Paced bottle feeding

Paced bottle feeding (meaning you’re setting the pace for how fast/slow baby drinks) helps prevent over feeding baby: it takes 20 minutes for the stomach to tell the brain that it’s full. If a baby takes a bottle too quickly, the mouth can still be “hungry” and wanting to suck when the stomach is actually full. Like going to an all you can eat buffet and eating a lot of food quickly and then realizing half hour later you ate way too much. A baby that happily sucks down too much milk from a bottle can make you think you don’t have enough breast milk even if you make a normal amount. It can also make baby frustrated by the flow of milk from the breast and inadvertently sabotage breastfeeding

These pictures are the same baby in two different positions for paced feeding: semi upright and side lying. Side lying is my favorite position to use as it puts baby in the same position as breastfeeding. Many parents feel baby is more supported in this position. Baby is supported by your leg or breastfeeding pillow.

Tips:

🍼Never feed baby on their back

🍼Keep the bottle parallel with the floor with about half the nipple filled with milk

🍼Use the slowest flow nipple baby will tolerate

🍼Rub the nipple gently on baby’s lips, allow baby to latch at their own pace, don’t force it into their mouth

🍼It should take 15-20 minutes to finish the bottle

🍼Watch the baby and not the bottle, stop when they show signs of being full

🍼Resist the urge to finish the bottle, even if there is only a little left, when baby is showing signs their tummy is full

🍼Take short breaks to burp and give the tummy time to fill naturally

🍼If baby is gulping or chugging, slow down

🍼If baby has taken a good volume of milk (2-4oz) in a short amount of time and is still acting hungry, offer a pacifier for a few minutes to help them digest and give the tummy to to tell the brain it’s full. If they’re still hungry, slowly offer more in 1/2oz increments

How much milk should I leave my breastfed baby?

How many ounces should I leave if I’m exclusively breastfeeding but need to leave my baby a bottle?

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 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 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.

The question is: how many feedings do they get in 24 hours? 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 babies eat more or less depending on the activities of the day, growth spurts, teething, and even babies emotionally eat sometimes. In general, take 25 and divide it by the number of feedings they average in any given day. Also take into account that growth slows between 6-12 months and baby should be eating table foods, so you don’t need to increase the ounces in the bottle during that time. If your baby took 4 Oz bottles at 4 months, 4 Oz bottles are still appropriate at 9 months because they’re also begging for the food right off your plate in addition to what you’re putting on their tray.

You are what you eat, and so is your baby

Did you know that not only do the volumes of milk produced by the left and right breast differ, the milk made in the left breast can also taste different than that made in the right… during the same feeding!!

What you eat used to change the flavor of your amniotic fluid, exposing baby when they were a fetus to the profile of your diet, preparing them for the flavors they would later experience in your breast milk. Eating a wide variety in your diet while you’re pregnant and breastfeeding exposes your little one to a wide variety of flavors, getting them used to the spices, herbs and tastes of food they will be given when they start table food eaten by your family. The more of a particular food you eat, research says, the better the chance your baby will also like to eat that food.

Eating allergenic foods during pregnancy also protects baby from food allergies, especially if you continue to eat them while breastfeeding suggests new research. So far, there is no evidence that avoiding certain foods while breastfeeding helps prevent baby from developing allergies or asthma. The exception to that might be eczema: avoiding certain foods may reduce the risk of eczema. Allergy studies are challenging because of many factors, including food introduction, genetics, and maternal diet. Most studies conclude that exclusive breastfeeding (even as little as one month) lessens how often some allergies occur. Evidence also suggests that exclusive breastfeeding during the first four months may offer protection against certain types of allergic diseases including cow’s milk allergy and atopic dermatitis. So while oatmeal 24/7 may help increase your milk supply, switch it up for baby’s sake (and yours!!)

How can I make more breast milk?

