Dear Karen, thank you for letting us chat today! Tell us your story:

A combination of everything: therapeutic conversations with the mother, as well as medical tasks when the babies are still very small. I want to give women the space to experience the existential experience of childbirth and the time that follows in the way they wish to.

Breastfeeding is incredibly convenient, but also highly complex – and the most natural thing in the world, because after all, it is the main source of nutrition for babies!

Breastfeeding follows a simple rule: demand regulates supply. When a baby sucks, various hormonal processes begin in the woman that enable breastfeeding. Simply put, the breast must be stimulated in order for milk to be produced. Milk production begins either by the baby sucking or by pumping with a milk pump.

Breastfeeding has a lot to do with relaxation. There are two hormones that come into play during breastfeeding: oxytocin and prolactin. However, both can only work unhindered if they are not inhibited by the stress hormone adrenaline.

Until the 1990s, it was mistakenly believed that there were “milk lakes” in the breasts. From this, it was inferred that if the baby had drunk from the breast, these lakes would be emptied and the breast would become soft again. This also led to the assumption that milk would only be produced again once the breast was empty. As a result, the baby was supposed to—and allowed to—feed only every four hours. None of this is true.

Milk is only produced when the baby sucks. That is why we now recommend feeding on demand or intuitively. There are so many old wives’ tales that persist stubbornly; sometimes it really is hard to believe.

Instead of “milk lakes,” there are milk ducts. The moment the baby starts sucking, a signal is sent to the brain: “Hey, someone is sucking here, make some milk!” Then prolactin comes into play—the hormone responsible for milk production. Many women can also feel their milk let down.

There are three important breastfeeding positions: the cradle hold, the back hold, and lying down to breastfeed – and many others. You can always get creative, as long as you follow the basic rules of latching to avoid sore nipples and similar issues. 

The cradle hold is often seen in cafés or when mothers breastfeed their babies on the go. The back hold is great for beginners because it gives you a good view of both the breast and the baby. Many babies feed well in this position, even when they are tired. It is also well suited for premature babies. Breastfeeding while lying down is particularly advantageous at night.

All three are great; it really depends on the situation. The best thing to remember is that the area of the breast where your baby’s chin rests receives the most stimulation and massage.

Especially at the beginning, I always recommend all three positions. As I mentioned, lying down to breastfeed can be very relaxing at night, while cradling or using other positions is often easier during the day. Different breastfeeding positions also change where your baby’s chin rests, massaging the entire breast. This is a good way to prevent clogged milk ducts.

In the so-called milk stasis, one or more milk ducts are blocked, so that the breast milk cannot flow freely. In addition, sometimes the lymph is also congested and the glands are swollen. When the breast is then stimulated and massaged again through breastfeeding, the lymph and glands usually relax again.

Milk stasis is also always associated with stress. A stressed mother can develop milk stasis very quickly. Some mothers have milk stasis very often and repeatedly, others only rarely – in any case, it is painful and can have several causes. By the way, an argument is sometimes enough to cause milk stasis.

If you notice that a hard spot has formed in a breast, that it may even have already turned red, a gentle (!) breast massage is called for. Because a milk stasis can easily develop into a breast inflammation (mastitis) without treatment. And that is really not to be trifled with. Working preventively is anyway the best thing to do to avoid milk stasis. So, regular palpation to see if there are any hard spots and then applying cabbage wraps or quark wraps to the breast. Cooling, showering, stroking out, or gently rubbing in an ointment can also work wonders.

Usually, it is latching issues, jaw tension, or other anatomical peculiarities such as a tongue tie that cause sore nipples. This is because with a tongue tie, the baby cannot pull the nipple back as easily. Then the nipple becomes very sore from the baby's attempts to latch.

To heal sore nipples, it helps to let fresh air get to them, let breast milk air dry, or also apply a very thin layer of pure lanolin after feeding. Silver caps for protection can also help, as can healing wool or so-called sock donuts.

Even with initial difficulties, there is not necessarily a reason to worry. Breastfeeding has to be learned, because even though it is the most natural thing in the world, you and your baby first have to adjust to each other. This is normal! As a rule, it takes a maximum of six weeks until even the biggest breastfeeding problems can be solved. And always very important: You don't have to handle all this alone. Your midwife, but also special breastfeeding consultants, are there to help you

Breastfeeding works like we discussed above: the baby latches on, sucks, and at that exact moment, the milk is produced. So the first sucking movements are "dry" - especially at the beginning after birth. Only then does the milk-ejection reflex deliver the breast milk to the child.

With a baby bottle, it usually works so that it just needs to be turned upside down, and the milk flows without much effort from the baby. Babies can quickly get used to this and become a little lazy. But it doesn't have to be that way, because after all, every baby is different.

If a mother wants to feed Pre starter milk but would actually prefer to breastfeed fully, there is the breastfeeding set as an alternative to the regular bottle. A very thin tube is taped to the nipple, and at the other end is a small container with the Pre milk. As soon as the baby sucks, the Pre also flows from the container in addition to the breast milk.

There are two hormones involved during breastfeeding: oxytocin and prolactin. However, both can only function properly if they are not inhibited by the stress hormone adrenaline.

Generally, I recommend that nursing mothers eat nutritiously. By this, I mean a nutrient-rich diet. In the morning, porridge with fruit is a good choice, followed by warm vegetables or hearty soups for lunch. Some calories are burned while breastfeeding. Therefore, the body needs energy. In between meals, trail mix, energy bars, and lactation balls are good options.

Well-known ingredients to stimulate milk production include fenugreek and milk thistle. There are even cultures in which mothers are recommended to eat a piece of fenugreek cake every day. 

Definitely! And yet it is important to remember again and again: Every mom and her baby decide for themselves how far along they are. Getting information is important, of course, but often your gut feeling is even more important! Don't let yourself be unsettled.

A good book doesn't come to mind right now, but there are three blogs that I like:

One is “von guten Eltern”, then “Geborgen Wachsen” and a blog by a pediatrician and father called “Kinder Verstehen”.

Karen Dirks is a midwife based in Berlin-Kreuzberg, employed at the maternity ward of a large hospital, and self-employed offering courses, prenatal check-ups, and postpartum care. In May 2022, she founded her practice sjael in the Bergmannkiez, thus fulfilling her lifelong professional dream.

The postpartum period is an incredibly intense time. We are also talking about the topic "When breastfeeding doesn't work out ...".

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