Monthly Archives: May 2013

Thyroid and Breastfeeding

The Sneaky Destroyers of Milk Production : Thyroid Function, Hormone Imbalance Or Nutrient Deficiency

We have written many articles on the causes of low milk production in breastfeeding mothers. If none of the other causes we have written about seem to fit your situation, consider having your blood checked for one of these sneaky destroyers of milk production. Particularly have your doctor check for the following:

Hypothyroidism – This happens when your thyroid gland is functioning below normal levels. Symptoms include weight gain, depression and low milk supply. Medication can be given to increase thyroid function.

Anemia – This is a low red blood cell count. The first symptom is fatigue which is difficult for a new mom to know if it’s a symptom of anemia or if she’s just tired from those middle-of-the-night feedings. Like an under-functioning thyroid, Anemia can affect breastfeeding and lactation and should be corrected with supplementing with iron, eating iron rich foods, and vitamin C, which helps with the absorption of iron. Look for an Iron / Vitamin C blend and take 30 Mg of iron and 200 Mg of Vitamin C per day with a meal.

High Testosterone – A certain kind of cyst (Gestational Ovarian Theca Lutein Cyst, to be precise) on one of your ovaries during pregnancy can cause it to produce up to 150 times the normal amount of testosterone. Symptoms include deepening of the voice, facial and body hair growth, male pattern balding, low milk production and difficulties breastfeeding. The reason is that high testosterone interferes with prolactin’s (the milk-making hormone) job of making milk.

If your blood test shows abnormally high levels of testosterone and the cause is a gestational ovarian theca lutein cyst, the simple fix is to simply wait 2 to 4 weeks after birth and continue breastfeeding and follow the advice for increasing milk production in our article on the 11 ways to increase milk supply. After that time, testosterone levels simply return to normal on their own without treatment.

Nutrient Deficiency – Being deficient in any nutrient can have a domino effect that reduces milk production. Correct any “low” or “low normal” with supplements. Be sure to have at least the following nutrients checked: vitamins C, D, B12, iron, zinc, folic acid, calcium and protein.

If the thyroid and other blood tests don’t reveal any problems, it’s not the end of the road. Sometimes the cause of low milk production remains a mystery, but it can still be treated and overcome in many situations. I’ve found that doctors frequently take this approach. One time I went in to see a doctor for a skin problem – sort of like a boil on my arm that wouldn’t go away. The doctor told me he didn’t know what caused it or even what it was but gave me a prescription anyway. He said, “If that doesn’t clear it up, come back in.” His solution worked, even though he didn’t know the cause.

Sometimes the cause of low milk production can be found out with a simple thyroid blood test, and a simple medication can restore your breastfeeding relationship. But other times   you just have to treat breastfeeding problems even though you do not fully understand the underlying cause. See our article index for a complete list of helpful articles. heart-logo

Obesity and Breastfeeding: A Cause of Low Milk Production

The Link Between Obesity and Troubles Breastfeeding

Obesity map 2005

Obesity map 2005 (Photo credit: Wikipedia)

If you were obese before becoming pregnant, there’s a possibility that your prolactin (the milk-making hormone) levels weren’t high enough to adequately prepare your breasts for breastfeeding. Additionally, lower prolactin levels after birth can be a leading factor in lower milk production.

Even if you have very large breasts that seem like they should be able to produce plenty of milk, you can still have a problem breastfeeding successfully. Often, very large breasts are mostly made up of fat tissue and other not glandular, milk-producing tissue.

If you believe obesity might be affecting your breastfeeding relationship, see your doctor and have your prolactin levels checked and follow the advice of your health care professional. In the meantime, there is some good news: you can safely diet while breastfeeding.

You may have heard that you have to increase your calorie intake by 300 to 500 while breastfeeding, however that only applies if you want to maintain your body weight. When faced with obesity, it is safe to diet and lose a pound or two a week through exercise as long as you are getting at least 1800 calories throughout the day. This is the minimum amount of calories believed necessary to maintain a healthy milk supply.

Your body has no problem with burning fat to make milk. But remember, fat may contain toxins that are released into the bloodstream when the fat is converted to energy. Too many toxins can overwork your liver and kidneys so keep weight loss to 1 to 2 pounds a week. Don’t worry though, research has shown that these toxins are not present in breast milk.

I personally have had success with “The Abs Diet for Women.” This widely available book isn’t really a diet, but a lifestyle change that increases the number of times you eat (3 meals and 3 snacks per day) and favors higher protein and healthier food over high carb food. However it is not a low carb diet. You can find it at Amazon.com or possibly from your local library.

Eating six times a day kept me from feeling hungry and is great for obesity-battling, breastfeeding mothers. Furthermore the meals and snacks are often quick and easy to prepare – something a mother of small children can really appreciates!

Another option is the Milk Up! Meal Plan detailed in chapter 8 of the Milk Up! book. An electronic copy of this book is included as a free gift with an order of Lactiful Supply Max. This nutritious meal plan is specifically for mothers who want to increase milk production and can be the basis of a healthy diet.

And finally, my sister lost a lot of weight with Weight Watchers and is now a lifetime member so if you haven’t found a diet that works with your lifestyle, keep looking! Obesity and breastfeeding are not best friends, but working on weight loss can lead to more milk production, more energy and better overall health. To help boost milk supply see the 11 ways to increase milk productionheart-logo

Gastric Bypass and Breastfeeding

If you’ve had gastric bypass surgery in the last 24 months, chances are very likely that you will have challenges breastfeeding. What’s going on is that you and your baby are probably not getting enough vitamins, minerals or protein. And just like with vegetarianism (see our article on vegetarianism and breastfeeding), if baby isn’t getting enough B12, he’ll be too sleepy to breastfeed effectively and leave milk in the breast. Leaving milk in the breast results in lower milk production because the body see it as a sign that it is overproducing.

What to do about Gastric Bypass and Breastfeeding

Even if your gastric bypass surgery was more than 24 months ago, be sure to see your doctor for a blood test to see if you are low on any essential nutrients. Especially look at B12, iron, zinc, folic acid, calcium and protein as these play important roles in breastfeeding. Supplement anything that comes back “low” or “low normal.”

Even if your protein level isn’t low, be sure to eat at least half a gram of protein for each pound of body weight per day. So if you weigh 160 pounds, eat 80 grams of protein. There are many high protein bars, protein smoothie powders or premixed shakes that can help make up the difference in what you eat. Just check the weight lifting section in your local vitamin store.

If you’re breastfeeding and have had gastric bypass surgery in the past, correcting any low nutrient level should bring your milk supply back up fairly quickly (as long as it has not be low for very long, because the longer breastfeeding problems persist the more difficult they are to correct).

If fixing the nutrient levels that are a common problem of gastric bypass does not help with breastfeeding or milk supply, see our article on the 11 ways to increase milk supply or check your daily milk productionheart-logo

Breastfeeding And Breast Reduction

What is Breast Reduction Surgery?

Reduction mammoplasty: The keyhole incision pl...

Breast Reduction Surgery: The keyhole incision plan for breast reduction. (Photo credit: Wikipedia)

Breast reduction surgery is a type of cosmetic surgery that removes breast tissue and relocates the nipple so that the breasts and body are in proportion. Breast reduction is done for many reasons including physical reasons such as back pain, shoulder discomfort from bra straps, and breathing troubles; emotional reasons such as self-confidence and body image as well as aesthetic reasons.

Breast Reduction and Breastfeeding Considerations

Fortunately, most doctors who perform breast reduction surgeries keep breastfeeding and lactation as a worthy objectives. They perform the breast reduction surgery in such a way that as many of the milk ducts and milk glands can be undisturbed as possible. So it certainly possible that  a woman will be able to successful with breastfeeding after breast reduction. Generally the more time that has passed between the breast reduction and the start of breastfeeding, the higher the chances of adequate milk supply and successful breastfeeding.

When to Undergo Breast Reduction

If a woman anticipates breastfeeding, breast reduction should be delayed until after her last child has weaned, if at all possible. (This same advice applies to breast augmentation as well.) If it is not possible to delay the breast reduction surgery until after the last child has weaned, the next best option is to have the surgery as far in advance of the beginning of breastfeeding as possible. This allows time for nerve regrowth and the returning of sensations. This is important because nerve sensations play and important part in breastfeeding – they signal the body to release prolactin, the milk-making hormone.

How Breast Reduction Affects Breastfeeding (and what to do about it)

Any breast reduction surgery will likely sever either nerves or ducts or both. Any ducts that are severed prevent the delivery of milk from the milk gland to the nipple. This effectively shuts down the affected parts of the breast. Milk will likely come in normally behind a severed duct but since it can’t be drawn out, it is eventually reabsorbed and production shut down. In a similar way, nerve damage prevents breastfeeding signals from reaching the pituitary gland and can cause lower prolactin hormone levels and thus lower milk supply.

The good news is that even though parts of each breast may be shut down, there may be enough parts still functioning that breastfeeding can be successful. Some women have very little with breastfeeding and milk production and however others have an extremely difficult time. You won’t really know how breast reduction affects breastfeeding for you until you try. If you are finding breastfeeding or milk production to be a challenge, understand that building your milk supply will not be easy and will require determination and active work on your part. If you already know that you are struggling with low milk supply, a good starting point is our article on the 11 ways to increase breast milk supply.

