Breast Milk Intake Chart: Infant Weight - How Much Breast Milk

One of the top questions we get, is how much do I leave for my baby in a bottle when I am away at work?  After all, your breasts don't come with ounce markers because your baby feeds on demand.  But for moms who are working or away from their baby short term, it is important to know how to determine how much milk is appropriate to leave.  For infants up to six months old, the quickest way to determine this is to take your baby's current weight rounding up to the nearest half pound and multiply by 2.5.  For example, a baby who is 10 lbs will need 25 ounces per day.  Then divide by the number of feedings per day, normally 8 for an infant under six months of age.  Therefore 25 ounces divided by 8 feedings is 3.12 ounces per bottle which we will round up to the nearest quarter ounce.  In other words, leave 31/4 ounces for a 10 lb baby for every 3 hours that you will be away.  Also leaving an extra frozen bottle is a good idea for emergencies.  Here is a link to a breast milk intake chart for those of you who are like me and have a mental block when it comes to math.

If you are trying to determine breast milk intake in those early days for your peace of mind or if your baby doctor is indicating that your baby is slow to gain weight, an affordable accurate baby scale with memory is a great tool.

Remember, diapers are a great indicator that your baby is getting enough.  Infants from day 6 through 6 weeks should have 6-8 wet diapers per day and 3-4 dirty diapers larger than a silver dollar.  Also note that older babies who are on solid food do not use this chart.  At that age, they take an average of 24-32 oz per day in addition to three solid meals per day.  When feeding solid foods, breastfeed first as breastmilk is still the main source of nutrition.  

If you still have concerns, having an affordable accurate digital baby scale is a plus.  Choose a digital baby scale that is accurate within 5 grams and has memory for before and after feeds to give you an idea of your baby's breast milk intake.

Best wishes!

Tanya

Pump Up Your Production: Milk Supply and the Pumping Mama

With today's easy to use breast pumps, moms sometimes think they just need to pump at work at lunch and break and then just go about their business.  Pumping, just like breastfeeding should be intentional.  We don't choose to breastfeed because someone said it is better for your baby.  We breastfeed because we educate ourselves to want the best for our child.  Pumping should also not be so haphazard.

First choose a quality hygienic breast pump.
There are many breast pump out there that while commonplace, are not the best choice.  You need an auto-cycling breast pump that does at least 60 cycles and has a closed system like Hygeia, Ameda and Spectra offer.  Double pumping increases the prolactin levels as well as save you time. Prolactin is the milk producing hormone.

Next determine your pumping schedule.
A mother of an infant under six months should pump at least every 3 hours that she is away from her baby.  That time frame is from the beginning of one pumping or nursing session to the beginning of the next.  If your schedule is erratic, you should still pump 3 times per day on an 8 hour work day. Just put some of them closer together if needed to get this time in.

Allow enough time for pumping.
You should allow a full 10-15 minutes for double pumping and then an extra few minutes to rinse your parts and put them away.  Do not stop pumping if milk stops flowing unless the time on the clock has passed.  Otherwise your body will think you don't need as much milk.  A good rule of thumb is that if milk is flowing for less than 10 minutes, pump for 10. If it is flowing past the 10 minute mark, pump for 15.  These extra few minutes simulate the non-nutritive sucking your baby does when nursing and is imperative for milk supply.

Don't forget about growth spurts.
Infants nurse more frequently during growth spurts.  At 10 days to 3 weeks, the first growth spurt is evident with the baby asking to be fed more frequently.  Breast pumps don't cry to be used so we have to intentionally pump more often during this 5 day period.  Pumping every 2 hours is best during the baby's third week, sixth week and three month milestone.  If this is not possible at work, pump at home after feeding the baby at least three extra times per day.  Don't worry about the amount of milk you are extracting.  This is more for stimulation than extraction, indicating to your body that your baby is about to grow and will need more milk.

