When There’s Not Enough Milk

Sometimes, despite doing all the right things, there’s just not enough milk to totally sustain a baby with exclusive, mama-only, straight from the tap, breastfeeding.  Whatever the reason – genetic, environmental, iatrogenic, mother-baby separation, illness, etc., all that can be done has been done and there’s still not enough. What to do?

  1. Realize that breastfeeding is more about the relationship than it is about the volume of milk. Once a baby has made the connection between mom and comfort at the breast, the volume of milk obtained is not as important as the emotional connection that occurs. This is an important concept to grasp. Many babies nurse 3 or even more years. Older babies get a full diet of family-friendly foods, still need and want that connection with mom. But it’s not about the volume of milk, it’s about getting mom’s undivided attention and the feeling of security at the breast.
  2. For a baby to make that connection between breastfeeding and safety in the arms of mama, breastfeeding needs to continue even when full breastfeeding does not provide all the baby’s nutritional needs. Giving up breastfeeding for breast pumping may seem like a solution to address issues of low supply when a baby is an inefficient feeder for some reason, but exclusive pumping does not allow for that connection and interaction to continue. Think hard before you give up direct breastfeeding.
  3. If supplementation is required, and donor milk is available, use that to support baby’s nutritional needs as long as possible. If baby is able to breastfeed well enough, use a lactation aid at breast as much as possible for supplementation. If supplementation must be done away from the breast, use bottles in a manner that supports baby-led feeding.  See http://hopebreastfeedingsupport.com/pacifiers-bottles-and-pumps-oh-my/ for more information on selecting pumps and bottles that may interfere less with continuing the at-breast feeding bond.
  4. Recognize that babies use suckling time at the breast to help with digestion, to comfort and settle. Large volumes of milk are not needed, or even desired for this activity. Breastfeed your baby after supplementing to allow for this benefit. Breastfeed whenever possible instead of giving a pacifier. Some people call this “comfort-feeding.” In the early days, combine comfort-feeding with skin-to-skin care to build the connection between you and baby.
  5. Accept the fact that breastfeeding length and milk volumes do not have to correlate. Adoptive mothers may not have a full supply of milk, but they can still breastfeed. Mothers of toddlers aren’t exclusive breastfeeders, but they can still breastfeed. Mothers with insufficient glandular tissue may not be able to provide 100% of their babies nutritional needs, but they can still breastfeed.

When It’s Time to Wean – Mothering After Breastfeeding

All babies wean eventually.  Some have to be weaned early because of circumstances beyond control. Some wean by themselves. In cultures where breastfeeding is the normal way of feeding a baby, many children nurse until 3 or 4.  Some tandem nurse when a new baby is born. Different circumstances may bring up different issues for mom or baby.

Sudden Weaning

When baby weans or must wean suddenly, and mom still has milk, the goal is to reduce milk supply comfortably and safely. Some measures are well known such as wearing a supportive but non-binding bra, using cool packs such as disposable diapers that have been wet and then frozen, cabbage leaves that have been crushed and placed on the skin of the breasts and changed out when limp. Hand-expression or very short pump sessions can be used to gradually reduce milk supply. This may take a week or more. When in the shower, stand with your back to the shower. Only express milk if absolutely necessary. Herbal remedies for drying up milk include peppermint, sage, oregano, lemon balm, chickweed and black walnut. Sudafed is an over the counter medication that has been shown to decrease milk production in mothers 6 weeks or more past delivery. It can take months for breasts to completely involute. Once breasts are comfortable, avoid hand-expressing “just to see”, as this may stimulate additional milk production for some women.

If baby did not choose to wean, but weaning is necessary, and she is 6 months or under, consider paced or baby-led bottlefeeding to allow him or her to be in control of the feeding as much as possible. See my printable baby-led-bottlefeeding for instructions on this method of feeding. For older babies, try a sippy cup without the spill-proof valve, a straw cup etc,  These may be preferred. If you are using formula, see my printable preparing-infant-formula-2016 for safe handling of formula.

Gradual Weaning

If your baby is older and you are preparing for weaning at a later date, start by limiting your feeding locations to a special area or chair. If you are nursing your baby to sleep at night, begin to develop a bedtime ritual that can be continued after weaning. Turn on white noise, rub his back and rock after you take him off the breast. If possible, as you get closer to planned weaning date, start the back rubbing and take him off the breast but hold him close as he falls asleep. Trust your instincts. The biggest hurdle is to have clear in your mind why you want to wean and when you want to wean. Start a bedtime ritual that can be transitioned to not include breastfeeding as soon as you feel it is helpful.  Every child is different.

The Relationship Goes On

The close relationship you have started with breastfeeding can easily transfer to other activities that will provide comfort through your child’s senses.  Touch, warmth, soothing sounds can all happen with you, even when breastfeeding is over. And the benefits of a strong immune system will last as long as he lives!

 

For Helpful Information on Introducing Solids –

Check out this website:  http://www.babyledweaning.com/

 

 

 

Employment and Breastfeeding – Continuing the Breastfeeding Relationship When Separation Must Happen

So you made it to the 6 weeks mark. You’ve overcome the breastfeeding learning hurdles and are starting to feel a little more confident about this new relationship. Your healthcare provider has released you from care and you are feeling better physically. But now comes the challenge of dealing with the realities of your life. You have to go back to work. Many women, and especially first time moms, fear this pending separation.

Some of the questions that may run through your mind include:  What if my baby won’t take a bottle while I’m gone? What if my baby likes the bottle better than me? What if I don’t have enough milk? What if my boss won’t allow me time to pump? Can I juggle my work and all the responsibilities of being a mother? And what about my other relationships – partner, family and friends – can I fit all of this into my life?

Let’s take these questions one at a time.

  1. Baby won’t take a bottle? See my post on how to bottle-feed a baby.
  2. Wondering about pumps and choosing the right bottle?  See my post on pacifiers, pumps and choosing bottles.
  3. What about the workplace that doesn’t support breastfeeding?  See this article on Federal law and the workplace. Here is an article that you can use to talk to your employer about supporting breastfeeding.  http://www.cdc.gov/breastfeeding/pdf/BF_guide_2.pdf
  4. Start saving milk for your “stash” early. Most moms have more milk than babies require by the 3rd to 4th week after birth. Get your pump and learn how to use it and start saving. Many moms find they have an abundance of milk in the morning. Nurse first, then express the remaining milk and freeze. This will serve as your back up supply for any emergencies and when you first return to work.  After you start back to work, what you pump one day will be the feeding for the next day to work. Freeze what you pump on the last day before a stretch off work and use some of your stash on your first day back.
  5. If you haven’t learned to nurse in bed, it’s time to learn. By the time a baby is 6 weeks old, she should have enough head control so you don’t have to hold her head and her latch should be secure. Check out side-lying positions. Put your co-sleeper crib next to your bed so it’s easy to transfer her into her own bed once she has nursed to sleep. Keep things simple so nighttime feedings are short and uncomplicated. Unless absolutely necessary to maintain your milk supply, do not pump in the middle of the night.
  6. If your baby starts sleeping longer than 5 hours at night, pump right before you go to bed to keep your breasts from getting uncomfortably full during the night. You will rest better and the extra milk goes to your stash.
  7. Try to make life simpler at home. Crockpots and quick meals will save time in the kitchen. Simplify clean up and household duties and of course, enlist help from anyone available to you. There are lots of websites out there that have suggestions for this.
  8. Make sure you continue recommended vitamins for yourself, including adequate Vitamin D. Here’s a technical article supporting the recommendation for nursing mothers to get an extra 6000 IU of vitamin D daily for improving their own and their baby’s health.  https://www.ncbi.nlm.nih.gov/pubmed/17661565
  9. Most importantly, try to take some time for refreshment for yourself. Eat healthy as you can. Take naps. Put baby in a front carrier and get outside when the weather permits. And take lots of selfies! This time will pass quickly!
  10. Remember that breastfeeding is not just about the milk you provide your baby. It’s about the special closeness that comes when your baby looks in your eyes while you are nursing her and she begins to realize that YOU are her source of life and nourishment, when she smiles at you and then buries her head in your breast as if to say, “I’m home!”

