How many ounces of breast milk should my exclusively breastfed baby be eating at a feeding? This is usually on the top five questions from families. The answer is: that depends.
Some babies are grazers. They like smaller, more frequent feedings to keep their tummy from being too full or uncomfortable. Their feedings can range from 1-3 ounces of breast milk and they may feed 10 or more times a day.
Other babies are bingers. They like a big, full tummy and may take 3-5 or even occasionally 6 ounces of breast milk but not as often. They may feed only 6-8 times a day and have longer sleep stretches. Their tummy doesn’t mind being stretched fuller and their bodies tell them it’s ok to go longer between feedings.
A helpful question to always be asking is: how many times a day is baby feeding? From one month to one year, babies take between 19-32 ounces of breast milk a day. The average is 25 ounces in 24 hours. There’s a range because, just like us as adults, some days we want to eat more than other days depending on the activities of the day, growth spurts, cravings, and even babies emotionally eat sometimes. Trust your baby to know their stomach better than you do.
Babies get hungry frequently: 8-12 or more times a day. They drink so much breast milk because they grow so rapidly. They will double their birth weight by six months and triple their weight by a year. Imagine how much you would need to eat to double your weight in six months! You may feel like you feed your baby all the time, and you are. Every 1-3 hours in the first few months is normal!! Every feeding is different and breast milk volumes taken vary throughout the day. Sometimes you want a snack and sometimes you want a buffet.
How is pumping going for you and can you keep up with his volume needs? Pumping is never an indication of your breast milk supply, it just indicates what your pump can empty from you. So many people have their breast milk supply sabotaged by baby being overfed from a quick flowing bottle, not enough time spent during the feeding, or interpreting baby’s cues wrong.
If your milk supply is keeping up with their demand there’s no problem. If you’re concerned about your baby’s feeding habits, definitely schedule a consultation with me.
Oxytocin is a hormone produced by the pituitary gland in the brain. It increases relaxation, lowers stress and anxiety, lowers blood pressure, and causes muscle contractions. Oxytocin, also called the mothering, cuddle or love hormone, is involved in social relationships, bonding, trust, and love. Breastfeeding stimulates the release of oxytocin from your brain. When your baby latches on to breastfeed, the nerve cells in your breasts send a signal to your brain to release oxytocin. The oxytocin causes the muscles around the milk-making glands in your breast to contract, squeezing the breast milk into the milk ducts. The milk ducts then contract to push the breast milk through your breast, out of the nipple to your baby. This is called the let-down reflex. As baby continues to breastfeed, more oxytocin is released and milk continues to flow. You may experience 2-14 let-downs in one breastfeeding session! The release of oxytocin while you're breastfeeding may make you feel sleepy and relaxed. It can raise your body temperature and is one of the reasons you may feel so hot while nursing. It might also make you feel thirsty or even give you a headache!
Oxytocin can cause your milk to let-down when you're not breastfeeding. Hearing a baby cry, thinking about your baby or even smelling something that reminds you of your baby can trigger oxytocin flow and make you leak!! While oxytocin is responsible for the let-down reflex and the release of breast milk from your body, it has nothing to do with the amount of breast milk that you will make. Prolactin is the hormone that does that.
Some people feel the oxytocin release (aka Let-Down) and others don’t. Both are totally normal!
Signs of let down include:
Tingling or a pins-and-needles sensation in your breasts. It could be a light sensation or even an electrical shock feeling.
Hearing baby swallow while at the breast.
Leaking milk from the other breast
Uterine cramps when breastfeeding, especially the first week.
Feeling happy and relaxed after you feed your baby.
Factors that inhibit oxytocin release and let down include: pain, breast surgery or trauma, stress, illness, fatigue, fear, embarrassment, drinking or smoking.