Maintain your breast pump.
Professional grade breast pumps like the Hygeia EnJoye, Spectra S2 have systems that are dependent on maintaining suction.  Replacing breast pump valves and filters every six to eight weeks is essential for keeping your breast pump working at it's optimal level.  Keep breast pump parts on hand and replace on schedule or more often if you notice evidence of decreased suction or damage to your parts.

With good information prior to embarking on full time pumping or working and breastfeeding it is entirely possible for you to maintain a healthy milk supply.

Happy Pumping!
Tanya

Pumping Schedule: Working and Breastfeeding

We get this question often as to how to ensure a healthy breast milk supply while working and breastfeeding.  Just as in raising kids, consistency is essential.  Most moms return to work when the baby is 4-8 weeks old so we will give you a typical schedule to keep you on track as well as a schedule for the early growth spurts.

This schedule is for a 24 hour period on any given 9-5 workday and can be modified to your changing schedule.  The imperative is to nurse or pump every 2-3 hours for a total of 8 times per 24 hour period when your baby is under 6 months old.  If you choose to delay solids past 6 months, then continue this schedule until solids are introduced.

Please note that we are not advocating scheduling a baby's every feeding.  Feeding on demand is best for milk supply so if your baby asks to be fed earlier that your normal "schedule" by all means, feed your baby.  We do however find that working mothers benefit from a routine when it comes to pumping to ensure that they do not miss feedings and therefore do not adequately stimulate the breast which lowers milk supply.

Sample Feeding - Pumping Schedule for Infants who Night Feed

6:00 am feeding

8:30 am feeding

11:30 am pumping

2:30 pm pumping

5:30 pm feeding

8:00 pm feeding

10:00 pm feeding

3:00 am feeding

Once the baby begins sleeping through the night, put daytime feedings/pumping closer together so that you still meet the 8 times per day minimum feedings.  

Sample Feeding - Pumping Schedule for Infants who Sleep Through the Night

5:00 am feeding

8:00 am feeding

11:00 am pumping

1:00 pm pumping

4:00 pm pumping

5:30 pm feeding

8:00 pm feeding

10:00 pm feeding


This schedule will vary when your baby is going through growth spurts.  PLAN on feeding or pumping every 2 hours for a total number of 11-12 times per day during the week that your baby is 3 weeks, 6 weeks, and the week that your baby turns 3 months old.  This will help ensure that your milk supply grows with your infant's needs.  For at least 5 days during that period, you will want your feeding and pumping schedule to look something like the one below:

Sample Feeding - Pumping Schedule for Infants During a Growth Spurt*

3:30 am feeding

5:30 am feeding

7:30 am feeding

9:30 am pumping

11:30 am pumping

1:30 pm pumping

3:30 pm pumping

5:30 pm feeding

7:30 pm feeding

9:30 pm feeding

11:30pm feeding

As a working mother, you should choose a quality closed system double breast pump such as Spectra, Hygeia or Ameda make.   The convenience of a hands-free pumping bra is nice.   Make sure that you are changing your breast pump valves and filters or backflow protector to keep your breast pump working at it's optimal suction levels.  Do not risk low milk supply by not replacing your breast pump parts.  Use a phone app timer or equivalent to make sure you pump for a full 10-15 minutes of double pumping whether milk is coming out or not.  The law of supply and demand when it comes to breastfeeding is more like DEMAND and then the SUPPLY will come!  

Happy Pumping,
Tanya

*Growth spurts typically occur either at 10 days or 3 weeks, and then recur at 6 weeks, and 3 months and last for 5-7 days.

ARDO & Lucina: Finding Breast Pump Parts for ARDO Calypso and Melodi Breast Pumps

In helping moms find breast pump parts for their insurance pumps, we noticed a similarity between the Lucina Melodi and ARDO Calypso breast pump parts.  In investigating further, we contacted Lucina whose chat rep denied such a connection.  You be the judge.  The parts are identical except the color of the cap on the double pump kit that fits on the flange.  While Lucina Melodi Advanced and Melodi Prime have a purple cap, ARDO Calypso and Carum use a green cap. We further noticed that the ARDO Amaryll manual breast pump is the exact same pump as the Lucina Melodi Manual Pump.

