Exclusive Pumping: Keeping Up Breast Milk Production While Pumping

I often get moms who want to exclusively pump instead of breast feed directly.  If you choose to pump exclusively, it is very important that stimulation starts in the hospital within 1 hour of the baby's birth.  Moms should double pump with a hospital or professional quality pump like the Ameda, Medela or Hygeia hospital grade rental pumps or a brand new (not used) professional quality pump like the Ameda Purely Yours,  Hygeia EnJoye Breast Pump or Spectra S2 Breast Pump. 



To initiate milk supply, pump every 2-3 hours with a 5 hour stretch at night for a total of at least 8 times per day of 10-15 minute double pumping sessions.  Many pumping moms get discouraged during the first 3-5 days as it is hard to see much going into the bottles as colostrum comes in teaspoons, not ounces.  Do not let this dissuade you, but draw this liquid gold up in a syringe and give it to the baby as it is chalked full of antibodies.  This schedule goes on for the first six months for the most part, but there are times when normal babies go through growth spurts that you will have to simulate with a pump.  When the baby is 2-3 weeks old and again when the baby is 3 months old, set aside a 5 day period that you will step up the pumping schedule to every 2 hours for a total of at least 11-12 times per day.  This must be 5 days in a row.  If your schedule gets interrupted, start over.   As you can see, this is a lot of pumping and cleaning of pump parts.  You will want at least 2-3 sets of breast flanges to use.  Some moms start this because it only takes 10-15 minutes to pump and a newborn baby takes 45 minutes to nurse, but as the baby gets older breastfeeding directly is much easier.  No bottles or pump parts to clean and most 2-6 month old babies will nurse in 20 minutes so you may want to reconsider your decision.  Pumping is great for the working mother, but if you choose to exclusively pump, experience shows me that these moms do not nurse as long as their direct breastfeeding counterparts.  If you breastfeed directly, it gets much easier by 6 weeks and by 3 months you feel sorry for moms who mix formula.   After all, have milk will travel!

If you do choose to exclusively pump, in addition to a quality breast pump a few key accessories will make your life easier.  These include a hands-free pumping bra so that you can multi-task while you are pumping, a breast pump cooler bag for transporting your pump and breast milk, an air dry bag to store and dry your breast pump parts on-the-go, and re-usable sterilizer bags to keep your parts sanitary anywhere you pump that you have access to a microwave.

Happy Traveling,
Tanya
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Every Ounce Counts!

Recently, I was asked to be the guest speaker for a breastfeeding reception at our local WIC clinic. August is always an exciting time to be in the business of breastfeeding because the first week is officially World Breastfeeding Week. Many cities and government agencies promote breastfeeding during this week and I am honored to be a part of the celebration in Granbury, TX.

As I was preparing, I researched the WIC theme, "Every Ounce Counts". What a great slogan! I encourage you to check out the WIC website because their campaign rivals those of major companies. Not only do they have great pictures of babies and what they might be when they grow up, but a song that can only be an encouragement to any nursing mother. The WIC ads include babies that want to grow up to be firefighters and doctors because breastmilk makes you stronger and smarter, which is very true! Breastfed babies develop better with fewer health problems and their IQ scores and performance in school is markedly better than their formula-fed counterparts. The next thing that came to my mind, was the composition of breast milk and how many moms are fooled into thinking that their milk isn't good enough or that the time they breastfeed isn't important. Collostrum comes in teaspoons, not ounces and yet it is the baby's first immunization against the world's diseases. Moms are also fooled into thinking that a bottle of formula occasionally doesn't affect anything, but supplementing even once per day before the age of 3-4 months, can cause early weaning. Babies who are breastfed just three months already have a reduced risk of juvenile diabetes, multiple sclerosis, heart disease and even childhood cancer!  The breast milk made the difference and the longer you nurse, the better. Babies who are breastfed for four months are less likely to be hospitalized for respiratory illness.

Those are some great benefits of breastmilk, but lets look at the flip-side. Diarrheal disease is four times more likely in formula-fed infants and formula-feeding increases risk of childhood obesity by 20-30%. Those are some statistics you can't argue with. And did you know that breastfed babies have fewer cavities than their artificially fed counterparts?

So many moms are discouraged from breastfeeding because they think their milk is not good enough or they
think that after a certain age, the benefits are gone. Nutritional content of breastmilk is consistent from mother
to mother even in third world countries. Between the ages of 12-24 months, toddlers can still get about 15 oz per day from nursing. These 15 oz provide the following RDA: 29% of energy, 43% protein, 36% calcium, 75% vitamin A, 76% folate, 94% vitamin B12, and 60% of Vit C. That is a lot more nutrition than they can get from chicken nuggets!

