5/28/10

How we unintentionally sabotage breastfeeding


A lot of mothers stop breastfeeding because they believe they aren't making enough milk. I see this all of the time and believe me, I wholeheartedly understand how easy it is to believe that. I had the same fears and insecurities about my milk supply with Jude. This article is not to blame formula feeding mothers for their decisions, this article is to debunk the myths and misinformation that contribute to the breastfeeding difficulties so many of us face.

I am simply trying to get evidence based information on breastfeeding out there and I know I have an uphill struggle against some Doctors and other Health Professionals who know shockingly little about breastfeeding.


Research shows us that only 1% of women really can't produce enough milk. So what is happening here? 


Women are unintentionally decreasing their milk supply by doing certain things. We examine the main culprits below and then we'll discuss the many ways they can increase their supply.


My opinion on how mothers (unintentionally) jeopardize their breastfeeding supply:


  • Some moms freak out when they don't see lots of milk at first. Some moms expect lots of milk from the very beginning, and when they didn't get it, they'd give baby a bottle. They didn't understand that right after birth, moms produce small amounts of colostrum, a concentrated, nutrient rich liquid that's measured in teaspoons, not ounces, and is the perfect food for newborns. Offering a bottle, pacifier, or sugar water in the hospital will affect your supply. Unfortunately, many well-meaning nurses will feed the baby in the nursery so you can “rest”. Demand that your baby is strictly breastfed. A good way to make sure is to room-in with your baby.
  • Supplementation (even one bottle of well intended formula or breast milk can greatly hurt a mother's supply. Many times, new moms think if baby won't stop nursing, he must not be getting enough milk, so they give formula. Sometimes babies just nurse and nurse and nurse - that's just what babies do. It doesn't mean you don't have enough milk. It just means you should keep nursing. I tell mom's that their SOLE job for the 1st 4 weeks to simply to "FEED THAT BABY", because some babies nurse more than others and it can be a bit exhausting, which is where support groups like La Leche League can be so refreshing. I also encourage moms not to stay at home to nurse round the clock, go out, bring the baby and have fun! I used to be terrified of nursing in public, but it got easier and easier over time!
  • Mothers are told either by (well-intentioned) doctors, friends and families or through "baby training books" that their baby should only eat every 3 hours and must sleep through the night by a certain age so then mom doesn't feed on demand, limits feeding time, etc. The best way to ensure you have a adequate amount of milk is to feed the baby on demand and not according to a schedule. Also, be sure to feed for at least 10-15 minutes on the breast to ensure baby is getting the "hind" milk, also known as the fattiest part of the milk.
  • Using Pacifiers or Artificial nipples before breastfeeding is established (At least 4 weeks.) I can't tell you how many times I've seen this. Breastfeeding was going great until one of these is introduced.
  • Pediatricians that push formula. If a pediatrician encourages formula, I always recommend getting a second opinion from a board certified IBCLC (Lactation Consultant) before supplementing.
Other reasons breastfeeding can be jeopardized include:
  • Having an un-supportive husband or or family members
  • Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.
  • An uninformed hospital staff or doctor. While most doctors know breast is best, very few are trained in breastfeeding or lactation.
  • Sleepy baby. For the first few weeks, some babies are very sleepy and only demand to nurse infrequently and for short periods. Until baby wakes up and begins to demand regular nursing, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.
  • FORMULA COMPANIES! They make sure you can’t even leave the hospital without samples, “free” diaper bags, and coupons. They even wait a few weeks for you to try breastfeeding, and when you are at your most vulnerable and frustrated, voila`, a free can of formula magically appears in your mailbox.
  • Bad advice from well meaning friends and family members.
  • Tongue-tied babies causing painful nursing. You can insist on clipping it if you are having trouble breastfeeding due to this. If the ped won't, call around to dentists and D.Os with experience in handling tongue-tied babies.
  • Thinking that since you have to go back to work soon, it's not really worth the effort. I pumped for 18 months at work - it can be done (especially with the new breastfeeding laws that require employers to provide paid breaks for pumping mothers.)
  • Nipple shields can lead to nipple confusion. They can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.
  • Being told to stop breastfeeding at one year or less. You can breastfeed as long as you and baby agree upon. Studies show that even though your milk supply decreases in the 2nd year, the health benefits increase. The World Health Organization recommends breastfeeding for at least 2 years or more.
I'm sure I am forgetting other things that can jeopardize breastfeeding. Feel free to post yours in the comments and I will update this list.

