013).

Even if a formula were just as nutritious as breastmilk, breastfeeding is about so much more than the milk. It is a special relationship that is uniquely yours–something only you can do for your baby. Breastfeeding keeps your baby safe and warm, promotes normal sleep patterns, allows normal brain development, and develops his immune system (including his thymus gland). The breastfeeding relationship cannot be bottled, and breastfeeding is best for your health, too.

My diet is limited to my budget, and I don’t always have access to fresh fruits and vegetables–is my milk still nutritious?

Absolutely! Your milk is always the most nutritious food for your baby, even if your diet is not as varied and nutritious as recommended by health experts. Information about nutrition during pregnancy and breastfeeding may not take into account the limitations that many mothers face: lack of food, limited access to fresh foods, and limited or no access to common food-preparation needs such as running water, stove, refrigerator, or microwave. That said, eating as wisely as possible is best for your health and that of your children. Cutting back on fast and convenience foods and increasing your intake of fruits and vegetables and other whole foods will be better for your health, especially for reducing the risk of diabetes and heart disease. If you are in a situation that limits the food you have available, here are some ideas:

  • Buy fresh fruits and vegetables from a local fruit stand, farmers’ market, or Community Supported Agriculture (CSA) organization. They are usually cheaper than your local grocery store (especially if you live where convenience stores are your main shopping centers or where fruits and vegetables are usually trucked or flown in). Many accept SNAP benefits or WIC cash value checks. You may even be able to barter for fresh food this way simply by asking.
  • Keep dry ingredients like beans, rice, and pasta on hand: they make inexpensive bases for healthy meals.

  • Pre-packaged “health foods” like granola bars and cereals are costly and often have unnecessary added sugar. Making your own snacks from bulk ingredients like nuts, oatmeal, cornmeal, and whole-grain flour costs less than buying commercial snacks and are healthier because you control the ingredients.

  • Build your weekly or daily menu around what is on sale at your local grocery store. Shop for markdowns in the meat, produce, dairy, and bakery sections. These sales may save you 30-50% of the cost.

  • If you do most of your shopping at convenience stores, choose more healthful options like mixed nuts instead of potato chips.

  • If you use a food bank, don’t be afraid to ask specifically for healthy foods.

  • Remember that WIC and SNAP both allow produce purchases and make special allowances for families who have limited resources for cooking and food storage (for example, SNAP would allow you to purchase hot foods from a grocery store). Both agencies provide nutritional counseling, as well as food-preparation classes.

  • Your tribal or community wellness agency may provide nutritional counseling and special assistance in buying wholesome foods.

Here is one tribe’s answer to the problem of where to find fresh, affordable, local food: Oneida Community Integrated Food Systems

Some families find getting enough food to feed a family especially difficult. If you need assistance in finding food, please contact these helpful agencies:

 WIC (Women, Infants, and Children)

USA Federal food programs

Community food programs

Do I need to take a multivitamin to breastfeed?

Your body will use your stores of vitamins and minerals to ensure that your milk has exactly what your baby needs. Finishing the prescribed prenatal vitamin is usually enough to meet your own health requirements (Nutrition During Lactation, 1991). However, if your diet is high in processed foods, you eat fewer than 2700 calories per day, you avoid or limit certain food groups, or you have any health conditions that may limit how well your body absorbs nutrients or vitamins, nutrition counseling is recommended. Increasing your intake of certain foods and food groups is likely to provide a greater benefit than a supplement (Lawrence & Lawrence, 2011).

Even though you are able to produce high-quality breastmilk on a diet deficient in some nutrients, when you take in more vitamins and minerals through supplements and dietary changes, some of them also increase in your milk. If you take in more of vitamins A, D, B1, B2, B3, B6, or B12, your milk will have more of these vitamins as well. Fatty acid and iodine supplements may also influence quantities in your milk. (Valentine & Wagner, 2012).

If you are concerned that you or your baby may not be getting enough of all the vitamins you need, talk to your health-care provider. She may recommend simple testing or vitamin supplements. Breastfeeding is still best in these situations.

Do I have to eat certain foods or take supplements in order to produce enough milk?

 No. However, in some cultures it is customary to eat certain foods after the baby is born in order to promote milk production. Interestingly, many of these customary “mother foods” are packed with B vitamins, iron, calcium, protein, antioxidants, and anti-inflammatory properties, which may help support lactation nutritionally. If your traditions recommend eating (or avoiding) certain foods after birth, you should feel encouraged to do so.

Sometimes mothers are told they need to take a certain herb, drink a commercial herbal tea, drink cow’s milk, eat oatmeal or oatmeal-based “lactation cookies”, or even drink one dark beer each night in order to produce enough milk. While most of the recommendations aren’t harmful, and some may even be beneficial from a nutritional standpoint, they aren’t likely to make or break your breastfeeding relationship. Milk production is controlled inside the breast, by the frequency and thoroughness of milk-removal. The best way to encourage your body to make all the milk your baby needs is to feed on demand.

 Please keep in mind that alcohol consumption should be limited while you are breastfeeding. Always talk to your health-care provider or traditional healer before taking any herbs or over the counter medications. If you are concerned about your milk production, talk to an IBCLC or other breastfeeding support specialist.

 Can I diet while breastfeeding?

 Reducing the number of calories you eat daily and avoiding desserts, sodas, chips, and other foods with “empty calories” will not cause your milk to lose nutritional value. Many mothers find that breastfeeding alone helps them lose the extra weight they gained during pregnancy. It is possible to lose additional weight through restricting calories while you are breastfeeding, but the current recommendation is that the diet not include fewer than 1800 calories per day (Lauwers & Swisher, 2011).

 Are there foods I should avoid while breastfeeding?

 The short answer is that there are no foods all mothers should avoid. Diets vary around the world, and so do the traditions of foods to eat or avoid while breastfeeding. Many experts recommend avoiding fish that are known to have high levels of mercury (tuna, swordfish, and others), foods like margarine that are high in trans fats, and foods that are common allergens like peanuts. However, the research on these topics is incomplete. Discuss any dietary restrictions you would like to make with your health care provider or IBCLC. It should be noted that milk-based formulas, including homemade formulas, contain trans fats (Mozaffarian et al., 2006; Satchithadandam et al., 2002; Ratnayake et al., 1997), and most formulas contain common allergens such as animal milk or soy proteins.

 I have heard that certain diets will make my milk much healthier for my baby. Should I still breastfeed if I don’t eat a traditional or natural-food diet?

 Definitely. While a diet rich in fresh fruits and vegetables and low in processed foods is an ideal choice for your and your family’s health, breastfeeding always provides the best possible nutrition for your baby, even if your diet is not as wholesome as it should be. A mother eating a typical American diet and a mother eating a whole-food diet may have some different types of fat and slight differences in the levels of some vitamins in breast milk, but this variation is not as great as the nutritional difference between broccoli and candy. Your milk is still best, even if your diet is not.

I have heard that what I eat and drink goes into my milk–so if I eat french fries or drink soda, my baby gets the same fat and sugar through my milk?