However if you are unsure of how your breast reduction is affecting breastfeeding a good starting point is to measure your milk supply and find out. heart-logo

How To Supplement Breastfeeding With Formula

baby formulaDone incorrectly, supplementing breastfeeding with formula can lower your milk supply and ultimately ruin your breastfeeding relationship. Luckily, you’ve come to the right place. Our six step approach gets your baby the nutrition he needs, while protecting and increasing your milk supply. Here are the six steps:

 How To Supplement Breastfeeding With Formula: The 6 Steps

Step 1: Decide if you should supplement
Step 2: Know how much to supplement
Step 3: Know what to supplement
Step 4: Know when and how to supplement
Step 5: Let your body know you are supplementing
Step 6: Evaluate weekly and ween off supplements

How To Supplement Breastfeeding With Formula: Step 1

Decide If You Should Supplement

Deciding to supplement is often emotionally charged. When my son was labeled “failure to thrive” and I was told to supplement by my lactation consultant, I felt like a failure. Overtime I came to realize that supplementing wasn’t the end I had feared but a means to an end. Supplementing gave my son the nutrition he needed and it gave me the time to work through my low milk supply issues. Ultimately, I weaned him from the supplements and breastfed until he was two.

If you’ve been told to supplement, but haven’t started out of fear of where it might lead, try to see it as a means to an end. Supplementing, using the methods described in this article, supports breastfeeding, gives your baby the nutrition he needs and gives you the time to solve your low milk supply issues.

You should definitely supplement if a health care professional (such as a doctor or lactation consultant) has told you to supplement. Their recommendation is likely based on your baby’s weight changes and on growth charts.

You should not supplement if your baby is in the 40th percentile or higher on the growth charts for weight and has been following his growth curve consistently (these are both things your doctor can tell you) and your baby has plenty of wet diapers (5 or more per day). This is a thriving baby and supplementing will be added expense and work without any benefit.

If you don’t fall neatly into either of the “definitely should supplement” or “should not supplement” groups, you’ll need to make your own call or get a doctor’s opinion. I recommend two things. The first is to trust your instincts. You know your baby better than anyone else on this planet and you probably know, in your gut, whether he needs supplementing or not. And second, we know how much milk the average baby consumes each day. If you have completed one of the milk measuring tests, you can compare how much milk you are making with how much milk a typical baby drinks in a day. Keep reading. The next step explains how to do this.

How To Supplement Breastfeeding With Formula: Step 2

Know How Much To Supplement

Most parents and professionals who take a guess at how many ounces per day of supplement the baby needs, end up overestimating. That’s certainly understandable and doesn’t hurt baby at all, but it does increase the odds of harming your breastfeeding relationship. Another common problem of bottle feeding happens when a baby spits out a bottle, satisfied, but a well-meaning caregiver will put the bottle back in and encourage baby to finish it, not wanting to throw out expensive formula or priceless breast milk. This well-meaning intention unfortunately overstuffs the baby, so he’ll go a longer time before he’s ready to breastfeed again. That leaves milk in the breasts for longer periods of time and milk left in the breasts signals the body that it is overproducing and that production should be cut. Talk about running backwards, up a hill, wearing roller skates.

Rather than guess how much supplement your baby needs, use either of the two tests described in another article to determine your current milk production per day. Next subtract your production number (in ounces per day) from 25. (We use 25 since an average 1-6 month old baby typically consumes about 25 ounces of breast milk per day – and somewhat more during growth spurts. A baby less than 1 month old typically needs a little less milk: 19 to 24 ounces per day.) The difference between your daily production and this guideline gives you the amount of supplement, in ounces per day, that you should give your baby.

For example, let’s say your pumping test showed you are producing 16 ounces per day. 25 – 16 = 9. You should plan to give your baby 9 ounces of supplement each day. If you breastfeed your baby 9 times a day, plan to give him 1 ounce of supplement at each breastfeeding session.

I strongly recommend that you do either of the milk production tests, but if you absolutely cannot there is another, though less accurate, way to estimate the amount to supplement. We know that
thriving babies 0 to 4 months gain about 6 ounces of body weight each week. If we know how your baby compares, we can get a rough estimate of how much you should supplement. Here’s how:

You’ll need to weigh your baby each week. Use an accurate baby scale and weigh your naked baby about the same time of day each week. Subtract your baby’s weight gain from the thriving baby’s weight gain who is the same age in the chart below. Multiply that result by 2 to get the number of ounces of supplement needed per day.

• Thriving babies 0 to 4 months gain 6 ounces per week.
• Thriving babies 4 to 6 months gain 4 ounces per week.
• Thriving babies 7 to 9 months gain 3 ounces per week.
• Thriving babies 10 to 12 months gain about 2 ounces per week.

For example, let’s say your three month old gained 2 ounces last week. From the chart above we see that a thriving three month old should gain 6 ounces per week. So we take 6 – 2 and get 4. Next we multiply 4 by 2 to get 8. Therefore, we estimate that baby needs 8 ounces of supplement per day.

Keep this method in mind, because we’ll use it during step 6: evaluate weekly and ween off supplements.

How To Supplement Breastfeeding With Formula: Step 3

Know What To Supplement

Here’s the what you should supplement in order of preference:

  1. Your own breast milk – fresh or frozen, produced from earlier pumping sessions.
  2. Breast milk from another mother – if it is available and is not objectionable or uncomfortable for you, it makes a healthy choice. See this article for how to pasteurize the milk.
  3. Formula.

The best supplement you can give your baby is your own pumped breast milk. Pumping is a great strategy for increasing your milk supply and you can use your freshly pumped breast milk as a supplement. If you banked up a supply of breast milk in your freezer from earlier pumping sessions, now is the time to use it. If you don’t have breast milk banked up or if you run out, breast milk from another mother, preferably a relative or friend is a good option.

Another option is a milk bank. See http://www.hmbana.org/index/locations for locations around the country. If there’s not a location near you, milk banks will often overnight frozen milk to your home. Milk from milk banks has been pasteurized – a process of heating the milk to kill possible harmful bacteria – so you can unthaw and use it immediately. If you’re getting milk from a friend or relative you may wish to pasteurize it before giving it to your baby. See our article How to pasteurize breast milk.

How To Supplement Breastfeeding With Formula: Step 4

Know How To Supplement

If you are already using a bottle to supplement, chances are you’re in big trouble. You’re on that slippery slope to exclusive formula feeding. It’s time for damage control. With much work and patience you can get back on the road leading out of Supplement Town. I’ll show you how later, but first let’s look at the best way to supplement while keeping and ultimately rebuilding your milk supply.

Monoject is great for supplementing with formula

A monoject 412 syringe.

First you’ll need to get a set of Monoject 412 periodontal syringes. A pack of 25 is enough to get started and you can find them online for less than $1 each. These are small capacity syringes that have a curved tip, rather than a needle. Here’s how to use them:

Each time you nurse your baby, you’ll use the syringes to give the supplement. Each syringe only holds 1/4 to ½ of an ounce (depending on how full you fill it), so you’ll need to determine ahead of time how much supplement baby needs at each nursing. If he needs 1 ounce then you’ll fill 2 or 3 syringes before starting breastfeeding. If he needs 2 ounces then you’ll fill 3 or 6 syringes depending on how full you fill each syringe.

Once your syringes are prepared and within easy reach of your nursing area, latch baby with as good of a latch as possible. Immediately take the first syringe and slide the curved tip into the corner of baby’s mouth. Lightly tap on the plunger to push the milk into the baby’s mouth. Empty the first syringe over the next minute to produce a slow flow of milk. Giving milk like this, right at the beginning, should invigorate baby and result in more vigorous sucking and better milk removal from the breast, which in turn increases your milk supply. Giving milk right at the beginning also helps babies who have negative feelings toward the breast to get immediate, positive response when they latch. This rebuilds their trust in the breast.

Have the next syringe handy and if baby starts getting frustrated or fussy, put it in his mouth immediately, otherwise give him a few minutes with just the breast. Continue to dole out the syringes throughout the breastfeeding session as evenly as possible. Try to use an even number of syringes per breast as well. When you switch breasts, watch baby’s cues, if he seems to be getting frustrated, give him a syringe right away just like when you started the session, however you may find that he is more patient after getting some satisfaction from the first breast.

Be sure to give all the syringes before the end of the breastfeeding session and allow baby to continue to nurse at the breast until he is finished.

Here are the benefits of supplementing with Monoject:

  1. Avoids the supplementing land mines of nipple preference, nipple confusion and flow preference.
  2. Maintains or increases milk supply, because your breasts get far more stimulation than when supplementing with a bottle.
  3. Keeps baby bonded to you and familiar with the breast.
  4. Baby learns (or relearns) that he can be satisfied at the breast which will reduce his frustration and fussiness with breastfeeding. Breaking the associations of feeling frustrated at the breast and satisfied from the bottle builds the foundation for conquering low milk supply and successful breastfeeding.
  5. It’s easy to change the amount of supplement and easy to ween from supplement.
  6. You decide when baby gets each syringe. This allows you to watch his mood and give him a supplement before he gets frustrated at the breast. This is a great way to bring baby back to the breast after he’s become attached to supplements from a bottle.
  7. By finishing at the breast, rather than with a bottle, you get to experience the peace and joy of a happy, satisfied baby in your arms. Your cozy baby may even fall asleep at the breast and continue to comfort suck, which will help increase your milk supply.

