7 Stages of Breastfeeding: A Baby's Perspective

Just for fun in honor of World Breastfeeding Week 2013, I thought I would write something from baby's perspective as a breastfeeding tip for mom.  Here is one tip for every day of this week!
1.  Birth-day Initiation:  My stomach is the size of a marble.  I am loving being skin to skin with Mama and the reward of a swallow of golden colostrum!
2.  10-Day-itis:  After 10 days, I start my first growth spurt.  I want to eat every hour or two and can't get enough of this liquid gold.
3.  6 weeks:  Breastfeeding is easier for me, but pooping is harder.  I am going through another feeding frenzy and things seem to be changing!  I was pooping all the time, but now only once in a while!
4.  3 months:  Another growth spurt.  Love it!  I get to eat as often as I like and no one complains, but I do get a little distracted 'cause there is so much to see while I'm eating.
5.  6 months:  I'm learning to sit up and trying solid foods just for fun.  My mom always lets me nurse first so I don't get too full for my milk, but I think it's so I don't get green beans on her breast!
6.  The Groove:  My mom and I are in a groove, we are nursing whenever and wherever I am hungry.  I may not be nursing as often as I was the first six months, but I can down a meal in 20 minutes if I am not too busy learning new things!
7.  Weaning:  Mom is letting me wean myself.  I haven't decided when yet, but we are in no hurry.  I heard her tell dad that if she does decide to wean me by a certain time that she is only going to drop one feeding no closer than 3 to 5 days apart.  This way, her breasts and my brain have time to get used to the change.   I love my mommy!

Happy World Breastfeeding Week, Mamas!
Tanya Roberts, BSEd, LC
Lactation Connection
{The Nursing Mother's Milk Supply}

Supplementing the Breastfed Baby: Lactation Aid Feeding Tubes vs Supplemental Nursing System & Lact-Aid Nursing Trainer

     In my practice as a board certified lactation consultant, there were times when it was medically necessary to supplement.  Whether it was due to a poor suck or mismanaged milk supply, we need options when recovering from these issues and getting back to breastfeeding.  Many times, I would recommend finger-feeding with a syringe to keep moms from using a bottle nipple.  I would have rather recommended a Supplemental Nursing System which has a container with tubes that runs to the breast; but I didn't want to see mom spending the extra money when her budget was so tight.  At that time, the only options were the Supplemental Nursing System (SNS) by Medela and the Lact-Aid Nursing Trainer.   These cost mom $50 or more and had small tubes to be cleaned which were cumbersome.   Now, with more options available, Moms can use a short-term feeding tube which accomplishes the same thing and can be cleaned for a few days before disposing of it.  It is a small investment in comparison to the commercial systems.  While moms who are adopting babies and inducing lactation, rather than just building milk supply may still want a commercial unit; the Lactation Aid Feeding Tubes are the best course for the short term situation.  Thanks to IBCLC, physician and lactivist, Dr Jack Newman videos and instructions are available for using these feeding tubes.  You simply cut a slightly larger hole into a bottle nipple.  Insert the adapter end into the bottle and feed the tube into the babies mouth while he is latched on.  You may also use medical tape if you prefer to have the tube in place prior to latch.  These can be purchased from the International Breastfeeding Center in Canada, but due to the long ship time of up to three weeks, we have added them to our selections at Lactation Connection.  Sold in a two pack for under $10, these will last up to two weeks while mom is re-establishing milk supply or training a baby with a weak suck.  Each tube is in an individual sterile pack ready to use.  Instructions are included with the feeding tubes when purchased here:  https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-5036-2.htm
     Dr. Jack Newman also has a helpful instructional video on YouTube.  I encourage you to view it and encourage lactation consultants and breastfeeding counselors to recommend and use these feeding tubes for short term situations of supplementation. 
http://www.youtube.com/watch?v=ezGIkIkhC_o&feature
     It is also important to recognize the appropriate amount of supplementation.  Always assess milk supply first, then only give the difference of what mom is producing and the actual need of the baby.  This is to say that you supplement not how much the baby will drink, but the need of a baby of that weight.  Here is a link to a chart for appropriate milk intake to show how much to feed per pound of body weight:  https://www.lactationconnection.com/Feeding_s/1907.htm  For example, a 7lb baby who is older than 6 days needs 2.25oz eight times per day.  If mom is making 1.25, then the appropriate amount of supplementation is 1 oz. per feeding.  Contact you local lactation consultant for further instructions on supplementation or give us a call at 800-216-8151 9-5 M-F CST. 


Lactation Aid Images: 

Note:  Most lactation aid feeding tubes sold are slow flow.  They are 36" in length so that the flow is regulated.  Shorter tubes change the flow to a faster rate.  If you do need a faster flow for an older baby, medium flow lactation aid feeding tubes are now available at: https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-6036r.htm 

Happy Nourishing!