Some mothers may breastfeed and let-down milk just fine to baby but struggle to release milk to an electric pump. A quality double electric breast pump will have two modes: a quick cycle/light suction or "stimulation" mode, and a slow cycle, hard suction of "expression" mode. By alternating several times between these modes in a pump session, you can trick your body into thinking baby is feeding to stimulate more let-downs of milk. When pumping, you can also help stimulate your body to let-down more often by:
Watching videos or looking at pictures of your baby
Smelling something that reminds you of your baby (a onesie, your baby shampoo or soap, lavender)
How can I make fattier milk? I get this question a lot. Fat in breast milk changes constantly both throughout the day and as baby ages. It is predominantly influenced by how full/empty the breast is which tells your body how old your baby is. Newborns nurse around the clock and have a higher milk fat content than toddlers who may only nurse a handful of times a day and are getting their fats from table foods. Your diet does not usually have an effect on the quantity of fat present in breast milk but it can change the type- saturated, trans, monounsaturated, polyunsaturated.
I often get questions about foremilk/hindmilk as related to making a fattier milk. But what is fore milk/hindmilk? Is that even a thing? The breast only makes one type of milk, however, because of the way milk is released during a feeding, the fat content can change. Fats make up about 3-5% of the nutrients of breast milk and each ounce of contains about 1.2 grams of fat. Milk is made in the alveoli, which are grape-like clusters of cells at the back of the breast. Once the milk is made, it is squeezed out through the alveoli into the milk ducts, which resemble highways and carry the milk through the breast to the nipple. As milk is produced, fat globules in the milk stick to each other and to the walls of the milk ducts. As time passes, milk gradually moves toward the nipple as the breasts fill, pushing the thin watery milk forward while leaving the denser and fattier hindmilk behind (because the fat is sticking to the walls of the ducts). Shorter time between feedings or pumping a help keep the hind milk at the front of the breast. Think of it like turning on a faucet in the sink.
At first, the water comes out cold and then gradually gets warmer until it is hot. If you come back a minute later and turn the faucet on again, it will still be relatively warm. However, if wait an hour, the water will be cold. You’ll have to wait for it to warm up again. Breast milk fat is similar.
When the baby first latches on, the higher-water content foremilk is released. Little by little the milk becomes fattier as fat globules are pulled down from the ducts. Frequent feedings or pumping mean the milk doesn’t have time to “get cold.” There is no switch that gets flipped – the change from foremilk to hindmilk is gradual. There is less foremilk for your baby to go through before they get to the fattier milk. Basically, the less time in between feedings, the higher the fat content at the beginning of that particular feeding.
Here are the best strategies to help increase the fat in your milk:
📌Nurse or pump more frequently. The fullness of the breast makes the most difference with the amount of fat in your milk. The fuller the breast, the more water content is in your milk because your body thinks baby is dehydrated from going a long time without feeding or that you have an older baby that is getting fats from table foods. The shorter amount of time you go between feeding or pumping, the higher the fat content in your milk. You will see a smaller volume, but a higher fat content.
📌Drain the breast. Let your baby completely finish on one side before switching to the other side. Emptier breast’s have higher milk fat content.
📌Use your hands. Compressing and massaging the breast from the chest wall down toward the nipple while feeding and/or pumping helps push fat (made at the back of the breast in the ducts) down toward the nipple faster.
📌Eat more healthy, unsaturated fats, such as nuts, wild caught salmon, avocados, seeds, eggs, and olive oil.
📌 Increase your protein intake. This helps increase overall milk supply, which = more fat for your baby. Lean meats, chicken, fish, eggs, dairy, nuts, and seeds are the best dietary sources of protein. Vegetarians if you do not get enough protein from your food alone, consider adding a protein supplement in your routine.
📌Sunflower lethicin. Often used to relieve frequently blocked ducts, this supplement works by decreasing the stickiness of breast milk by mixing the fatty parts of breast milk with the watery parts to make it “slide out” easier. Some people believe that this helps increase the fatty acids in milk at the beginnings of feedings, too.