So moms, take heart. Every ounce does count and not just for your baby, but for you too. Not only does making breastmilk burn calories, but if you nurse for a total of 2 years, even if that is 3 babies for 8 months each, your reduce your risk of breast cancer, uterine cancer and ovarian cancer. Do remember, whether you nurse for 2 weeks or 2 years, any breast milk is good for your baby.

My Dad always had a saying, plan your work and work your plan. Most moms plan how to feed their baby, so there are a few things that are need to know. First, supplementing early causes early weaning. Moms who think they can nurse and feed formula early on, loose their milk supply. To keep up milk supply, partial weaning which is what we call it when moms choose to nurse at home, but not at work, can be accomplished only after your milk supply is well established. This happens when your baby is 4 months old. Full milk supply is best achieved when moms do not supplement solids until the baby is 6 months old and even then after the nursing, not before. Next, watch for growth spurts. Babies are supposed to act like they are hungry all the time at 3 weeks, 6 weeks, 3 months and 6 months. This is normal, don't schedule them, just use it or loose it!

For more answers to breastfeeding questions, check out our Q & A:
http://www.lactationconnection.com/breastfeeding_questions.aspx

Induced Lactation: Protocols for Adoptive Breastfeeding Mothers

Motivation as in anything is extremely important in breastfeeding and even more important is tenacity when inducing lactation.  The success rate for the following protocols according to Nemba in the 1994 Journal of Trop Pediatrics was 89%.  In this study 33 of the 37 women nursed their babies for 9 months or longer.
These mothers began with a 100 mg single priming dose of medroxyprogesterone (Depo Provera).  After 7 days, they began 25 mg of chlorpromazine 4 times daily or 10 mg of metoclopramide (Reglan) 4 times daily until adequate lactation was established.  Frequent pumping before infant's arrival and/or frequent suckling afterward is encouraged.  A supplemental feeding device is necessary until adequate lactation is established.  Inducing lactation is a gift of time and love!
Breastfeeding an adoptive baby is more than about breastmilk.  It is about bonding.  Skin to skin contact is essential.  Use a lactation aide to feed donor milk or formula at each feeding.  This is essential for stimulation of the milk production, bonding and success.

Best wishes for nurturing and nourishing your baby,

Tanya Roberts, BSEd, IBCLC

www.lactationconnection.com 

Engorgement: Bowling Ball Breasts

If you are experiencing difficulty with breast pain or latch-on 3 to 5 days postpartum, it is probably due to engorgement. Your breasts can feel as hard as bowling balls making it difficult for your baby to get a good latch.  Most of the time severe engorgement can be prevented by nursing the baby immediately upon delivery and putting the baby to breast every 2-3 hours.  If your baby is sleepy or there is a delay in breastfeeding, engorment can set in heavily.  Advil is safe for breastfeeding and contains an anti-inflammatory that may reduce some swelling and discomfort. Your best friend during this time is a hot compress. Turn the tap water and let it run until hot. Take two disposable baby diaper and swipe it under the tap three or four times. Mold the diapers around your breast. Repeat this procedure before each feeding. Commercial hot packs are also available, but the diapers work just as well so you may want to save your money for a good breast pump. If the areola is still too hard for the baby to grasp, use a quality breast pump for three to five minutes before latching the baby on. If the baby goes to sleep before emptying the breast, finish pumping afterward. Take heart! Engorgement only lasts for 48-72 hours.

Milk Intake: Your Breastfed Baby at 12-36 months

As a Lactation Consultant, my main clients are mothers whose babies are under 12 months of age, so when looking for information for my daughter-in-law, I found it hard to find anything on milk intake for babies older than 12 months.  After doing some research, I have come to the following conclusion that I thought I would share with all moms.

Babies who are 12-24 months of age and weigh 20 lbs or more should take in 16-20 oz of milk; more if they are underweight. Normal weight gain during this period is 2 oz per week. A typical schedule would be nursing or feeding expressed milk 4 x daily, feeding solids 3 x daily with one or two healthy snacks in between. If you are weaning to cows milk, it should be whole milk unless advised otherwise by your pediatrician.  For toddlers 2-3 years or age, typical milk intake is 3 servings or nursings per day. After 24 months, most pediatricians recommend switching to 2% milk if you have weaned from breast milk. Toddlers 24-36 months should gain approximately 1 oz per week and eat 3 meals per day with one healthy snack.

Between the ages of 12-24 months, toddlers can still get about 15 oz per day from nursing. These 15 oz provide the following RDA: 29% of energy, 43% protein, 36% calcium, 75% vitamin A, 76% folate, 94% vitamin B12, and 60% of Vit C so if you are pressured to wean before you or your baby is ready, stand your ground, even if it is in the snow!

