These answers are from Kellymom... Although actual experience from one of our moms always helps.
Don't complain about life if you're not willing to get off your ass and do something to change it.
Group Admin Breastfeeding Moms Uncensored
Nursing your newborn
Is baby getting enough milk?
Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom's milk comes in, the average breastfed baby gains 6 oz/week (170 g/week). Take baby for a weight check at the end of the first week or beginning of the second week. Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.
Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two...). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often--this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy.
Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two...). Once mom's milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.
Breast changes
Your milk should start to "come in" (increase in quantity and change from colostrum to mature milk) between days 2 and 5. To minimize engorgement: nurse often, don’t skip feedings (even at night), ensure good latch/positioning, and let baby finish the first breast before offering the other side. To decrease discomfort from engorgement, use cold and/or cabbage leaf compresses between feedings. If baby is having trouble latching due to engorgement, use reverse pressure softening or express milk until the nipple is soft, then try latching again.
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Call your doctor, midwife and/or lactation consultant if:
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Weeks two through six
The following things are normal:
- Frequent and/or long feedings.
- Varying nursing pattern from day to day.
- Cluster nursing (very frequent to constant nursing) for several hours—usually evenings—each day. This may coincide with the normal "fussy time" that most babies have in the early months.
- Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 - 10 days, 2 - 3 weeks and 4 - 6 weeks.
Is baby getting enough milk?
Weight gain: The average breastfed newborn gains 6 ounces/week (170 grams/week). Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.
Dirty diapers: Expect 3-4+ stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often--this is normal, too. The normal stool of a breastfed baby is yellow and loose (soft to runny) and may be seedy or curdy. After 4 - 6 weeks, some babies stool less frequently, with stools as infrequent as one every 7-10 days. As long as baby is gaining well, this is normal.
Wet diapers: Expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. After 6 weeks, wet diapers may drop to 4-5/day but amount of urine will increase to 4-6+ tablespoons (60-90+ mL) as baby's bladder capacity grows.
Milk supply?
Some moms worry about milk supply. As long as baby is gaining well on mom's milk alone, then milk supply is good. Between weight checks, a sufficient number of wet and dirty diapers will indicate that baby is getting enough milk.
When do babies have growth spurts?
Common times for growth spurts are during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). Babies don't read calendars, however, so your baby may do things differently.
Growth spurts don't stop after the first year - most moms notice growth spurts every few months during the toddler years and periodically thereafter on through the teenage years.
How long do growth spurts last?
Growth spurts usually last 2-3 days, but sometimes last a week or so.
What is the best way to handle a growth spurt?
Follow your child's lead. Baby will automatically get more milk by nursing more frequently, and your milk supply will increase due to the increased nursing. It is not necessary (or advised) to supplement your baby with formula or expressed milk during a growth spurt. Supplementing (and/or scheduling feeds) interferes with the natural supply and demand of milk production and will prevent your body from getting the message to make more milk during the growth spurt.
Some nursing moms feel more hungry or thirsty when baby is going through a growth spurt. Listen to your body -- you may need to eat or drink more during the time that baby is nursing more often.
Don't complain about life if you're not willing to get off your ass and do something to change it.
Group Admin Breastfeeding Moms Uncensored
Latch on, suck a moment, pull off... latch on, suck a moment, pull off. Nurse a minute, pull away to smile at mom. Nurse a minute, pull away to see who just walked in the room. Nurse a minute, pull away to listen to the TV. Nurse a moment, pull away because the dog wagged his tail.
Sound familiar?? Baby starts to nurse and just as soon as your milk starts to let-down, baby pulls off and wiggles around in your lap. Babies aged two to six months are notorious for pulling off the breast at any distraction (real or imaginary) and tend to forget to let go before they turn around (ouch!).
This is a passing developmental stage that can be quite a nuisance - it's usually at it's worst between four and five months. At around 2 months, your baby will become able to see things clearly across the room. At around 3 months, he'll start to stay awake longer and take a greater interest in the world around him. Your baby is also beginning to recognize that he is separate from mom. All of these things can result in a distractible baby. When baby first becomes aware of the rest of the world, he will have a hard time concentrating on nursing. In effect, he will be unable to "walk and chew gum at the same time." Once he gets a little older, he'll find it easier to both nurse and take in the world around him at the same time.
Distractibility is also common around 8-10 months, and can lead mom to think that her baby is trying to wean. If your baby is younger than a year, it's highly unlikely that this temporary disinterest is self-weaning. It's very rare for a baby younger than 12 months to self-wean.