Supplementing With A Bottle

Monoject and the method just described is the best way to give baby the nutrition he needs while making your stay in Supplement Town as brief as possible. That being said there may be some times when you find you have to bottle feed. Here’s how to limit the damage of bottle feeding:

  1. Use the slowest flowing nipples you can find. Sometimes they’re marked as a 0 (zero) or labeled “newborn.”
  2. Pick a bottle nipple that’s most shaped (length and width) like your nipple. (This may help with nipple preference and confusion.)
  3. Latch baby on to the bottle much like you latch baby to the breast – get the nipple back in the mouth so that his lips are around the base of the nipple. When you look at baby’s mouth while latched on to the bottle, it should look much the same as when baby is latched on to the breast.
  4. Sit baby up and hold the bottle level with the floor to further reduce the flow. (This may prevent flow preference.) Pretend as though the bottle is a breast that has letdowns. After latching baby, let him suck a bit without much (or any) milk in the nipple. Don’t’ worry about baby sucking air – they swallow air all the time and it will just come back up as a burp. After he’s sucked for a little time, gently lift the bottle to fill the nipple with milk (this is the letdown). Let him suck for a minute or two then drain the milk out of the nipple again. Repeat as necessary.
  5. Use less supplement. If baby needs 1 ounce of supplement per feeding, only give about three quarters then put baby on the breast. Once he gets fussy, switch sides. The goal is for him to end, satisfied and happy with the breast and to associate those good feelings of being full and content with the breast. If after nursing on both sides, he is still fussy, you can finish with the bottle.

How To Supplement Breastfeeding With Formula: Step 5

Let Your Body Know You Are Supplementing

While you know your baby is being fed 9 ounces of supplement every day, your breasts have no clue. From your breasts perspective, baby consumed the 15 ounces of milk it produced and didn’t demand any more so all is right with the world.

Your body doesn’t know you are supplementing, so your breasts will continue to underproduce indefinitely because they don’t know they are underproducing! Your job is to let your breasts know they are underproducing.

You have to create an artificial demand for your milk to make up for the demand your body isn’t getting from baby. Here’s how.

You’ll need a decent pump. The best option is to rent a hospital-grade pump from a hospital or WIC office. A one month rental is typically $50 to $100. If you know you’ll be returning to work or school and will want to pump, you might consider investing now in a high quality consumer pump that you’d probably buy soon anyway. Expect to invest $200 to $400 for a good consumer pump.

If either of those options don’t work, get a quality manual pump over a “cheap” electric pump. You can build up your arms like pop-eye or get the foot pump accessory and build up your leg muscles! Plus it’ll remove milk effectively. These run about $50.

If you don’t to pump, you can still use hand expression to remove milk. See our article on how to hand express.

Once you have your pump or have decided to hand express, it’s very important to pump or express after each nursing session! The purpose here isn’t to extract milk – so don’t be discouraged if you get very little milk or none at all – the purpose is to let your body know that baby is demanding more milk than is being produced.

• Very Important: After each breastfeeding session (day or night), pump or hand express for 10 minutes on each side or for as long as milk is flowing, whichever is longer.

Next add one or more pumping sessions. Your body will see this as baby adding extra nursing sessions, just like what happens during a growth spurt, and your body will attempt to meet the increased demand with increased supply. In addition you can use the milk you pump as your first source of supplement.

Try to add a bonus pumping session in the middle of the longest gap between your baby’s typical nursing sessions during the day (this is usually nap time). Add another bonus pumping session a couple of hours after baby goes to sleep for the night (usually just before you go to bed). You can get up in the middle of the night for a bonus pumping session, but evidence suggest that getting more, high quality rest is equally beneficial. However if you can’t sleep one night try a bonus pumping session. Pumping releases oxytocin, a relaxing hormone, that may help you get back to sleep.

Here are the rules for Step 5:

  1. Pump or hand express after every breastfeeding session. If you want to leave Supplement Town this is not a rule you can bend or break. It is the most important point in this entire article, so I’ll say it again, pump or hand express after every breastfeeding session.
  2. Add 1 to 3 bonus pumping or hand expressing sessions each day

The more you let your body know that baby is demanding more milk, the easier it is to correct undersupply. If there are not any underlying issues, your supply will likely rise to meet the demand. Using an herbal supplement like Lactiful Supply Max can increase your milk supply even faster. Finally you’ll need to evaluate your baby each week and adjust the amount of supplement accordingly.

