Your Lactation Questions Answered! Part 1

I asked for followers to submit there lactation questions for my mom (the lactation specialist) to answer. The previous post is just a general list of

This first post is just a general list of resources and recommendations: good websites, things for feeding right after birth, pumping, life span of milk, how much to feed your new baby, foods that are known to increase and decrease milk supply. You can read that post >> here.

Here are the first set of answers. The rest will be answered later in a separate post.

**Disclaimer: I do the newborn period in the hospital, so that is what I am most familiar with. I cannot prescribe. Anything I recommend, follow up with your physician first, as he/she knows you and your baby specifically.**

Lactation Questions and Answers

Q: Going back to work in two weeks! Currently feeding on demand and pumping 2x a day or if feeling engorged (if babe takes extra long nap or if he takes a bottle if I am away) should I continue the 2x pumping early morning and evening if pumping at work and nursing him in the morning before day care? Also plan to nurse evenings and until at least 6 months.

A: If you have the time, I would continue to do what you are doing until you find out if your milk supply decreases at work. A baby is more efficient then a breast pump and a mother releases more prolactin hormone when a baby nurses then to a pump.  You may need to adjust the pumping times on the 2 extra pumpings per day to fit your new schedule.

 

Q: Is there a good way to establish a pumping nursing schedule? I’ve started back to work part time and am afraid my supply is decreasing, and I want to be able to stock pile as much as I can on the weekends/ evenings, etc. thanks!!

Yes, decide how much you want to have stored in a month. For example if you come home from work and breast feed and consistently pump at the same time a day, you will increase the milk at that time. So, if you pump once a day then you will have 30 bottles in a month.  When a baby latches, the prolactin hormone is increased more than with a pump, so that is normal that on returning to work, your milk supply may decrease. Also, if you can’t pump as often at work as the baby feeds this can decrease the supply. You might consider renting a hospital grade symphony double electric breast pump.


Power Pumping to increase milk supply is an option. It’s like mimicking cluster feeding. A baby cluster feeds at growth spurts to increase milk supply. Watch a movie and use a double pump. Pump off and on during the move: pump for 10 to 15 minutes, then rest for 15 to 30 minutes, then pump, then rest, like a baby does at growths spurts to increase milk supply. Do this several days in a row. Prolactin is higher at night. So, evenings are better, if possible.

Q: Is it ok to use a nipple shield all the time? Is it normal for your baby to feed for over an hour? Are you suppose to do both sides or just one during feedings? What are some foods that help increase milk supply? And any tricks on what to give or eliminate due to a gassy baby?
She’s 2 months and approximately 8 lbs.

A: Yes, it is ok to use a nipple shield all the time, just watch your milk supply. You might consider a lactation consultant visit to assess the baby’s feeding. You may need to add some additional breast pumping to keep the supply up. I recommend cleaning the nipple shield well in between use and boil it once a day. You want to clean off any yeast or bacteria. If it gets sticky, get a new one.

You want to watch for milk transfer and listen for swallowing.  You can add some breast compression as long as the baby is able to handle the flow and give gentle reminders under the chin to keep the baby feeding and feeding more efficiently, in less time.

Each baby feeds differently.  Without seeing the baby feed, I can’t tell if one hour is too long for your baby. I try to get a baby fed in around 20 to 40 minutes and get them to feed effectively. If she is peeing and pooping enough and gaining weight at the Pediatrician’s visits and the Pediatrician says everything looks good, then yes.

One side or both sides is a personal preference. Some people breast feed on one side, if they have enough breast milk volume to meet the baby’s needs, and pump on the other side and store it. Others, breast feed on one side and then at the next feeding breast feed on the other side. Some breast feed on both sides, so their breasts will stay approximately the same size.

            Gassy foods can be baby specific. For example, if you eat dinner and in the middle of the night she’s gassy, then it’s what you ate for dinner.  Dairy, broccoli, cabbage, legumes are some foods that may cause gassiness. You will have to ask the Pediatrician about any over the counter or prescription medication for gassiness.

Please refer to this previous post for references on foods that are known to increase and decrease milk supply.

Q: Should I nurse on demand always? Should I ever wake up my baby to nurse? When should I introduce a bottle/paci?
Baby is 2 weeks old and 7 lb 5 oz 

A: I’m in favor of on demand feeding because a baby is a human being and everyone has his/her own feeding pattern. But, some people like to put a baby on a schedule.  I would, however,  breastfeed a 2 week old on demand.  It will give you a better milk supply.
I would wake a baby up during the day every 2 to 3 hours and try to get in as many feedings during the day as possible. The baby should eat at least 8 to 12 times in 24 hours. And, I would wake a baby up at night, every 2 to 3 hours with a maximum of four hours between feedings at night, until the Pediatrician said it’s ok to let the baby sleep through the night. 

I do not believe in nipple confusion. The issue is volume flow. Plus, you can do suck training and correct the tongue movement between breast and bottle feeding. The American Academy of Pediatrics recommends one month for well babies to introduce bottle and paci. However, NICU babies breastfeed, bottle feed, and use a paci.
A paci teaches a NICU infant to comfort itself, increase jaw/cheek strength, and teaches a NICU infant to suck, breath, swallow.  Some babies like to suck more then others. Follow your Pediatricians recommendation or use your own best judgment for your baby.

 

Q: I had to eliminate dairy and eggs from my diet to clear up my babies eczema. When and how do I introduce those foods to her once she is able to eat solids? She’s almost 4 months now. Also if I have half a glass of wine, how should I space out her feedings so it won’t reach her in my milk supply?

A: I have to say this first, that alcohol can increase the chance of sudden infant death syndrome. With that said, if you have a half a glass of wine, if you do not feel the effects of it at the next feeding, 3 hours later, than you should be OK.

Alcohol is present in the breastmilk at the same rate as it is present in the blood. Therefore, you can’t necessarily just pump the alcoholic milk out and have clean milk for baby if you’re still feeling the alcohol. But, if in doubt, you can always feed your baby a bottle of previously pumped clean breastmilk and pump and dump that feeding so your body knows to keep making milk at that time. 

Some moms choose to have their drink towards the end or right after nursing. This way, by the time the alcohol gets into her blood and milk, the baby is already finished eating and won’t need to nurse for at least couple of hours.

Most likely a year to reintroduce those foods, but ask your Pediatrician. I know they have been doing research lately on introducing certain foods earlier.

Q: how often should a baby poop? 4 months.
A: Babies bowl habits vary. As I mostly do the newborn period, I would call and ask your Pediatrician’s office nurse. I believe at 4 months that some babies stool every day to even every few days. The stools should be soft. If the stools become hard, dry, or difficult to pass then, call your pediatrician.

Q: how often should you be nursing at 8 months?
A: As I work with the newborn period, and am less familiar with older babies eating patterns, I believe a minimum of 6 times in a 24-hour period plus whatever table food you are feeding them. But, you can always make a quick call and consult with your pediatrician’s office nurse.

Q: What is a normal amount of oz of breast milk to get from each breast? Baby is 5 months and 14 lbs.

A: {1 ounce = 30 ml).  This is just an approximation: 10 ml per pound for 8 feedings in a 24 hour period. So, approximately 4 & 2/3 ounces per feeding for 8 feedings for 37.33 ounce in 24 hours.
Or, if feeding 6 times then, 6.22 ounces per feeding in a 24 hour period. Some, babies eat more.  This is just a general ballpark figure.
Remember that a baby can nurse out more milk then a breast pump can pump out. Our breasts are never really “empty”.

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