Many moms find it more and more difficult to nurse a distractible baby, and sometimes even interpret it personally ("I don't want mom any more" or "I don't want to nurse any more"). At the very least, it's frustrating to deal with a distractible baby. Less frequent/shorter nursing during this distractible stage can lead to a low milk supply, so do your best to get in a few decent feedings during the day.
Until this stage has passed, baby may need a quiet place to nurse and/or more night nursing until he's figured out how to deal with distraction. Do take advantage of night nursing during this time - it doesn't matter when baby takes in his calories during a 24-hour period. One study showed that older babies can consume as much as 25% of their total daily intake of mother's milk during the night, probably partly because of daytime distractibility.
Nursing in a quiet, darkened, boring room often helps. Talk in quiet, soothing tones (if you talk at all). Nurse while lying down; nap nurse. Cover baby with a shawl or put him in a sling to nurse. Nursing while in motion (walking, rocking) can also help baby to focus better on nursing. Try to catch your baby when he's more willing, such as when he's just waking up, already a little sleepy, or actually asleep. Baby's initial pulling off is probably not an indication that he is finished - just an indication that he saw/heard something interesting across the room. When he pulls off, try to coax him back to the breast a few more times before giving up.
If baby pulls away without letting go, keep a finger ready to break the suction as soon as he starts to pull away. You can also nurse baby in the football (clutch) hold so you have better control of his head, or nurse him in the cradle hold in a sling. This type of behavior sometimes leads to biting; if your baby bites, see When Baby Bites.
If baby is not nursing as much because of distractibility, offer the breast often (even when he doesn't "ask" to nurse). Make up for lost time by nursing more often during the night. Older babies may nurse better if you try different and novel nursing positions in which they have more control - baby standing up, sitting on your lap facing you, etc
My breasts feel empty! Has my milk supply decreased?
t is normal for a mother's breasts to begin to feel less full, soft, even empty, after the first 6-12 weeks.
Many mothers have concerns about milk supply after the early weeks because they notice a drop in pumped amounts or they notice that their breasts feel "soft" or "empty". It is normal for your breasts to feel mostly soft after the first weeks, although if there has been a long stretch without nursing or pumping they might feel a little full and heavy.
The feeling of fullness (sometimes even engorgement) that nursing mothers notice during the early weeks of breastfeeding is really not the norm at all, but means that mom's breasts haven't yet adjusted to the amount of milk that baby needs. At some point, typically around 6-12 weeks (if a mom has oversupply it may take longer), your milk supply will begin to regulate and your breasts will begin to feel less full, soft, or even empty. You may stop leaking, you may stop feeling let-down (or feel it less), and if you pump you may notice that you're not getting as much milk. This doesn't mean that milk supply has dropped, but that your body has figured out how much milk is being removed from the breast and is no longer making too much. This change may come about gradually or seem rather sudden. Many people are not aware that these breast changes are normal because so many mothers stop breastfeeding early on and never see this change (or mistakenly interpret this change as a sign that milk supply has dried up and wean because of this change).
Why the change? Although milk synthesis has already switched over to autocrine control (driven by breast emptying) after mom's milk comes in, the extra hormonal influence of the early weeks and months frequently causes moms to have more milk than their baby needs. Early postpartum hormonal levels tend to "turn up the volume" on milk synthesis so that extra milk can be produced if it is needed (most moms can produce enough milk for twins or even triplets). Over the first few months, this high baseline prolactin level that is the norm in the early weeks gradually decreases to the lower baseline that is the norm for later lactation. After this point it may be easier for mom's body to adjust milk production down to baby's needs.
How does milk production change over the course of lactation?
For the first few days, up to and including the point at which mom's milk "comes in," milk production does not depend upon milk being removed from the breast. After those first few days, it is necessary for milk to be regularly removed from the breast (via baby or pump) to continue milk production. The breasts will begin to shut down milk production within several days if milk is not regularly and effectively removed.
During the early weeks, assuming nursing is going well, a mom will often have more milk than baby needs. Many moms also experience varying degrees of leaking and/or breast fullness/engorgement in the early weeks -- this is not the norm for the entire breastfeeding experience but simply a period of adjustment as mom's body determines and adjusts to the amount of milk her baby (or babies) actually needs.
In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months (though it likely increases short term during growth spurts). Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months. Sometime between six months and a year (as solids are introduced and slowly increased) baby's milk intake may begin to decrease, but breastmilk should provide the majority of baby's nutrition through the first year.