Switching baby too quickly from breast to breast while they are still actively sucking means that they aren’t getting enough time to let the fattier hindmilk unstick from the milk ducts.
Depending on your nursing pattern, it’s possible for fat content to be higher at the beginning of a particular feeding than it is at the end of other feedings. The longer the time between feedings, the lower the fat content at the beginning of the next feeding. If feedings are closer together, you’re starting off with a higher fat content.
Because every baby varies in the amount of time it takes him to receive his fill of the higher-fat milk at the end of the feeding, it’s important not to switch breasts while baby is actively nursing.
The number one complaint I get my mothers going back to work is a drop in supply when they start to pump. They go from seeing tons of milk to very little. Pumping at work is a PITA. You have to be very committed to it and depending on your job it can be stressful or difficult to get away to pump. What most women don’t seem to understand about Breastfeeding is that the more milk you remove the more milk you will make. You can’t just will your body to make the same amount of milk whether you pump once or six times. The science doesn’t work that way.
Through the first year of life, I recommend mothers pump three times on an 8 hour shift and four times on a 12 hour shift. Remember, I recommend leaving the same number of ounces as number of hours you will be gone. If you’re gone 8 hours, you only need to leave 8 ounces. Make sure your caregivers are doing paced bottle feedings and not accidentally sabotaging your milk supply. Mothers can add in additional pump sessions by pumping in the car with the battery operated pump. Once your baby turns a year, and his or her milk needs decrease; as long as they are taking a healthy amount of solid foods mom can drop down to pumping twice or three times a shift.
As your Toddler continues to grow, you can make the decision to add in another milk/milk substitute, continue to pump, or just breastfeed when you are home and have caregivers give water depending on how much you are gone from your older toddler.
Breastfeeding will working is a large commitment. I know this full well. These are the guidelines I followed with my own daughter. Up until she was 12 months, I pumped 3 times on my 8 hour shift. I had decided at 17 months to stop pumping while at work and just feed my daughter when I was home. However she had other plans 🙂 she constantly asks for May May, which is her word for my milk, while I am gone. So I was back to pumping just once a day and mixing my small amount of breastmilk with flax milk. She eats off of me like a barracuda when I walk in the door. (I think she just wants the snuggles). At 18 months I am now no longer pumping at work. She will nurse when she wakes up, when I come home, around bed time at 6:30, and every once in a while she’ll still wake up around 4am for an early morning snack. This is what my tiny human does. You have to figure out what works best for your tiny human, your family, and your health. Happy pumping!
We have done a very good job in America of separating the functions of the breast. Too often we see them as sexual OR as a tool of nutrition for our young. Even breastfeeding supporters who are pro-feeding tend to swing too far the other direction by not seeing the feeding breast as a sexual breast. We need to learn to appreciate the breast as both sexual and nutritive and in doing so actually increase the pleasure and function of both acts.
Many parts of the body have dual features. Yet we would never try to inhibit one of them or consider it odd or out of place. The mouth, for instance, has three purposes. With it we also feed the body. It is the first step in digestion where chewing and swallowing take place. Yet it is also communicative. With it we share it thoughts and express our wants and needs. But let us not forget it is also sexual. With it we kiss and perform all nature of sexual acts. Our hands perform tasks beyond number: communicative through the written word, nutritive in bringing food to the mouth, and sexual with the nuances of caressing, holding, and fondling. Society has no problem with these utilitarian organs.
Breasts are sexual organs. Their stimulation aids in the release of Oxytocin. According to Psychology Today, “Oxytocin is a powerful hormone that acts as a neurotransmitter in the brain. It regulates social interaction and sexual reproduction, playing a role in behaviors from maternal-infant bonding and milk release to empathy, generosity, and orgasm.” This “love hormone”, as it is often called, is released through touching, hugging, kissing, and yes, nipple stimulation. Oxytocin is the hormone that underlies trust. It is also an antidote to depressive feelings, which is why breastfeeding mothers have a largely reduced risk of post partum depression.
