No You Can't See Antibodies In Your Breastmilk - Myth Busted

"My milk is really poor quality and doesn't have any antibodies anyway", said a mum during a phone call yesterday.  She went to continue but I had to interject - sorry, wait, what?

Turns out mum had seen some photos on Facebook. One showing white milk and the other showing a rich golden yellow - with the claim because baby was sick, the yellow colour was all the antibodies, just like colostrum....

Oh my days.

YOU CAN'T SEE ANTIBODIES with the naked eye!  Any more than you can see vitamin D or harmful bacteria, antibodies do not colour breastmilk.

Colostrum is not coloured by antibodies. The fact is colotrum can vary from mother to mother - it can be clear, pale and golden or bright orange like cordial!  What's more, colostrum can vary in colour hour to hour, day to day from the same mother. The colour variation and orange tinge is because of carotenoids in the fat, NOT antibodies.

Eat enough beta-carotene rich carrots, squash, sweet potatoes etc and you can turn your whole self orange too, in a condition called "carotenemia" (I kid you not).

Breastmilk is shown to be a dynamic fluid that changes moment to moment, hour to hour, day to day - to best meet the needs of that individual baby.  This means the time of day she expresses, how long ago it was since her baby fed/she last expressed, how full her breasts were at the time - all can make a massive difference to how milk looks when milk is removed.

We can best see this difference if a mum who has full breasts expresses until they feel softer and a "full feed" volume of milk has been removed (or more if mum has oversupply/engorgement):

As this post discusses - when mum is full, the first milk is higher in lactose (to fuel brain growth and provide a "drink").  As the breast drains, we see the fat content increase. If mum was to express milk right at the end of a feed, when her breasts felt much less full and softer, we'd see a picture more like the right. However unless mum was extremely full and then got a superb expression with a pump, she'd be unlikely to notice such a distinct difference as above - it's a gradual transition, not a flipping switch. If stood in the frige, it typically looks much more like this.

What's even more ridiculous about the whole "visible antibodies theory", is it seems people can't even decide what colour they are!

Vaccines DID NOT turn her breastmilk green, or blue, depending on your point of view (maybe it's like that dress where people saw different colours?). The claim is her body thought it was sick from the vaccines, sent this signal to mother who made coloured milk!

What's far more likely is mum ate some green foods, drank some Gatorade, took a Spirulina supplement or something else that tinged her breastmilk.

Mums are often worried their breastmilk doesn't look "right", or "nourishing" or that there isn't enough fat. This is purely because cow's milk proteins result in a yellowy/creamy hue (and typically the more cream the more golden/yellow). Yet human breastmilk as the norm has more of a white/bluey tinge unless the fat is separated out.  What's more, even expressing with hands on techniques, you're unlikely to remove as much milk (and thus fat) as a baby feeding well.  If you just put the pump on and go without breast compressions, you typically remove less still. 

Rest assured your milk is perfect for your baby.

When To Introduce a Bottle To a Breastfed Baby?

A few months ago I received a call from a confused mum; her baby was 3 months old, breastfed, and that night he had refused his daily bottle.  Mum couldn't understand why, after all they had given a bottle once per day since week 2 as advised to "get him used to it".  He had always taken it without a problem why now should he refuse?

I get asked when should parents introduce a bottle a lot, and like the mum above many are told early introduction equals success, and conversely if the bottle isn't introduced early then baby is likely to refuse or struggle with technique.

What's the deal?

Firstly expressing:

In the early days of breastfeeding (once milk has "come in") your body is trying to establish how much milk your baby needs and thus how much to produce.  It does this based on what is removed, so if you feed baby and then express, your breasts will replace a feed plus more to replace the amount expressed.

Mums often plan to express so dad can give a feed and allow a longer stretch of sleep, but in the early days this often proves rather impractical as missing a feed results in overfull, painful breasts - meaning mum ends up pumping again whilst dad gives the bottle.

Some mums deliberately choose to cultivate an oversupply early on, usually if they want to build a stockpile for some reason ie they want to feed baby now, plus add a regular amount to the freezer.  Otherwise an oversupply can be problematic, leading to engorged painful breasts between feeds, faster flowing milk and increased leaking (as an example at the extreme end of the scale, one mum I worked with had to sleep with a super absorbent nappy taped over each breast at night).

Bottles:

I've spoken to so many mums over the years who have diligently given a bottle every day, or every week from a young age to ensure baby would be used to taking it.

This doesn't however account for the fact babies have personalities. 

Some will take that daily/weekly bottle fine until one day they decide out of the blue that they don't want it thanks; others will continue to take a bottle just fine.  Some will refuse a bottle in the early days, then one day decide actually OK they will drink from it.  Others that aren't offered a bottle when young will take it just fine when offered at any age.   The same can also happen to a baby fed exclusively from the bottle.  I've worked with mums struggling to get the necessary amount of formula or expressed milk into baby because they fuss or refuse the bottle, take hours to consume small amounts or leak, splutter and gulp.