 The old adage “you are what you eat” sounds catchy, but it is not helpful to breastfeeding mothers wondering if their milk is nutritious enough for their babies. Most of the nutrients found in your milk do not pass directly from your food to your blood to your milk–the process your body uses to produce breastmilk is much more complex. Many substances in the foods you eat are never found in your milk, while others can pass through. However, no matter how much junk food you eat, there is no evidence to support the idea that your milk is not the best available food for your baby.

 If my milk is still the best choice for my baby, why should I bother to try to make healthier food choices for myself?

 Your health is important, too! Breastfeeding helps protect you from diseases like breast cancer (Bartick & Reinhold, 2010; Stuebe, 2009), but your diet is also crucial in maintaining your health. Also, your baby will not be breastfeeding forever–he will soon learn to eat table foods, and he will want the same foods he sees on your plate. Now is the perfect time to begin making those changes in your diet which will help your baby learn to eat healthily, and the foods you eat will flavor your milk so he will grow accustomed to their tastes. Some first table foods for your baby are also great for you: sweet potatoes, avocados, bananas, beans, lean meats, and oatmeal are simple to prepare, easily mashed with a fork, and very nutritious. Fresh ingredients cost less than prepared baby foods and cereals, and they are free of added sugar and other unnecessary ingredients.

 All children benefit when their parents are healthy, and good health will allow you to have the energy and positive mood you need to meet the intense demands of motherhood.

 Is it true that you shouldn’t eat “gassy” foods like broccoli, onions, and beans while breastfeeding?

 Don’t worry! These vegetables are great choices for breastfeeding mothers. Even if they give you gas, the substances in them that can cause gas do not get into your milk.

 I am diabetic. If my blood sugar is high, will my milk have too much sugar?

 No–your body produces the main sugar in your milk, lactose, in the breast, and the amount of sugars in your milk remain fairly constant no matter how high the level of glucose in your blood may be (Dewey et al., 1991). Many mothers find that breastfeeding keeps their blood sugar lower than it was before they were breastfeeding, but if your blood sugar does get too high, do not worry about your milk–glucose only makes up a tiny percentage of all the sugars in breastmilk (Butte et al., 1987). However, if you have uncontrolled diabetes, you should seek treatment from your health-care provider as soon as possible for the sake of your own health.

 You may be happy to know that breastfeeding reduces the risk of your child’s developing both obesity and diabetes.

 I keep hearing conflicting advice about breastfeeding, and I am so confused! Where can I find the most accurate information?

 Breastfeeding is a hot topic in the media right now, and many people are eager to voice their opinions. Many mothers are unsure where to turn for answers. Fortunately, there are trained professionals who have access to high-quality research and can help. Find them here:

Guide to breastfeeding support professionals

Find a lactation consultant


 Balmer, S. E., & Wharton, B. A. (1989). Diet and faecal flora in the newborn: breast milk and

infant formula. Archives of Disease in Childhood, 64, 1672-1677

Bartick, M., & Reinhold, A. (2010). The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics, Published online April 5, 2010. (doi: 10.1542/peds.2009-1616)

Butte, N. F., Garza, C., Burr, R., Goldman, A. S., Kennedy, K., & Kitzmiller, J. L. (1987). Milk composition of insulin-dependent diabetic women. J Pediatr Gastroenterol Nutr., 6 (6), 936-41.

Cruz-Hernandez, C., Goeuriot, S., Guiffrida, F., Thakkar, S. K., & Destaillats, F. (2013). Direct quantification of fatty acids in human milk by gas chromatography. J Chromatogr A. 1284,174-9. (doi: 10.1016/j.chroma.2013.01.094).

Dewey, K. G., Heinig, M. J., Nommsen, L. M., & Lonnerdal, B. (1991). Maternal Versus Infant Factors Related to Breast Milk Intake and Residual Milk Volume: The DARLING Study. Pediatrics, 87(6), 829 -837.

Friesen, R., & Innis, S. M. (2006). Trans fatty acids in human milk in Canada declined with the introduction of trans fat food labeling. J Nutr., 136 (10), 2558-61. Source: The Nutrition Research Program, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada V5Z 4H4.

Hassiotou, F., Geddes, D. T., & Hartmann, P. E. (2013). Cells in Human Milk: State of the Science. J Hum Lact., [Epub ahead of print]

Host, A. (1994). Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol., 5(5 Suppl), 1-36.

Innis, S. M. * Kuhnlein, H. V. (1988). Long-chain n-3 fatty acids in breast milk of Inuit women consuming traditional foods. Early Human Development, 18(203), 185–189.

 Lauwers, J. & Swisher, A. (2011) Maternal health and nutrition. In Counseling the Nursing Mother (5th ed., p. 171). Mississauga, Ontario, Canada: Jones and Bartlett.

 Lawrence, R. A. & Lawrence, R. A. (2011). Breastfeeding: A Guide for the Medical Profession, 7th Edition. Elsevior. Maryland Heights, MO.

Mevissen-Verhage, E. A., Marcelis, J. H., Harmsen-Van Amerongen, W. C., de Vos, N. M., & Verhoef, J. (1985).  Effect of iron on neonatal gut flora during the first three months of life. Eur J Clin Microbiol., 4(3), 273-8.

 Mozaffarian, D., Katan, M. B., Ascherio, A., Stampfer, M. J., & Willett, W. C. (2006). Trans Fatty Acids and Cardiovascular Disease. N Engl J Med, 354, 1601-1613. (DOI: 10.1056/NEJMra054035)

Power, K. A., Yan, Q., Fox, E. M., Cooney, S., & Fanning, S. (2013). Genome Sequence of Cronobacter sakazakii SP291, a Persistent Thermotolerant Isolate Derived from a Factory Producing Powdered Infant Formula. Genome Announc 1(2), e0008213. doi:10.1128/genomeA.00082-13

Ratnayake, W. M., Chardigny, J. M., Wolff, R. L., Bayard, C. C., Sebedio, J. L., & Martine, L. (1997).  Essential fatty acids and their trans geometrical isomers in powdered and liquid infant formulas sold in Canada. J Pediatr Gadtroenterol Nutr., 25(4), 400-7.

Riordan, J. & Wambauch, K. (2010). Nutritional values. In Breastfeeding and Human Lactation (4th ed., pp. 125-7). Mississauga, Ontario, Canada: Jones and Bartlett.

Satchithanandam, S., Fritsche, J., & Rader, J. I. (2002). Gas chromatographic analysis of infant formulas for total fatty acids, including trans fatty acids. J AOAC Int., 85(1), 86-94.

Savilahti, E. M., Saarinen, K. M., & Savilahti, E. (2010). Specific antibodies to cow’s milk proteins in infants: effect of early feeding and diagnosis of cow’s milk allergy. Eur J Nutr., 49(8), 501-4. (doi: 10.1007/s00394-010-0109-8). Epub 2010 Apr 20.

 Stuebe, A. (2009). The Risks of Not Breastfeeding for Mothers and Infants. Rev Obstet Gynecol, 2(4), 222–231. PMCID: PMC2812877 [PubMed]

 “1 Summary, Conclusions, and Recommendations.” Nutrition During Lactation. Washington, DC: The National Academies Press, 1991.