When the nipple is stimulated during sex, it plays a part in the release of Oxytocin for orgasm. When the nipple is stimulated during breastfeeding, it plays a part in the release of Oxytocin for milk ejection. This is why when parents become intimate after having a baby, a mother will often leak during orgasm. But a sexually blocked or traumatized mother, who had difficulty with the sexual nature of her breasts, may also find difficulty with the nutritive side of breasts and may have difficulty with the let down of milk.
When we can appreciate breasts as multifunctional, we can appreciate the complex nature of breast feeding. And also understand how to increase milk supply. Breastfeeding is hormone and simulation driven. The more you stimulate, the more hormones are released to make and release milk. Just like with sex, if a mother is stressed, distracted, or uncomfortable, the body’s natural reactions and functions can be impacted (example a distracted woman may not orgasm during sex and a stressed mother may have decreased let down and milk flow). On the other side, we can also use this information to our advantage. We can set the stage to increase milk flow, especially when pumping. By romancing the breasts when pumping (massaging or caressing them, giving gentle nipple rolls, listening to favorite soothing music, having a cup of tea, smelling baby’s clothes or blanket, watching videos of baby) we facilitate the hormone release to make and release milk. When we woo our breasts, speak softly to them and take a time out while feeding our baby or when pumping, we honor the dual nature of our magnificent body and in turn our body will respond positively.
Take a moment to reflect on how amazing breasts really are.
Think about how you can change the mood around feeding and pumping to help facilitate the hormonal influence on milk production.
The number one method to sabotage your milk supply when you go back to work is a caregiver who over feeds your baby.
Scenario one: Baby is given a full bottle and takes 5 ounces in five minutes. Baby then spits up half the feeding and caregiver tries to give more to “keep it down”. Caregiver tells mom baby is fussy and has reflux. Baby gets put on Zantac and rice cereal.
Reality: there are several factors going on in that scenario that will sabotage a working mother’s milk supply. First, babies are not supposed to take five ounces in a feeding. Their stomach is the size of their fist and should only be taking 1-3 ounces per feeding through the first year of life. Their stomach can only hold so much and if it’s past capacity, the only place for it to go is up. I can eat a whole cake, but I shouldn’t. As an adult, if I overeat I get uncomfortable, too. I either take peptobismol or put on my stretchy pants to wait for the pain to subside. Then I don’t eat that much again. Babies fuss and spit up for the same reason. We’re over diagnosing babies with reflux that are being fed too much or too fast.
Scenario two: Caregiver gives a baby six ounces every feeding, 3 times while mom is gone, every time the baby cries or wants to suck. Baby appears fussy and wants to suck all the time.
Exclusively breastfed babies should consume 25-35 ounces across each 24 hour day and approximately 20% of their calories should be taken over night. If you do the math, that’s a little over an ounce an hour, or 1-3 ounces every two to three hours. And in accordance to what the baby needs, mom will make that volume. So if caregiver is feeding 6 ounces three times in an 8 hour shift, you’re expecting mom to pump 18+ ounces. In reality, her body will most likely make 6-10 ounces which would be the amount she would make if she were home with her baby. In a few days of over feeding the baby, mom becomes discouraged that she’s not making enough and pretty soon she’ll start supplementing with formula
Babies also want to suck for a variety of reasons: comfort, pain, bonding, nutrition, pleasure, etc. Babies use mom as a pacifier without actually drinking. When babies are away from their mommies is very stressful, so their way to soothe is to suck.
Scenario three: Baby is given 4 ounces and chugs it down in five minutes. Baby is happy to chug down high volume and the caregiver thinks baby is just a piggy and really hungry. Baby occasionally coughs and chokes and milk comes out her mouth.