Finally, we took a close look at the Lucina Double Pump Kit image on their website and we noticed that you can read part of the ARDO brand name on the side of the flange shaft.  

Our conclusion is that the parts are made by the same company and can be used interchangeably. Good news for the mom who can't find Lucina Melodi breast pump parts!  We would love to get your feedback on using the ARDO parts on your Lucina Melodi Advanced or Melodi Prime breast pump!  

Happy Pumping,

Tanya

When & How to Use a Nipple Shield

Nipple shields have changed over the years.  You will find videos and images of rubber or latex nipple shields which are no longer used due to their thickness. Latex is also no longer used since it has a tendency to break down, has a smell and a taste and is an allergen to some.

Modern nipple shields are silicone.  Medela even made them with a cut-out which was supposed to be used for more skin to skin contact with the baby's chin or if flipped the other direction to prevent possibly obstructing the infants airway.  Since these "contact" style have less surface area, they do not adhere as well as a full circle design such as the Ameda Nipple Shield.

When is the use of a nipple shield indicated?

1.  When a mom has an inverted nipple and the baby does not latch or suck because it does not feel the nipple in its mouth.  Some nipples are easily identified as inverted, but others only invert when the baby tries to latch.  An easy test for this is to take your index finger and thumb and compress the areola 1" behind the nipple.  If the nipple goes in, it is indeed flat or inverted even if it appears to protrude upon inspection.

2.  When a mom has a flat nipple or a nipple that "hides" when compressed as explained above.

3.  When a baby is bottle confused and does not identify a fleshy nipple as it's trigger to suck.  Depending on how long the baby is on a bottle, moms can train the infant to go from bottle to nipple shield and then to breast in the following steps:
     a.  For the first 24 hours, use a wide mouth bottle nipple on the baby's bottle, but turn the baby in tummy to tummy held tightly to feed.  Babies who are used to feeding on their backs tend to fight you when you hold them tightly at first so this is the first step to getting back to the breast.
     b. Wet the nipple shield with your own expressed milk to help it adhere.  You can even take a syringe and squirt some milk into the tip of the nipple shield so that babies who are used to immediate gratification from a bottle will continue to suck.
     c.  After using the nipple shield to get the baby to feed from the breast, try removing it after the feeding has started.

When should I not use a nipple shield?

A nipple shield is a last resort.  It is not the first thing to try when you have a sore or abraded nipple.  If the nipple is sore, it is most likely a poor latch and that needs to be corrected.  Using a nipple shield for a poor latch is not indicated.  See our blog post on correcting the latch instead because a nipple shield used incorrectly can cause more problems down the road as discussed below.

How long should I use the nipple shield?

Nipple shields were intended for short-term use as a bridge to help a mom with a flat or inverted nipple until the baby has a strong suck.  Or to help a bottle-confused baby nurse at the breast.  This short term should last no more than a few weeks.  It you use a nipple shield for longer than a few days, it is important to pump 2-3 times per day with a good double electric breast pump after feedings.  This will offset the decrease in stimulation and milk supply that a nipple shield can cause. 

How can I wean my baby off the nipple shield?

1.  Try removing the shield after the first 2-3 minutes of the feed.
2.  Try feeding the baby when she is in instinctive mode such as half-asleep or in the bathtub without the nipple shield.
3.  Buy a second nipple shield, invert it and take a sliver off with a clear sharp razor each day until the tip is gone.  Make sure you invert the shield and you do not use the only one you have in case your baby has a bad feeding in the middle of the night.  Inverting the shield before slivering it keeps any uneven edges towards you and not towards the baby.

What if my baby refuses to get rid of the nipple shield?

If the baby refuses to nurse without the nipple shield, it is not the end of the world.  Many moms who did not try a nipple shield for a baby who refused to latch, end up exclusively pumping.  Therefore pumping 2-3 times a day after feeding is much easier than pumping 8 times per day.  Your baby will still benefit from the tooth and jaw development that occurs when they are directly at the breast and of course whether you are pumping or nursing, the benefits of breast milk are immense. 