 Valentine, C. J., & Wagner, C. L. (2012). Nutritional management of the breastfeeding dyad. Pediatr Clin North Am., 60 (1), 261-74. (doi: 10.1016/j.pcl.2012.10.008)

Virtanen, S. M., Saukkonen, T., Savilahti, E., Ylonen, K., Rasanen, L. Aro, A., Knip, M., Tupmilehto, J., & Akerblom, H. K. (1994). Diet, cow’s milk protein antibodies and the risk of IDDM in Finnish children. Childhood Diabetes in Finland Study Group. Diebetologia, 37(4), 381-7.

 Wasmuth, H. E., & Kolb, H. (2000). Cow’s milk and immune-mediated diabetes. Proc Nutr Soc., 59(4), 573-9.

Whitney, E., Debruyne. L. K., Pinna, K. & Rolfes, S. R. (2011). The body’s energy budget. In Nutrition for Health and Health Care (4th ed., pp. 143-44). Belmont: Wadsworth, Cengage Learning.

© Adrienne Uphoff, IBCLC and Jolie Black Bear, IBCLC 2013–All Rights Reserved

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The Alphabet Soup of Breastfeeding Support

Because breastfeeding can have a positive lifelong effect on your baby’s health and development as well as your own health, its importance is widely recognized in the health-care field. However, many mothers find themselves unsure where to turn for help or information when problems related to breastfeeding arise. New mothers may be especially overwhelmed by the volume of information that is shared with them or confused by conflicting advice given by different caregivers. This article presents a guide to the different types of breastfeeding support specialists you may seek out or encounter as you begin your breastfeeding journey.

Your family, friends, and community may influence your decision to breastfeed and will be an important source of support after your baby arrives. Sometimes you simply need a little encouragement, a nutritious meal (that you didn’t have to prepare), or the company of a friend to keep you going through breastfeeding challenges. Your partner, mother, grandmother, auntie, friend, or even a stranger on the internet can help you find information you need or offer “been there, done that” advice. If you need more specialized information, help, or connection to the social support of a breastfeeding group in your community, trained breastfeeding specialists are available to fill the need.

There are many different training programs available to the aspiring breastfeeding support specialist or volunteer. The resulting “alphabet soup” of initials can be downright confusing, even for people who work with breastfeeding moms! Understanding what the initials stand for, as well as what training, education, and experience is required to earn them, may help you choose whom to call if you need breastfeeding help and support.


Professional Fellowship and Certification

Professional fellowship and certification requires post high school education, including health education that provides an understanding of whole body systems and how they affect lactation. Professionals perform clinical evaluations of breastfeeding and create and oversee a plan of care, which may involve more than one type of health-care provider. One factor that sets professionals apart is the requirement to follow an ethical code of conduct overseen by the organization that provides the fellowship or certification.

Breastfeeding Medicine Specialist (Fellow of the Academy of Breastfeeding Medicine–FABM)

Breastfeeding Medicine Specialists are Medical Doctors (MD or DO) who have completed additional training in breastfeeding and human lactation and specialize in this field. They are able to treat complicated breastfeeding issues that require evaluation by a physician such as failure to thrive (a baby not gaining weight, not growing as expected), tongue tie, breast abscess, low milk production that is not resolved by more frequent nursing/expressing, and breast or nipple infections. They are also able to assist with common and ordinary breastfeeding problems as well as concerns that relate to the normal course of breastfeeding.

Breastfeeding Medicine Specialists often work in either private or group physician practices. They may work entirely in the field of breastfeeding medicine or use their breastfeeding expertise while working in another medical speciality such as obstetrics, pediatrics, or family medicine. Most often, mothers are referred to FABMs by an IBCLC or another physician who recognized an issue that required their expertise. As with most physicians, however, mothers may self-refer.

Education and experience:

An applicant must have completed the required education and training to become a physician, additional education in lactation science and management, as well as the required clinical experience hours working directly with breastfeeding mother-baby pairs.

Breastfeeding Medicine Specialists are recognized by the Academy of Breastfeeding Medicine to have “demonstrated evidence of advanced knowledge and skills in the fields of breastfeeding and human lactation. FABM denotes that the physician has ongoing specialized professional activities related to clinical expertise, research or teaching experience, and/or significant advocacy efforts in the field of breastfeeding medicine.” See the full reference here. Breastfeeding Medicine Specialists must apply to maintain their fellowship every 10 years.

Breastfeeding Medicine Specialists can:

  • make a medical diagnosis
  • prescribe medication
  • order and perform medical testing
  • perform medical procedures

Find a Breastfeeding Medicine Specialist:

Currently, a publicly accessible database is not available. You may call the Academy of Breastfeeding Medicine and ask how to contact the closest Breastfeeding Medicine Specialist to you.

Contact information: Academy of Breastfeeding Medicine


International Board Certified Lactation Consultant (IBCLC)

Certification by the International Board of Lactation Consultant Examiners (IBLCE) is recognized as the gold standard credential for professionals who work with breastfeeding mothers.

IBCLCs are allied health professionals who have completed extensive, comprehensive education in breastfeeding and human lactation, education in health sciences and related subjects, and the required hours of supervised clinical experience. By passing the IBLCE exam, they have demonstrated they are qualified to work with breastfeeding mother and baby pairs as clinicians. IBCLCs can help mothers overcome common breastfeeding difficulties such as sore nipples, mastitis, and milk production concerns. They can also provide assistance with more complex issues, such as breastfeeding with illness or disability, low weight gain, and tongue tie. IBCLCs also help with concerns related to the normal course of breastfeeding (sleep, returning to work or school, etc.).

IBCLCs may work in private practice, group practices, hospitals, birth centers, health clinics, parenting centers, WIC clinics, physician practices, midwives practices, chiropractic practices, or multi-faceted practices such as perinatal clinics. They are part of the maternal-child health team and coordinate care with physicians and other health-care professionals. Additionally, IBCLCs may work in research, advocacy (including policy-making), non-profit management, or as volunteers. IBCLC is a stand alone credential, though many practicing IBCLCs are also licensed professionals such as physicians, registered nurses, or registered dietitians.

Education and experience*:

At least 90 hours of education specific to breastfeeding and human lactation

At least 1000 hours of supervised clinical experience working with mother and baby pairs, or 300-500 hours of directly supervised clinical experience with a mentor

A degree in one of the health sciences OR completion of the following courses:

  • Biology
  •  Nutrition
  • Human Anatomy
  • Psychology or Counseling or Communication Skills
  • Human Physiology
  • Introduction to Research or Statistics
  • Infant and Child Growth and Development
  • Sociology or Cultural Sensitivity or Cultural Anthropology
  • Basic life support
  • Medical terminology
  • Medical documentation
  • Occupational safety and security for health professionals
  • Professional ethics for health professionals
  • Universal safety precautions and infection control

(*Source: International Board of Lactation Consultant Examiners Candidate Information Guide 2013)

The eligibility requirements above were implemented in 2012. Please note that these requirements have changed several times since the exam was first administered in 1985.  See this presentation from IBLCE for full details. Depending on which year an IBCLC took the exam, and which pathway was taken, the candidate was required to acquire between 1000-8000 supervised clinical experience hours or 300-500 clinical experience hours that were directly supervised by an IBCLC mentor before applying for the exam. It is also of note that many candidates have more lactation-specific education hours than required at the time of application not only because they attend conferences and webinars earning Continuing Education Recognition Points (CERPs) while working towards eligibility, but also because it takes many hours to cover all the topics in the exam blueprint. For example, one of the most popular comprehensive education programs available to IBCLC hopefuls is the 120-hour Health e-Learning BreastEd course.

