Milk Supply?  Work Smarter, Not Harder.

Milk Supply? Work Smarter, Not Harder.

Today our expert owner Dr. Kathleen F. McCue is sharing her thoughts on low milk supply and some of the underlying reasons.

Dr. McCue:

It’s fair to say that I make a living regulating milk supply. The number one complaint we hear from clients is, “I don’t have enough milk!” Sometimes I’m in agreement and other times, expectations are totally unrealistic. There are so many things that come into play; storage capacity of the breasts (meaning amount of glandular tissue and milk-making alveoli within the breast itself); adequate nipple stimulation to help produce prolactin (a hormone that promotes milk production); suckling ability of the baby (big strong baby or jaundiced baby with a low birth weight); frequency of stimulation by either baby or breastpump.

Here are some of the issues I look for, and as always, a consultation with an International Board Certified Lactation Consultant will help determine what’s happening and how to assist:

  • Do you have adequate breast tissue, in other words, do you have very small or conical shaped (meaning tubular-shaped) breasts? Did your breasts increase with size during pregnancy? You should have gone up approximately one cup size.
  • Are you bleeding for a prolonged period or passing clots in addition to not making enough breast milk? These are signs of retained placenta, which can prevent the milk from fully coming in.
  • Are you using a personal use pump to express milk more than 3-5 times a week? The pumps from insurance companies are rarely adequate to pump when separated from babies for extended periods. This means if you’re exclusively pumping, or back at work, leaving the house at 8 and returning at 6, you’re going to most likely need a hospital grade pump. Insurance pumps that you own are sometimes called “hospital grade” but in the world of lactation consultants, we mean the kind that you rent from your lactation consultant or hospital. My favorite is the Medela Symphony because it’s only seven pounds and has a soft stimulation phase that helps moms produce prolactin.
  • Are your flanges the correct size? The flanges are the funnels that cover your breasts and nipples. I can’t tell you how many times we’ve seen JUMBO flanges that are totally unnecessary. You want some stimulation for the nipples. You can size your flanges properly by looking at the nipple when you pump. There should be clearance enough around the entire perimeter of the nipple (mid base to tip) and you should not have a large part of the areola or breast itself being sucked in. You also don’t want them too small or you could cause damage (read: soreness) from pumping, and prevent milk from draining well from the breast. This can be tricky, so again, find a local lactation consultant to help you.
  • I always recommend double pumping (both breasts at once) for 20-30 minutes when back at work or when pumping to substitute for direct breastfeeding. Fifteen minutes rarely cuts it unless you have an oversupply but again, if that’s your problem you’re not my reader! Yes, I know the milk stops coming but if you can hang in there a few minutes longer, you’ll get another letdown, meaning the milk will start to squirt out again. It’s great to have at least two or three letdowns.  Some moms can initiate another letdown but putting the pump back on the stimulation (or letdown) phase, or by taking a short pause to massage the breasts before resuming pumping.
  • Have you had a low supply since baby’s birth? Maybe you’re dealing with a tongue tie or lip tie or both. Is baby a good feeder, meaning is he/she gaining at least an ounce a day?  If you suspect your baby is having difficulty latching onto your breast and emptying them well enough to bring your supply in, an in-person evaluation with an IBCLC will help you figure out how best to help.
  • Is your baby sleeping through the night? If they are in bed by 7 or 8pm, you should pump before going to bed at 10 or 11pm. If you go to bed when baby does, you should optimally not go longer than 6 hours without stimulation to the breasts.
  • Do you have thyroid problems, low iron or insulin resistance? These can all cause low milk supply.
  • Are you on ANY type of hormonal contraception? OBs and midwives sometimes aren’t aware that even progesterone only (mini-pill) or IUDs like the Mirena can really impact milk supply negatively.
  • Are you drinking more than what you’re thirsty for? More water than you need actually works against you and you’ll end up peeing more and making less milk.

If you’ve ticked through this entire list and are still unable to increase your milk supply, visit your local IBCLC or contact us!





Help!  My pump won’t work!

Help! My pump won’t work!

