How to Make More Breast Milk

Question:
I’m a breastfeeding mom who recently went back to work. It’s difficult for me to find the time to pump as often as I should, and as a result my milk supply has dwindled. I only manage to express a half-once or ounce of milk, as opposed to the 4 to 5 ounces I produced when I first started pumping. Is it possible for me to restore my milk supply?

Answer:
A. Even if you get only a half-ounce, it is certainly worthwhile to continue pumping your milk! Breast milk is not only beneficial to a baby's overall health (and intellectual development), but expressing at work will keep you connected to your baby while you're apart. If you've got a love-hate relationship with your breast pump, know that you're not alone. I remember the challenges my wife faced when she was pumping milk for our babies. One day she got so frustrated about not being able to express enough, that she threw one of the plastic pump parts at me! Rather than taking out your frustrations on your partner, try these tips for increasing your milk supply:

Think positive! Breastfeeding is often and aptly described as a confidence game. Worrying about how little milk you're able to pump will only further suppress your milk supply. Instead, focus on what you are able to express. Consider how fortunate you are to be able breastfeed at all.

Get "pumped up" yourself. There are several ways to stimulate your milk ejection reflex: Do a few minutes of breast massage and drink a couple of glasses of water right before you pump. Place your baby's blanket or a piece of his clothing close by so that you can enjoy his smell. Put pictures of him where you can see them. Many working mothers even call baby on the phone to listen to the cooing and babbling. As you take in the sights, smells, and sounds of your baby, visualize streams of your milk flowing. It's also important to be relaxed when you sit down to pump. Soothing music can help (to minimize distractions, use a Walkman or Ipod).

Pump more frequently. If possible, pump at work as frequently as your baby would nurse, preferably every two to three hours. More frequent pumping for shorter periods will stimulate your milk ejection reflex better than pumping less frequently for longer periods.

Go high-tech. Consult a lactation specialist or a local La Leche League leader about the best breastpump for your work situation. I recommend the double-pumping system: Studies show that prolactin levels (the hormones that stimulate your milk) are higher when you pump both breasts at the same time. The newest double-pumping systems are not only more comfortable, but more efficient, allowing you to pump more milk in less time. (Moms in our practice like the Playtex Embrace.)

Set up a nursing station. Many companies now feature lactation lounges, comfortable office areas where moms can pump their milk. Studies show that creating a breastfeeding-friendly workplace is good business: Working moms who breastfeed miss fewer work days, mainly because their infants are not as sick as often. If there are other breastfeeding mothers in your office, band together and speak to your supervisor about setting up a lactation lounge.

Breastfeed more often when not at work. Nurse full-time when you're not at work, and eliminate bottles as much as possible. Most pumping mothers find that by the end of the week, their milk supply is lowest, but after frequent breastfeeding over the weekend they're able to pump more milk on Mondays. Your baby's sucking will stimulate your milk supply more effectively than any breast pump. If your baby has already started solid foods, always nurse before feeding him, and think of solids as just an additional supplement to the more valuable breast milk.

Set priorities at home. Even if you can't change your work environment, try to make changes in your overall lifestyle that will enhance your breastfeeding. Ask your partner to relieve you of as many household tasks as possible. Explain that these chores, on top of your work demands, drain your energy and therefore hurt pumping abilities. Make sure he understands the importance of breast milk for babies. Hopefully, he'll be as supportive as the father of one of my patients. He once said to me, "I may not be able to breastfeed or pump milk, but I'll do whatever I can to help my wife make more milk for our baby."

Breastfeeding While Sick

When you are sick, you and your baby will almost always benefit from continuing to breastfeed. There are very few illnesses that require a mother to stop nursing. Since most illnesses are caused by viruses that are most contagious before you even realize you are sick, your baby has already been exposed before you even develop symptoms (such as fever, diarrhea, vomiting, rash, runny nose, cough, etc). Continuing to breastfeed will help protect your baby from the infection, because your body produces antibodies to the specific bug that is causing the infection, and you pass them on to the baby in your milk. Often, a breastfed baby will be the only member of the family who doesn’t get sick. If he does get sick, he will usually have a much milder case than the older members of the family.
Illnesses are most often transmitted through skin contact and secretions from the mouth and nose. Be sure to wash your hands often, and try to avoid face-to-face contact (and sneezing directly on the baby).

Breastfeeding  your baby while you are sick makes it easier for you to rest. Tuck him into bed with you to nurse, then have someone take him away when you’re done. I remember being so sick that my older kids would bring the baby in to nurse every couple of hours, and I was so out of it that I didn’t even know when she nursed.

Weaning abruptly is never a good idea, especially when you are sick. You put yourself at risk for engorgement and mastitis, as well as the emotional trauma of sudden weaning for both you and the baby. (see “Engorgement” and “Breast Infections and Plugged Ducts“)
You need to make sure that you get plenty of fluids when you’re sick, because you don’t want to become dehydrated. Your milk supply may decrease during and immediately after your illness, but it will quickly build back up when you feel better.

Every year, over 4.3 million women in the U.S. have babies. Nearly all of these moms will use at least one drug while they are pregnant or nursing.

Breastfeeding Baby Refuses Bottle

QUESTION:
I'm trying to get my 3-month-old son to take a bottle for when I have to go out, and he absolutely refuses. I've tried every different nipple on the market, and he just won't drink from them - even when it's my breast milk. How can I get him to do this so that I can leave my son with his dad, or anybody for that matter, without worrying that he is screaming because he's so hungry?