Fitting Baby In

When you have a baby, everything about life changes. The love of your child may hit you like a ton of bricks. Or, like other love relationships, it may creep up on you slowly. Some parents take the coming baby experience with a laissez faire attitude. They trust they will get through childbirth and child raising by the seat of their pants. Others plan everything, like a military expedition, trying to think of every possibility and plan for every outcome. Others take a middle of the road attitude. Whatever the personal style of the parents, they will be bombarded with all sorts of advice and warnings. Some of it will be useful, and a lot of it, not.

If the parents are “researchers,” they may discover many opposing viewpoints on almost every issue. The “planners” may find this frustrating and overwhelming and make a firm commitment to adopt a viewpoint that causes issues within their relationship with each other and the baby. The “flyers” may find themselves validated when everything goes smoothly or be able to adjust to any bumps in the road they encounter. The key is having two parents on the same wave length – which often doesn’t happen! It’s a good idea for parents to discuss these things before baby comes and be prepared to change strategies if they find that the planned one is not working for them and their baby.

The truth is, babies need love, comfort, security, food, and warmth. Breastfeeding provides that very first connection that simultaneously provides all of a baby’s needs with one activity. The challenge comes in providing those needs for the baby while caring for the mother and father. Here is where family and community support becomes vital.

If you are a laissez faire sort of person, consider the possibility that childbirth may not go in a predictable pattern. It helps to have supportive folks in the wings ready to step in and give a hand if you need it. Have the conversation with family and friends so they understand your point of view, but can plan to be available in case you need a little help with coping in the first days. If you are a researcher or a planner, try to accept that there unforeseen events may occur and contingency plans may be required. Give yourself room to breathe and try not to set impossible goals as a measure of success.

Babies are non-stop needy. They go from having their needs supplied without any effort on their part before birth to a world that is cold, bright, hard and must be engaged to get anything that they need. Babies have massive brains (compared to other animals) but few connections established. Everything must be learned from scratch. Primitive reflexes such as suck, swallow, breathe that are essential to survival are present but baby must associate those with actions that bring food and satiation together. Those associations build over time. Connections between the brain and mouth and neck become more secure by 5-8 weeks. This becomes obvious to parents when baby begins to smile in response to interaction with other humans. In these early days, babies need to be near their mothers, enjoying skin to skin contact and free access to mother’s breasts for nourishment and comfort. Interestingly, this time when baby is mainly reflex-driven is also the time when mother’s milk supply is built and established. Frequent and unrestricted access to breastfeeding has been shown to increase milk supply better than scheduled and limited feeds. Frequent breastfeeding helps to increase hormone levels and sensitivity of lactation tissue to hormones of milk production. For mom to be available, it helps to have household and toddler assistance (if needed) during this early period. Slings and wraps that keep baby close to mom can help reduce stress.

Sometimes parents are tempted to use artificial carriers such as car seats, Rock ‘n Plays, swings and other devices that put baby in a semi-upright position and provide movement and/or noise like the uterine environment. The thought is that these devices will give parents a break and are harmless. Studies, however, show that babies who spend too much time in these are more likely to develop acquired torticollis, reflux and plagiocephaly. Here’s an article that gives more information about one product. By age 3 months, babies have progressed and gained more head and neck control and can use these products without some of the side effects.

As babies grow and mature, they become more sociable. Stomachs grow and babies can take more milk in at a session and sometimes go longer between feedings. Feedings can also be shorter at times. The unique personality of your baby becomes more obvious as time goes on. Your relationship grows and develops. Most moms find that after 3 months, breastfeeding becomes easy – and so much easier than all the work it takes to bottle-feed a baby. Breastfeeding becomes more than just a way of transferring nourishment to your child – it is a communication tool, a way of comforting, and a way of teaching about relationship.

In most non-Western cultures, breastfeeding to 2 years and beyond is the normal pattern. Of course, older babies do not nurse as frequently as newborns and some sessions may last only a couple of minutes. Extended breastfeeding (breastfeeding exclusively for the first 6 months and thereafter as long as the child desires) is associated with better development of facial structures, reducing the need for orthodontics in children nursed over 18 months. Family-friendly solid foods can be introduced starting at 6 months of age. For more information on introducing solid foods to older babies, check out this website:

Whatever your parenting style, know that it is possible to grow and adapt as time goes by. You are not committed to one style of parenting forever. You can compromise and change as you need to. Love, after all, is the most important gift that you will ever give your child.