GETTING STARTED:
When you start breastfeeding, it may be reassuring to you if you use a feeding log, like this one to record feedings and diapers. This log shows you how many wet/dirty diapers you need to see on each day so that you'll feel confident that your baby is getting enough.


If you are already supplementing, with either pumped breastmilk or with formula and you want to return to exclusively breastfeeding, you can use this log to wean off supplements (with the okay from your lactation consultant or pediatrician.)


Here is a great handout on feeding the breastfed baby a bottle, this is helpful if you will be working, or need to leave the baby with a sitter.


If you are trying to increase your milk supply here are some ways you can do that, keep in mind that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby. Checking wet & dirty diaper counts will determine if your baby is getting enough milk.




Increasing your milk supply from kellymom.com:
Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production. To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.
  • Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.
  • Nurse frequently, and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.
  • Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).
  • Offer both sides at each feeding. Let baby finish the first side, then offer the second side.
  • Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to manage breastmilk intake. This can be particularly helpful for sleepy or distractible babies.
  • Avoid pacifiers and bottles. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).
  • Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.
  • Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.
  • Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
  • Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. Herbal galactagogues are fenugreek, blessed thistle, and alfalfa.
Resources:
http://www.cnn.com/2007/HEALTH/08/09/ep.breastfeeding/index.html
http://www.kellymom.com/
http://www.kellymom.com/store/freehandouts/index.html
http://www.drmoz.com/lactationsupport.html
 

3 comments:

  1. Great Article Taryn. I have read a really wonderful book called "Impact of Birthing Practices on Breastfeeding; Protecting the mother baby continuum."
    It opened my eyes to all the issues that aggressive suctioning, head pulling during cesarean birth and drug use can affect the baby's ability to latch and feed well. The book talks about full term healthy infants that are unable to feed effectively. Just a reminder that the 1% applies to mothers ability to produce milk, but babies must have effective sucking to trigger milk production, so this percent is not a true reflection of what the success rate should be or is (obviously!). This reason is exactly why putting the baby to the breast as often as he/she wants is so important.
    I really like this La Leche League philosophy statement - one of ten "Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start." The way a woman gives birth and more importantly how she feels regarding her birth plays a huge role in her confidence towards breastfeeding.
    You are wonderful, thanks for this article- I'll be passing it on!
    tori

    ReplyDelete
  2. Tori, you are so right and I appreciate you taking the time to read this post. I really respect your knowledge on this topic and I should have made mention in the blog that other factors play a role in breastfeeding success, like you said.

    I think there needs to be a entire blog post devoted solely to the effects of childbirth practices on breastfeeding. Perhaps you could write it and I could pass it along? :) That book you refer to sounds wonderful!

    ReplyDelete
  3. I just wanted to point out that I am also a doula and my son's name is also Jude. Lovely coincidence.

    I was never afraid that I wasn't making enough milk, even when hospital nurses told me I was starving my son with my lack of milk when he was born. Jude was a sleepy stink and wasn't interested in eating. No biggie. He gained 10oz after a weekend nurse-a-thon!

    I definitely see it happen often that women think they don't produce enough milk. All it takes is a well-meaning pediatrician telling a mom that her newborn is not gaining on a "normal curve" to completely discourage her efforts.

    There need to be far more EDUCATED breastfeeding friendly medical professionals. Even lactation consultants can give the wrong information. And if YOU are educated then you definitely need to share all of your knowledge. How else will all the women get the RIGHT information? How can we possibly hope to increase the rate of mothers nursing passed the first few months. I encourage sharing articles on Facebook. Or even recommending a good class on breastfeeding. We can make this happen!

    Thanks for this post, love it.

    ReplyDelete

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