The best way to lose weight is to be in a calorie deficit. Choosing the right foods, protein, fruits and vegetables with moderation of carbs, sugars and starches is guaranteed for most to lose extra pounds. Sure, exercise helps. It helps burn calories, again contributing to calorie deficit. But exercise alone won’t help you lose weight if you’re still eating a high calorie diet. Sure, going vegetarian or vegan or doing Weight Watchers or Atkins or any other “diet” helps. It helps you monitor intake to be in a calorie deficit. But even on any diet plan, if you’re not following it correctly and still eating high amounts of foods you won’t lose weight. Certain people do better on certain diets or with specific exercise programs because of how their specific body handles and processes food, vitamins, stress, movement, and all of the other factors like environment and genetics. Finding a nutritionist, weight loss coach, or personal trainer helps you look at your specific body and goals and helps you reach them. You can absolutely get there in your own, having someone counsel you through often gets you quicker results from their experience and wisdom. But the principle remains: calorie deficit is the number one way to lose weight.

The best way to make breast milk is to empty breast milk. Whether that’s your baby or a high quality breast pump, moving milk multiple times a day tells the body to make more milk. The more often milk is removed, the faster it is made. Sure, supplements help. They support your thyroid and blood with the extra nutrients and hormones needed to produce milk. But supplements alone is no replacement for moving milk. You can take the best lactation bars and drink all the tea you want, but without emptying the breast every few hours routinely I wouldn’t expect the majority of us to make enough milk to feed baby. Sure, hydration and nutrition are important. It takes calories to make calories and hydration help with that process. But even the research shows women who are malnourished in famine torn countries make plenty of milk for their babies when baby is allowed unrestricted access to the breast. Yes, adding in chia seed, flax seed, oats, nuts and nut butters, and coconut water helps make milk. Certain people do better on certain herbs and foods because of how their specific body handles and processes food, vitamins, stress, hormones, and all of the other factors like anatomy and genetics. Finding a lactation consultant, peer counselor, or trained doula helps you look at your specific body and goals and helps you reach them. You can absolutely get there in your own, having someone counsel you through often gets you quicker results from their experience and wisdom. But the principle remains: emptying milk from the breast is the number one way to make breast milk.

Pumping while away from baby helps maintain your supply

How to build a breast milk stash

You don’t need to have a stash. If you want to exclusively breastfeed and are never away from your baby, you don’t need any milk in your freezer. You don’t need a huge stash if you’re going to be gone from baby. It’s nice to have stored up milk, but that milk is extra milk. Feed the baby, not the freezer. You only need enough milk for when you’re away from baby. If you’re only going to be gone for 2-3 hours, you may not need any milk at all. Feed your baby immediately before you leave. If baby becomes fussy before you get home, have your caregiver take baby on a walk, distract with toys or use a pacifier and feed them as soon as you walk in the door. If you’re going to be gone more than 3 hours, you only need to have enough milk for the time you’re gone. Optimally if baby is being fed by bottle, to maintain your milk supply, you should be pumping, thus replacing the milk from your stash that was used.

There are several ways to build your stash

🍼Passively collect with a milk catcher like a Lacticup or Milkies Milk Saver. No extra work needed, this works great in the early weeks if you leak

🍼Use manual silicone breast pump like the Haakaa. While these look passive, the vacuum created does stimulate the breast and can increase leaking and milk supply

🍼If you have a large to very large storage capacity and only feed from one breast at a time, pump the other breast during or after feeding baby

🍼Pump with a double electric pump, after breastfeeding, for 10-15 minutes. Only expect to get 1/4-1 ounce as this is “left over” milk that your baby doesn’t need.

🍼Pump with a double electric pump in between breastfeedings when you think baby may take a longer nap. Aim to pump half way between when you think baby will want to feed again. If you think baby will go 2 hours, pump after an hour, etc. try not to pump too close to the next feed as baby may get fussy at the slower flow of milk.

Remember:

🥛Decide how often and how much you want to pump/collect. Know that the more you empty, the more you will make as you’re telling your body baby needs that milk.