Happy Nurturing,
Tanya
www.amamante.com

Weaning: Gradual & Partial

There are many considerations when deciding to wean your baby. The American Academy of Pediatrics recommends breastfeeding for at least one year. If you choose to wean before one year, first make sure your baby tolerates other foods well. Next absolutely, positively, do not wean cold turkey. Before you wean, consider your alternatives such as pumping at work or partial weaning. Partial weaning works well when a baby is older than 4 months. Moms can choose to use formula during the day while at work and still nurse in the morning and at night. This only works after milk supply is well established which is why you should wait until at least 4 months of age before employing this method and always follow the same schedule seven days per week. You cannot put the baby to the breast in the middle of the day, if you have weaned that feeding. Whether you choose to partially wean of fully wean, drop one feeding every three to five days. For example, if you are nursing 8 times per day, drop one feeding in the middle of the day, substitute formula, and continue that schedule for at least three days. At the end of the three days, if your breast have no plugged ducts or pain, you can drop a second feeding. If you feel discomfort, wait until the 5th day to drop another feeding. You continue dropping on feeding every 3-5 days until all feeding are dropped. After the last feeding is stopped, you may need to nurse or pump one or both breast a final time within the next week to make yourself comfortable. One pumping or nursing in a 24 hour period will not increase your milk supply and helps to alleviate any discomfort. This method is slow, but pain free. Sudden weaning can lead to clogged milk ducts, breast infections and even breast abscess. Both you and baby will be happy with gradual weaning.

Don't be misled by advice that tell you to bind yourself.  If you need to expedite weaning, cold cabbage leaves in your bra replaced every hour can help, but make sure you listen to your body and if it is talking to you by means of pain, you are weaning too quickly and you will need to nurse or express milk if you are feeling lumps.  If you have chills, fever or flu-like symptoms, call your doctor right away.

Best wishes for painless weaning,
Tanya

Cup Size Confusion: DD, E, DDD, F

One of the most common questions I get as a professional bra fitter is where do I find a DDD?  There are several reasons moms are having such a hard time finding their bra, even after they have been measured.
1.  They don't understand the cup size equivalents.
2.  They haven't been properly measured.
Let me address the measurements first.  If your bra fitter did not take three measurements, she has been trained to fit you into certain brands of bras.  Many companies do not offer cup sizes larger than a DD so they use two measurements and add 4 or 5 inches to make up the difference.  Another problem with fitting is when moms measure themselves, the assume the size under the bust is equal to the band size. 
Here is the scoop on bra fittings:
1) Make sure you get three measurements.
2) Understand whether you are buying a full figure bra or a standard bra.
Not all bra companies use standard equivalents.  Most brands like Bravado Nursing Bras, QT Intimates, La Leche League Intimates and Amamante Nursingwear are as follows:  6" difference between under the bust and the fullest part of the bust = DD, 7" = DDD/F, etc.  That is where the confusion comes in so let me make it clear.  A DD cup = E for full figure bras, DDD = F, but if you are used to buying a standard bra that comes in cup sizes B-DD and no higher, there will be about a half cup size increase between the DD in a standard style and a DD/E in a full figure style.  To clarify, full figure styles start at D cup size; they do not make the B or C cup.  That's how you know if a DD will equal an E.  
Some manufacturers like Bravado Designs Nursing Bras advocate a 2 measurement method, but do offer larger sizes.  You should still use the 3 measurement method to get your Bravado Bra size, as their size charts still correspond since they use a multi-cup system. For example, they offer a 36FG which fits both and F and a G cup.  Some of their styles fit an even wider range of cup sizes.  For example, the Bravado BodySilk Nursing Bra comes in 4 sizes, but also Consider Amamante Caress and Contour Nursing Bra which has two sizes making it very versatile and affordable option for the new mom whose shape is constantly changing in the early weeks of breastfeeding.
To make things even easier, go to our fitting room for full measuring instructions and a sizing chart.
Shop by nursing bra size here.
When you order bras online, make sure to order at least two different brands in the size you are measuring.  You would not take just one swimsuit into a dressing room and expect it to fit.  The more nursing bra styles you try, the better the fit.  You may also want to order more than one cup or band size if your are measuring an in-between size.  When you receive your bra, hook it in front of you and then turn it around to make sure you know which hooks you are using for the band size.  Then turn it around to put the straps on.  Then either lift the bust into the cups or lean into them to ensure that all of the busts are in the cups before determining if it is the right size.  DD and DDD are by no means the largest cup sizes as we offer nursing bras that come in cup sizes G, H, I, J and K!

Here is to clearing up the cup size confusion!

Tanya