The IBLCE exam contains 175  multiple choice questions of which 100 include clinical photos. The exam covers all aspects of breastfeeding and human lactation as well as related topics such as child development, pharmacology, nutrition, anatomy and physiology, and ethics.  All IBCLCs must recertify every five years by CERPs (a total of 75 hours) and at least every 10 years by exam.

IBLCE is the only certification program in lactation accredited by the National Commission for Certifying Agencies.  The NCAA is a regulatory body that provides volunteer oversight for allied health professions.

IBCLCs  can:

  • take a complete lactation history including evaluating breast anatomy and function and assessing factors related to breastfeeding such as maternal condition, social support, and potential challenges
  • assess the baby’s facial and oral structure and evaluate neurological responses and reflexes
  • assess for developmental milestones and normal infant behavior
  • perform a comprehensive, clinical evaluation of breastfeeding efficiency and effectiveness including assessing latch/attachment, milk transfer, and milk intake
  • assist the mother to find comfortable and effective positions for breastfeeding
  • assess the mother’s milk production and provide education  and assistance regarding  adjusting milk volume if necessary
  • use the appropriate World Health Organization growth chart to assess the breastfeeding child’s weight and growth patterns
  • evaluate and demonstrate the use of breastfeeding techniques and devices and provide evidence-based information to mothers about their use
  • write a comprehensive evaluation of a mother’s lactation history and breastfeeding assessment and work with the mother to develop and implement an appropriate and achievable breastfeeding plan
  • assess and provide strategies for initiation and continuation of breastfeeding in challenging circumstances such as a medical condition in mother or baby, compromised lactation, or emergency situation
  • provide information and strategies for overcoming breastfeeding challenges such as painful nipples, mastitis, and engorgement
  • empower mothers and families with information, support, and appropriate referrals to help them cope with peripartum mood disorders
  • educate mothers and families about normal baby behavior including signs of hunger and expected feeding and sleep patterns
  • provide current, unbiased, evidence-based information to assist the mother in decision making
  • obtain the mother’s consent to gather and disclose information and written assessments to pertinent health care providers

 Find an IBCLC:

  • ILCA: Find a Lactation Consultant Directory-IBCLCs who are also members of the International Lactation Consultant Association may choose to have their contact information listed on this page. Due to that limitation, it may not be a comprehensive listing of all IBCLCs in your area.

  • Department of Public Health or WIC breastfeeding resource directory-Search your state Health Department or WIC website for this valuable listing of breastfeeding support resources in your community. It is usually updated annually.

  • Search-Most IBCLCs in private or group practice have a website and/or a Facebook page that is searchable using a web search engine such as Google or Bing. Searching for IBCLCs in a specific city or geographic region may help you narrow down the results. (For example “IBCLC New York, NY” or “IBCLC Bay Area CA.”)

  • Word of mouth and referrals-If you need the services of an IBCLC, you can ask your physician, nurse, or nutritionist for a referral. Your insurance company may have a referral list of  IBCLCs that are covered under your plan. You may also find recommendations from from other women through parenting groups, breastfeeding support groups or meet-ups, and online groups.

 More info:

Clinical Competencies for the Practice of International Board Certified Lactation Consultants (IBCLCs)

Scope of Practice for International Board Certified Lactation Consultants

Position Paper on the Role and Impact of the IBCLC


Mother-to-Mother Support

Experienced mothers are trained in basic breastfeeding management, modeling optimal breastfeeding practices, and sharing (or facilitating the sharing of) information and experiences with pregnant and breastfeeding women individually and in group settings.  Mother-to-mother support gives mothers the opportunity to talk with other women about their concerns in a way that might not otherwise be possible in today’s world. Women are empowered to explore options that are the foundation of a personally satisfying breastfeeding experience. Mothers often find it easier to share their concerns with other mothers; this mutual sharing of experiences and information builds trust and respect. Mother-to-mother support has the following benefits:

  • It is community-based and easy to access.
  • It provides an essential complement to existing health care and social services systems.
  • It counters incorrect or misleading breastfeeding information with accurate, evidence-based information.
  • It enables and empowers mothers to make informed choices about breastfeeding and parenting.
  • It provides a social outlet for mothers (group meetings).

WIC Breastfeeding Peer Counselor (WIC BFPC or WIC PC)

Through the federal Women, Infants, and Children program, WIC Breastfeeding Peer Counselors provide mothers with breastfeeding information and support from pregnancy through weaning. During pregnancy, they visit with mothers by phone and in person to provide them with basic breastfeeding information, answer questions, and offer anticipatory guidance to help make breastfeeding easier. After a mother’s baby is born, her BFPC will continue to make regular contact with her, answer her questions, and offer practical suggestions to help her reach her breastfeeding goals. Depending on the policies of her state or tribal program, BFPCs may also facilitate support groups, teach breastfeeding classes, dispense breastpumps, certify participants for the WIC program, and make home or hospital visits.

Personal experience:

Breastfed for at least 6 months, WIC participant

Education and training:

20-hour on-site training  that covers all aspects of the normal course of breastfeeding and human lactation as well as communication skills. Training activities include role play and demonstration of necessary skills including assisting moms with using common breastfeeding tools and equipment (such as breastpumps).

Continuing Education:

1 hour per month minimum; additional requirements vary by state

More info:

Who are Breastfeeding Peer Counselors, and what do they do?

Volunteer Breastfeeding Counselors

The following volunteer organizations offer one-to-one breastfeeding counseling (which may include online or text communication and home visits), group meetings, and online resources. Counselors are educated and mentored within the organization before beginning to work with mothers. They may be supported by a network of professionals in the field of lactation that works as a sounding board for complicated situations.

La Leche League Leader (LLLL)

Personal experience:

Breastfed for at least 9 months at time of application; Please see additional requirements here.

Education and training:

Applicants must complete required reading, writing exercises, and role play which covers all aspects of the normal course of breastfeeding and human lactation, as well as communication skills.  For full details, please see here.

Continuing Education:

Leaders are expected to keep up-to-date and are strongly encouraged to continue their education. Proof of completion is not required. To fill the need for continuing education, Chapters, Area Networks, and Regions regularly provide education opportunities such as seminars, conferences, lunch and learns, as well as informative publications such as Leaven and newsletters.

More info:

How can I become a LLL Leader?

About La Leche League

Breastfeeding USA Counselor (BfUSA Counselor)


Breastfed for at least 1 year at time of application.

