Fact of the Day

Babies are the best pump. They empty the breast better than either hand expression, manual or electric pumps. Even as the most efficient pump, babies never completely empty the breast. Breasts work on what could be called the “80:20 concept.” The 80 percent is the average amount of milk removed by your baby each day. The 20 percent is the residual amount of milk that remains in your breasts. If more than 80 percent of the milk is removed, supply increases to maintain the 80-20 ratio. If less than 80 percent is removed, supply decreases to maintain the 80-20 ratio. Even though this is an over-simplification of a very complex process, as new research emerges this core principle proves true.

Make mine a double! Caffeine and breastfeeding

This picture kinda reminds me of “the girls”… if you know what I mean…

“I’d like a skinny vanilla latté, extra foam extra whip cream!!” One of the first questions I get from a lot of nursing moms is, “when can I drink coffee again?!?” Some doctors don’t have a problem if moms drink one a ounce cup of coffee throughout the entirety of the pregnancy. Other moms because of risk factors are told not to have any until after the babies born. Whether you have coffee or not during your pregnancy, there are a few things to know before introducing it after your baby is born. The first is that it affects infants differently than adults. The following chart was taken from Kelly mom.com. It shows the half-life of caffeine in the bloodstream. I was surprised that Caffeine will stay in the bloodstream of the brand newborn for an average of up to five days!

Their sensitivity to caffeine decreases as they age. Signs of sensitivity are hyperactivity, difficulty sleeping or sleeping for long periods of time, jitteriness, irritability, and fussiness. If you drink coffee during your pregnancy, you might not see as much of an impact on activity levels in your baby if you continue to drink after birth. However if you have stained from college and your pregnancy, you may notice changes in your baby. Per Medications and Mother’s Milk (Hale 2017, p. 139-140) caffeine is in Lactation Risk Category L2 (safer); milk levels are quite low (0.06-1.5% of maternal dose) and usually peak 1-2 hours after ingestion. The American Academy of Pediatrics has classified caffeine as a “Maternal Medication Usually Compatible with Breastfeeding.” If you’re iron deficient or iron deficiency rubs in your family, be extra careful. One study indicated that chronic coffee drinking might decrease iron content of breastmilk (Nehlig & Debry, 1994). We actually routinely give caffeine directly to premature babies in our neonatal unit for lung stimulation!

Remember caffeine isn’t just in coffee! Tea, soft drinks, sports/energy drinks (including the “sports water” products), some over-the-counter and prescription medications, and foods containing coffee or chocolate can also have caffeine!! I can’t have Haagen Daz coffee ice cream late at night because it keeps me up!!! Herbal products containing guarana/paullinea cupana, kola nut/cola nitida, yerba maté, or green tea also contain caffeine. Each food and liquid has varying amounts of caffeine. Different roasts of coffee and the way that the coffee is made also impacts caffeine level. Make sure to check the caffeine level you’re ingesting by serving size to see how much you’re getting!! According to Breastfeeding Answers Made Simple (Hale Publishing 2010, p. 521), excessive caffeine consumption by the mother (more than 750 mg per day) can result in a baby who shows signs of caffeine stimulation.

I typically recommend no more than one 8-ounce cup of coffee a day for nursing mothers (but as a note!! An 8-ounce Starbucks coffee has 250mg of caffeine while a non-gourmet brewed 8-ounce cup of coffee only has 120-160mg of caffeine!!!!!!) The important thing is to know your body and know your baby. Be informed of what you are putting into your body and what is going into your baby. Watch for how your baby reacts to that 1st cup of coffee and if you need to, cut out coffee for a little while longer or switch to decaf.

I personally have my one cup of Costa Rican drip coffee with almond milk every morning. If I’m really lucky, my husband will make me an Italian latte before I leave for work. I can only have one cup. The few times I’ve had a 2nd cup early afternoon, I am up all night. So far my daughter has never had a reaction to coffee. Although, I drink a cup of coffee through most of my pregnancy with the blessing of my midwife. As with anything you consume, if you have any concerns talk to your primary care physician or your pediatrician. You may still want to avoid the Unicorn Frap…

Make it a double

They say you can’t over feed a breast fed baby. They’re usually pretty good about taking what they need and stopping when they’re full. This is because of stomach and breast anatomy. Remember how sucking and milk flow rate at the breast are different than the bottle? This directly links to stomach anatomy.

There are two kinds of receptors in the stomach: density and stretch. Density receptors tell you how calorically dense or fat-rich your food is. It’s why at the Cheesecake Factory your belly starts to feel really full after about ten bites of Godiva chocolate Cheesecake but you can eat 3 bags of popcorn at the theater. Chocolate is much richer and calorically denser than popcorn. Stretch receptors tell you how full your stomach is from a volume perspective. Your stomach at rest is on average the size of your fist. That’s true throughout your entire life. But the stomach can stretch. Just like my stretchy pants at Thanksgiving. It can still only fill to a certain capacity. The only problem is, it takes approximately 20 minutes for your stretch receptors to tell your brain that the stomach had stretched to capacity. This is what I call the twenty minute phenomenon. You know, when a group of college boys order a pizza, they each eat a whole pizza in ten minutes and then twenty minutes later feel over full and sick. They as much as they could as fast as they could but paid for it in the twenty minute window. Exclusively breast fed babies don’t typically over eat because again, breast milk flow varies over a feeding. It starts slow, mommy goes into let down, then milk shows, mommy changes the baby to the other side, milk starts slow, mommy goes into let down, 15-20 minutes later the baby’s stomach tells the brain it’s full and the baby stops eating. Anatomy and physiology in perfect harmony.

