Your Breastfeeding Questions Answered

Dr. Jane Morton, Clinical Professor of Pediatrics at Stanford University School of Medicine, is an expert on nursing premature infants as well as a member of the Breastfeeding.com medical advisory board.

Dr. Morton works one-on-one with new mothers at the Lucile Packard Children's Hospital at Stanford University, teaching moms how to breastfeed successfully.  In 1997, Focus Magazine named Dr. Morton one of the "Best Doctors in the Bay Area," and she was again selected by her peers as one of "Silicon Valley's Best Physicians" as reported in The Sane Jose Magazine in 1999.

	How long can breastmilk be stored at room temperature?
	I'm traveling and need to store my breastmilk - Help!
	I had a difficult breastfeeding experience, and now my supply is almost gone!
	I am going back to work - how can I continue to nurse?
	My baby regurgitates a lot of breastmilk - is this normal?
	Can I take antidepressants while I nurse?

How long can breastmilk be stored at room temperature?

If I leave freshly expressed milk at room temperature for a couple of hours, can I put it in the refrigerator or freeze it later?





There are guidelines for how long you can leave out fresh milk, and for how long you can keep in the refrigerator and freezer.  The truth is that breastmilk remains uncontaminated for a longer period of time than processed milk, primarily because of all of the antibacterial factors.  What cannot be factored in, however, is how the milk was collected.  Obviously if you are scrapping it off your breast into a cup there is more skin contamination than if you are only collecting the sprays or milk directly into a container.  I would feel comfortable refrigerating milk that has been sitting out for several hours and using it within a 72-hour period.  Milk can be frozen for 6 months, but if there is concern about collection techniques I would use it sooner rather than later.

Charmaine, I noticed your baby has gained 17 ounces at one month.  For a large baby, this is relatively small weight gain.  This may be absolutely fine, but because the average baby (average birthweight 7.5 pounds) gains 26 ounces at a month, I'd suggest double checking with your pediatrician to make sure some of this milk you are putting in the refrigerator shouldn't be given to your baby.

I'm traveling and need to store by breastmilk - Help!

We are traveling via plane for 8 hours for vacation.  We arrive at 11 pm and the next morning at 9 am I will be leaving my baby for approximately 30 hours.

I want her to have my milk, but am unsure how I can transport my already expressed and frozen milk in the plane.  I read the guidelines for storage and was unsure if I took the frozen milk in a insulated lunch bag with freezer packs keeping it cool and then refrigerated once I arrived if it would still be OK towards the end of my 30-hour absence?  Or is there another method for transporting it?  Thank you for your time!





It sounds like the milk will be in a refrigerator or the equivalent for about 38 hours.  This is perfectly fine. Freshly expressed breastmilk can be stored in a refrigerator for up to three days without spoiling. Have a good trip!

I've had a difficult breastfeeding experience, and now my supply is almost gone!

My angel was born by C-section after two days of contractions.  The cesarean was necessary because of a suspected infection, which would have affected Julia while being born.

Although I was exhausted and passing out from the drugs and fatigue, I was "encouraged" to nurse soon after she was born.  I had no idea what I was doing at any point in the hospital.  Nurses would watch Julia feed and tell me that we were doing fine.  A lactation consultant came by and didn't say much.  The baby even had one or two of those brownish urine diapers, which I was told was normal but now I think was dehydration.  She lost 15 ounces in the first two days - which the pediatrician said was a lot, but nothing to be overly worried about.

I nursed a lot after she was born, and at first, everything seemed to be going well.  We saw the pediatrician when Julia was 10 days old and her weight was coming up.  However, at her 1-month appointment, she had only gained an additional 3 ounces and had not recovered her birth weight.  I began giving her formula after nursing per doctor's orders.  I also saw a lactation consultant.  She helped some and was worried that Julia was not latching on properly.  I began to take Regulan and Fenugreek.  Julia began to gain weight.

Then I went back to work. I'm a teacher and I only had two weeks left in the year.  I rented a Medela Lactina pump.  I have a lot of trouble getting very much milk to pump out.

I'm so frustrated I could scream, cry, and bite nails.  Until I went back to work, I was still nursing five to six times a day.  I try to pump and nurse, but I'm completely out of sync and off schedule.  The baby gets much more formula than breastmilk much to my chagrin.

The last couple of weeks when I nurse, the nipple gets really soft really fast and she can't hang on.  This has always been a little bit of a problem, but not as bad as it is now.  I am so frustrated that it is easier to give her the bottle at most feedings.  I save the breast milk I pump, since she isn't getting any by nursing and give that to her in a bottle when I have at least 3 ounces.  Breastmilk from a bottle seems to be her favorite.  She tolerates the formula, but we have no choice.  I can't let the poor child starve.

She is a tall baby and grows lengthwise easier than she does to gain weight.  She is very healthy and has been gaining weight steadily, if not a little slowly, since supplementing.

Help me if you can!





Dear Beth,

It sounds like a cascade of problems you have experienced.  First, let me say that your story is very familiar, and it sounds to me that you did a heroic job!