Reason: Babies have a swallow reflex that is with them at birth. When liquid reaches the back of the throat it triggers the swallow reflex. Babies are obligated to swallow otherwise they will choke or let the milk pool out of their mouths. When you see a baby chugging down milk really fast, it’s not usually because they are starving, but because they are trying to keep up with the flow of the bottle. As I said in an earlier post, there’s really no such thing as nipple confusion, but flow confusion. At the breast, other than during active let down in the first few minutes of active feeding, the baby controls the flow of milk by how they suck. In bottle feeding, the bottle will flow because gravity always wins. Caregivers need to be taught paced bottle feeding. Using a slow flow nipple, feeding baby in side lying, and frequently tilting the fluid away from the nipple to slow the baby from drinking so fast gives the baby more oral control and time to appropriately eat.
There are two kinds of receptors in the stomach: stretch and density. It should take a baby 10-20 minutes to eat from a bottle. This is also how long it takes the stretch receptors to tell the brain that the stomach is full. I can eat a whole pizza really fast, but I shouldn’t. Babies can eat a large volume really quickly, but they shouldn’t. Not only is it not developmentally appropriate, but pretty quickly the high volume needs will sabotage mom’s opinion of her perfectly healthy milk volume. She’ll turn to all kinds of milk makers: cookies, teas, herbs, etc and eventually if she’s discouraged enough she’ll turn to formula, when in reality if the caregiver would slow down feedings and give the rigjt volume, every one would be happy.
Asking for medical advise from social media forums, especially mommy groups, is like asking a mother who’s had a baby to deliver yours. Just because she has experience in the field does not make her qualified to give technical advice in that area. She can give you her opinions or share her experience, but she did never be relied on as a trustworthy source when providing care to YOUR child.
Breastfeeding is especially one of those areas that we need to tread wisely into when asking for help and advice. Or culture has hidden breastfeeding from the norm and made it this mysterious, murky action where myths and misunderstandings abound. So much of the information found in quick Google searches are anecdotal, antiquated, or based off formula feeding data which is completely distinct and sometimes totally opposite of true breastfeeding. We should be seeking community support for breastfeeding, but not when medical advice is being solicited.
When mothers give out advice on social media platforms, they are not taking into consideration the whole breastfeeding picture and may inadvertently give advice that could care harm or actually negatively impact breastfeeding. For instance, when a mother of a two month old asks for advice on increasing her breastmilk supply and mother start giving advice on herbs, lactation cookies, or teas, they may not be considering WHY she is needing to increase her supply. Is her baby in the NICU? Is she going back to work and stressed with the pumping process? Does she have. History of sexual abuse that she actually needs to work through? Did her pediatrician have her supplement which impacted her supply? Is she trying to sleep train and sabotaging her own supply? Is she ALLERGIC to the herbs in those teas and supplements? How often is she feeding? Does she have a metabolic or hormonal disorder impacting her supply? Does she have enough glandular breast tissue to even produce sufficient milk supply? Does her baby have a tongue tie? Does the baby simply have a poor latch? These are the questions that are crucial in giving appropriate breastfeeding advice to protect the breastfeeding relationship. The best advice a mother can give on the social media platform is to have the questioning mother contact a lactation consultant.
The gold standard for breastfeeding advice is the International Board Certified Lactation Consultant (IBCLC). There are other forms of lactation consultants that teach and serve out of a variety of backgrounds. The IBCLC is the top most coveted professional because of the extensive education and rigorous testing they need to go through in order to be able to assist lactating mothers. In order to sit for the FOUR HOUR board exam, candidates must have extensive education in specific health science subjects, like nutrition, psychology, and childhood development; 90 college level credit hours of education in human lactation and breastfeeding, and hundreds to thousands of clinical practice in providing care to breastfeeding families. They must also maintain a high level of continuing education courses and continue to sit for the board exam every 10 years.
