Sunday, March 24, 2013

Breasfeeding: When and How to Supplement a Breastfed Baby

     Although breastfeeding is natural and a full milk supply is available in almost all women, there are times that milk supply is down for reasons that we can usually trace to supply and demand issues.  These issues include mother baby separation, scheduling, good baby syndrome, and birth control prescriptions. 
     Many times, however supplementation occurs because of perceived low milk supply.  Just because a baby gulps down a bottle of formula when offered doesn't mean moms milk supply is low.  If you feel your milk supply is low, stop and calculate.  First, check your baby's wet and dirty diapers.  Your baby should have at least 8 diapers.  The number of dirty diapers is age dependent.  If your baby is 6 days to six weeks, he should be having 3-4 silver dollar sized stools per day or more.  If your baby is over six weeks as little as one stool every 3-5 days can be normal.  Your baby's stool schedule changes at about six weeks so if additional changes occur, check weight.
     If your baby is not wetting an pooping properly, the next step is a weight check.  Your baby at ages 6 days to 6 months, should be gaining an average of 3/4 oz per day.  You can go by your doctor's office and use their scale or buy a baby scale or rent a baby scale.  Calculate how many weeks it has been since the last weight check and subtract from the new weight.  Divide the difference by the number of weeks.  Your baby should have gained at least 5 oz per week.  (Remember, there are 16 oz per lb.)
     If your baby has really not gained appropriately and you must supplement, do it wisely.  If your baby is under six weeks, use a 10 cc slip tip syringe for finger feeding, medicine cup or feeding tube.  If using a syringe, please note that 30cc is equal to one ounce.  Feeding tubes can be used for finger feeding or for supplementing while at the breast.  If you have an older baby, someone other than mom may supplement with a wide-mouth slow flow silicone nipple in a tummy to tummy position with the baby held tightly.

     Before you begin supplementing, check your milk supply.  Do this with a professional grade or hospital grade double breast pump.  The best time of day to check milk supply is the second feeding of the morning.  Nurse during the first feeding as usual, wait three hours and then double pump for 15 minutes.   Use the breast milk supply chart on this page to determine if your milk supply is normal.        
     Once you determine your output, subtract that amount from the average output and supplement only that amount.  For example, and 8 lb baby extracts an average of 2.5 ounces per feeding.   If your output is 1.5 ounces, then supplement no more than 1 ounce after feeding for no more than two days.  Pump after each and every feeding that you supplement.  Use breast milk to supplement whenever possible.  On the third day, check your supply again.  If your supply is now 2 ounces, only supplement the difference of 1/2 ounce and check again on the third day.  This consistent stimulation of pumping and limited supplemental schedule should keep the supplementation from spiraling into a vicious cycle. 
     Do not supplement additional amounts unless your baby has signs of dehydration such as no wet diapers or diapers that have a red brick powder-like substance in them.  If your baby is fussy after the allotted amount, put them back to the breast.  This will help you baby stimulate breast milk production as well as soothe them with suckling.
     Call a doctor or lactation consultant if your supply does not increase with the above method.  You can use lactation bars or cookies than contain galactagogues or take herbs like Fenugreek and Blessed Thistle to increase milk supply.  You can take 3-5 capsules of Fenugreek three times daily or a combination of three Fenugreek and two Blessed Thistle capsules three times daily for a minimum total of 15 capsules per day.  In general, herbs in glass bottles are more potent than those in plastic bottles due to freshness and quality.
     Is summary, supplementation should not be taken lightly.  If done improperly, it can be the beginning of the end of breastfeeding.  If necessary supplement wisely, minimally and with a plan for increasing milk supply in hand.

    

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