Tanya

Breastfeeding Essentials: Budget for Breastfeeding

     We all know that all you really need for breastfeeding is a boob and a baby, but I often get the question, "What do I need for breastfeeding?".   The answer is that it really depends on your situation and your budget.  Are you going to be working outside the home?  If you are mostly working in the home, do you have times that you need to be away from your baby for conferences, etc? 
     Formula costs about $150 per month so you budget for breastfeeding could be over $1000 and still be ahead, but most most do not spend that much.  If you work inside the home and are not separated from the baby, you can spend very little.
     The following is a checklist and depending on whether you are work at home mom or a mom who works outside the home, you will want to pick and choose the type of breast milk collection product you will need based on your situation.   I have been in the business of breastfeeding for 20 years and am very familiar with the major brands and products associated with breastfeeding so the product list below is one given with experience and based on what products I would buy for myself, my daughter or my daughter-in-law:
Nursing Pads
__2-3 packs of washable nursing pads
Breast Cream
__1 large tube of breast cream
Nursing Bras and Gowns
__2-3 quality nursing sleep bras
__2-3 daytime nursing bras with good support (non-underwire)
__2-3 nursing gowns
Breast Milk Collection and Storage
__1 quality double electric breast pump
__2-3 packs of breast milk bags
__3 packs of breast milk bottles for storage
     The best time to be fitted for a nursing bra is 3 weeks prior to delivery.  This is a great time to finalize your list and make sure your hospital bag is packed and ready.  Happy nurturing!

Nursing In Public: To Cover or Not to Cover

     There is an ongoing debate in the breastfeeding community about covering up while breastfeeding.  Many lactivists insist on nursing without a cover.  Others may even be rude to a nursing mother who is nursing in public.  A cover is a personal choice.  Nursing in public may be more comfortable to you while you are learning to latch on discreetly with a nursing cover.  Once you and your baby learn to latch well, a nursing top or other discreet top may work for you.  If you are in a group of women, it is actually helpful to nurse without a cover so that other women can learn from you.  One of the reasons our culture has a difficult time with the early days of breastfeeding is that we have never seen it done.  Although Spanish is my second language, in my 20 years of counseling nursing mothers I have had less Hispanic clients who needed help with latch due to the culture of women helping women. 
      If you choose to cover a nursing scarf makes an excellent nursing cover. It is fashionable, easily accessible and helps your baby stay on the task of nursing. 
   So cover, don't cover.  It is up to you.  Do whatever makes you, not just others feel comfortable.  The more comfortable you are, the longer you will breastfeed!

Here is to nursing anywhere and everywhere!

Tanya

Introducing a Bottle to the Breastfed Baby

When should I introduce a bottle to my breastfed baby?

     

Waiting to offer a bottle is essential for initiation of lactation.  Experts tell us that we should wait at least 3-4 weeks.  I believe it should be at least four weeks because even a bottle of breastmilk can interfere with stimulation during the three week growth spurt period. It can undermine moms confidence when baby gulps a bottle down during the hunger games of growth spurts.  When you offer a bottle of expressed milk, it is essential to pump to replace that feeding or it can interfere with milk supply or cause plugged milk ducts. 
     Most moms begin a bottle because they want the freedom of allowing someone else to feed or out of necessity because they are going back to work.  If you choose to nap and let Dad feed make sure to fully empty the breasts by nursing first.  If a bottle has been given while you were asleep or running errands, pump when you return even if you have nursed immediately when you came through the door.  Anytime a bottle was given, baby will not be as hungry and therefore not empty the breast as well and residual milk can cause clogs especially in the early weeks of breastfeeding.
     If you are not going back to work or want someone else to feed, a bottle is not an absolute.  You may wait longer if you wish, but some moms who wait longer than 8 weeks find it difficult to coax their baby into taking a bottle.  So if you are going back to work, the best window may be 4-8 weeks.  If you are not going back to work, but find yourself in an emergency situation that you have to be away from your baby, the baby will normally take a bottle from another person if you are gone very long.  If you are not gone more than 3-4 hours, the baby may also wait for you.  In any case, it is important to have stored up at least 24-48 hours worth of breastmilk in the freezer.   Here is a breast milk intake chart to help you determine how much you need based weight.

Store milk in 2-4 oz increments.  This makes it easy to defrost and access just the right amount without waste.  You may store breast milk in sealed bottles or breast milk bags.  Bags have been the preferred method for most moms due to the quicker defrost time and space saving size.  They are more costlly in the long run so bottles may be more cost effective and better for the environment, but today inexpensive biodegradable breast milk storage bags are available.

What to do if you baby refuses a bottle?

First of all, don't panic.  Almost all babies will eventually take the bottle.  Here are some tips to help you get things going:

1.  Start with a soothing environment such as in a favorite rocking chair and you could even put on some music or white noise.

2.  Use a silicone wide mouth nipple so that the nipple itself does not have a taste.

3.  Squeeze a few drops out of the bottle nipple so that the baby can smell and taste immediately.

3.  Let someone other than mom initiate bottle feeding.

5.  Place the baby in a breastfeeding position which is tummy to tummy with the caregiver and hold the base of the bottle close to your collar bone.

6.  If the baby just takes the tip of the nipple, gently screw it in like a lightbulb to get their lips flanged.

7.  Often the best time to try bottle feeding on a reluctant infant is when they are already falling asleep or not yet fully awake from a nap.

8.  If  you are still having trouble, try walking while feeding.

Happy Feeding!

Tanya

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.