Best wishes, Mamas!
Tanya

Bigger Bras for Breastfeeding: Buying Nursing Bras in Sizes DD E F G H and I

Not all bras are created equal and especially nursing bras that need to not only support but prevent plugged milk ducts and give easy nursing access all while looking great.  The good news is that they are out there if you know what you are looking for.

One of our new favorites for moms with cup sizes up to DDD or F cup is the QT Natalie Nursing Bra.  It is a great wire free solution with good support for larger busts and is available in sizes 34D-44DDD/F.  We like the smooth look and easy fit of this bigger nursing bra as well.

If you are looking for a bigger underwire nursing bra, QT Foundations offers an excellent choice is the Dottie Nursing Bra style #3325.  This nursing bra for larger cups offers great coverage and support in sizes 34G-42H.

For our curvier moms, they appreciate that the 40, 42 and 44 bands come in the bigger nursing bra sizes of 42D through 44F and 44G nursing bra sizes thanks to QT Foundations!

As for a 24 hour bigger sleep nursing bra for sleep and leisure, the Bravado Original Double Plus Nursing Bra is the way to go since there are no hooks in the back to be uncomfortable for sleep and it is styled in a way that has a sport bra appearance which keeps you from falling out when you are lying on your side.  Bravado has recently updated this style to offer a lower front and narrower racerback to allow you to wear with today's fashions.

So if you are still searching for a hard-to find nursing bra size, check out this shop by size link or give us a call at 800-216-8151 and ask to speak to a nursing bra fitting specialist.  We have over 20 years experience in fitting your changing shape at Lactation Connection.

Breastfeeding Pain: Good Mom Syndrome

You may have heard of good baby syndrome which is when a baby is content and doesn't ask to be fed.  (This can happen with good-natured babies who are content to play while mom tends to other siblings and not get enough feeding in by the end of the day which can lead to slow weight gain.)  But have you heard of Good Mom Syndrome?  This is the new mother who wants the very best for her baby so she is gritting her teeth and accepting the pain of a poor latch.

STOP THE MADNESS!

Normal breastfeeding should not hurt.  A good latch is one that encompasses at least an inch of the areola so that baby is latched on behind the nerve ending.  A poor latch is one where the baby is on the end of the nipple either initially or has slipped down and is causing pain.  I hate to be a lactation nerd, but I here is a diagram of the breast.

It is so important that moms have this information because you can see where the nipple and areola are in relation to the milk (lactiferous) sinuses.  In other words, the farther onto the breast your baby is latches, the less pain you have and more milk is transferred.  In other words, you are a good mother.  You want the best for your baby, but letting your baby cause you pain is not best for you or the baby.

If you already have nipple trauma and correct the latch, there may still be pain for the first 30-60 seconds, but after that it should be comfortable to nurse.  If your baby slips down during the feeding because you are not supporting the breast or the arm with which you are holding your baby tires because you are not supporting your arm with a nursing pillow or armrest, detach the latch.

The proper way to detach a latch to to take your finger and slip it into the baby's mouth past the gums so that the suction is broken.  Turn your finger slightly to release the baby's grip and then take him off.  Start your latch again.  See our breastfeeding latch blog post for proper latch techniques if you need more help with this.

If you have followed proper procedure and still have pain, this is the time to see a lactation consultant, but normal breastfeeding should not hurt.  It should be a comfortable experience for mom and baby.  The sooner your latch is corrected, the better chance you have of meeting your personal breastfeeding goals.

If you need time for one nipple to heal while you are correcting the latch, using a quality breast pump to express and syringe feed the milk to your baby is a good way of transitioning to pain-free nursing.  And as always, the right nipple cream can help healing.  We recommend Breastmilk Bandit Natural Nipple Cream made from organic extra virgin coconut oil.



Happy Nursing!
Tanya