If you’re experiencing an issue with your Medela Symphony rental pump, our troubleshooting guide may help you resolve the issue. If you’re still having difficulty with your pump after following these troubleshooting steps, please contact us at 301-943-9293, or for assistance!  If necessary, we will make arrangements to exchange your pump.


Issue #1: My pump won’t turn on!

Please make sure the back of the Medela Symphony pump is plugged in properly – the short black cord needs to be plugged back into the pump itself, while the long cord is plugged into a power source.  See the photos below for an example:

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Issue #2: My pump has low suction!

There are several possible causes for low breastpump suction. First, please check your pieces. The valves and membranes should be free from defects.  Make sure the white membranes lay flat against the yellow valve and don’t have any tears.  Over time, these membranes will need to be replaced.  If you pump often (4 times a day or more), the membranes may need to be changed every 2 weeks or so.  If you pump less frequently, every few months should be sufficient.


Your tubing should be purchased from a Medela-authorized retailer. It is common for generic tubing to not work well. If your tubing appears to have any crimps, punctures, or mold growth, please purchase another set of tubing.

The flanges (the pieces that come in contact with your breasts) should fit properly. Not every woman will need the 24mm flanges that are included with the kit. Aside from some discomfort, your pump may appear to have suction issues if you are using the wrong flange size. You can view Medela’s sizing guide here to determine if you need a different size. If you are still unable to determine your best size, please contact us to set up a time to visit us in our office for a professional fitting.

The caps under the lid will sometimes come loose during regular use. Make sure that the caps are properly secured. When you put them in the breastpump, you should hear and feel a small “pop”, and that means they are secured correctly. See the photos below:

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If you think only one side of your breastpump is having suction issues, you can do a quick test to determine the cause. Open the lid and switch out the parts from one side to the other, caps and all. If the side with the suction issues is suddenly better and the other side is worse, you should inspect your parts for defects; there is likely nothing wrong with your breastpump. If you’re still experiencing low suction on the side you initially thought was the problem, contact us to arrange an exchange.


Issue #3: My pump displays an error message, chirps, then shuts down!

Sometimes unavoidable problems occur with the pumps as they age. If your pump is displaying an error message, you can reset the pump to get you through the next couple of pumping sessions, but you should make arrangements to exchange the pump as soon as possible.

To reset your pump, follow the steps outlined below:

  1. Press the let-down button and hold.
  2. While holding the let-down button, press the on/off button.
  3. Release both buttons when pump reads “please wait.”

You can also do a hard reset of the breastpump by removing and reinserting the program card. To do that, disconnect the plug from the wall outlet, remove the screw from the cord protector, and slide everything up until it comes off. Remove the card, gently dust it off with a clean, dry cloth, then reinsert it. Put the cord protector back on the breastpump and screw it in place. Refer to the pictures below:

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This is what the back of the cord protector should look like before you put it back on the breastpump:


Keep in mind, it is normal for your Symphony breastpump to shut off automatically after 30 minutes.


Issue #4: My battery-operated Symphony breastpump keeps saying “battery flat” or “battery low” even though it just finished charging!

Just like a laptop, sometimes the internal batteries in the Symphony Plus model need to be replaced. If your pump has charged for the recommended amount of time (12 hours) and will not remain on for at least two full 30-minute pumping sessions throughout the day, please make arrangments to exchange it as soon as possible. The pump will continue to work while plugged in, but you shouldn’t depend on a spent battery for continued cordless operation.

Here are some tips to extend the life of your Symphony Plus pump:

  1. Charge the pump for a full 12 hours upon receipt.
  2. Do not fully drain the battery on a regular basis.
  3. Allow the pump to charge when not in use.
  4. Charge the pump for 12 hours each night at a minimum. Pumps will still work while they are plugged in.


Issue #5: My Medela breastpump is making strange noises, movements, or noticeably fluctuates in suction while pumping.