Unfortunately bottle fed can be over fed. Bottles have these lovely ounce markers on them that tell us how much the baby needs to eat to be full. At every feeding my baby NEEDS to get a full 5 ounces of she will be hungry. She NEEDS to eat 24 ounces in a day or she will starve to death. And when baby stops eating at 3.5 ounces, I just jiggle the bottle or wait a few minutes and jiggle the bottle until baby takes that full feeding. Jiggle, wiggle, look at that she took the full feeding. Instead of listen to baby’s cuts that she’s full, we let the bottle dictate how much baby needs. And we wonder why formula feed babies have a significantly higher rate of obesity. Here’s the thing. Bottles are not the enemy. My daughter takes breast milk from a bottle five days a week while I’m at work. They are lovely devices that do an essential job. But we need to be mindful to not over feed our bottle fed babies.

Tips to not over feed a bottle fed baby (regardless of what’s in the bottle)

1. Always use a show flow nipple until 1 year of age. Slow flow most closely mimicks the flow at the breast. It also shows a baby down so the brain can keep up with the stomach (aka be mindful of those stretch receptors).

2. Watch your baby’s cues. Does he push the bottle away? Did he become sleepy? Do his hands and body relax? Does he release his iron grip on the nipple? These are signs he’s done. Over fed babies tend to spit up or vomit more because their tummies are at capacity. Don’t try to force in that last half an ounce. Respect your baby and stop feeding. Your baby will let you know if he’s still hungry.

3. In reality, babies only ever need 3-5 ounces of milk per feeding. In the first four to six months when your baby isn’t eating any solids, here’s a simple rule of thumb: Offer 2.5 ounces of formula per pound of body weight each day. For example, if your baby weighs 6 pounds, you’ll give her about 15 ounces of formula in a 24-hour period. Once a baby is six months of age and starting solid foods, offer the breast or bottle first (3-5 ounces), then offer well balanced, nutritious, solids. The solids will provide them the additional nutrition they need. (**Disclaimer : if your baby is not ready for solids at six months, that’s FINE. Your baby is ready to start solids when they can sit unsupported for a good amount of time, uses a pintcher grasp, and has the hand eye coordination of hand to mouth. If your baby is over six months and not taking solids, your baby may need additional milk per feeding.)

4. It is OK for volumes of feedings to be didn’t throughout the day. We take for granted that babies can know their bodies. They can tell us when they’re hungry and when they’re full. Sometimes I’m really hungry in the morning and I eat a Grand Slam breakfast. Other times I only want a piece of toast. It’s OK to have your baby eat a ton one meal and very little the next. Remember, there are no ounce markers on the breast. Exclusively breast fed babies do this all the time. And there’s no amount of nipple jigging that will get them to take more in a feeding.

Here’s the big take away: it’s OK to take the pressure off feeding, especially if your a working mom trying to keep up with pumping. As long as your baby is following their growth curve, making enough wet and dirty diapers, and happy, keep doing what you’re doing. If your baby is not getting enough nutrition, not gaining weight, or unhappy, please have your pediatrician write a referral to a pediatric clinic ASAP or give me a call and we can dialogue through a plan of action.

Happy feeding!!

Pumping Log #2

What’s in my pumping bag. A well stocked pumping bag is the most essential item you will need when you go back to work. Packing the bag efficiently and with necessities can help eliminate stress and worry while pumping at work. Here are a few of the things in my pumping bag. Obviously the pump is the most important piece. Make sure to check that you have all the pieces and parts in the morning before you leave for work. I had forgotten one or two pieces several times. I actually now keep a spare pump in my car that is always ready to go in the event that I forget something. I always keep instant oatmeal, mothers milk tea, and honey sticks ready for a quick snack on the go. When I know I am going to work the next day, I bring empty bottles to put my milk in. That way I can keep it in the fridge and handy for the next days feedings. If I know I am going to be home the next day, I use disposable milk storage bags. I’ve tried several brands and really like the Dr. DuDu. They’re sturdy and have a double zipper. Plus they come in a handy 8oz size for streamlining in the freezer. I can put my pumped milk in the freezer and it will be ready to go the next time I’m at work. I always keep extra nursing bra pads. I wear washable ones made of bamboo fiber. But you never know when you might need to change them. I keep it small stash of disposable ones in my bag at all times. Another necessity is my stash of essential oil’s. I use fennel to help keep my supply up. Serenity, lavender, balance, and citrus bliss help elevate my mood when I’m feeling down at work. What’s in your bag?

 

 

Food for Thought

How long should I breastfeed my baby?

The American Academy of Pediatrics recommends that babies be EXCLUSIVELY breastfed for about the first six months of life. This means that your baby needs no additional food (except Vitamin D) or fluids unless medically necessary. Babies should continue to breastfeed for one to two years or for as long as is mutually desired by the mother and baby.

When should I start solid foods with my baby?

How do you know when your baby is ready for solid food? After six months of age, they should be able to do these three things:

  1. They sit unsupported for an extended length of time
  2. They are starting to use a pincher grasp (thumb and forefinger together to grab little objects)
  3. They start to have eye-hand coordination to bring their hands to their mouth