ANSWER:
I understand your concerns - in fact I remember when I had this same question years ago. I'll try to give you the information that helped me to better understand and to meet my son's needs.
It can be worrisome for loving parents to think that their baby may be in a situation in which an important need such as hunger cannot be satisfied. However, a bottle is not a good solution. Many babies will suck only from one or the other, breast or bottle. One reason for this is that the sucking method is, surprisingly, quite different. A baby who is breastfeeding successfully can become confused by something that requires a different sucking method. But I would not recommend that you teach him how to drink from a bottle, even if you could do so. If he were to successfully learn to suck from a bottle nipple (or a pacifier), that could bring about what is termed "nipple confusion" and interfere with his ability to nurse properly. As there are literally hundreds of benefits of breastfeeding, both physical and emotional, for both baby and mother, anything at all that might interfere with this extremely beneficial relationship should be avoided.
Your son has good survival instincts! While his resistance to bottles may be frustrating for you, your baby is strongly communicating his legitimate need to be with you as much as possible. Bottles, even when filled with breastmilk, cannot satisfy a baby's emotional need for the mother's presence. For the early months and years, it is essential that he have full opportunity to bond first with his mother - only then can he successfully move on to bonded relationships with his father and, later, with other persons.

Breastfeeding, beyond all of its many physical benefits, has the added bonus of requiring the mother's presence. A baby has no sense of time and no way of knowing that an absent mother will ever return, yet he understands that her presence is essential. Thus her absence can be quite terrifying. For this reason, it is imperative to keep absences to the barest minimum (in terms of length of time and number of times), and if it is absolutely essential to leave him, try to be gone as short a time as possible, and to schedule things so that you are gone between feedings, or during naps, rather than during a time when he is apt to be hungry.

If a separation is absolutely unavoidable during a time when he is hungry, perhaps he will accept expressed breastmilk from a spoon. In a relatively short time, he will be able to drink from a cup. However, I offer these suggestions reluctantly and definitely not as a routine solution, but only as something that might be used in a rare, emergency situation. It would be far better to avoid separations as much as possible, and to carefully schedule any departures that cannot be avoided. In fact I urge you to make every effort to avoid such departures altogether if possible. Not only do alternate feeding methods interfere with his ability to nurse from you, but more significantly, all separations can interfere to some degree with his developing sense of trust and security.

I would like to stress an important practical consideration that is often overlooked. Sometimes parents assume that a baby will not be welcome or appropriate in a certain situation, when in fact they may be pleasantly surprised if they ask to bring the baby along. Many parents have had the frustrating discovery of attending a function without their baby or child, only to find that others have brought theirs along. If a mother must attend a function where babies are definitely not allowed, she can ask that the baby be brought to her for nursing breaks. Requests like this can even help others in society to become more aware of the critical importance of breastfeeding and bonding. With such a request - even if it is denied - a mother can contribute to the process of social change. In many countries of the world, babies and children are far more welcome in "adult" settings than in North America. It is time to request and advocate change in this area!

It is not only the baby who finds separation difficult. Breastfeeding mothers quite naturally find that they also become uneasy when separated from their baby. The following is excerpted from the La Leche League book, The Womanly Art of Breastfeeding (New York: Penguin Books, 1991):

"You won't want to leave your baby any more than you have to because babies need their mothers. It's a need that is as basic and intense as his need for food. 'That's all well and good,' you may be thinking, 'but what about me? I have needs too.' Of course a mother has needs, and sometimes other responsibilities and obligations cause a mother to be away from her baby more than she wants to be. But you may be surprised to find how strong the bond is that develops between you and your baby. A mother often finds that when she does leave her baby for that long-awaited 'night out', she worries so much about how the baby is getting along that she doesn't really enjoy the occasion!"

Reference: http://www.naturalchild.org/advice/q26.html

Making Sure Your Baby is Getting Enough Milk

I'm breastfeeding my baby. How can I tell if she's getting enough milk?

There are several ways you can tell whether your baby is getting enough milk. They include the following things:

• Your baby has frequent wet and dirty diapers.
• Your baby appears satisfied after feeding.
• Milk is visible during feedings (leaking or dripping).
• Your baby is gaining weight after the first 4 to 5 days of life.

Your baby should have several wet or dirty diapers each day for the first few days after delivery. Beginning around the time that your milk comes in, the wet diapers should increase to 6 or more per day. At the same time, stools should start turning green, then yellow. There should be 3 or more stools per 24 hours. Typically, once breastfeeding is going well, breastfed babies have a yellow stool during or after each feeding. As your baby gets older, stools may occur less often, and after a month, may even skip a number of days. If stools are soft, and your baby is feeding and acting well, this is quite normal.
Your baby's feeding patterns are an important sign that he is feeding enough. If you add up all the feedings over the course of the day, your baby should feed at least 8 to 12 times a day. Remember, newborns feed often and will give cues or signs when they are ready to feed. The length of each feeding varies and your baby will show signs when she is finished.
When feeding well with good latch-on, the infant will suckle deeply, you will hear some swallowing, and the feeding won't be painful. The baby should appear satisfied and/or sleep until time for the next feeding. If your baby sleeps for stretches of longer than 4 hours in the first 2 weeks, wake him for a feeding. If your baby will not waken enough to eat at least 8 times per day, call your pediatrician.
Your child will be weighed at each doctor's visit. This is one of the best ways to tell how much milk your baby is getting. The AAP recommends that babies be seen for an office visit (or home visit) between 3 to 5 days of age to check on breastfeeding and baby's weight. During the first week, most infants lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. Once your milk supply is established, your baby should gain between ½ and 1 ounce per day during the first 3 months.

Early Signs of Hunger

Your baby starts to let you know when she's hungry by the following early signs or cues:

• Small movements as she starts to awaken
• Whimpering or lip-smacking
• Pulling up arms or legs toward her middle
• Stretching or yawning
• Waking and looking alert
• Putting hands toward her mouth
• Making sucking motions
• Moving fists to her mouth
• Becoming more active
• Nuzzling against your breast