Introducing a bottle and finding baby takes it, really only tells you they will do so at that point in time.  It is no indicator of how baby will respond at any point in the future.

It seems a standard expectation (particularly with first babies) that mum will of course express and bottle feed at some point, imagine not being able to leave baby!  Some mums have no alternative but to do so if they need to work or be separated.  On the flipside if you don't need to, it's also OK if you don't want to, mums often tell us that the expectation she will want time away, is greater than her desire to actually do so.

Babies naturally settle into a more predictable pattern of feeding, and so some mums find it's easier to work things in and around this rather than expressing.  From around 4 months some soft spouted cups are suitable if you don't need bottles on a regular basis, and things like a doidy cup can be used even earlier.

Nipple confusion, real or not?

This really depends on who you ask!  In my experience the biggest risk in terms of bottles is if a baby hasn't completely mastered the breast and/or has reduced milk transfer, the flow from a bottle can cause some to quickly show preference to the easiest milk source, causing them to fuss earlier and earlier into breastfeeds (although as the breast isn't just food, they will often be happy to return to it afterwards).  Others in this situation will refuse a bottle outright too, but ultimately the key is resolving the initial problem, the bottle is a symptom.

Although more and more bottles are claiming to be "like the breast", realistically to baby they are still poles apart.  No bottle can deliver the smell, sounds and scents of mum (think Heston Blumenthal style dining). None are made of the same substance as nipples or let down in milk ejections as the breast does.

This can cause some to become impatient waiting for the breast to "letdown", which is why mums are often advised to use the slowest flow teat and encourage sucking without milk beforehand, with regular pauses during the feed.

For an infant refining his breastfeeding technique, I like an analogy Lisa at Everyday Miracle uses.  Imagine you are just learning to use a knife and fork, but at some feeds these are swapped for chopsticks - something that requires a totally different action and technique.

The added difference however is that the bottle requires far less effort than the breast, and the baby may try out techniques that work on the bottle when at the breast:

"When bottle feeding occurs, only the buccinator muscles and the orbicular muscle(s) of the mouth are exerted without stimulating other muscles. They concluded sucking only during breastfeeding promotes correct muscle activity, and thus proper development of the oral motor structures" (1) 

It's important to note however....

That giving a bottle doesn't mean baby wont be able to breastfeed effectively again.  I get asked quite frequently whether its worth persisting with breastfeeding if baby has had a bottle, could learning this incorrect action permanently hinder skills at the breast and be the cause of their problems?

Dig a little deeper however and a lot of mums experiencing problems now, who introduced a bottle in the early weeks when trying to establish feeding, did so because they were experiencing a problem; pain, baby that wouldn't leave the breast and settle, slow weight gain - whatever.  So we always have to question what came first, the chicken or the egg?

Even after a bottle baby can still refine, improve and develop their technique at the breast. Conversely some mums never need or want to use one and that's fine too :) 

1) The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers BMC Pediatrics 2009, 9:66 doi:10.1186/1471-2431-9-66

14 Tips For Expressing To Increase/Maintain Breastmilk Supply

1.  Consider Which Method Is Best For You:
In the first few days after your baby is born when colostrum is being produced, hand expressing is typically the most effective way to express. Typical volumes are around a tsp or two and can get lost in the mechanics of a breastpump.  Using a pump after hand expression is shown in one study to be beneficial to milk supply.

One volumes increase, double pumping with a hospital grade pump (such as the Ameda Elite) is for many the most effective in terms of removing milk as well as stimulating higher levels of prolactin.(1) It is also faster - therefore if you're exclusvely pumping, trying to increase supply or need to express regularly and want to reduce time they can be great to have.  In the UK your hospital or Surestart Centre may be able to loan you one, or you can hire them privately via pump agents and online.

Some mums do find they can hand express particularly well, but using both hands on techniques and pumps as outlined in point 2 appears particularly effective where possible.  Other mums struggle to hand express, and this video clip is well worth a watch if your current technique isn't working well.

If you're using a double pump, many will also allow either one or two collection sets to be attached - so you can start out with both and then switch to single if you want to use hands on.

An alternative is a hands free expressing bra such as this - you can see this demonstrated if you click the link in point 2.  

Always ensure you have the right size flange attached.

2.  Hands On Expressing:  View this clip   Yes it's aimed at mothers expressing for their premature infant, but anyone expressing can use these techniques.  Not only will you obtain more milk per express (the mothers in the video got double), but as the clip describes also increases supply as the breasts are well drained.

3.  Power Pumping: Some mums find "power pumping" can give supply a boost.  It is basically expressing more frequently mimicking a baby having a growth spurt.

Pump for 10-20 minutes

Rest for 10 minutes

Pump for 10 minutes

Rest for 10 minutes

Pump for 10 minutes.

This can be done once per day with standard pumping at other sessions, or back to back over a day or two before returning to typical pumping.

