Milk Supply
I’m afraid that I am not producing enough milk. How do I know that my baby is getting enough?
Mothers often worry that their babies are not getting enough to eat. Remember that a newborn baby should breastfed 8-12 times in a 24-hour period. Let your baby determine the length of the feeding, not the clock. It is important that your baby nurse long enough to get the rich hindmilk at the end of the feeding. Keep in mind that babies will have growth spurts at approximately age 1 week, 3 weeks, 6 weeks, 3 months, and 6 months old. Your breasts should feel softer/lighter at the end of the feeding. If a baby is completely breastfed, and is having at least 6 wet diapers and 3 bowel movements in 24 hours, he or she is usually getting enough to eat. Your baby should gain ½ to 1 ounce per day. A change in the size or feeling of your breasts does not mean that you have stopped producing milk.
My baby prefers to nurse more on one side than the other and I'd like to increase my supply in the breast that he doesn't use as often. How can I do that?
You can increase your milk supply in the breast that you have not been using very much by using it more. That means breastfeeding more often, longer, and massaging while the baby is feeding to increase milk flow. The baby cannot be sleeping at the breast. There needs to be at least 10 sucks and swallows at the beginning of the feedings. Babies nurse most vigorously at first so try starting every feeding on the side in which you are trying to increase production. Some mothers take herbal supplements, too.
My baby has been nursing every 3 hours since he was born. I was thinking of pushing him to every 3 ½ to 4 hours. Obviously he will have to take more at each feeding. I am afraid of my milk supply decreasing before he starts taking more at each feeding. Should I start rice cereal?
If your baby is gaining weight well, rather than watching the clock, you can allow him to let you know when he is ready to eat. Very few babies eat on a schedule, so you should fine that he will (all by himself) ask to eat less often than when he was younger. His stomach capacity has increased as he has grown, so this is a natural occurrence.
Your milk supply will be fine because - although he will probably eat less often - he will take more milk at each feeding.
Your baby is ready developmentally by about 6 months to begin to sample and learn to eat semi-solid foods. Your goal is not to get a large amount into the baby but rather to teach the baby to socialize at mealtimes while trying foods. At first your baby will eat a small amount (about the size of a pencil eraser) – working up to two tablespoons after several weeks. For the first year, your milk is the best nutrition available. After 1 year, the foods at mealtimes start to increase in amount.
Milk Pumping, Storage, and Bottles
If I plan to give my baby a bottle of pumped milk every now and then while I’m away or when I go back to work, when should I introduce the bottle? What about a pacifier?
Babies can get nipple confusion if you give them any artificial nipples too early. Wait until the baby is at least 4 weeks old, preferably older, and breastfeeding is well established before you introduce a bottle or pacifier. You may want to limit pacifier use and make sure that most of your baby’s sucking needs are met at the breast.
How much breast milk should I leave with the babysitter if I leave my baby for a few hours?
The answer to this question depends on the age of your baby, but a small baby will not take more than about 2-3 ounces per feeding. Leave that amount prepared for the baby, and freeze additional milk in an ice-cube tray. Pop out the cubes after they are frozen and store them in a freezer bag. The cubes will be about one ounce each and will enable your babysitter to thaw just an ounce at a time if the baby seems to want additional milk. Many babies over 15 pounds still drink only 6 ounces at a feeding. Milk in a bottle from which the baby has been sucking will have been mixed with the baby’s saliva, so the extra milk should not be saved to give to the baby later because of bacteria. This is the best reason to store breast milk in small quantities, to avoid preparing too much milk and wasting it.
What is the best way to thaw milk to feed my baby?
You can put the milk bag or bottle in warm water to thaw it. Never put breast milk in the microwave!
My baby has recently been drinking pumped breast milk in bottles. Unfortunately, now it seems that the bottles have made her forget how to latch correctly. She also expects the milk to flow as freely as from a bottle, so she doesn’t suck as strongly. How can I teach her to latch on and suck effectively again?
Cup feeding is a good alternative to bottle feeding. It requires that the baby stick out the tongue and slurp or lap up the milk. This action is similar to breastfeeding and so is less likely to allow her to “unlearn” the skill of nursing.
I would be very patient with her and just keep offering the breast – pumping first so your milk is right there – painting her lips and tongue with it as well as your nipple and areola. You cannot struggle with her – you need to keep her happy as she relearns how to make your breast work.
An SNS (Supplemental Nursing System) at the breast will encourage her to suck because of the almost instant flow of milk, so if she’ll latch-on you may find that to be a helpful bridge to resuming nursing.
If none of these work, I would give her the bottle with her dressed in just a diaper and you with no shirt or bra. Hold her as if you were giving the breast so she’ll relax and associate the nursing position with the satisfaction she has learned to associate with getting the bottle. Then, I’d get a lactation consultant to fit you for a soft silicone nipple shield to use temporarily so the baby will feel the familiar artificial nipple and be more likely to suck. You may find you can start the feedings with the shield and then remove it when she needs to burp because she will be calmer after she has gotten some milk and better able to work on learning when she is not too hungry.
How long can I keep pumped breast milk? How should it look?
Breast milk can be kept in the refrigerator for 24-48 hours before use. It will separate after a few hours into the thicker “cream” on the top and the thinner milk on the bottom. This is normal because the milk has not been homogenized, or combined, so that it doesn’t separate. Fresh cow’s milk does the same thing before being processed. Simply shake to combine the layers. If it is going to be stored longer than that, it can be kept in a refrigerator-style freezer, toward the back, for up to 6 months, or in a self-contained, “deep” freezer, for up to 2 years. Select thick, sterilized breast milk storage bags to store your pumped milk. A good brand is Lansinoh.
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