Tools for Breastfeeding

I often get asked this question by pregnant women: “What are the essential tools I need for breastfeeding?” My answer is almost always this: At least one breast and at least one healthy term baby. That’s it! Provided everything goes well with birthing, you are able to avoid mother and baby separation and you are able to keep your baby skin to skin, things should go well.

Sometimes they will follow with this question: “But what things do I need to know or know how to do?” My answer is this: Get comfortable with handling your breasts and nipples. Review reverse pressure softening and hand-expression, especially areolar expression. Review breast massage. Watch some YouTube videos on baby-led latch. Talk to your partner about protecting you and your baby so that you have the private time you will need for learning.
Breastfeeding is a relationship between mom and baby. All relationships require one on one time to foster closeness and confidence. Pregnancy is like a Facebook romance where you communicate only with pictures – and the other party can’t speak back to you! You make a commitment to that person before you ever meet face to face, know what they really look like or anything substantive about their personalities. You sign the marriage contract (like an arranged marriage) with a vast unknown before you. You consummate the marriage – and then you begin to learn about your partner.

The next question I may get is this: “But what if there are issues? Are there any products or supplies you would recommend to have on hand, just in case?” Here is my list:

1. Breast pump – double electric. If your baby has some issue that makes it difficult for her to attach and draw milk from your breasts AND you need to establish your milk supply, I strongly recommend temporarily renting a Symphony from your local rental agency. You can use your breast flanges and attachments from a Medela personal pump, but will need to purchase a conversion kit if you have not received one from the hospital. Breast milk supply potential is established in the first four weeks of breastfeeding. Failure to remove milk from the breasts signals lactocytes to shut down production. It is easier to protect your supply from the beginning than to try to rebuild a supply later on. Medela Pump In Styles are my favorite personal pump, but I will admit prejudice. Your insurance company may provide you with this. This style of pump was designed for helping moms transition back to work and for occasional use when you have a healthy nursing baby.

2. Tendercare Hydrogel Pads by Medela. These are sold online, by Target, Baby’s R Us and hospital boutiques. For sore nipples. There are other brands but Medela pads can be cut in half to go further, if needed.

3. Microwave sterilizer bags. These save a ton of time if you need to sterilize/clean breast pump parts, pacifiers, bottles etc. You may never need these for your baby. They make great bags for steaming broccoli and other vegetables if you don’t need them for baby supplies. And they’re reusable!

4. Nursing pads – disposable or re-washable. Soft cotton pads are very comforting especially if your nipples are sensitive but not sore.

5. Bacitracin. A great topical antibiotic for scrapes and cuts and useful, should you need it, for treating nipple trauma.

6. Ice diapers.Make these yourself. Take 4 disposable diapers. Open them out and wet them. Drape them over a cup in the freezer. These are great for soothing tight breasts throughout the engorgement period.

7. Nursing support pillow There are lots of styles and brands. One of my favorite is the Boston Billow. This can be found on-line and in stores (check with the website). Additional pillows, some firm, some more adjustable, may be needed. Make your own wrist support. This can be made from a long tube sock filled with rice and tied off. The wrist support can be placed strategically to help support your hands, arms and the baby during the first few weeks while baby is unable to support his own head.
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Breastfeeding Confidence: Are you gaining or giving it away?

Entering Motherhood Unsupported

Let’s face it.  Our culture has totally undermined our confidence and security in ourselves as being dearly loved children, created lovingly and capably by a gracious God. What does that have to do with breastfeeding? Many women have bought into the idea that they are not good enough physically, mentally or emotionally just as they are, to be a woman, a wife or a mother. First, we feel the need to mold ourselves to the Victoria Secret models’ shapes and appearances. We feel a need to use whatever femininity we have to attract a mate. Then, when it’s time to have children, instead of being empowered through education to guide us in doing what we were created to do, birth becomes a maze and we are taught we can’t birth without medical technology. Even when this technology is needed, the way it’s administered can leave us feeling more like victims instead of capable mothers.  Finally, once the baby has been “delivered” (notice the disempowering language of  delivered instead of the mother who partners with God in giving birth!),  we are then expected to produce the life-giving, unduplicatable fluid that the baby needs, on demand, in time and in sufficient quantity.