So when you see moms with questions related to breastfeeding in social media forums that are beyond opinions or personal experience, the best advice is professional advice.
Lactose is the number one carb/sugar in human milk. We wouldn’t survive as a species if babies were lactose intolerant. Human milk actually has 50% more lactose than cow’s milk! Our bodies produce a protein called lactose that breaks down lactose in the gut. Lactase is supposed to disappear after baby is weaned- usually by seven years of age. Yes, babies are supposed to be breastfeed until between 2.5 to 7 years of age. Human babies are supposed to drink only human milk and our bodies are designed to digest it efficiently and effectively. When this protein disappears, the body has a hard time digesting lactose. In reality up to 70% of adults are lactose intolerant as adults because this protein is supposed to disappear. We’re not meant to drink milk after childhood. But this shouldn’t happen until after baby is weaned- as a toddler or preschooler. The reason babies can have indigestion and upset from milk is from bovine protein either that mom is eating (those excessive cheese lovers know what I’m talking about) or from introducing artificial baby milk (aka formula that is cow’s milk based).
The proteins in milk can be divided into two categories: caseins and whey proteins (remember Little Miss Moffett on her tuffet eating her curds and whey? Curds are like the globs in cottage cheese and the whey is the watery substance). Human milk contains these in a ratio of 40:60 casein to whey; while in cow’s milk the ratio is 80:20 respectively. The amount of total protein in cow’s milk is more than double that of human milk to help baby cows double in size very quickly after baby. Cow’s milk contains considerably more casein than human milk to achieve that growth. Casein can be difficult to digest, in fact it is used as the primary ingredient of some glues! Artificial baby milks have to be formulated or altered to contain more whey than casein, to try to replicate the ratio of whey to casein to be as similar to that of human milk as it can to be better digested. But it is still a forgoing protein that the body wasn’t designed to digest.
Now there are truly some babies who have difficulties with digestion, however congenital lactose intolerance is very, very rare. It would be seen immediately after birth with very severe symptoms and should be diagnosed by a pediatrician as soon as possible. A small percentage of breastfeeding mothers notice an obvious difference in their baby’s behavior and/or health when mom eats certain foods. As previously stated, cow’s milk products are the most common problem foods and the only foods conclusively linked by research to fussiness/gassiness in babies because of the protein found in cows milk. Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think.
There are some really well written articles if you feel your baby has a protein intolerance. For more information, check out the following resources:
The Comparative Composition of Human Milk and of Cow’s Milk. http://www.jbc.org/content/16/2/147.full.pdf
A Comparison Between Human Milk and Cow’s Milk. https://www.viva.org.uk/white-lies/comparison-between-human-milk-and-cows-milk
I was recently contacted via Facebook about my opinions on supplementing at birth when mother’s milk “doesn’t come in right away”. I thought you might be interested in my response. The first several paragraphs are the background anatomy and physiology of early breastfeeding. Below are the questions I was sent as well as my responses. Enjoy!
Breastfeeding is a natural process that has become misunderstood by the general public as it became hidden from the community. I believe when mothers actually understand the process of breastfeeding, it can help then understand what is going on in their newborn. Prenatal breastfeeding classes are essential for this. At 10-14 weeks of gestation, every mothers breast begins to fill with colostrum, a high protein milk which acts as a laxative. It’d why their breast change size during pregnancy. Mothers already have the first milk in the breast that their babies need for birth. It is in a small volume because babies are born constipated and fluid overloaded from the womb. In a natural, uncomplicated delivery, a newborn has a high need to suck because of this constipation. Sucking causes peristalsis (a wave like movement) to travel through the esophagus through the stomach to the intestines to push out the poop. It takes approximately three days for all the meconium to be pooped out (which is exactly how long it takes for colostrum to change over to mature milk!!) Nature designed the breast to feed the need of the baby in perfect balance to allow baby to become unconstipated so the gut would be ready for nature milk at the right time. Breast milk actually doesn’t “come in”. It’s already there in the form of colostrum. The first few days are controlled by the autonomic system. You’re pregnant so you will produce colotrum and your body will think you’re feeding a baby. You need your baby to suck at birth to lay down hormone receptors in the breast for prolactin, the milk making hormone. The more your baby simulates your breast in the first few days after birth, the more hormone receptors are activated to make milk for your baby. After the first few days, you switch from the autonomic system to the demand a supply model that continues for the duration of breastfeeding. The more the baby demands, the more mama makes.