🥛Too much pumping or frequently changing your pump routine does increase your risk of plugged ducts and mastitis

🥛You can combine 24 hours of milk into one batch

🥛Breastfed babies usually only need 2-4 ounces every 2-4 hours. Aim to leave 1-1.5 ounces for every hour you’re gone

Forever milk

Did you know that you will ALWAYS be able to make milk? You’ve had the milk making glands in your breasts since puberty. They’re like little empty clusters of balloons at the back of the breast. Pregnancy activates your milk making hormones, allowing the glands to expand and start filling with milk between 16-20 weeks gestation. In the early days after birth, the more stimulation the breast has (from feeding or pumping), the more the milk making glands and their corresponding hormone receptors multiply. The milk balloons fill and empty milk multiple times per feeding.

After at least 40 days of not expressing any milk, once you completely wean, your milk making balloons deflate and become dormant, like before pregnancy. But they aren’t dead. Pregnancy and breastfeeding hormones caused a permanent change in your body. Your milk making glands will FOREVER remember how to make milk. They can ALWAYS make milk again, no matter how long it has been. They just need enough of the right stimulation to turn on and start filling again. Some times years after breastfeeding a mother may feel the tingle of let down if she hears a baby cry. Or she may leak if her partner does enough nipple stimulation. There are grandmothers in other cultures who bring back milk to breastfeed their grandchildren! Our bodies are AMAZING!! Now you know!

Where did my milk go?

What can cause a late onset decreased milk supply?

1.The mother is pregnant again. Milk supply decreases during pregnancy. Domperidone will not work when the mother is pregnant.

2.The mother is taking some hormonal birth control method (pill including progestin only pill, IUD, etc)

3.The mother is breastfeeding on only one side at a feeding or “block feeding” (several feedings in a row on the same breast, used to treat “overabundant milk ejection, “overabundant milk supply”). I have posted on “block feeding” previously.

4.Some medications other than hormones can decrease the milk supply (antihistamines for example).

5.Can an emotional shock decrease the milk supply? Possible but unusual in our experience.

6.Blocked ducts/mastitis as well as any febrile illness may decrease the milk supply.

7.The use of bottles more than occasionally can very much decrease the milk supply.

8.”Overdoing it”. It’s time that others do most of the usual chores that fall on women’s shoulders.

9.An “abundant milk supply” associated with a less than “ideal” latch. In this situation, the milk flows into the baby’s mouth with little participation of the baby. The baby may often choke while breastfeeding, especially when the mother has a milk ejection reflex. A tongue tie is a common cause of a baby having a less than “ideal” latch and can be a significant cause of late onset decreased milk supply even if neither the mother or the baby had problems early on.

This problem of late onset decreased milk supply and accompanying symptoms is typically the problem of the mother who once had an abundant milk supply and milk supply may still be quite good, but less than it once was.

Natural Weaning from the Breast

NATURAL WEANING

Natural weaning is the biological process of gradually decreasing milk supply as baby gets older. This process starts around 7-9 months as baby takes more solid foods and progresses toward sleeping longer stretches at night. It ends when baby finally weans (which may not be until 2-3 years old!!). Natural weaning doesn’t mean that you need to wean baby from the breast. Decreasing milk supply doesn’t mean you’re at risk of losing your supply, either. Your breast is designed to match the stage of development your baby is in. 

Milk supply iss highest from month 1-6 when baby is going through multiple growth spurts. They need to double their birth weight by 6 months. Milk is also the only food in their diet.  Therefore, your milk supply is supposed to be at its highest to meet their nutritional needs. From 6-12 months, weight gain slows but their need for milk volume needs remain stable. It is natural as baby transitions from a full milk diet to a milk+solids diet to then a solids+milk diet that breast milk supply will shift along with it. Your milk supply varies compared to baby’s solids intake and there is a wide range of normal based on your individual baby. Some babies love solids and eat them in large quantities many times a day. Other babies continue on a mostly milk diet until almost 1 year.  At 12 months, milk finally takes a back seat to solids, but still fills in nutritional gaps and acts like medicine against illness. From 12 months on there continues to be a wide range of normal for milk supply depending on your child’s eating and feeding habits. Some babies continue to nurse occasionally over night while others seem to become boob barnacles again and would happily stay on the breast all day, every day.