Every new phase of womanhood is just that–new, uncharted territory!  Everyone’s experience is unique, so despite the best education possible, or no education at all, we venture into the breastfeeding relationship as rookies.

Mixed Messages

In today’s world, the internet, social media and television/radio broadcasts have informed us dramatically that breastfeeding can fail us and the baby. But we are also confronted with the growing body of evidence that breastfeeding is essential and necessary. What to do? Many moms are trying to be preemptive in their preparation. They research all the best herbs for increasing milk supply. They search for the best breast pumps. They look into special diets and techniques. When their babies are born, they are quick to assess and intervene for any perceived difficulty. For other moms, however, the possibility of failure is so daunting, that they never even begin the journey. They opt to formula-feed from the beginning. Better safe than sorry!

Imagine a Better Way: Birth, Breastfeeding and Beginning Again

What if?

But imagine with me for a moment what the world could be like if we could breach the chasm between flying and the fear of failing.  What if moms could find a middle way that empowers women from birth to breastfeeding? That way might include research to identify the best environment for birth for their newborns and themselves. It might include education about the normal progress for mothers and babies during the early time after birth and making plans and contingency plans should unexpected difficulties occur.  But, above and beyond all this planning, let’s include trust. Trust in the birth caregivers she has chosen. Trust in her partner to protect and support her desires. Trust in her family to honor her decisions.

What if moms could develop relationships with other mothers who have journeyed and reached the goal desired? What if they could find supportive professionals to answer questions and guide the journey when needed? What if we treated the breastfeeding relationship as normal and necessary, but respected it as so important that we celebrated the RELATIONSHIP part of it as much as we did the milk-making (FOOD PRODUCTION) part of it? Those who have gone before us could celebrate the choices made, whatever they are, for what they are worth, choices made in the best interests of mother and baby? We could stop blaming ourselves and each other for the past mistakes and sins and move forward from here, learning from the stories of life and love that we each bring to the table.

One Team

I am so tired of hearing about “mommy wars” and “breastfeeding Nazis” and “need for more research before pushing breastfeeding on mothers.” What would happen if we took out the word “breastfeeding” and replaced it with “sex”? No one would stand for a war on sex to make it only used for reproduction!  No one would shame a woman (or man) for seeking professional help if there were issues on either the relationship or reproductive front. Then why is there so much shaming of something just as natural and essential to producing and maintaining life as feeding our children? We need to re-prioritize and support women trying to navigate motherhood and breastfeeding.

Love, Not Fear

Let’s change this paradigm and create an environment that is normal, helpful, supportive and non-shaming to mothers no matter how they feed their babies, while continuing to educate and celebrate what has sustained humanity up until the 20th century.

Let’s start now.  If you are reading this and you didn’t breastfeed your child, or you didn’t breastfeed “properly”, let me be the conduit of forgiveness.  You operated within the knowledge and barriers of your time.  Yes, you had responsibility.  It’s OK to own that and say, “I wish I had known better” or “I wish I had had better support” or “I wish I had made better choices.”  It’s OK to own it.  Then give yourself grace and forgiveness.  When you own something, you are then able to use it for good. Perhaps you will help someone by supporting them or offering to find them the support they need. You don’t have to be in denial or defense, you just move forward.

If you are reading this and in the middle of a feeding struggle, then get the help or accept the help you need, but cherish what you already have. If your issue is low milk supply or latch, don’t give up the breastfeeding relationship, the cuddling and skin-to-skin and eye-to-eye language without words. If you have plenty of milk, but a baby who can’t or won’t latch, take off the pressure. Make bottle-feeding as much like breastfeeding as possible with positioning, allowing baby control etc. Take as much of the stress away as possible by taking each day as it comes. Pray blessings over your baby.

In summary, loss of confidence comes when we allow fear to take control of our actions and thoughts. Fear is paralyzing but it can’t be overcome by will. Perfect love casts out fear (1John 4:1) F.E.A.R. equals False Expectations Appearing Real. Let those who love you understand what your desires are and accept acts of love that are truly loving and supportive. Let love be your guide, knowing that love is the antidote to fear. As you make small steps, your confidence will grow and you can then help others along the way.