Some noises and lid movements are normal, especially if you’re using higher suction settings. Unless you notice a decrease in performance, it is not always necessary to contact us about these issues. However, if the suction on your breastpump fluctuates without any user input or if you become concerned with noises/lid movements, please do not hesitate to contact us for troubleshooting, or an exchange. We want you to be completely satisfied with the services you receive from us!

If you are having any other problems with your pump that haven’t been discussed in this article and would like to discuss a solution, please don’t hesitate to contact us.

Metropolitan Breastfeeding Now Takes TriCare!

Metropolitan Breastfeeding Now Takes TriCare!

Thank you to all our incredible service members in the community!  We are thrilled to announce that we are now in-network with TriCare health insurance.  Members of TriCare can look through the website to see what services are covered.  As in-network providers that means you can book appointments with Metropolitan Breastfeeding and be seen in-home or in-office using your insurance plan!

Did you deliver at Walter Reed? Our Bethesda office is right around the corner!  Not close to Bethesda?  Our consultants can come see you all over the Maryland, Virginia and DC area.

Service members also receive a military rate on breastpump rentals.  Make sure when you call our office you mention that you are a service member.

As always, we will work with all of our families regardless of insurance status.  Please call the office at 301-943-9293 to discuss your needs.

image courtesy

Photo credit: Vanessa A. Simmons, CLEC –



Self Care in the Postpartum Period

Self Care in the Postpartum Period

So, here’s the deal. You just had a baby! After nine long months of preparing for this very moment, you find yourself swept into a whirlwind of excitement, fear, exhaustion, and joy. No matter how many parenting books you read or hours you spent typing questions into the Google search bar, you may still feel an overwhelming sense of, “What do I do now?”

The postpartum stage of pregnancy is often neglected in the intense journey towards your due date, but it is one of the most physically and emotionally challenging periods for a new parent. Much of your focus will be dedicated to your brand new baby as you become acquainted and try to decipher every cry. It’s easy to forget that you just completed a nine-month marathon where your body, mind, and soul were stretched to their absolute limits. Take a moment, breathe, and congratulate yourself! In order to be the best parent you can be, you must first take care of yourself.

Here are 7 essential tips to help new parents power through the postpartum period:

  1. Get more sleep. Many new parents struggle to get any semblance of rest as they shoulder new responsibilities and cope with their baby’s erratic sleep schedule. It’s best to sleep when your baby sleeps, but getting your baby acquainted with day and night needs to be a priority. Small things like leaving the curtains open during daytime naps and keeping the nursery dark and quiet during nighttime dozes can encourage a regular circadian rhythm. And a rested baby is a rested mother.
  2. Keep taking your prenatal vitamins. Although it might seem logical to stop taking prenatal vitamins when you are no longer pregnant, these crucial doses of nutrition may be important for both breastfeeding and your body’s recovery. Make sure you are eating regularly, and talk to your OB/GYN about continuing your supplement regime.
  3. Be patient with breastfeeding. Breastfeeding is a completely new experience for both you and your baby, so try not to panic if you encounter a few obstacles. In general, make sure you are staying hydrated, keeping calm, and caring for your breasts.  If you are having difficulty or need answers to your questions, ask for help – there are lactation consultants for a reason!
  4. Make a funny file. How long has it been since you laughed out loud? With all of the emotions and exhaustion weighing you down, you truly need a dose of laughter to keep yourself afloat. Start making a folder of silly memes, YouTube videos of animals making weird sounds, or clips from your favorite stand-up comedian. We promise that these will come in handy later!
  5. Join a group. If you are struggling to get out of the house in the weeks or months following delivery, you may begin to feel alone. The stress of parenthood can be isolating in itself, as you may find it difficult to keep up with your old social circle. Find other parnets in your area through MeetUp, Mothers Offering Mothers Support (MOMS), or Mocha Moms. Connecting with others who are experiencing the same crazy life changes as you may help you make the journey a little less scary.
  6. Treat yourself. Find 20 minutes each day to dedicate totally to yourself. Make a cup of green tea and read a book. Light some scented candles and take a bubble bath. Pop on a pair of headphones and listen to your favorite podcast. A little bit of self-care will go a long way!
  7. Ask for help. Throughout all the craziness, it’s crucial to remember that you are not alone. Don’t be afraid to ask for help with watching your new baby, cleaning around the house, buying groceries, or folding the laundry. Every Superparent needs a couple sidekicks to get through the day.
The Winter Baby

The Winter Baby

Oh- the weather outside is frightful, but the Winter Baby is so delightful!

