Tuesday, September 4, 2012

Increasing milk production and weaning from supplements

Before working to increase milk supply, make sure there is a true supply issue first! Take a look at these articles to first see if you have low milk production:

The golden rule of milk production: The more frequently and completely the breasts are drained, the more milk will be produced: How Mother’s Milk  is Made

Increasing milk production:

  • offer both breasts two times at every feeding
  • use breast compressions
  • nurse frequently (at least 12-14 times in 24 hours)
  • increase skin to skin contact
  • rest, and stay hydrated

What this process looks like:

Offer baby the first breast and allow him to nurse as long as he likes. When he starts to slow down on his sucking/swallowing start doing some breast compressionsWhen you squeeze your breast you should see baby respond with an increased sucking/swallowing. Baby has “finished” the first breast when breast compressions no longer get baby nursing more, baby falls asleep or lets go of the breast. When baby has finished the first breast offer the second breast. Repeat the above steps with breast two, (offer breast, use breast compressions and allow baby to finish the breast) then repeat the whole process again with both breasts. If baby is still hungry after taking both breasts two times, then you can continue the process, nursing on one side and then the other, until he is full and/or falls asleep.

Mom resting with baby after nursing with a starter SNS
When working to increase milk production, increase milk intake, or work to eliminate supplements, spending as much time as possible resting with baby skin-to-skin on your bare chest, encouraging frequent nursing, can make a big difference in a short amount of time. This can also be a chance for mom to rest, with baby napping on her bare chest. It can be a great time to have a movie marathon. If you have older children they can be movies to entertain them while you and baby rest and nurse.

Supplement in a way that supports breastfeeding:

Consider using an at breast supplementer instead of bottles for the supplemental milk. This will provide extra stimulation to your breasts and prevent a preference for bottles.

Lact-Aid at breast supplementer

If you are using bottles make sure you are giving them in a way that supports breastfeeding and minimizes flow preference. Bottle feeding in a way that supports breastfeeding includes:
  • Using a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind).
  • Starting by resting the tip of the nipple on the baby's upper lip and allowing him to take it into his mouth himself, as if he were nursing.
  • Keeping the bottle only slightly tilted, with the baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel overwhelmed by the flow (Kassing, 2002).
More information on bottle feeding in a way that supports breastfeeding: 

If you are currently supplementing with a bottle at every feeding, baby may expect that the time at the breast is always followed by a bottle. If you are using an at breast supplementer at every feeding, baby may expect the constant flow of milk from the tubing whenever he is at the breast. The first step towards eliminating supplements is to get baby comfortable with nursing without supplements at every feeding. Begin by encouraging comfort nursing between feedings, for at least a few days, before you begin to eliminate supplements. If baby is using a pacifier between feedings begin to replace the pacifier with your breast as much as possible.

The Finish at the Breast Method can be a great way to supplement with the bottle and encourage more breastfeeding. You may have heard to breastfeed first, then finish with the bottle if baby didn't get enough. Sometimes it works better to turn things around as described here. The "Finish at the Breast" Method of Bottle Supplementation

Nursing without supplementing

Weaning from supplements:

If baby is gaining weight on target and is showing signs of getting enough milk then you can safely begin to wean off of supplemental milk.

One way to do this is to start by eliminating the first supplemental feeding of the day. First determine what time in the morning you give the first supplement. Try eliminating that first supplement of the day. You may be able to eliminate it completely, or you may need to start by delaying it by about an hour or two.

Follow the steps above to nurse multiple times on each breast and use breast compressions. If baby is still having enough wet diapers (5 per day, plus at least 3 poops if baby is under 4-6 weeks old) then after a few days you can eliminate the next supplement of the day. Eventually you will get to where you are only giving one supplement in the evening and that will be the last one to drop.

Common Questions and Concerns:

I’m afraid to cut back on supplements, I ‘m worried my baby will starve!
Taking away one supplemental feeding will not cause your baby to starve or get dehydrated. You need for baby to be hungry enough to want to nurse more as that will increase your milk production. You can always go back to more supplemental milk if you realize you cut back too much too soon.

I tried eliminating the first time I usually supplement, but baby was screaming and refusing to nurse any more before it was time for the next supplement.
Go ahead and give the next supplement. You can simply delay the time of the first supplement instead of just eliminating it. If you were to delay that first supplement by one hour every day, by 24 days you would no longer be supplementing.

My baby seems hungry 10 minutes after taking both breasts. Does that mean it is time to give a supplement?
No. If baby is hungry again soon after nursing on both sides, offer both sides again. And again. Your breasts are never “empty”. As you continue to nurse, your body continues to produce milk.

How can I nurse so frequently? My breasts don’t have time to “fill up”.
Your breasts are never empty and don’t need time to “ill up”. The emptier the breast is, the faster it tries to refill - similar to an automatic icemaker. Emptier breasts make milk faster than fuller ones (How Mother’s Milk is Made).”

If I eat better and drink more water, will I make more milk?
“Research shows that the mother's diet, her fluid intake, and other factors have little influence on milk production. If the "milk removal" piece of the puzzle is in place, mothers make plenty of good milk regardless of dietary practices. If the "milk removal" part isn't there, nothing else can make up the difference (Smith, 2001).”
The more milk is removed the more milk you will produce. Pumping will remove more milk and help to increase your milk production. However, if you are nursing at least 12-14 times in 24 hours it will be hard to fit in pumping. Some thnigs to ask yourself include: Is it worth the additional stress? Would it be better to spend that time resting with your baby skin-to-skin? If you do pump, you can use it to replace any other milk you have been using to supplement.

Book: The Breastfeeding Mother's Guide to Making More Milk By West and Marasco

Bottles and At Breast Supplementers