 

Milk Donation

I have heard many questions from moms over the years about what to use in a situation where they don’t have enough milk to feed their babies. I do not support formula companies.  However, I don’t support homemade formulas either.  Neither can come up to the specificity of human milk for human babies.

What I DO support is milk banking.  This can be done for your own child or for others.  Proper handling, labeling and storage of the milk makes this process more useful.  Here are a few helpful hints.

  1. Set out to have an excellent supply.  That means the first hour after birth is critical for baby getting the most volume – and studies are now beginning to show that moms whose babies nurse well in the first hour (or who start pumping and hand-expressing right away if baby can’t nurse) have more abundant supplies and are less vulnerable to negative events later on in their lactation. Make sure your support person is on the same page with you in helping you achieve that early stimulation and milk removal. Mothers who get 30 sessions of effective breastfeeding or hands-on pumping within the first 3 days of birth have twice as much milk at 10 days after birth as those who have less breast stimulation and removal of milk. This has been found in more than one study.
  2. Pay close attention to your baby’s effectiveness in the first four weeks. If baby is not removing milk well during this period of time, the breast will reduce milk production capacity and possibly storage capacity as well. If your baby is not removing milk well, using a breast pump after morning feedings and before bedtime can help protect your supply.  If your baby is not nursing effectively, please see a skilled lactation consultant for assessment.   Medical-grade rental breast pumps (such as the Symphony) are generally more effective in setting up a high supply than personal pumps, which are designed to maintain supply once lactation is established and a healthy baby is nursing.
  3. Store your precious milk carefully. Most women use plastic bags for storage. Use bags that are thick enough and have wide enough seams to reduce breaking and leaking during thawing. Don’t over-fill bags. Get as much air out as possible and lay bags flat for freezing. Label with at least the date of pumping. Use a sharpie on part of the bag that is not in contact with the milk (on the edges) or use a piece of tape for the label. Ink written directly on plastic will leach into the milk inside. Once bags are frozen solid, they can be stacked vertically in a plastic shoe box to keep in order in the freezer. Caution: plastic milk bags that are over-filled or have thin seams can break during freezing or when transporting in the frozen state. When stacking horizontally, put a layer of paper or plastic between rows of bags. If you are shipping milk through Fedex, contact them for information. Styrofoam lined shipping boxes with dry ice can be used to ship milk overnight. Layers of bags should be separated by cardboard or thick paper to prevent puncturing each other during transport.
  4. Think about how much to store and when to share. To avoid wasting milk, don’t put too much in a bag – a maximum of 5 ounces. If you are pumping a couple of ounces at a time, you can add to a previous amount until you get your desired amount, as long as it is all obtained within 48 hours and kept refrigerated until frozen. The best place to store milk is in a separate deep freezer that is not opened frequently. Regular freezers should be turned as low as possible, to the point that ice cream is frozen solid. Do not store your milk in the door of the freezer. Some moms start out storing a lot of milk because they have babies with nursing difficulties. Once those babies have overcome their difficulties, moms find they don’t need the extra stored. At that point, sharing becomes a possibility, and sometimes even a necessity when freezer space becomes low!
  5. What about formal versus informal milk donation? Milk banks have requirements for moms since their customers are NICU’s with very tiny, vulnerable infants whose very survival depends on milk donation.  Milk sharing done between healthy moms with healthy babies can be a little more relaxed. Some medications that are OK for nursing moms may be acceptable for another nursing mom – but unacceptable for a tiny medically vulnerable baby. Eats on Feets, Human Milk for Human Babies and other mother-to-mother sharing sites can help re-distribute milk from moms who are not eligible for milk bank donation to moms whose babies are not eligible for receiving banked donor milk. Tennessee is establishing it’s very first Mother’s Milk Bank. Here’s a link to find out more about how to donate and how to help. UPDATE: 2 Local donation sites are now available – in Nashville at Meharry General Hospital and in Memphis at Regional One. More donation sites are expected to come on line. Check the Mother’s Milk Bank site for more info. http://mothersmilkbankoftn.org/