Education and Training:

Training varies based on experience. Includes reading, online training activities, and role playing.

Continuing Education:

Minimal number of credits every 3 years

More info:

Becoming a Breastfeeding Counselor

 Nursing Mothers Counsel Counselor (NMC Counselor)

Requirements vary by chapter.  Please see the chapter website for specific information.

Nursing Mothers Counsel (California)

BACE: Nursing Mothers’ Council

Nursing Mothers Counsel (Oregon)

Certificate Programs

The following programs offer similar preparation to individuals who may provide mothers with information about the normal course of breastfeeding and basic breastfeeding support. After completion, they will be prepared to:


  • answer questions about common breastfeeding concerns such as prevention of sore nipples, preparing for return to work or school, and milk production issues
  • offer practical tips for helping mothers fit breastfeeding into their lifestyle
  • provide anticipatory guidance about common breastfeeding situations and problems
  • provide education to help mothers prepare to breastfeed or return to work or school
  • recognize when breastfeeding is going well and when more help is needed
  • recognize when a breastfeeding issue is beyond their scope of practice and refer to the appropriate professionals.Many certificate program graduates use their education in their occupations as nurses, nutritionists, midwives, labor doulas, postpartum doulas, baby boutique and pump rental station employees, or WIC Breastfeeding Peer Counselors. Some work as part of a group practice, usually with an IBCLC as the lead, while others start businesses to support women in their communities directly.

Certification vs. Certificate Programmes:  What’s the Difference? 
Practice Analyses

Certified Lactation Counselor (CLC)


Healthy Children’s Project, Inc

Exam, certificate, and renewal administered by Academy of Lactation Policy and Practice, a division of Healthy Children’s Project, Inc. The ALPP certificate is accredited by the American National Standards Institute.  ANSI accreditation means that the testing process of the certificate program has been found to be fair, valid, and reliable.


5 day on-site breastfeeding education (45 credit hours), role play, competency check (example: watch a short video and describe what action the CLC would take) and pass a 100 question exam with 75% or better immediately after program; Program information

Renewal: Every 3 years with 18 hours of breastfeeding education, plus required fee

Advanced Lactation Consultant (ALC) and Advanced Nurse Lactation Consultant (ANLC)


Healthy Children’s Project, Inc (please see CLC listing above)


45 hour course; Program information

Prerequisites: RN license and CLC or IBCLC 

Prerequisite: CLC or IBCLC 

 Certified Lactation Specialist (CLS)


Lactation Education Consultants


5 day on-site education and training (45 credit hours), complete assigned homework and readings, and pass final exam immediately after program; Program information



Certified Breastfeeding Counselor (CBC)


Childbirth International


Mentored online training, required reading and exercises, create portfolio of local breastfeeding resources, provide 30 hours of breastfeeding support, and complete final open book exam; Program information



Breastfeeding Counselor (BC)


Breastfeeding Support Consultants Center for Lactation


Distance learning course (95 hours), read required text, complete study questions and role plays, and pass final exam; Program information



The following certificate programs prepare candidates to provide breastfeeding education rather than support. Please see the program requirements and accompanying documents for more details, including the scope of practice of the certificated educators for each program.

Certified Lactation Educator (CLE) 


Childbirth and Postpartum Professional Association (CAPPA)


Complete all assignments and read all required texts/books, write one-page essay, attend 20-hour training (a distance track is also available), attend 2 breastfeeding support group meetings, attend 1 breastfeeding class,  submit 2 letters of recommendation, develop breastfeeding class outlines and handouts, create local breastfeeding resource list for families, complete part 1 of HUG your baby training, and pass final online exam with 85% or better; Program information


Every 3 years with 15 hours of breastfeeding education, required evaluations, reports, reviews, and fee. Details

Lactation Educator (LE)


Evergreen Perinatal Education


5 day on-site education and training (45 hours), written breastfeeding project (homework), write study guide on breast anatomy and physiology, participate in quizzes, case studies and role plays, evaluate program; Program information



Lactation Educator Counselor (LEC)


University of California at San Diego Extension: Breastfeeding Education by Gini Baker, RN, MPH, IBCLC


5 day on-site education and training (45 hours) or online (60 hours). Complete assignments including internet resource, nutrition, clinical, and counseling problems, review 4 research studies, observe a breastfeeding class, develop breastfeeding class curriculum, read required text, satisfactorily complete periodic testing; Program information




For more information about, and a comparison of, the various breastfeeding support specialists in the USA please see The Landscape of Breastfeeding Support by the Massachusetts Breastfeeding Coalition.

Finger Lakes-  Ganondagan’s Native American Dance and Music Festival - Ontario

Because of the immense importance of breastfeeding to both individuals and public health, it is imperative that our communities support and empower mothers both to initiate breastfeeding after birth and to continue breastfeeding as long as desired, ideally through the first year and beyond.

While it is helpful for mothers and community members to be aware of the diversity in breastfeeding specialists, these practitioners only represent one part of the larger picture of essential support for mothering. Breastfeeding specialists, community advocates, and health-care providers must work together with families in order to ensure that women have access to the accurate, evidence-based information and support they need to develop and meet their own breastfeeding goals.


 Thank you to all the colleagues and friends who shared information to make this resource as comprehensive as possible. Special thanks to Adrienne Uphoff, IBCLC for her time and patience while editing and updating this article, as well as for the generous gift of her wordsmithing wizardry.



© Jolie Black Bear, IBCLC 2012– All Rights Reserved

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A Mother’s Guide to Weaning

Gradual Weaning

(c) Serena Meyer 2013 When weaning happens gradually, it is a process by which nursing frequency decreases slowly over time. The partnership between the mother and child during breastfeeding can be respected and honored if the weaning is done as compassionately as possible.

Mutual weaning happens when both the mother and the child are ready. Experts have described the natural age of weaning to be anywhere from about 2.5 years to around 7 years old, but weaning may happen before or after that age. Currently, the World Health Organization recommends that children be nursed for a minimum of two years.

How Weaning Happens

Breastfeeding should be able to continue unhindered as long as the relationship is working for both the mother and her child. Because there are two people in a breastfeeding relationship, the mother and the child’s feelings are equally important. Breastfeeding can be adapted to make it work for both of them if full weaning is not the best choice.

Parent-led: The mother may choose to drop feedings that are less important to the child’s emotional well-being and continue nursing at nap or bedtime. In some instances she may choose to night wean her toddler and continue to nurse during the day. It may be easiest to choose a daytime nursing-session as the first one to go, because it is can be easier to distract a child with other activities when it is daylight, and interesting things are happening.

Child-led: There are some toddlers who become so interested in the outside world that they are like little butterflies flitting from one thing to another. Sometimes, the result is that they begin to wean by nursing less frequently during the day and more during the night.  Other children gradually stop nursing on their own over the course of weeks, months, or even years.
When a mother is ready to wean a child who can communicate well, she may try nursing only when the child asks. How long this process takes depends on the child’s readiness for weaning. As weaning occurs, the mother and child will start the next chapter of their relationship, built from the core emotional attachments forged through breastfeeding and attentive mothering.