Unfortunately in the modern world of medicine, we have tampered with the natural process of birth and thereby impacting breastfeeding. With IV fluids, the epidural, and other medications used in birth, we’re changing how newborns interact with the world and how hormones in mom are being produced. The epidural rate in hospitals in LA County is over 80%, with many hospitals over 90%! It actually causes sleepy babies that do not do as well at the breast (Richard and Alade, 1990, https://youtu.be/4eQdQ1Ww9-k) Cesarean births also significantly delay the Natural switch from colostrum to mature milk for obvious reasons based on the above information. Babies really need to be skin to skin and at the breast with no interruption for the first few days of life or until mature milk had come in. Skin to skin contact promotes physiologic stability in the baby (including regulation temperature ebooks sugar) while promoting free access to the breast to facilitate the process described above. If hospitals encouraged mothers in Birthing a more natural and unmedicated way, we would actually see a significant drop in the need for supplementation and in breastfeeding issues.
The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding. Formula fed babies have a 50% higher risk of dying of SIDS at all ages of infancy with even higher rates in other developing nations due to unsafe water and lack of finances for parents to afford formula. Baby friendly hospitals in the US understand the importance of breastfeeding but aren’t the best at communicating why. Breastfeeding is better for babies for a laundry list of reasons.
What should expectant parents look for when searching for a lactation consultant? They need to find someone who is skilled and trained. An IBCLC is always the gold standard because of the extensive training we go through. Facebook forums are horrible for information because there is a lot of poor information floating around. Yelp is great for reviews of local consultants. If they suspect a tongue tie, they need to find a lactation consultant specifically trained in it. Not every one is.
How are lactation consultants accredited and are their different professional organizations? http://blog.mothersboutique.com/whats-the-difference-between-lc-ibclc-cle-etc/
What is generally the maximum amount of time a mother should wait for milk to come in before offering formula? For instance, after a c-section when it can take longer. This is a loaded question because every story is different. In the hospital it’s always based on bilirubin numbers and the risk for jaundice. In my practice, if a baby has not has the recommended number of wet diapers by day three we’re supplementing at the breast using an SNS at the very least.
What are the guidelines when it comes to (temporarily) supplementing with formula for newborns? Unfortunately there are no guidelines and every practitioner comes from their own experience and setting. There are no rules and it’s a case by case basis which should be based on parents breastfeeding goals, but unfortunately is not always an option.
When waiting for milk to come in, what amount of weight loss would be a red flag? 10% is normal weight loss for all infants. Birth weight needs to be regained by 2 weeks. And we need to know WHY. Is there a tongue tie? Does the mother have a hormone issue? Does the baby have birth trauma or tortícolis? Is there a metabolic issue or heart defect? Is it simply a poor latch or improper position? Did the baby have poor oral skills? These all can relate to weight loss. At what point would you advise a breastfeeding mother to offer formula? If baby gets adequate skin to skin time and constant access to the breast, most of these issues resolve on their own. If a baby is lethargic, sleeping more than 4 hours multiple times in a row, or not making enough wet and dirty diapers by 48-72 hours, I’m all about supplementing. But that’s me coming from a hospital background. I don’t mess around with the risk of jaundice. I also always prefer supplementing at the breast with an SNS and with donor breast milk when possible. Stimulate the breast for increased production while getting the baby fed and used to the breast at the same time.
