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.

    

Sleep Training and Breastfeeding

     Sleep training is understandably a popular subject among sleep deprived new mothers.  Unfortunately popular methods like BabyWise and the Ferber method can decrease milk supply dramatically.  I recently had a mother contact me who was using the Ferber method.  Her 5 month old baby who was previously gaining weight well had only gained 3 ounces in six weeks after starting the Ferber method*.  This can occur because a baby is not feeding frequently enough during the day and then is not being fed when he wakes in the night.  Please know that sleep should take a back seat to weight gain.  And waking at night is not only healthy for milk supply, but there may be other benefits as well.  Breastfed babies have a lower incident of SIDS.  We do not know whether that is due to the superior nutrition in breast milk or whether it is because they wake more frequently at night.  Breast milk is more easily digested than formula so it is normal for the breastfed baby to feed more frequently than a formula fed baby. 
     Having stated the case for night nursing, I do not want for you to loose all hope that you will ever sleep all night again.  Here are some things you can do to gently guide your baby into a longer nights sleep:
1.  Make sure that your baby feeds frequently during the day.  A baby under 6 months of age should feed at least 8 times per 24 hour period.  The baby 6-12 months normally feeds 5 times per day.  Getting more feeding in during the daytime hours, will help with less feedings at night.
2.  Unless you want to practice attachment parenting and the family bed, you can start with the baby in his or her crib at the beginning of the night.  If after nursing the baby at bedtime, you put the baby in a crib, when he learns to sleep through the night, he is already in his own bed.  This prevents the baby from waking just because he smells your milk.  (Note:  If your baby is not gaining weight properly or you are trying to increase milk supply, you should certainly take the baby to bed with you for unlimited feeding.)
3.  Try to keep your baby on task when feeding during the day.  If your baby is distracted, try nursing in a quiet darkened room or use distractions for the older children to be less of a distraction for your baby.  One of my favorite tricks is to devide toys into bins and bring down a fresh bin of toys right before nursing.  Another is to have a drink or helthy snack ready for your toddler so his needs are met before you start.

Additional Tips for Moms:
1.  Don't let sleep training "experts" fool you.  It is not normal or even healthy if you look at the SIDS studies for a baby to be alone in his crib for 12 hours.  Count it a blessing if your baby sleeps for 5 hours so you can get some REM sleep and jump for joy if he sleeps for eight hours at any given point in time.  This is the norm for breastfed babies. 
2.  Sleep when your baby sleeps.  It may be necessary for you to get a nap during the day or even go to bed a little earlier if your baby goes to sleep early for you to get your much needed sleep.
3.  Know that normal "schedules" go out the window when your baby goes through growth spurts.  Even if your baby was sleeping for 5-8 hours, during the 3 week, 6 week, 3 month or 6 month growth spurts, feeding will be more frequent.  This is normal and usually only lasts 5 days if you do not delay the feedings.

     Breast milk supply is all about supply and demand.  Weight gain is based on total calories consumed in a 24 hour period.  If your baby is distracted during the day and not feeding well, it is important that he or she gets her calories at night.   You are a good mother, if you were not you would not be reading articles to learn more about parenting your baby.  Every child is different and norms do not hold true with every child.  All I can do is give you information based on training as an International Board Certified Lactation Consultant and 20 years of experience.  I hope this article helps you to protect your milk supply and meet your breastfeeding goals.

*Note:  The average baby from 6 days to 6 months of age gains 5-7 ounces per week.