So what does this mean? If you’re exclusively breastfeeding you may not notice anything.  You can continue to bring baby to breast for as long and often as baby wants. You may notice baby spacing out feedings or not nursing as long. They may want the breast more when teething or going through growth spurts or developmental leaps. They have days with little interest in the breast. 

Moms who pump (either exclusively or because of work) report overflowing milk in the early weeks, often able to pump 4-6 or even 8-10 ounces in a morning pump session. By 4 months supply regulates and mom gets about 3-5 ounces per pump in place of a feeding. By 9 or 10 months it can feel like your trying to wring out a wet rag to get even 2-4 ounces a pump session. As long as baby has unrestricted access to the breast when your not working and you still have a regular pump routine in place no intervention is usually needed. Every journey is supposed to look different because it is your unique journey.

Photo Credit Jermaine Love
@jermainelove44

One Breast or Two?

SHOULD I OFFER ONE BREAST OR TWO WHEN BREASTFEEDING?

Just as no rule says you must eat the same amount at every meal, there’s no rule that says your baby must eat from both sides every feeding.

  • Factors that play a role in offering one side or two include your individual breast storage capacity, and milk supply, when your last feeding was, and your unique baby’s volume needs.
  • Storage capacity is not indicated by breast size, but by glandular tissue in the breast. People with lots of glandular tissue have a higher storage capacity in each breast regardless of the actual breast size. Their babies may only want one side per feeding as each side makes plenty of milk. Some people have smaller storage capacities and their babies will want to feed off of both sides (maybe even multiple times!) to get what they want.
  • You will get to know your breast storage capacity and how quickly your breasts make milk as you get to know your body and your baby.  Every feeding can also be different. There’s no right or wrong. Sometimes a baby will want both breasts if they’re really hungry and sometimes they’ll want only one when they just want to comfort nurse to sleep. Some times you may feel like you’re offering each breast 5 or 6 times in a feeding, rotating constantly!! NORMAL!!! Trust your baby and your body. You can always offer the second breast/side but don’t feel stressed if your baby doesn’t always want it. 

BREASTS ARE SISTER, NOT TWINS

You may also feel like baby always prefers one side or even does better feeding on one side!! That’s because breasts are sisters and not twins!!!! One side can be bigger, one side can make more. Nipples can even be different shapes and sizes, making one side easier to latch to from purely an anatomical perspective.

  • Around 70% of us produce more milk on the right. Which means 30% make more on the left. 
  • It is VERY common for one side to produce more than the other, often double. This is not a reason to neglect one side. You want to make sure you rotate which side you offer first. This can also cause one breast to be significantly larger than the other especially if you continue to only feed from one side.
  • Babies may prefer one side over the other for various reasons
    • They like to lay with their head in a certain direction
    • They prefer the flow (one side may flow faster or slower than the other)
    • They may prefer the flavor (YES!! Milk can taste different from each side during the same feeding!!)
    • They may have tension in their body from positioning during pregnancy or from trauma during birth.
  • If you want to help balance out a slacker boob, you can try offering the slacker first more often.
  • Ending on the slacker can also help, especially if baby just wants to use you like a pacifier.
  • Pumping the slacker side after feedings can also help stimulate more milk production.

Don’t stress too much about a slacker boob if it’s not an issue. If baby is happy, there’s really no need to fret over differences between your breasts. If you start to notice one side is increasing in cup sizes significantly from the other, schedule a consultation and we can get to the root of why baby only wants one side and we can work on it together.

How Much Breast Milk Does Baby Need?

HOW MUCH BREAST MILK DOES MY BABY NEED IN A DAY?

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.