If the Mother or Child is Not Yet Ready to Wean

Optimal nursing allows both the mother and child to be comforted and relaxed. When circumstances change, and mother or child is ready to reduce or stop breastfeeding, weaning may be done in respectful and gentle way. Partial weaning and other creative strategies may help make breastfeeding more manageable.
Sometimes small adjustments to breastfeeding behaviors, such as instructing the child to ask before lifting mama’s shirt so that she doesn’t feel exposed, can be taught to children beforehand in order to increase the comfort level of the mother. Mothers who can make these small changes are able to both preserve the breastfeeding relationship and meet their own needs.
Only a mother knows when the time is right for weaning: mothers have unique, intimate knowledge of their children, and they may have an intuitive sense of the process. If weaning feels too early or difficult, or the baby is under a year old, it may be best to delay weaning until a more appropriate time.

Emergency Weaning

When weaning in a rush, the mother and the baby may have not have had much time to prepare emotionally. It can be a highly-charged time filled with a sense of loss or even anger at the situation. For some mothers, there is acute medical necessity for weaning: treatment with chemotherapeutic drugs or other medications contraindicated during breastfeeding (dangerous to take while breastfeeding) and without possible safer substitutions or maternal addiction to harmful substances.
A mother in these situations must often choose a difficult weaning process that is entirely mother-led, and it may occur far earlier than her baby is ready.

For the Weaning Mother

Careful attention to how engorged (full of milk) she is getting will alleviate the discomfort she experiences. If needed, there may be medications that her healthcare provider can offer to speed up the process of “drying” her milk up.

Breast Engorgement

When a mother is breastfeeding normally, the milk is removed regularly, and breastmilk production may continue without discomfort. If a mother suddenly stops nursing, her breasts will fill with milk and cause engorgement. Engorgement is usually very uncomfortable: it can make the breasts feel hot or heavy, and it is frequently painful.
Having full breasts sends a message to the breast to stop producing milk. A mother who is weaning should consider wearing loose, comfortable clothing to minimize pressure on the breasts during this transition.
Some mothers have reported that expressing (removing) some of their milk so that they are not painfully engorged is helpful. Removing a little milk can help a mom avoid feeling really uncomfortable. With milk expression, the goal is to remove just a little for comfort and not to drain the breast. A mother who is removing milk in this manner in order to wean rapidly because of a dangerous medication or medical condition should avoid feeding this milk to her baby unless her health care provider has advised her to do so.

Quick Comfort Measures

  • Cold packs, frozen peas, frozen cabbage leaf compresses, and other cool compresses on the breasts may help with engorgement pain. A mother can check with her health care provider to see if taking an over the counter anti-inflammatory medication is an option.

Occasionally some mothers experience blocked ducts or mastitis when they have been engorged for a long time. Some signs and symptoms of mastitis requiring prompt treatment from a health care provider include: a fever over 100 degrees, body aches, very painful breasts, red streaks on the skin of the breasts, or hot, hard places in the breasts.

Offering Another Method to Feed the Baby

Fluids may be offered in cups or sippy cups, bottles, or spoons. The liquids a baby should consume vary depending on his age. Some mothers may be able to acquire donor human milk for young or premature babies. Other mothers of babies under a year old will be advised to use an iron-fortified formula. Mothers of toddlers or older children may offer water or other fluids approved by their health care providers.

Some quick tips for weaning

  • Redirect a toddler with a special toy or favorite snack.
  • Offer a sippy-cup of water or expressed milk.
  • Offer another form of comfort.
  • Avoid places you usually nurse.
  • Go to the park more often, take walks, or get outdoors when you can.
  • Wear clothes with buttons or layers. Avoid clothes that are easy for your toddler to lift Don’t be afraid to nurse if weaning isn’t working well that day–there is always tomorrow.
  • Try to be consistent.
  • Be gentle, patient, and loving.
  • If you feel engorged, express some of the milk for comfort, but don’t drain your breast all the way.
  • Try a warm/cool bath or shower or cool compresses for breast discomfort.
  • Be kind to yourself–weaning is emotional work for both the mom and the child.
  • Once you have weaned, don’t express milk to see if any is there: give your breasts some time off from any handling.

A Mother’s Feelings about Weaning

Some mothers feel relieved that weaning has been achieved and that they have experienced the amazing feat of breastfeeding. Being pregnant and breastfeeding are tremendous accomplishments: all mothers, whether they nurse for a few weeks or years, should be commended for their efforts.
The physical sensations of engorgement and the emotional effects of not being able to nurse may be very difficult for other mothers. These women may feel that the hardest part of weaning is not being able to respond in the normal fashion to her baby’s need to nurse, cuddle on her breast, or reconnect after separation. A mother may miss the private time that nursing offered the two of them and may have feelings of regret or miss the tiny baby that she once held in her arms.  Throughout the gradual weaning process, the adult can understand why weaning is happening, but a young child will not have the same experience. The mother may see some behavioral changes in her child during and after weaning. Obtaining the caring support of family or friends is helpful during this challenging period of adjustment and will potentially ease some of the strain placed on the mother-child relationship.
It is normal to feel “touched-out,” sad, relieved, anxious, worried, or frustrated. Mixed emotions are common. Finding another mother to speak with may be helpful. Mothers who are unable to discuss weaning with family or friends or who need further support should consider seeking out community support programs that offer free counseling to mothers in crisis as soon as possible.

If a mother experiences signs of depression or if she says she feels like hurting herself or her child, she should find help immediate.y. She could call 1-800-273-TALK or Chat http://www.suicidepreventionlifeline.org/ There is never any shame in reaching out for help when it is needed.

*Some mothers who have weaned do change their minds and resume breastfeeding. An article addressing this topic may be found here: Can There Be Breastfeeding After Weaning?


Riordan, J., & Wambach, K. (2010). Lactation Following Breast cancer. In Breastfeeding and Human Lactation (4th ed., pp. 316-317, 606). Mississauga, Ontario Canada: Jones
and Bartlet.

Dettwyler, K., Ph.D. (1999). A Natural Age of Weaning. Retrieved April 21, 2012,
from Katherine Dettwyler’s website: http://www.kathydettwyler.org/detwean.html

Gordon, Jay. (2010) Sleep, Changing Patterns in The Family Bed. Retrieved December 17, 2012 from Dr. Jay Gordon’s website: http://drjaygordon.com/attachment/sleeppattern.html

World Health Organization. 2012. Health Topics: Breastfeeding. Retrieved December 17, 2012 from the WHO website: http://www.who.int/topics/breastfeeding/en/index.html


(c) Serena Meyer RN, IBCLC. 2015 All rights reserved.

You can find serena at https://www.bayareabreastfeedingsupport.com/

Posted in Articles for Breastfeeding Support Workers, Breastfeeding, Breastmilk or Formula?, Women's Issues | Tagged , , , , , , , , , , , , , , , | 1 Comment

What Causes Low Milk Production?