Breast Pump Insurance Coverage & Reimbursement

   As the Affordable Care Act is enacted and more and more moms are becoming aware of the benefits of it, we are learning more and more about getting insurance to cover your breast pump.
 First, don't take "no" for an answer.  Call your insurance company.  If the representative tells you that a breast pump is not covered ask why.  Some insurance companies are still classifying breast pumps as "personal comfort" items.  According to the US Government Department of Health & Human Services, " Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012."
     The Affordable Care Act covers Breastfeeding support, supplies, and counseling.  Some insurance companies are covering hospital grade breast pump rentals, but others are covering quality personal use pumps sold by DME supplies like Lactation Connection.  We found the United Health Care policies buried in a table entitled Expanded Women's Preventative Health and it states that these items are required coverage for plans beginning after 8/1/12.
     Make sure to get prior approval from your insurance company before purchasing from an out of network supplier, especially if you are on an HMO.  But it is always a good idea to call your insurance company first for information on how to get reimbursement.  Take down the name of the person you spoke to.   If the answer is "we don't cover that"  ask why and if the answer is not that you have to buy "in network" or that your plan is grandfathered.  Call back and speak to someone else until you get a knowledgeable helpful representative.  Finally, ask what paperwork you need to submit for reimbursement.  Lactation Connection provides you a receipt with the appropriate insurance codes attached for your convenience when you purchase at http://www.lactationconnection.com

http://www.hrsa.gov/womensguidelines/
http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Preventive_Care_Services_CD.pdf

Comparing Hygeia Breast Pump Models

     The Hygeia EnJoye Breast Pump has become our most requested pump of 2013, but the different models can be confusing.  First, all EnJoye pumps have the same motor with the same three year warranty. All three are "green" pump so they are approved by the FDA for multi-person uses so can be resold.  If you are purchasing a used Hygeia EnJoye you will need your own sanitary double pumping kit which includes the tubing, filters bottles and valves. And all three have the CARE function witch is an audio recording device to record your baby's coos or cries and play them back to assist with let down while pumping.  The distinctions are below:
Hygeia EnJoye EPS Breast Pump has an external power supply (AC adapter) only and can be purchased on our site with or without a tote.
Hygeia EnJoye EXT Breast Pump has both the AC adapter and an external AA battery pack.  You can purchase these with a brown or black tote which makes a very nice diaper bag as well.
Hygeia EnJoye LBI Breast Pump has both the AC adapter and includes an internal lithium ion rechargeable battery for moms who don't have access to an outlet and reply on a battery to pump.

The Hygeia EnJoye Breast Pump is an excellent purchase and is covered under your insurance plan if purchased from either a network provider or a DME supplier like Lactation Connection in most cases.  Always check with your insurance company for details on breast pump insurance coverage, but know that in 2013 a breast pump is covered as preventative care under the Affordable Care Act so don't take no for an answer.  Breastpumps and breastfeeding supplies are covered. 
     If your insurance company pays for breast pump rental, the Hygeia EnDeare is an excellent choice.

Stocking Up and Storing Breastmilk

It is always a good idea to have a stockpile of breastmilk in the freezer.  You never know when you might have a medical procedure come up or your hubby may want to wisk you away for a romantic weekend.  Sometimes it is a daunting task to get a significant amount of breastmilk stored, so here are some tips:
1.  Pump Efficiently:  Purchase an effective breast pump.  Pumping with a bad breast pump will make any mom want to throw in the towel.  You don't have to spend $300 on a pump, but budgeting a months worth of what you would have spent on formula and getting the basic model of the Ameda Purely Yours is just the ticket at less than $150 or the Spectra S2 Breast Pump for under $200.
2.  Start Early:  Don't confuse the advice that says that you should not give your baby a bottle for 6 weeks to mean don't pump for the first six weeks.  The former is to avoid nipple confusion.  If you begin pumping in the early weeks, you will have more to store before your milk supply regulates and you will be ahead of the game.
3.  Pump Early:  On the average, moms get 1 oz after feeding in the morning hours as opposed to half an oz later in the day.  So if you pump in the mornings, you will get more for your effort.
4.  Replacement Pump:  If Dad gives a bottle of stored milk because you are running late getting back from the store, pump immediately and you will replace the entire amount!
5.  Pump Easy:  Pump into the same refrigerated container for up to 24 hours and then place in the freezer.  Since breastmilk has antibacterial properties, you can also just rinse breastshields and re-use as opposed to sterilizing each time.  Do sterilize parts once per day. 
6.  Store Smart:  Pump in 2-4 oz increments so you can easily defrost just what you need to avoid waste.  You can save space with breast milk freezer bags or save time by pumping into the same bottles you are going to use to feed.  If you use bottles, use a sealing disc and don't put nipples in the freezer.
7.  If you have an upcoming event to store up for, you can use lactation cookies or bars to boost supply so you can stock up faster

For moms storing breast milk short term to use during the same week, using a system to organize your milk keeps you from wasting freshly expressed breast milk. Breastmilk Bandit easily labels your milk with My Mommy's Milk and the Day of the week making this an economical and easier method that tagging your milk with post-its.

