Many pregnant women plan to breastfeed their babies. Parenting
books and magazines are full of information about how breastfeeding is best for your child. There are substantial health benefits to both mother and child and breastfeeding fosters a close bond. Breastfeeding families don’t have to pay for formula nor do they have to worry about remembering to bring bottles before leaving the house. Most women assume they won’t have any problems breastfeeding – after all, that’s how babies have been fed for thousands of years.
So what happens when it doesn’t work the way you planned? For most families, the first hint of a problem is when the baby has his first checkup after leaving the hospital. Babies are expected to lose up to 10% of their body weight in the first week, but anything beyond that is a cause for concern. If your baby has lost more weight than is normal,the pediatrician may tell you to supplement with formula.
The first step in the process of increasing milk supply is to make an appointment with a lactation consultant. Your pediatrician should be able to recommend one – in fact, many hospitals have them on staff and offer visits to every postpartum woman. A lactation consultant should evaluate your breasts, the baby’s mouth and muscle tone, the baby’s latch and positioning, and the baby’s weight. The baby can be weighed before and after a feeding to determine how much milk he received while nursing. She should give advice on how to get the baby latched on properly and how to make sure he’s sucking properly (babies can do nutritive and non-nutritive sucking-obviously, you want the baby to be sucking for food, not comfort). If the lactation consultant fails to do any of these things, speak up and ask her to do so. If you don’t feel that your lactation consultant is doing all she can to help you, find another one-sometimes it takes several tries to find a good match. Attending a meeting of your local La Leche League will also be helpful.
If your milk has definitely come in (you feel fuller before nursing than after, your breasts leak milk, and you hear your baby swallowing frequently when sucking), the problem can usually be remedied by simply nursing more often. Babies should nurse every 2 hours in the first few weeks, and every 2-3 hours in the first few months. The bad news is that if you supplement using a bottle, your baby will most likely end up nursing less than before, which will cause a further decrease in milk supply. The best way to supplement a breastfed baby is to use an at-the-breast supplementer. At-the-breast supplementers basically consist of a bottle or bag of formula and a tube that lies next to your nipple in the baby’s mouth, so the baby sucks both on your breast and the tube at the same time. The two major supplementers are the Medela Supplemental Nursing System and the Lact-Aid. Medela makes two versions – a temporary SNS (Medela says the temporary SNS should only be used for 24 hours, but it can be used for up to a week if cleaned properly) and a long-term model. Both versions can be complicated to use, but well worth it if you can establish a good supply. The Lact-Aid is the better option when the baby has a weak suck, as the bag of formula is held lower than the baby’s head, so he must work to get the formula out; the SNS provides a continuous drip of formula into the baby’s mouth.
You should also consider renting a hospital-grade pump. Most lactation consultants and hospitals rent electric pumps that are much more efficient than most of those which you can buy in the store. The goal when pumping to increase supply is to pump for at least 10 minutes after every nursing session. Don’t be concerned if you can’t produce any milk when you start pumping; breastfeeding has as much to do with your mind as your body, and you certainly don’t have the same sort of bond with a pump as you do with your baby. It can help to look at your baby or a picture of him, to have an article of his clothing nearby so you can smell his scent, and to just think about him while you pump. That said, some women find they’re more successful pumping when they’re distracted by a magazine or movie-try different things to see what works best for you. Any milk you pump can be added to the formula in your supplementer.
Make sure you’re taking good care of yourself. Rest when the baby rests and try to find someone to give you a break if the baby just needs to be rocked or held. Drink whenever your thirsty (try to get at least 64 ounces of fluids a day) and eat whenever you’re hungry (nursing moms need about 500 extra calories a day). Don’t overdo it with guests, housecleaning, or anything else that tires you.
When you’re nursing, switch sides any time the baby slows down in his sucking. This can be every 3-5 minutes if necessary. Let the baby nurse from both sides, each at least twice during a feeding. Use breast compression to stimulate a let-down (you can find a good description of how to do this from Dr. Jack Newman, at http://www.kellymom.com/newman/15breast_compression.html). You’ll also want to make sure you have plenty of skin to skin contact-you can strip the baby completely and nurse topless. If it’s chilly, wrap a blanket around yourselves but make sure your skin is touching.
Try using a galactagogue. A galactagogue is any substance that increases milk supply. The most common of these is fenugreek. Fenugreek can be bought at health stores like GNC. The usual dosage is 3 capsules 3 times per day. You should smell like maple syrup when you’re taking enough to increase supply. Other common galactagogues are blessed thistle, alfalfa, and oatmeal. You can find a list of galactagogues at http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html. There are also two prescription medications that can be used to increase supply-Reglan and domperidone. Reglan can easily be prescribed by your physician and has been known to be effective, though many moms report depression as a side effect. Domperidone is anecdotally safer, but hard to find in the United States. With any galactagogue, prescription or otherwise, research it thoroughly before making a decision.
There are certain foods and medications you’ll need to avoid, as well. Antihistamines, some decongestants, some weight loss medications and appetite suppressants, high doses of B-6, diuretics, and hormonal birth control can lower your milk supply. Caffeine and chocolate supposedly lower milk supply as well. In general, you should try to eat as healthfully as possible and check with your lactation consultant or obstetrician before taking any medications.
Other maternal causes of low milk supply are hypothyroidism, anemia, rapid weight loss, hormone imbalances, retained placenta, and insufficient glandular development. Your doctor can do blood tests to check your thyroid, iron, and hormone levels.
A baby who sleeps through the night can also cause low milk supply. A woman’s milk supply is often greatest at night, so a newborn should be woken every two hours during the night to nurse if you’re trying to increase supply. Sometimes, a baby’s nervous system is still too immature to be able to rouse the baby from sleep when he needs to nurse. Nursing lying down can make nursing at night easier on the mother and baby.
If all avenues to increase supply have been tried thoroughly (for at least two months), and it’s still not working, you may be one of the few mothers who truly cannot exclusively breastfeed your child. This can be devastating news for the mother who truly wanted to breastfeed her child. With both of my children, I tried desperately to nurse exclusively but was unable. My milk never fully came in and neither of my children got more than an ounce during a normal feeding session (my first only ever got a quarter of an ounce). It’s been extremely hard to come to terms with and feels almost like I’m grieving a loss. The good news is that breastfeeding is not all or nothing. I nurse my baby whenever he desires (usually at night) and he still gets some of the benefits from drinking mother’s milk. We also have a very close bond and love snuggling skin to skin. Any combination of breastfeeding and bottlefeeding that works for you is good. You can also continue to use an at-the-breast supplementer for as long as you like – I know one woman who used it for seven months. My oldest is two years old and is very healthy and intelligent, despite not receiving all the benefits of breast milk. He’s never had any ear infection or any sickness worse than a cold. You can bottle feed with love and your children will turn out to be just as healthy and well-adjusted as any breastfed baby. The important part is to enjoy your baby and develope a bond – and sometimes, this means letting go of your battle to increase your supply.