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Tuesday, September 23, 2014
Although I wanted so much to breastfeed exclusively, three days after leaving the hospital, our baby had lost >10% of her body weight and so we were referred to a lactation consultant who showed us some breastfeeding techniques but also recommended we supplement with formula (which I felt okay about since our baby didn`t seem to be getting enough from me). I`m still trying to breastfeed, but need some advice and encouragement. Now, I try to breastfeed, I express (about half of her intake), and I supplement with formula. 1. Any chance we`ll ever move to breastfeeding exclusively? 2. Our baby seems to latch on well now, but falls asleep almost immediately and does a lot of nonnutritive sucking (which seems to tucker her out). How can I encourage/teach her to suck effectively? 3. How much breast milk do women typically express in one sitting? (I seem to be stuck at about one ounce, not matter how long I try.) 4. How much should she be getting each day (milk and formula combined)? She weighs just short of 8 lbs. Any help would be much appreciated. Thanks.
Congratulations on the birth of your daughter. It sounds like you and she have had a bit of a rocky start, but to answer # 1, yes, it sounds as if there is a very good chance you and she can eventually move to exclusive breastfeeding. Many mothers and babies have done so after similar beginnings. It may take some patience and persistence, but from your description, she already has made a lot of progress. When you feel discouraged, remind yourself that breastfeeding is going better, and you and she have come far with breastfeeding when compared with the first days after her birth. #2. Did the lactation consultant or your baby`s pediatrician have any idea why she falls asleep so quickly at breast? A baby is more likely to have difficulty breastfeeding effectively if she was born even a little early, was distressed during pregnancy or birth, was affected by medications given to mother during labor and delivery, has some other physical condition that is tiring-an infection, jaundice, etc., or has a "mechanical" problem such as tongue-tie. A mother and baby may have to "wait out" some of these issues, which can take a few days to a few weeks. (Incidentally, many of these babies have difficulty bottle-feeding initially. It`s often a feeding difficulty in general, not just a breastfeeding difficulty.) Some mechanical problems can be "fixed," and a mother and baby can work around others. #3. Women vary in the amount of milk they express in a sitting, so there is no "standard" answer for this. You don`t mention how you are expressing your milk or how often you are expressing milk, although you mention it doesn`t seem to matter how long you express milk. If you are not already using a self-cycling, hospital-grade electric breast pump, consider renting one for a few weeks. Unless you are confident your baby is suckling (removing milk from your breasts) effectively, you also will want to pump/express milk for AT LEAST 8, or for at least 100 minutes, in 24 hours. Many mothers find it helps to pump for about 10 minutes immediately after most breastfeedings. Others also pump between some breastfeedings. Try this routine for at least 3 days to give milk production a chance to pick up. As your baby becomes more adept at breastfeeding in the next days or weeks you can decrease pumping/expressing milk. #4. An 8 lb. baby probably will take about 16-20 oz. in 24 hours, which is about 2-2 « oz. per pound of body weight. Keep track of the number of wet and dirty diapers-she should wet at least 6 diapers and dirty at least 2-3. I would suggest keeping your milk separate from any formula rather than mixing the different substances together. You don`t want any of your valuable milk to be wasted if she can`t take all that is offered, and it`s good to keep the taste and odors separate, too. So offer your expressed milk first, and then complement with formula as necessary. Going back to #2, to encourage effective suckling, keep the baby close and encourage lots of skin contact. Take the baby`s shirt off and your shirt off, lay her on your chest and put a sheet or large top over both of you. Let her enjoy being near you without any "pressure to perform" at the breast, but offer the breast when she demonstrates feeding cues, such as licking, rooting, bringing her hands to her mouth, light fussing, etc. If she falls asleep while suckling, gently nudge her to suckle some more, but don`t continue if it isn`t helping or if either of you becomes frustrated. Stop and offer the supplement and then pump/express your milk. (When Dad or someone else is available, let someone else offer the supplement so you aren`t having to do everything.) The method used for supplementing can influence her transition to the breast and encourage, or discourage, breastfeeding behaviors. Since she is latching on and breastfeeding a little better than before, she might be ready to receive your expressed milk or infant formula via a feeding tube device that is taped to Mother`s breast during breastfeeding. When using this, a baby receives the supplement while breastfeeding. As a baby breastfeeds more effectively, she takes less through the tube device. A feeding tube device also can be used for finger-feeding-the tube is taped to Mother`s or Dad`s finger (finger pad side vs. nail side) and baby receives supplement while sucking on the parent`s finger. Syringe-feeding or cup-feeding, using a cup about the size of a medicine cup, also are options. If finger-feeding or using a bottle, encourage breastfeeding behaviors by having her latch onto the finger or bottle teat. Tap her lip and encourage her to open wide and get her tongue over her bottom gum before letting her latch on to either. If bottle-feeding, I`d suggest using a slow-flow nipple, or teat. (Usually this type has "slow flow" printed on the package, but test each by angling the bottle as if in her mouth and watching for about 3 seconds to pass between drips.) A slow-flow teat gives a baby enough time to take a breath between drips so she can keep her tongue over the bottom gum as for breastfeeding. If she`s getting used to food coming instantly, you might express/pump your milk to the point of "let-down" just before breastfeeding so she won`t have to wait as long. I would strongly recommend you remain in contact and review these suggestions with an International Board Certified Lactation Consultant (IBCLC) or an experienced La Leche League Leader (LLLL) so that either might help you fine-tune them to meet your particular situation. Also, it is helpful and may be safer to have someone show you the technique for using the alternative feeding devices mentioned. To locate an IBCLC in your area, contact the International Lactation Consultant Association through their web site below. La Leche League International also has a page at its web site for locating local LLLL. Continue to hang in there. Just as your baby`s breastfeeding ability has improved since birth, it will continue to improve over the next days to weeks. I know patience isn`t easy during these early postpartum weeks, but it will be worth it! If you have additional questions, feel free to contact me again at this site. All the best for you and your new daughter.
Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati