Read What to Expect the First Year Online
Authors: Heidi Murkoff
What to Expect the First Year (24 page)
Keep an eye on the supply.
When you do begin supplementing, the decrease in demand for your breast milk may quickly result in a diminished supply. You'll need to make sure that you fit in enough breastfeedings so that your milk supply doesn't drop too much. (For most women, 6 thorough breastfeeds in a 24-hour period is enough to maintain adequate milk production for a newborn.) You might also need to pump occasionally to keep your milk supply up. If your baby doesn't nurse enough (or if you're not pumping to make up those missed nursings), you may find you don't have enough milk to continue breastfeedingâand the combo can backfire.
Choose the right nipple.
You've got the right nipples for breastfeedingânow choose the right one for the bottle. Pick a nipple that resembles those made by nature, one with a wide base and a slow flow. The shape of such a nipple enables your baby to form a tight seal around the base, rather than just sucking the tip. And the slow flow ensures that your baby has to work for the milk, much as she has to when breastfeeding. Keep in mind that some babies are pretty picky about their nipples, so you may have to experiment to find one that she'll happily accept.
Maybe you'd like to try the “combo” of breast and bottle. Or maybe you'd just like to introduce a bottle so you have the option of falling back on one every now and then. But you've heard that bringing on the bottle too soon or in the wrong way can cause “nipple confusion,” and now you're confused about how to proceed. Though some lactation consultants warn that starting a bottle before breastfeeding has been mastered may sabotage nursing, others believe that there's no such riskâand no such thing as nipple confusion. And in fact, the majority of infants seem to agree, switching effortlessly between breast and bottle if the combo is started at the right time.
Timing is key in introducing the bottle. Bring it on too soon, and baby may get hooked on the bottle's easy-feed features and decide to reject the harder-to-work breast. Bring the bottle on too late in the game, and baby may already be too attached to mom's nipples to consider sampling the factory-made variety. Personality plays a part, too, in whether a baby will go for both breast and bottleâsome babies are more flexible when it comes to feeding (as long as they get fed), others are intractable creatures of habit. Most important, however, is perseverance. While your breastfeeding baby may well be puzzled by this unfamiliar milk dispenser at firstâand may even reject it repeatedlyâchances are he or she will eventually take the bottle bait. For more on introducing a bottle,
click here
.
Choose the right formula.
Ask the pediatrician which formula you should supplement with. There are many different kinds (
click here
), including one designed specifically for supplementing. It contains lutein, an important nutrient found in breast milk, as well as more prebiotics than other formulas to help keep your baby's stool soft and seedyâlike a breastfeeding baby's poop.
You're committed to exclusive breastfeeding but something's not working out as planned (your milk won't come in because of a hormonal imbalance, for instance, or baby's not able to suckle effectively) and now the doctor is telling you that formula is medically necessary to adequately nourish your little baby. But you're reluctant. After all, you've heard over and over that breast is bestâand of course, you want to give your baby the best. That breastfeeding isn't always easy and takes time to work out all the kinksâso of course, you want to give it more time. And that supplementing with formula sabotages the chances of breastfeeding successâand of course, you want breastfeeding to succeed.
Completely understandableâyou're feeling the way you feel for all the right reasons. And yet, there are sometimes reasons to rethink a breast-only approach (either temporarily or long term) or to rethink breastfeeding entirely. The truth is, breast-only is best only when breast alone can nourish your baby the optimum way (and in the way a newborn needs). When it isn't, supplemental or exclusive formula may be needed so your baby can thrive (and in some extreme cases, even survive).
If your baby's doctor (or the hospital staff) has told you that supplementation is necessary to protect your baby's well-being, ask whyâand whether there are alternatives (such as pumping to pump up your supply or getting intensive help from a lactation consultant). In some cases, routine policy might be at the root of the recommendation. For instance, formula may be prescribed when a baby has hypoglycemia (low blood sugar), even though many experts agree that breastfeeding can help baby regulate blood sugar just as well (except when the condition is severe). If that seems to be the case with your baby, consider asking for a second opinion.
But if supplementing or switching to formula turns out to be necessary, don't hesitateâand definitely don't wait to follow the doctor's orders. Refusing formula that's needed for medical reasons can put your baby at risk.