4.  To save washing flanges etc after each use: Pop in a ziplock bag or airtight tub and store in the fridge between uses (remember to rinse under hot water to warm them up before use!)  Then wash well with hot soapy water at the end of the day.  Sterilisation is not normally needed, one study that compared bacterial contamination of  milk when collection by sterile kits and a mother’s own kit, found no difference (2)

5.  If you're trying to build additional milk: Say for building a stash ready for returning to work (but don't need the milk immediately on demand for the baby) or are maintaining supply by pump, where feasible choose set times to express and try and stick within a 2 hour window of this time.  Ie if you pick 1pm, try and express as close to that time as possible - at least between 12-2.

6.  If pumping to supplement ie you need the milk now and want to increase supply, expressing around an hour after feeding your baby can give more milk than expressing immediately after, and still allow a gap before the next feed.

Mums with chronically low supply may find their breasts refill more slowly and if baby is feeding every 1 1/2 - 2 hours, expressing after an hour can leave them feeling emptier than usual for the next feed - in this instance expressing straight after the feed (or after the supplement is given if appropriate) may work better.

7. Some mum find starting with a faster speed yet low suction help trigger the milk ejection reflex (letdown):  You can then slow the cycle down, but gradually increase the vacuum to the maximum level that is comfortable.  Some pumps have cycles that automatically follow this pattern, others require manual adjustment.  Never turn the suction up more than is comfortable.

8.  Create sensory triggers:  When a baby is feeding, the contact, smell, sounds of baby can help the milk to flow.  Pumping is in comparison mechanical, and a learnt art that can take practice - introducing sensory stimulation can therefore help.  Some ideas include applying warmth to the breast before feeding, smelling/touching/stroking baby if possible, if not a photograph and an item that smells of them can help, perhaps even a recording of sounds they make on a phone, a video clip or suchlike.

Many mums find visualising flowing milk to be surprisingly effective, and light massage to the breast as shown in the video in clip 2.  Some mums find that they literally have to tune out and watch a film, read a book or magazine once letdown has been triggered - others find they yield more by watching or visualising; play around and see what works for you.

9.  Create positive associations:  Very few mothers love expressing and a lot hate it!  Therefore trying to link a positive association to pumping can help with the psychological aspect.  One mum saved her "trashy mags" for pumping time, another had a chocolate each time she expressed and a rather nice partner recently gave mum a shoulder/neck/foot massage when she expressed.  It of course depends on age of baby, whether partners are around, how long you are expressing for etc but as they say a spoonful of sugar...

10. Night pumping:  It's best to pump when you naturally wake during the night to tend to baby if possible, if you're apart from baby or struggle to wake some recommend drinking a large glass of water to prompt a middle of the night waking.  The logic is that waking naturally occurs during a lighter sleep cycle and thus you feel more well rested by morning than if disturbed by an alarm when in a deep sleep.

Night expressing is important for most mums trying to build or maintain supply with a pump, as prolactin levels are higher in the early hours.

Keep a cool bag/box next to the bed so you can pop expressed milk and pump parts in their until morning to save trekking to the fridge, and invest in a nightlight so you don't need to turn bright lights on to find everything.

11.  Pump frequently enough:

"A normal newborn baby nurses on average 8 to 12 times in a 24 hour period. Most experts suggest it is best if mom can come close to matching what the normal nursing baby would do at the breast, and recommend she pump about every two hours, not going longer than three hours between sessions. Understanding how milk production works can help moms in their efforts to establish good milk supply. The more frequently the breasts are emptied, the more milk mother should have. Therefore, if she were to pump at least every 3 hours, for about 20 minutes, she should establish and maintain a good milk supply. In the first couple of weeks, she may also want to pump at least twice at night, but not all mothers do this." Kellymom

12.  Pump for long enough:
This is typically 15-20 minutes, some suggest 5 minutes after last drops of milk.  If your baby needs you mid express however don't panic, you can try and slot an extra express in later if needs be - or perhaps do a few shorter expressions closer together (a variation of power pumping)  there has to be some degree of flexibility if mum is home alone and expressing longer term.

13.  If you have larger breasts play around with positioning.
I supported a mum recently who expressed with massage, yet applying slightly more pressure to the flange (not an uncomfortable amount) delivered even more milk still, so play around with pressure, positioning etc during different parts of the feed for maximum production.  Similarly try not to spend long periods expressing leaning forward too much - or you can end up with sore shoulders and back.  Get some pillows, cushions and get comfy.

14.  Use heat
Evidence suggests applying heat to the breasts prior to feeding increases expressing levels.  Heat packs that can be reheated in the microwave can be an easy and affordable option.

Remember the amount you can express is not an accurate reflection of the volume produced.  As the video clip in point 2 highlights, mother's can as much as double milk production after using an electric pump - highlighting they do not alone drain the breasts well.  Oxytocin levels are typically naturally lower when pumping (hence the additional sensory stimulation) and some mums do struggle to express well, even when they have lots of milk.

Do you have any other tips and tricks that worked for you?

1. Auerbach, K. Sequential and simultaneous breast pumping: a comparison. Int J Nurs Stud 1990; 27(3):257-65.

2. Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3rd Rev Ed. Schaumburg, IL: LLLI, 2007