Happy Pumping!
Tanya

Are you Mom Enough: Time to Speak Out!

Unfortunately, the Time Magazine article picture did not help to promote breastfeeding.  This photo was shot to sell magazines, not to help make breastfeeding the norm.  While I personally nursed my children for up to 18 months, there is no doubt that breastmilk is beneficial for much longer.  The controversy comes in with the child standing and the captioning challening moms to nurse their older child.  As a retired lactation consultant, I always tried to help moms meet their personal goals and encourage them to nurse at each stage of breastfeeding.  Whether it was the first month, three months or hopefully at least a year.  I gave advice on partial weaning when a mom did not want to pump when returning to work and advice on gradual and baby led weaning when asked about weaning.  The caption depicts all who promote breastfeeding as breastfeeding Nazis and not the supporters of mothers and babies who we are.  It makes nursing mothers look radical instead of impassioned.  While I support the mother on the cover and her personal decision to nurse her toddler, I reject the notion that we are all out there screaming that if you don't nurse for over a year, or at all, that you aren't mom enough!  Breastfeeding can take tenacity.  Tenacity which you need when you are parenting teenagers later on, but moms should be encouraged, not called out in a confrontational manner for not breastfeeding.  Having said that, I personally have been atacked for statements such as "breast milk has never been recalled".  Proponets of breastfeeding should be allowed to speak the truth without it being perceived that we are attacking the other side.  Truth is truth whether you believe it or not and whether you choose it or not.

Breastfeeding Diet: How to Lose Weight While Breastfeeding

      As a retired lactation consultant, mother of 3 and grandmother of one, I get asked this question quite often:  "How do I loose the baby weight?"  More recently I was asked about diet pills, which are unsafe for the nursing mother.  That caused me to take action so I am giving you a guideline below based on two decades of experience and the additional 500 calories per day needed by nursing mothers or 1000 extra calories if you are nursing twins.  As with any diet, consult your doctor before beginning this and do no begin until the baby is at least 3 months old. 

     Losing weight is not necessarily how much you eat, but what combination of foods you eat in order to jump start your metabolism.  Start by measuring yourself and not just weighing yourself because you begin to lose inches faster than pounds so it is encouraging to see the smaller waistline, etc.  An inexpensive food scale and measuring cups is helpful for this process.  Do not “cheat” by exchanging servings and eat everything recommended in the course of the day.  Serving size for veggies is 1 cup and fruit 1 apple, orange, etc. 

7 oz meat (nothing fried; cheese is included in this category)

3 fruit

2-3 non-starchy vegetable (not peas or corn)

4 bread (1 cup pasta, regular sliced bread  = 1, but a muffin or biscuit = 2)

3 cup dairy (1% milk or yogurt, not Yoplait or any brand with corn syrup, no ice cream)

1 fat = (1 TBS salad dressing or peanut butter or low-fat mayonnaise)

Weight loss varies depending on how much weight you gained during the last pregnancy ad this weight comes of faster than extra pounds that have been there for years.  Typical weight loss after you reach pre-pregnancy weight should be 1-2 lbs per week, do don't skimp on food to make it go faster. You are better off keeping weight off than loosing too quickly!  Please don't make your goal getting back into your favorite jeans from high school, that is unrealistic.  You goal is a healthy weight, womanly curves are not your enemy.  After all, you need hips to carry your toddler around!

For additional breastfeeding tips, visit our website!

Happy, healthy eating!

Tanya Roberts
Lactation Connection