That’s right, we’re going to be talking about Winter Babies! What is a Winter Baby? Well, it’s simply a baby born in the midst of the cold winter months! Some parents may become a bit worried about having a baby during the colder months of the year, so we wanted to ease some of those concerns by highlighting the pros of having a Winter Baby.

Snow days

Snowing? No need to worry! You can stay in with your baby and enjoy watching the snow fall while cuddling up with your little one! Throw on a movie or a show to binge and get comfy with your bundle of joy.

Baby will be ready to go out on Spring adventures

By the time Spring comes around, your baby will be more interactive and ready for Spring and Summer adventures with the family.

Holidays and sense of togetherness

The holidays are the staple of the winter season, and you’ll have an amazing gift to share the season with. Click here to read our blogpost on setting holiday boundaries with your family!

Pajama Season> Bathing Suit Season

After giving birth, you probably want to cuddle up in your pajamas and fluffy blankets. This is what winter is all about! We think pajama season is a hundred times better than swimsuit season!

Comfort food

Who doesn’t love food? Winter time is known for turkey, stuffing, mac n’ cheese, and all types of desserts (are you drooling yet?). There’s something about a plate of food, a cup of hot chocolate, and cuddles from a newborn that can bring a feeling of happiness to anyone.

Did you have a Winter Baby? If so, what are some of your favorite things about having your baby during the cooler months? Tell us on our Facebook! Also, check out our tips on surviving winter with a newborn to make sure you’re prepared for cold and flu season.

Holiday Boundaries with Baby

Holiday Boundaries with Baby

Tis the season of holiday gatherings and events, and we know how stressful the season can be for parents with a newborn. This season is full of love and family togetherness, but it can come at a price for newborns. With the weather getting colder and families spending most of the days inside, colds and flu are a cause for concern for many parents of newborns. Because of this, it’s important for new parents to set boundaries with family and friends during holiday get-togethers. A general rule we believe is important is the ‘No touching’ rule. It seems simple enough, but we all know that there will be at least one person that wants to believe they are the exception to the rule.

Saying No

The grandparents, aunts, uncles, etc., will want to cuddle and kiss on their new addition to the family, and you might be a little more hesitant to tell them ‘no.’ We get it – they’re family! But the little bundle of joy you brought into the world needs you to be the one to protect them from possible exposure to the cold and flu. If you are having trouble thinking of how to lay down the law, here are some helpful tips:

  • Be Upfront and Confident – Don’t beat around the bush! Tell anyone that will be around your baby what you expect from them. They should respect your rules, as it’s for your baby!
  • Be Calm – If someone is challenging/questioning your rules, try and stay calm and don’t give in. People get frustrated when they can’t kiss a cute baby, but that frustration will pass (and if it doesn’t, then it is not on you to compromise).
  • Be Patient – There might be times where you might want to bend your rules but be patient and hold onto them. For example, you may have a little niece or nephew that wants to cuddle with your newborn, and as cute as that maybe you should be cautious of who is exposed to your newborn. Your baby will be grateful that you were!

Sick and Breastfeeding

If you or your breastfed baby do become sick, the best thing you could do is continue breastfeeding. The amazing thing about breastmilk is that its composition will change to help baby’s needs. For example, your body will know if you or your baby is sick and will increase the antibodies produced in the breastmilk. So, if the breastfeeding parent stopped breastfeeding they will not only hurt their supply, but they’ll also prevent the baby from obtaining those needed antibodies.

The holidays can be a tad stressful, but don’t let that stop you or your family from enjoying it! Set your ground rules, be sure everyone fully understands, and go have a little fun. If you have any holiday stories about your baby, we’d love to hear about it on our Facebook!