Many mothers worry that they may not produce enough milk for their babies. Well-meaning friends and relatives share their own experiences or stories they have heard from others in an effort to prepare expectant mothers for the worst. Even before their babies arrive, mothers may hear alarming reports:

  • “I tried to breastfeed, but I couldn’t make enough milk.”
  • “My milk never came in.”
  • “My milk suddenly dried up!”
  • “Your mother had to supplement, so you will, too.”

helping preterm baby latch in NICUMost mothers have heard at least one of these reports before their own babies arrive. The good news is that the majority of women can produce all the milk their babies need for healthy growth and development. More often than not, concerns about milk production are simple misunderstandings of normal newborn behavior or breastfeeding management issues that can be fixed. Rarely, a woman may have a physical or hormonal condition that makes it difficult to build or maintain milk production. One study suggests these conditions occur in about 5% of the population of women (Neifert, 2001). The following sections outline some of the medical causes of low milk production:

Maternal Conditions Related to Low Milk Production

Insufficient Glandular Tissue: During puberty, progesterone and estrogen signal the growth and development of the mammary (breast) glands. Active growth of ductal tissue takes place during each menstrual cycle. In rare instances, the glands do not grow or develop fully during puberty, and insufficient glandular tissue, known as breast hypoplasia, may result (Neifert, Seacat, & Jobe, 1985). Some women with insufficient glandular tissue may have breasts that are unusually shaped or appear not to be developed at all. Some women may have breasts that seem to be fully developed but have a limited capacity to produce milk because fatty tissue is present, but glandular tissue is not sufficient. During a normal pregnancy, glandular tissue continues to develop, and there is usually (but not always) a noticeable change in breast size, increased sensitivity or tenderness, visible veining on the breast, and darkening of the areolas. Some signs of breast hypoplasia are:

  • “oblong”, tubular shaped breasts
  • “flat,” underdeveloped breasts
  • widely spaced breasts (more than 1.5” apart)
  • breast asymmetry (one breast noticeably larger than the other)
  • very large or “puffy” areolas
  • absence of noticeable breast changes during pregnancy or after birth

Any or all of these signs do not always indicate that a woman is unable to produce milk, but they should prompt women and their health-care providers to be aware of potential problems and have a plan of action to overcome them. Women with signs of insufficient glandular tissue are encouraged to develop a breastfeeding management plan with an International Board Certified Lactation Consultant (IBCLC) before they give birth.

Breast Surgery: Milk ducts may be cut, and nerves can be damaged as a result of surgery. The milk ducts may “re-grow” (recanalize) during pregnancy as the breast changes rapidly in preparation for lactation. Mothers who are unable to produce enough milk to meet the needs of a first baby may have better milk production with the next child as a result of breast development that occurs with each pregnancy. Sometimes, chest surgery or injury may result in nerve damage that affects the milk ejection reflex, or rarely, it may cause damage to the glandular tissue of the breast and result in a decreased capacity to produce milk. Mothers who have had breast, nipple, or chest surgery or injury may find the evidence-based website, Breastfeeding After Breast and Nipple Surgeries, to be helpful and encouraging.

Hormones: Many mothers with a hormonal imbalance such as Polycystic Ovary Syndrome (PCOS) have reported trouble producing enough milk for their babies. To date, PCOS, other hormonal disorders, and related conditions such as insulin resistance and infertility are not well-understood in terms of how they may affect milk-production. Some women may produce excess milk, while others struggle to meet their babies’ needs. There are medical treatments which may help maintain balance and an adequate milk supply. A woman who thinks she may suffer from a hormonal imbalance should discuss her concerns with a health-care provider and develop a breastfeeding management plan with an IBCLC before she gives birth.

Impaired Thyroid Function: Hypothyroidism is common in women and may affect “4-10% of women” in the postpartum period (Ogunyemi, 2011). Both Hyperthyroidism and hypothyroidism result in irregular production of the hormones T3 and T4 which act on the metabolism of the body. Women who are experiencing low milk production may benefit from having their thyroid hormone levels tested so that problems may be treated. Many mothers with these conditions will have improved milk production when their symptoms begin to resolve.

Hormonal Birth Control: The use of combined estrogen/progesterone hormonal birth control is associated with low milk production. Many breastfeeding mothers are prescribed progestin-only hormonal birth control because it does not typically decrease milk production. However, it can be associated with a decrease in milk production in some women especially if started before 6 weeks postpartum. Women who are planning to breastfeed should discuss alternative forms of birth control with their health-care providers.

Retained Placenta: The detachment of the placenta signals a cascade of hormones that cause the milk to “come in” after the baby is born. Even a tiny piece of placenta left attached to the wall of the uterus may cause the mother’s body to “think” it is still pregnant. When the placenta does not completely detach as it should, progesterone levels stay too high to allow copious milk production. When the placenta is shed or removed, the mother’s milk production is likely to increase (Neville & Morton, 2001). Retained placenta can be very serious. Health-care providers will explain warning signs to watch for, such as very heavy postpartum bleeding.

Excessive Blood Loss: When an abnormal amount of blood is lost during childbirth or through postpartum hemorrhaging, the system that triggers the release of prolactin (the “milk making” hormone) in the pituitary gland may be interrupted, and inhibit milk production.

Infant Conditions Related to Low Milk Production

Latch: A baby who is not attached well and positioned comfortably at the breast may be unable to transfer milk efficiently. An ineffective latch may result in:

  • damaged nipples
  • disorganized sucking
  • fussiness at the breast

(Genna, 2008)

A common solution for pain during breastfeeding is to ensure baby is positioned comfortably, stabilized, and given assistance to latch deeply. Ocassionally, a change in position and a deeper latch do not resolve pain, and there may be a structural problem such as tongue tie, lip tie, or high palate. When breastfeeding discomfort continues despite position and attachment changes, an IBCLC can help with assessment, recommendations for feeding, or referral, if necessary, to other professionals that can assist with treatment.

syringe supplementation at breastSuck Dysfunction: If baby is not able to suck effectively and remove milk from the breast, the result may be low milk production. Suck dysfunction is associated with some medical conditions, early birth, low muscle tone, and other problems which should be addressed by a IBCLC or other health-care provider. Some of these babies may tire at the breast while feeding, while others may use their tongues ineffectively or have trouble coordinating the behaviors associated with feeding (Genna, 2008). Sometimes, position changes that increase “positional stability” for the infant (Colson et al, 2008) may be helpful. Some babies improve dramatically with age, but in many cases, close attention from a IBCLC or other health-care provider is also necessary.

Non-Medical Causes

Infrequent Nursing:
In many cases of low milk production or slow weight-gain, the baby simply needs to nurse more often. Healthy newborns breastfeed an average of at least 10-14 times in 24 hours, and most babies must feed frequently in order to take in enough milk. Many babies who are not gaining weight well simply need more time at the breast, and some babies need encouragement in order to feed more often. A mother may help this process by offering the breast every 1-2 hours and paying close attention to signs that the baby is hungry or satisfied. When the breast is drained, the body responds by making more milk. Placing the baby directly onto the bare skin of the mother’s chest facilitates intimate contact between the two of them and is associated with more frequent breastfeeding and greater milk production. All babies need unrestricted access to the breast in the first three weeks, when the body is “primed” to learn to make enough milk (De Carvalho, 1983).