Do keep in mind that just because you're giving your newborn formula that's medically necessary, it doesn't mean you'll have to give up completely on breastfeeding. It's very possible you'll still be able to make it workâwith the combo (
click here
) or by relactating (
click here
). Also remember that there's nothing more important than your baby's health and well-being, no matter where his or her first nourishment comes from.
“I've been feeding my 10-day-old baby both formula and breast milk since birth, but now I want to breastfeed him exclusively. Is this possible?”
It won't be easyâeven this short stretch of supplementing has cut down on your supplyâbut it's definitely doable. The key to weaning your baby off formula will be to produce enough milk to make up the difference. Here's how you can pump up your milk supply, and make a successful transition to exclusive breastfeeding:
⢠Go for empty. Because frequent draining of your breasts is critical to milk production (the more you use, the more you'll make), you'll need to drain your breasts (either by nursing or pumping) at least every 2½ hours during the day and every 3 to 4 hours at night, or more if your baby demands it.
⢠Top off with the pump. Finish each nursing session with 5 to 10 minutes of pumping to ensure that your breasts are thoroughly drained, stimulating even further milk production. Either freeze the pumped milk for later use (
click here
) or feed it to your baby along with any supplemental formula (you can mix the two).
⢠Ease off the formula. Don't wean off formula cold turkey. Until full milk production has been established, your baby will need supplemental feedings, but offer the bottle only after breastfeeding sessions. As your milk supply increases, gradually feed less formula in each bottle. If you keep track you should see a slow decrease in the amount of formula baby takes daily as your milk supply increases.
⢠Consider a supplementer. Using a supplemental nursing system (SNS), such as the Medela Supplemental Nursing System or the Lact-Aid Nursing Trainer System, may make your transition from breast and bottle to breast alone a lot smoother. While it doesn't work for every mom-baby team (and it may take a lot of practice before you and baby feel comfortable with it), an SNS is designed to help you feed your baby formula while he sucks at the breast (
click here
). This way, your breasts get the stimulation they need and your baby gets all the food he needs. If possible, try to enlist an LC to help you get started on the SNS.
⢠Do diaper counts. Remember to keep track of your baby's wet diapers and bowel movements to make sure he's getting enough to eat (
click here
). Also, keep in touch with the pediatrician to make sure baby's getting enough to eat during the transition.
⢠Possibly, try medication. There are herbal options (some lactation consultants recommend fenugreek in small amounts to stimulate milk production or herbal tea combos like “Mother's Milk Tea”), and even a medication called Reglan that may help stimulate milk production (though it's not approved by the FDA for the purposes of stimulating milk production, and there are side effects for mother and baby). But, as with all herbs and medications, don't take anything to stimulate your milk production without the advice of your practitioner,
your baby's pediatrician, and/or a certified LC familiar with your situation.
⢠Consider CAM. Complementary and alternative therapies, such as acupuncture, may help pump up supply. Ask your LC or pediatrician for a referral to a CAM practitioner who has experience in treating moms with milk supply issues.
⢠Be patient, and be supported. Relactation is a time-consuming process, and you'll need all the patience you can musterâand all the help, too. Enlist family and friends to help out with household chores and other obligations so you can focus your time and energy on your relactation campaign. An LC or advice from a La Leche League volunteer can also provide the support you'll need.
Relactating will take round-the-clock effort on your part for at least a few days and as long as a few weeks, but chances are your hard work will pay off. Once in a while, however, even with best efforts, relactating doesn't take and you won't be able to produce enough milk to breastfeed exclusively. If that does end up being the case with you, and you end up having to bottle-feed either partially or completely, don't feel guilty. Your efforts to nurse should make you proud. And remember, any breastfeedingâeven for a short timeâbenefits your baby greatly.
You're determined to give your new bundle nature's bestâyour own breast milk. But what happens if you can't, for whatever reason? Would someone else's breast milk be next best?
It might be. Research shows that donated breast milk can nourish babies just as well as mother's own milk can. Just as safelyâwell, that depends. Though you can obtain milk through private donations (from friends or family) or through online milk share collectives, studies show that it may be unsafe for your babyâin some cases carrying infectious disease or containing harmful bacteria due to unregulated collection, storage, and shipping practices. Accredited, nationally recognized milk banks screen all donors and pasteurize milk before freezing and sending on to hospitals and families, ensuring its safety.