Unfortunately, the likelihood of having a dramatic increase in your milk production at this point is remote.  But, if we had it to do over again, what would we do differently?

Generally a baby loses no more than 8% of her birthweight before she begins gaining.  By 48 hours, Julia was down 12%, a real red flag!  This suggests that she was nursing ineffectively.  By doing so, she was not only inadequately accessing milk for herself, but also was inadequately stimulating your milk production.  At this point, I would have suggested renting a hospital grade pump, and looking at it with love in your eyes as the "ugly twin," using it eight times every 24-hour period  (six times during the day, two times during the night), would be imperative, in my experience.

A dehydrated, undernourished baby easily becomes apathetic and a less vigorous nurser.  By supplementing her with formula after an abbreviated nursing session (20-30 minutes) for several days, she would become more vigorous and less likely to fall asleep out of exhaustion rather than satiety.

A baby who cannot access a generous amount of milk easily at the breast frequently falls asleep or becomes frustrated.  A mother whose production has been significantly impaired for the first 10 days postpartum will typically have problems producing adequate volumes subsequently.  But this does not need to be repeated.  I hope your next experience can help you overcome your sadness about nursing Julia.

I am going back to work - how can I continue to nurse?

I am an RN.  I have been off of work for 11 months, and I must return to work in six weeks.  I work the ER on the night shift  (three 12 hour shifts per week).  My baby nurses approximately two to six times per night. I'm worried about her being traumatized by waking up and only her Dad is there and not me.  I don't want to wean yet, but everyone is pushing me to.  I'm feeling like it's already going to be so hard for her to adjust to me being gone.  I don't know what to do.





Suzanne,

I would certainly not advise you to wean her, particularly because it seems you both enjoy breastfeeding so much.  Women return to work all of the time and continue breastfeeding simply shifting the schedule and creating a more flexible situation  (i.e. a baby who is comfortable with a bottle of breast milk).  I think that you'll find that breastfeeding right before you leave and once you return home is the most wonderful way to say good-bye and then reconnect with your little Summer!  Nothing can be as comforting and focusing, as well as relaxing for both of you!

Remember to pump approximately every 4-6 hours while you are gone.

Yes, Summer will have to adjust to your absence, but she will quickly learn that her Father is as loving and nurturing as you in his own way.  Remember that every significant step of growth you take in your life comes with a bit of work.  This could be a gift rather than a traumatic experience.

My baby regurgitates a lot of breastmilk - is this normal?

Dear Jane,

I have been breastfeeding my daughter successfully from birth.  However, in the last couple of days, she has started sucking in air, which has made her regurgitate almost a whole feed on a couple of occasions.

I find this quite distressing.  She seems to be latched on properly.  Am I doing something wrong? Thank you for your help.





Dear Avril,

At 16 days, little Aurora is now 8 ounces above birthweight.  This is perfect! Your production is obviously picking up nicely.  Occasionally, Aurora will take more than she needs.  The stomach is j-shaped and frequently a bubble of gas collects a the tip of the j-shape.  When she burps, she'll also be spitting up some volumes of milk.  This is called a "wet burp."  The worst part of this is simply the laundry!  Aurora will quickly insist on taking in the calories she needs.  You don't need to worry about this.

Some babies begin gulping when their mother has a hard letdown.  This is particularly true in mothers with generous production.  Sometimes, they even back off and get sprayed in the face.  If she has a difficult time handling your letdown (seeming like she is trying to take a sip out of a fire hydrant), once you begin feeling the sensation of your letdown, take her off and take your forearm and press it firmly over your nipple and areola.  Hold it for 5-10 seconds, and see if this helps to slow things down.  Then, put Aurora back on the breast. Good luck!  Just keep doing the laundry.

Can I take antidepressants while I nurse?

Dr. Morton,

I have suffered from depression for years, but it has
been getting worse.  I went to my family doctor and we have made an association to my menstrual cycle.

I am currently trying Evening Primrose Oil and vitamin B6.  I haven't noticed a change and was wondering if there is something else herbal I can take.  Before I was pregnant I had great success with St. John's Wort, but have heard (not from my doctor) that I can't take it while nursing.

Griffin's nursing schedule is as follows:  In the morning when he awakens, before he naps and after he wakes up  - and maybe a quick nurse in the late afternoon and before bed.

I would rather stay away from antidepressants and just go the herbal route, but I feel as though I'm running out of options.  Please help me if you can.





Dear Jennifer,

Typically doctors know very little about herbal remedies.  While they may be very effective, the hard research has not been done to support the efficacy of many of these remedies.  I'm so sorry I can't help you out in this respect.

I would say, however, that depression is, unfortunately, not an uncommon problem for many mothers, and trying to effectively handle your feelings is extremely important.  Before I would try antidepressants, I would make every effort to work with a good therapist, one that I trusted and felt comfortable with.  We've had more and more experience with antidepressants, and have to date found little evidence that the baby is adversely affected.  If you are parenting is strengthened while on antidepressants, I think it well worth taking them and continuing to breastfeed.

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