After the first 6 weeks to 3 months (or sometimes later - this varies for different mothers), the high baseline prolactin level that is the norm in the early weeks gradually decreases to the lower baseline that is the norm for later lactation. Around this time, mom's breasts may feel less full, leaking may decrease or stop, let-down may become less noticeable, and pumping output may decrease. These are all normal changes and, on their own, do not mean that milk supply has decreased.
Do breasts need time to refill?
Many people mistakenly think of a mother's milk supply as being like "flesh-covered bottles" that are completely emptied and then need time to refill before baby nurses again. This is simply not how we understand milk production to function.
First of all, milk is being produced at all times, so the breast is never empty. Research has shown that babies do not take all the milk available from the breast - the amount that baby drinks depends upon his appetite. The amount of milk removed from the breast varies from feed to feed, but averages around 75-80% of the available milk.
Trying to completely empty a breast is like trying to empty a river -- it's impossible, since more milk will keep flowing in while milk is being removed. Research also tells us that the emptier the breast, the faster the breast makes milk. So when baby removes a large percentage of milk from the breast, milk production will speed up in response.
Rather than thinking of nursing or pumping as "pouring milk out of a container" think of it as flipping on the "high speed production" switch! Yet another analogy: Imagine you are using a straw to drink from a glass of water. As you drink, a friend is very slowly pouring water into your glass. The emptier the glass, the faster your friend pours the water. Would you be able to drink all the water in your glass? Waiting a set amount of time to nurse your baby (under the mistaken belief that breasts need time to "refill") is actually counterproductive. Consistently delaying nursing will lead to decreased milk supply over time because milk production slows when milk accumulates in the breast.
Using large amounts of the following herbs and other natural remedies should be avoided while nursing because they have been known to decrease milk supply. The amounts of these herbs normally used in cooking are unlikely to be of concern; it's mainly the larger amounts that might be used therapeutically that could pose a problem. However, some moms have noticed a decrease in supply after eating things like dressing with lots of sage, sage tea (often recommended when moms are weaning), lots of strong peppermint candies or menthol cough drops, or other foods/teas with large amounts of the particular herb. These herbs are sometimes used by nursing mothers to treat oversupply, or when weaning.
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Other herbs should be avoided while nursing due to their potential for harming mom and/or baby. Check the index of herbs for more specific information. Here are a few herbs that are generally considered to be contraindicated for nursing mothers. This is by no means a complete list.
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Hidden Hindrances to a Healthy Milk Supply by Becky Flora, IBCLC
Too much milk: Sage and other Herbs (this website)
Birth control pills are also well known for decreasing milk supply, particularly the ones that contain estrogen.
Sudafed (a decongestant) can also decrease milk supply, particularly with regular use
Is your milk supply really low?
What if you're not quite sure about baby's current weight gain (perhaps baby hasn't had a weight check lately)? If baby is having an adequate number of wet and dirty diapers then the following things do NOT mean that you have a low milk supply:
- Your baby nurses frequently. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.
- Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.
- Your baby nurses more often and is fussy in the evening.
- Your baby doesn't nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.
- Your baby is fussy. Many babies have a fussy time of day - often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.
- Your baby guzzles down a bottle of formula or expressed milk after nursing. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).
- Your breasts don't leak milk, or only leak a little, or stop leaking. Leaking has nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby's needs.
- Your breasts suddenly seem softer. Again, this normally happens after your milk supply has adjusted to your baby's needs.
- You never feel a let-down sensation, or it doesn't seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.
- You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill (different than nursing), and can be very dependent on the type of pump. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time.
Potential causes of low milk supply
These things can cause or contribute to a low milk supply:
- Supplementing. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.
- Nipple confusion. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.
- Pacifiers. Pacifiers can cause nipple confusion. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.
- Nipple shields can lead to nipple confusion. They can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.
- Scheduled feedings interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.
- Sleepy baby. For the first few weeks, some babies are very sleepy and only demand to nurse infrequently and for short periods. Until baby wakes up and begins to demand regular nursing, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.
- Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight and last longer between feedings.
- Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you're trying to increase your milk supply, let baby finish the first side, then offer the second side.
- Health or anatomical problems with baby can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.
ncreasing your milk supply
Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production.
To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.
OK, now on to things that can help increase your milk supply:
- Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.
- Nurse frequently, and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.
- Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).
- Offer both sides at each feeding. Let baby finish the first side, then offer the second side.
- Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to increase intake of breastmilk by the baby. This can be particularly helpful for sleepy or distractible babies.
- Avoid pacifiers and bottles. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).
- Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.
- Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.
- Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
- Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.
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shes killing my nipple!!!!
- sparkyskitten
on Dec. 8, 2008 at 9:36 PM