There are a growing number of milk banks in the U.S. that operate under the strict guidelines set up by the Human Milk Banking Association of North America (HMBANA), an organization of pediatricians and other health care workers. You can search for one at
hmbana.org/milk-bank-locations
.
Once a baby's born, there's just about nothing that a biological mother can do that an adoptive mother can't. And that even goes, to some extent, for breastfeeding. Though most adoptive moms don't end up lactating enough to breastfeed their babies exclusively, a few moms do manage to breastfeed at least partially.
Breastfeeding will be possible only if the baby you are adopting is a newborn and not yet attached to bottle-feeding, and if you have no medical condition (such as a history of breast surgery) that might prevent you from producing milk. Even with all those boxes ticked, however, it's important to also consider this: Establishing lactation will be extremely challenging, and even if you're serious about facing those challengesâand giving your effort to breastfeed everything you've got and then someâyou may not manage to reach your goal.
Keep reality in mind, but if you're determined to do whatever it takes to try breastfeeding your baby, you should definitely consider going for it. Following these steps will increase your chances of success:
⢠Read up. This chapter will tell you everything you need to know about breastfeeding.
⢠Visit the doctor. See your gynecologist to discuss your plan and to be sure that you don't have any condition (or take any medication) that will make breastfeeding especially difficult or even impossible. Ask for advice on logistics, too. If your doctor isn't familiar with lactation induction, ask for a referral to one who is. Also loop in the pediatrician you've chosen for your baby.
⢠Start popping. A prenatal vitamin or supplement designed for lactation can help boost your nutritional status and get your body geared up for baby feeding.
⢠Get help. Contact the La Leche League for advice and to recommend a local LC who can join your support team. You also may want to consider enlisting an acupuncturist or other CAM practitioner who has experience with breastfeeding issues.
⢠Get a head start. If you know approximately when your baby will be arriving, begin priming your breasts for that momentous day. About a month or so in advance, start stimulating lactation with a breast pump, preferably a powerful double electric one. Try to pump every 2 to 3 hours during the day and twice at night (if you don't mind interrupted sleep even before your baby arrives). If you successfully produce milk before your baby arrives, bag it and freeze it for future use.
Click here
for information about expressing milk.
⢠Feed frequently. Once baby arrives, you'll want to nurse often, depending on the age of baby (at least every 2½ hours during the day and every 3 to 4 hours at night for a newborn), being sure to supplement with formula so your new arrival gets the nutrition he or she needs.
⢠Stimulate while you feed. A supplemental nursing system (SNS,
click here
) will allow your baby to stimulate your supply by suckling, and at the same time, get the feed he or she needs from supplementary formula. Even if baby arrives unexpectedlyâand you didn't have a chance to get a head start on milk production by pumpingâan SNS may help you catch up, without shorting your little one on nutrients. And if you don't end up making enough milk to meet your baby's needs completely, you can keep supplementing with the SNS (if your baby cooperates with SNS feedingânot all will) as long as you breastfeed.
⢠Encourage let-down. If you're having trouble with milk let-down (that is, there's milk in your breasts, but it needs hormonal help making its way out), ask your doctor whether a prescription for oxytocin nasal spray might be useful. Just keep in mind that so far the use of oxytocin for boosting let-down is a little controversialâstudies show that it isn't always effective, and some experts believe more research should be done before it can be safely recommended.
⢠Relax. Get plenty of rest, relaxation, and sleep. Even a woman who has just given birth can't produce enough milk if she's super stressed and super exhausted. Stress can also interfere with let-down, so try to do some serious relaxing before each nursing or breast stimulation session.
⢠Don't give up too soon. A pregnant woman's body usually has 9 months to prepare for lactationâgive yours at least 2 or 3 months to get it going.
You'll know your body is making milk if you feel the sensation of letdown in your breasts. But the only way to know if you're making enough milk is if your baby shows signs of adequate intake (such as contentment after feeding, wet diapers, frequent bowel movements). If it doesn't seem like you're meeting all your little one's needs, continue to use the SNS.
If, in spite of all your hard work, you don't succeed at producing milk, or don't produce enough to make you the sole supplier of your baby's nourishment (some biological mothers don't, either), you can quit knowing you and your baby have already shared some of the important benefits of breastfeeding. Or you can continue nursing for all the nonnutritive perks and pleasures it offers. Just supplement your baby's intake of breast milk, if any, with formula, either through the SNS, with a bottle, or a combination.