How To Supplement Breastfeeding With Formula: Step 6

Evaluate Weekly And Ween Off Supplements

Once you begin to supplement you’ll need to track your baby’s progress and for that you’ll need a baby scale. While you can plan to stop by your doctor’s office or WIC office each week, most moms find it more convenient to have a scale at home.

baby scaleThe best option is to rent a scale from your hospital, doctor’s office or WIC office. Alternatively, you can purchase a baby scale online for less than $100, but these won’t be as accurate as a rented one and you’ll have a baby scale to store or sell once you’re finished with it.

Once a week, about the same time of day, weigh your completely naked baby. No clothes, no diaper. If your baby has settled into a nursing schedule and has bowel movements so regular that you can set clocks by them, the ideal time to weigh baby is after a bowel movement and before nursing. Don’t worry if your baby doesn’t meet this ideal; weighing him at 3:00 PM every Monday works just fine.

What you are looking for week to week is baby gaining the amount of ounces he is supposed to be gaining for his age. Use this chart as a guide:

  • Thriving babies 0 to 4 months gain 6 ounces per week.
  • Thriving babies 4 to 6 months gain 4 ounces per week.
  • Thriving babies 7 to 9 months gain 3 ounces per week.
  • Thriving babies 10 to 12 months gain about 2 ounces per week.

If your baby gained more than the target ounces, you are over supplementing and can cut back on supplementing.

If your baby gained the target amount, you can cut back a little on supplementing. If your baby didn’t gain the target amount, you should supplement more.

Here’s how to adjust the amount of supplement:

Gained more than 4 oz over target Reduce supplement by 6 oz per day
Gained 3-4 oz over target Reduce supplement by 4 oz per day
Gained 1-2 oz over target Reduce supplement by 2 oz per day
Gained target ounces Reduce supplement by 1 oz per day
Gained 1-2 oz under target Increase supplement by 3 oz per day
Gained 3-4 oz under target Increase supplement by 5 oz per day
Gained 5-6 oz under target Increase supplement by 7 oz per day
Lost weight See below

If your baby lost weight, reweigh baby right away to rule out a false reading. If baby lost more than a couple of ounces it may indicate a serious problem and you should contact your health care professional right away. However if baby lost just an ounce or two, weigh baby again in 3 days. If baby is continuing to lose weight call your health care professional and increase supplement by an additional 10 ounces per day.

Each week, adjust the amount of supplement up or down, based on baby’s weekly weigh-ins.

Always keep in mind why you went to “Supplement Town”. It’s a place where baby can get the nutrition he needs to thrive and it buys you the time you need to figure out the cause of your low milk supply and take action to correct it.

Questions? Comments? Join the conversation in the comments below! heart-logo

Vegetarianism and Breastfeeding

A diet rich in soy and whey protein, found in ...

A vegetarian diet has many benefits, but also poses a challenge for breastfeeding. (Photo credit: Wikipedia)

If a steaming plate of fatty, barbecued baby back ribs makes you want to toss your cookies, you might be a vegetarian.  Did you know that vegetarians have a few extra breastfeeding challenges compared to meat-eating moms?

Vegetarians are at risk for a vitamin deficiency that can lead to low milk supply. Here’s how it works: vegetarian diets are typically low in vitamin B12. Babies who don’t get enough B12 are often sleepy and lethargic. They often don’t have enough energy to completely empty the breast and whenever milk is left in the breast it signals the body that it is over producing, therefore supply will decrease.

The fix is easy. The vegetarian mom needs to take vitamin B12, which will naturally pass through to the baby when he breastfeeds. Even if you’re still taking your prenatal vitamins (which you should be) you need to supplement with a much higher concentration of vitamin B12. Take 1000 mcg per day.

Another risk of vegetarian diets is insufficient calories for nursing. Your body needs 300-500 more calories per day to make an adequate milk supply. See the “Eat Well, Diet Later” article for more info.

Supplements provide a quick fix but shouldn’t be substituted for good nutrition. Check out “The Vegetarian Mother’s Cookbook” by Cathe Olson. Available on Amazon.com or possibly at your local library.

While the B12 takes effect follow the advice in the 11 ways to increase milk supply to move your milk production in the correct direction. heart-logo

Breasts Don’t Feel Full

If you’re breastfeeding and your breast don’t feel full you may wonder what it mean? Is it a sure sign that you have low milk supply?

Breasts that don’t feel full can be a symptom of low milk supply but don’t panic yet! This symptom by itself does not conclusively mean you have a problem with breast milk production.

Here’s why:

While it is true that a breast that is full of milk will feel full, firm or lumpy, the opposite; a soft breast or empty feeling breast, doesn’t mean that the breast is low on milk. Often, as your body learns exactly how much milk your baby needs, it produces that exact amount and your breasts won’t ever get that full feeling they sometimes do when you’re beginning breastfeeding. Your body has figured out how to balance supply and demand for your breast milk.

And that’s okay. In fact, that is exactly what you want. If your breasts get too full of milk hormones are released that tells your body that your baby does not need as much milk as is being produced. So your body thinks, “Okay it’s time to cut milk production!” If you’re worried about your milk production, this is probably the last thing you want to happen. So from that stand point having breasts that don’t feel full is not necessarily a bad thing.

I know it can be disconcerting to feel like your breasts are empty all the time. Try not to worry. Your breasts are never truly empty and they are always generating more milk, particularly when you sleep.

 What should you do next?

Breasts that don’t feel full is a symptom of low milk supply but it can also be a sign that everything is working the way it is supposed to. If you suspect you have low milk supply, you need to investigate more. Consider these articles:

heart-logo

Producing Enough Milk?

Measure Your Milk Production And Find Out!

You won’t truly know if you are producing enough milk until you find out exactly what your daily milk production is. Fortunately there are two tests that you can use to determine if you are producing enough milk.

The Two Tests

There are two reliable methods for determining how much milk you are producing. They are the feed weight test and the pumping test. Here’s a bit about each method.

Feed Weight Test

Duration: 24 hoursRequires: Extremely accurate baby scale

Pros: Records weight changes before and after breastfeeding, so it’s great for mom’s who don’t respond well to pumping.

Cons: Long duration

Pumping Test

Duration: 4.5 hoursRequires: Hospital-Grade pump with good fit

Pros: Fast

Cons: Not great for moms who don’t respond well to pumping. Baby can- not breastfeed during the test and will need to take a bottle when hungry.

Both methods are accurate so it’s really a matter of personal preference. If you respond well to pumping and feel you can relax through the test, I’d recommend the pumping test. Even if you’ve never pumped before, but are feeling positive, I’d recommend the pumping test.

If you’re sworn enemies with all pumps or are simply feeling anxious about how much milk you’ll pump I recommend the Feed Weight Test. Here are the details of each.

Determine If You Are Producing Enough Milk :  The Feed Weight Test

You’ll first need to rent or borrow an extremely accurate baby scale such as the Tanita BLB-12 Professional or the Medela BabyWeigh II. A less accurate scale won’t be able to distinguish the slight changes in your baby’s weight that we need to measure. To find one of these scales, contact your OB / Pediatrician, your hospital, your local WIC office, or possibly a private practice Lactation Consultant. Explain that you are doing a feed weight test and need an extremely accurate baby scale such as the models listed above.

Once you have your scale you are ready to find out if you are producing enough milk. Take any 24 hour period – it doesn’t matter when you start. You’ll record the weight of your baby immediately before and immediately after each breastfeeding session.

Set your scale to display the weight in grams (g).

BEFORE you nurse, weigh baby and write this number down. It’s fine to leave his clothes and diaper on – what we’re measuring is the change in weight from before breastfeeding to after breastfeeding.

WHILE you nurse, be sure to offer both breasts.

AFTER you nurse, immediately weigh baby again and write this number down. Be sure you haven’t added or removed any clothing and you haven’t changed his diaper. It’s fine if baby has a bowel movement while nursing, just weigh him dirty. Then change him.

Your first entry might look something like this:

Feeding #1 – 2:08 pm to 2:35 pm
Weight before: 4874 g
Weight after: 4912 g

Continue to record the before and after weights for the next 24 hours for EVERY feeding. Feel free to change diapers and outfits as normal when not nursing.

After 24 hours, grab a calculator – it’s time to see if you are producing enough milk!

For each feeding, subtract the before weight from the after weight. In the example above 4912 – 4874 = 38.

Next add all the change in weights together. For example let’s say baby breastfed nine times over the twenty-four hour period. 38 + 56 + 48 + 36 + 52 + 38 + 64 + 58 + 56 = 446

Next multiply the total number of grams by .035 to convert to ounces. Continuing with our example: 446 x .035 = 15.6 ounces.

Congratulations! You now know exactly how much milk you are producing each day! 15.6 ounces in this example.

Determine If You Are Producing Enough Milk :  The Pump Test

You’ll first need a hospital-grade dual breast pump. Like the baby scale for the feed weight test, these can often be rented from a hospital, OB / Pediatrician office, WIC office or sometimes from a private practice Lactation Consultant.

Be sure to be fitted to the pump by a professional. Generally softer, flexible flanges will provide a better fit (and more comfort) than rigid, plastic flanges.

Plan a 4 hour time block when your milk supply is typical – usually mornings and early afternoon are best. You will not be able to breastfeed your baby during the test, so plan to give baby a bottle with the milk you’ll be pumping during the test. Any milk baby does not drink can be frozen for later use.