Do you feel the threat of “nipple confusion,” supply issues, or a mother “giving up” breastfeeding are valid reasons for avoiding formula when milk hasn’t come in? Are there other reasons to avoid temporary supplementing? This is another misconception. There really isn’t “nipple confusion”. It’s actually flow confusion. At the breast, babies need to stimulate milk flow at the beginning of a feeding with active suckling. It can take one to two minutes of suckling for let down to happen. Breasts can flow at different rates and even flow different during a single feeding. Bottles, however, are instant and constant. It’s much easier to feed from a bottle, so some babies “prefer” this from having to work at getting their milk. A lactation consultant can help with any issue of flow at the breast to help with this. Opinions vary in the introduction of a bottle. Some say no sooner than 2-3 weeks or when breastfeeding is well established. Die hard lactation consultants say no sooner than 6 weeks. In NICU where I work, we use bottles from day one and babies easily transition back and forth between breast and bottle. We use and teach paced bottle feedings and use of a slow flow nipple to try to replicate breast flow from a bottle.
What do you think is the biggest benefit to enlisting lactation consultants’ help in breastfeeding? The earlier you get help, statistics show, the longer mothers will breastfeed. If breastfeeding is your goal, get help in the first 72-96 hours. Enlisting help give mothers the confidence in knowing subtle changes in positioning and latch that can make a world of difference. An LC can also identify if there is something wrong, like a tongue tie, inverted nipple, swelling of the breast from fluids at birth, etc that is impacting feeding.
Do you feel pediatricians are being pulled in different directions when it comes to supplementing? For instance, they are promoting breastfeeding because of the proven health benefits, but also want to be able to offer formula because sometimes it’s needed? Pediatricians get a 45 minute lecture on breastfeeding on medium school if there lucky. It depends on their training and setting. They are mostly concerned about weight and usually have no problems supplementing outside the hospital setting. In the hospital, if it is baby friendly, there are guidelines for when formula can be introduced.
What are your thoughts on the “fed is best” campaign? I strongly disagree with it. But I’m in the profession of breastfeeding. The risks of not breastfeeding far outweigh the benefits of formula feeding. There are obviously cases when supplementation is absolutely necessary and mothers should never be shamed of needing to supplement. They should also be encouraged to get professional help as soon as possible to facilitate breastfeeding from the beginning. So many issues can be prevented before they’re a problem.
Do you feel that there is too much pressure to breastfeed currently? Whether from society, lactation consultants, media, doctors, etc. I believe we don’t have enough proper education on breastfeeding. With good quality education of the risks of not breastfeeding and the benefits to the mother, baby, partnrr and community, as well as having adequate postnatal support, I believe more families would actually choose breastfeeding.
In your opinion, is there anything that can be done to prevent instances where babies or starving or losing too much weight while waiting for milk to come in? The best practice after a normal delivery is keeping babies skin to skin on mom and with free access to nurse on demand. Babies should not be swaddled in isolettes away from their mothers. They should be allowed to sleep with skin to skin contact for the first few days of life. If a baby is not making enough wet and dirty diapers by 48 hours, they need to be evaluated for a tongue tie or other oral motor issues by a therapist in the hospital or a skilled/trained lactation consultant who is trained in oral motor which may be impacting the ability to drain the breast this causing the cycle of not enough milk taken in by baby and the breast not being stimulated by baby to produce more milk.
If not, do you think more breastfeeding mothers should be informed of this scenario before labor? I believe every mother needs to attend a high quality breastfeeding class before birth and breastfeeding support groups after birth. So many mothers don’t get education because they think it’s going to be natural and easy. But we’ve lost the communal/tribal living where we breastfeed with other women and learn about breastfeeding from childhood. There is so much misinformation on social media it perpetuates problems. But I also believe we should be educating mothers about the real impact of epidurals, medications, and induction on breastfeeding so mothers can understand how it will impact breastfeeding.