Many factors can lead to babies spending too little time at the breast:

  • Early formula supplements can lead to less breastfeeding and lower milk production.
  • Frequent visitors, traveling, or entertaining can reduce the time a mother spends alone with her baby, skin-to-skin, and breastfeeding. Early feeding cues can be missed if mother and baby are not together or the baby is sleepy or overwhelmed from being passed from person to person.
  • Scheduling, delaying, or limiting breastfeeding restricts the amount of milk a baby is able to remove and how much a mother can produce.

By responding to the needs of her baby when he indicates a desire to nurse, a mother can ensure her baby will get enough milk. A new family may benefit by limiting visits from well-meaning family and friends for a few weeks after birth. If loved ones are eager to help with the new baby, the mother can suggest they provide some meals, run errands, or help with housework rather than having someone else care for the baby. Nursing at the first sign of a hunger in the early weeks, can maximize milk production in the long term.

Lack of support: Many mothers experience a lack of support for breastfeeding from their communities. Well-meaning friends, family members, and even health-care providers may undermine breastfeeding by inadvertently giving unhelpful advice.  Some health-care providers have little or no training in human lactation and may not have enough information to provide accurate advice about breastfeeding. Family members may want a turn to bottle-feed the new baby. Friends might not be familiar with breastfeeding and question how frequently the baby is at the breast. These situations may result in less breastfeeding and lower milk production.

Misunderstanding normal infant behavior: A fussy or unhappy baby is not always a hungry baby. Mothers and concerned friends and family may worry that a baby who is fussy or needs to nurse frequently is not getting enough milk. It is not uncommon for there to be periods when a newborn nurses for 20 minutes and then is ready to nurse again 10 minutes later. The mother is often told, “He can’t be hungry; he just ate,” or “You’ll spoil him.” This kind of advice can lead to giving supplements when they are not needed. Instead, a mother may need to be reassured that her baby is getting enough milk at the breast.

When Supplementation is Necessary: Sometimes babies do not gain weight at the minimal expected rate for health and development and need temporary additional nutrition. Ideally, a supplement should be the mother’s own milk or donor human milk. In the early days, if a supplement is necessary, mothers should be encouraged to hand express and supplement with their own colostrum as demonstrated in this video from Stanford School of Medicine: Hand Expression of Milk. Sometimes, a mother is not yet producing enough milk to feed as a supplement and uses formula. Whether a mother supplements with donor human milk or formula, she should be encouraged to express her milk in order to maintain (or increase) her milk production. Because formula takes longer to digest, many babies who are taking supplemental feedings exhibit less-frequent hunger cues. Over time, a baby receiving this kind of supplement may feed less frequently, and if the mother is not also removing milk as frequently as her baby would normally demand, decreased milk production may result.

If a mother does not breastfeed and/or express her milk frequently or fully enough, an unproductive cycle can develop quickly; baby fills up on formula and spends less time at the breast. Baby spends less time at the breast, so the mother produces less milk. Mother produces less milk, so she gives more non-human milk, and so it continues until she is no longer making enough milk for her baby. This cycle can often be reversed if the mother instead makes sure to increase time at the breast, remove milk frequently, and use breast compressions while nursing.

If a baby needs supplemental feedings it is important to explore all of the possible maternal or infant causes of low milk production in order to help restore full breastfeeding. Supplemental feedings, while sometimes necessary, do not address the underlying cause of low milk production. Identifying the cause of low milk production is important. While supplemental feedings may be part of the plan of action, steps should be taken to ensure exclusive breastfeeding resumes.

If you are concerned that you are not making enough milk, or if you are worried if your baby is not getting enough milk, an International Board Certified Lactation Consultant or community breastfeeding support worker may be able to help. Finding the support you need, can help you reach your breastfeeding goals.

Breastfeeding After Breast and Nipple Surgeries
Hidden Hinderances to a Healthy Milk Supply
Hypoplasia/Insufficient Glandular Tissue
Making More Milk
MOBI Motherhood International
Is your milk supply really low?
My breasts feel empty. Has milk milk supply decreased?


Akre J. E., Gribble, K. D., & Minchin, M. (2011). Milk sharing: from private practice to public pursuit.  International Breastfeeding Journal,  6(8). Retrieve December 12th, 2012 from International Breastfeeding Journal Website: http://www.internationalbreastfeedingjournal.com/content/6/1/8

Colson, S. D., Meek, J. H., & Hawdon, J. M. (2008). Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development,  84(7), 441-449.

De Carvalho M, Robertson S, Friedman A, & Klaus M. (1983) Effect of frequent breast-feeding on early milk production and infant weight gain. Pediatrics, 72(3)

Genna, C. W (2008). Supporting Sucking Skills in Breastfeeding Infants. Sudbury: Jones and Bartlett Publishers.

Kent, J., Mitoulas, L., Cregan, M., Ramsay, D., Doherty, D., & Hartman, P. (2006). Volume and frequency of breastfeedings and fat content of breastmilk throughout the day. Pediatrics, e117(3).

Lieberman ,T. (2011). Booby Traps Series: Postpartum hemorrhage and retained placenta – Two birth-related causes of low milk production. Best For Babes. Retrieved December 12th, 2012 from Best for Babes Web Site: http://www.bestforbabes.org/booby-traps-series-postpartum-hemorrhage-and-retained-placenta-two-birth-related-causes-of-low-milk-pr

Marasco, L., PCOS and Breastfeeding. Retrieved Decemeber 12th, 2012 from Hcp.obgyn.net website: http://www.obgyn.net/displayarticle.asp?page=/pcos/articles/childers-chats

Neifert, M.R., (2001). Prevention of Breastfeeding Tragedies, Pediatr Clin North Am., 48, 273-297.

Neifert, M.R., Seacat ,J.M., Jobe, W.E., (1985). Lactation failure due to insufficient glandular development of the breast, Pediatrics, 76(5), 823-8.

Neville, M.C., Morton, J. (2001). Physiology and endocrine changes underlying human lactogenesis II. J Nutr., 131(11), 3005S-8S.

Ogunyemi, D. A. (2011). Overview. In Autoimmune Thyroid Disease and Pregnancy.
Retrieved April 8, 2012, from Webmed LLC Web Site: http://emedicine.medscape.com/article/261913-overview

Pennington, S. S., Abrams, A. C., & Lammon, C. B. (2009). Physiology of the Endocrine System. In Clinical Drug Therapy (9th ed., p. 341). Philadelphia: Lippincott, Williams and Wilkins. (Original work published 2001)

The Academy of Breastfeeding Medicine Protocol Committee (2005). ABM Clinical Protocol #13: Contraception During Breastfeeding

West, D., & Marasco, L. (2009). The Breastfeeding Mother’s Guide to Making More Milk. McGraw-Hill.

(c) 2015 Jolie Black Bear, IBCLC, Serena Meyer RN, IBCLC, Teglene Ryan, and Adrienne Uphoff, IBCLC -All Rights reserved.


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