I am excited to be able to feature Kate Gulbransen today, a certified lactation consultant, or CLC. Those of you on Twitter probably know her better as HygeiaKate, from the Hygeia Company. Recently, I asked readers to submit their breastfeeding questions for Kate to answer. Here are the questions and her responses:

Q. I would love to know why you should pull baby to you when they bite? What else can you do to help prevent biting?
A. When you pull baby closer to your breast after biting, it blocks the nose so she’ll instinctively open her mouth to breathe.

Older babies will sometimes bite when they’re distracted towards the end of a feed, so it can help to monitor baby’s cues and be ready to end the feeding if you notice she seems to be getting restless and no longer actually interested in eating. During this period of biting, you might avoid snack feedings, and only offer the breast when baby is really hungry.

During periods of teething some babies will bite to relieve some of the aching in the gums. Offering baby a chilled teething ring or cool, damp washcloth to chew on before a feeding session can help prevent the urge to bite while she’s on the breast.

If biting does occur, ending the feeding session temporarily and saying a firm “No biting/Don’t Bite” will teach baby that biting is not ok.

Q. Are there really male CLCs like on the office? Do CLCs really grab your breast when helping?
A. While there are a few male lactation consultants (Dr. Jay Gordon is one well-known male IBCLC), the overwhelming majority are women.

Most lactation consultants will ask permission before touching your breasts or will use their hands to guide your hands over the breast as they instruct.

Q. What are the most common causes of a lack of breast milk production? One of my midwives told me that only about 5% of women can’t produce milk and I was one of them.
A. Insufficient milk production is frequently due to unresolved breastfeeding difficulties in the early weeks of nursing. Poor latch, early supplementing, shortened/limited nursing sessions can all contribute to low milk supply. Allowing baby to nurse on demand, avoiding supplements, and working with a lactation consultant to resolve positioning issues can help ensure a good milk supply from the start.

Many moms become concerned about milk supply because their baby nurses frequently or is fussy. These are very common concerns, but not accurate indicators of milk production. Kellymom has a great reference card on supply indicators.

There are a handful of maternal and infant factors that can also contribute to low supply. A few of these factors include breast surgery, PCOS and insufficient glandular tissue. It’s especially important for these moms to advise their lactation consultant of their conditions to develop a customized nursing plan. Herbal galactagogues or medications like domperidone can also be helpful to boost milk production in the case of low supply.

I always like to remind moms with supply challenges that breastfeeding doesn’t need to be an all or nothing proposition. Moms can feel good about any amount of breast milk they are able to provide their babies.

Q. My baby had a poor latch (now corrected), that really damaged my nipples and they haven’t had a chance to heal. I started to pump, but I don’t seem to be making enough and have had to supplement with formula. What can I do while pumping to make sure that my milk production keeps up with her growing demand? What kind of challenges can I expect and try to combat in the next few days as I heal and try to switch her back to breastfeeding? Is there a difference between exclusively pumping and actually breastfeeding?
A. Poor latch can definitely contribute to sore nipples, so if that hasn’t been completely corrected I would strongly recommend working with an IBCLC (International Board Certified Lactation Consultant) when you get her back on the breast. During the next few days as pump full-time, it’s important to keep up your supply by pumping at least eight times a day. Many moms will see a difference in output by using a hospital-grade rental pump and combining pumping with gentle compresses/massaging of the breast to maximize production. This is sometimes called “hands-on pumping”, and this video from Stanford is an excellent guide.

Make sure that your pump flanges are the right size so your nipples can move freely and are not rubbing against the sides of the tunnel. I also recommend using a slow-flow nipple to help prevent her from developing a flow preference (nipple confusion).

Exclusively pumping is an option worthy of its own post as it comes with very unique challenges. I see many moms turning to this option because they don’t get enough support resolving breastfeeding difficulties. I always recommend resolving the problem at hand (poor latch causing sore nipples) before turning to exclusive pumping. Exclusively pumping adds a significant time commitment to the daily feeding routine without many of the personal rewards of breastfeeding (I’ve yet to meet a mom who looks forward to pumping). Because exclusive pumping is such a labor of love – emphasis on labor – I am continually impressed by the commitment of these moms to providing their babies with breast milk.

Q. I heard the health benefits of breast milk stop after about 4 months. Is that true?
A. There’s no timeline to when the health benefits of breastmilk end for moms and babies.

Both The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding (no solids) for the first six months of life, as breastmilk provides all of the nutrients a baby needs. After baby begins to eat solids, breastmilk will continue be a primary source of nutrition during the first year of life and beyond and will continue to offer protection against illness.

Breastfeeding offers many health benefits for moms as well. The longer a mom breastfeeds, the lower her risk is for breast cancer, endometrial cancer and ovarian cancer. Longer-term breastfeeding has also been associated with a reduced risk of heart disease for moms.