At the beginning of each hour empty both breasts completely with the hospital- grade pump (typically 10 to 20 minutes). Record, in milliliters (ml), the amount of milk you pump at each of the four pumping sessions. If your test began at 11am, your entries might look something like this:

 

Pump Time Left Side Right Side
1st Hour – 11:00 am 12 ml 11 ml
2nd Hour – 12:00 pm 12 ml 13 ml
3rd Hour – 1:00 pm 6 ml 9 ml
4th Hour – 2:00 pm 10 ml 14 ml

After you’ve finished the fourth and final pumping session it’s time to do some math. Important: This test only uses the pumping numbers from the third hour and fourth hour pumping sessions. You can completely ignore the numbers from the first and second pumping sessions.

Add the four amounts from the third and fourth pumping sessions. In the above example this would be 6 + 9 + 10 + 14 = 39 ml. Remember, we’re not using any of the numbers from the first, and second pumping sessions.

Divide the total milliliters by 30 to convert to ounces. 39 / 30 = 1.3 ounces.

Divide this number by 2 to get the amount of milk your body is producing every hour. 1.3 / 2 = .65 ounces per hour.

Multiply your ounces per hour by 24 to determine how much milk you are producing each day. .65 ounces per hour x 24 hours = 15.6 ounces of milk produced per day.

Congratulations! You now know how much milk you are producing each day!

Are you producing enough milk? Now that you know how much you are producing each day you can compare it what a baby needs which is typically between 25 and 30 ounces per day. If you find that your milk supply is less than this, like it was for our example mom. Be sure to see the 11 ways to increase breast milk production.

How To Pasteurize Breast Milk

Glass bottles are used to pasteurize breast milkThis home method mimics the same process that milk banks use to pasteurize milk from donors. You’ll need glass bottles for pasteurizing the breast milk such as the 8 ounce Evenflo Classic Glass bottle 6 Pack. These are available online and at baby stores for $15 or less. Six bottles may be a good starting point, but don’t hesitate to get a second set to make your Be sure to get enough bottles so you’re not having to constantly wash and reuse the same bottles. Four to eight bottles is a good starting point.

Once you have the bottles wash them. Using the dishwasher is fine. Next, thaw the donated breast milk if it’s frozen, then pour 5 ounces into each bottle and screw on the cap. If you bought 8 glass bottles, you can pasteurize 40 ounces of breast milk at a time.

Next get a pot large enough to easily hold the bottles to be pasteurized while leaving a one inch space between each bottle and its neighbor. Fill the pot 4 to 5 inches with water – the water should be at the same level as the milk in the bottles or a little higher. Remember the water level will rise each time you put a bottle in the pot.

After you have test fitted the bottles and the water level, take all the bottles out of the pot and heat the water to boiling. Remove the pot from the heat, wait 1 minute and then put the bottles in the pot spacing them at least an inch from the nearest neighbor.

Wait 30 minutes and remove the bottles from the pot. Leave the caps on until you are ready to use the milk. Once the milk cools it can be consumed immediately, stored in the refrigerator for 12 hours or frozen.

Please Note: Don’t actively boil the bottles – that is not how to pasteurize breast milk! Be sure to remove the pot from the burner and let it sit for one minute before putting in the milk bottles – otherwise you could cook the milk! heart-logo

How To Hand Express

The breast pump is a modern invention less than one hundred years old. For thousands of years before its invention women used hand expression to remove extra milk or increase their supply. Here’s how they did it:

  1. Find a bottle or container. The wider the mouth the easier it will be to get your milk into it.
  2. Starting at your chest wall, as far back from the nipple as you can get, grasp your breast with four fingers on the top and thumb on the bottom (or vise versa if it’s more comfortable.
  3. Grip to apply pressure. It should be firm but not painful.
  4. Move your hand toward your nipple while maintaining pressure. Your hand should be traveling about one inch every 10 seconds. When milk begins to flow, pause your hand progress and continue to apply pressure.
  5. Once milk stops flowing continue to move your hand toward your nipple, pausing whenever milk flows.
  6. Once you reach your nipple, start over but rotate your grip an inch clockwise to reach new milk ducts.
  7. After you’ve gone all the way around your breast. Express the other side in the same way.

Plan on hand expressing for the same amount of time as you would normally pump (usually 10 to 20 minutes). Keep in mind, hand expression is a skill and just like all skills, practice makes perfect. If you feel awkward at the start, just keep with it, keep practicing and soon you’ll get the hang of it.

Another method of Hand Expression that is very successful for many mothers is the Marmet Technique. Print a handy guide here.

Finally, here is a video on how to hand express: