Expert: Sally Wendkos Olds - 8/28/2008

Question
Hi, I am a first time Mom and I am aiming to breast feed my daughter min 6 months. Easier said than done. She is now 4 1/2 weeks old. She use to feed most of the time every 2 hours and less and i try to feed her on one breast for 30min or until she came off, which is usually more than 15 min. But just yesterday, she feeds almost every 1 1/2 and sometimes an hour and she came off sooner, like 10-15 minutes. But when offered the breast again she doesn't seem interested. She sleeps for a while then she gets restless and I have to feed her again, which throws off the whole feeding schedule. I thought as they grow into the 2nd month, the feeding gets more regular and spaced out, not the other way around. I'm so worried about this. I'm also worried as i am trying to get a schedule so I can prepare when I start work in the third month. If she drinks a little and often, then its very hard fo gauge how much to pump for every feed. As leftover milk from a feed has to be discarded, it will be wasteful.

My another problem is, pumping breast milk. I tried to do after feeding on each breast, but nothing or very little comes out! The only time I get a lot, as in 1-2oz is when I pump whilst breast feeding and that is very tricky to do! I'm now worried about my supply and whether i can pump enough for a day's worth when I start working. I envy those mums that just says to me, just pump after feed or in between. It's alright if supply is plenty! But it is very discouraging when pumping results in small quantity.

I am very worried that a situation would arise where I leave for work and she doesnt have enough to drink at home. And I also worry that i dont have enough stash since I am nursing as well as trying to pump but little comes out.

Also, another question is suppose i have to get a bottle out of the freezer and I don't have the time to thaw in the fridge as it could be I need the supply for emergency or something. How do I thaw it quickly?

Your feedback is greatly appreciated.

Diana

Answer
Dear Diana,

First, congratulations for giving your daughter the best start in life by breastfeeding her! A lot of women have questions and problems like yours, and trust me, they can be worked out.

I will give you a few suggestions, including an excerpt from my book (see below), but I would also urge you to call in a lactation consultant (LC) who can watch your baby nursing and may pick up some clues to her behavior. Your hospital or pediatrician may have someone on staff whom you can see, or you can go to www.ilca.org to find someone in your community. It is an excellent investment for your breastfeeding success, and will pay for itself many times over.

Meanwhile, on your questions. First, it isn't unusual for babies of this age to have a very irregular feeding pattern. Since you have been having good success pumping from one breast while nursing from the other, I suggest you continue this -- and get someone to help you with the mechanics. Maybe you need to buy or rent a higher-level pump that would be easier to manage. For suggestions on the best kind to get, ask an LC or a local La Leche League leader. You can usually find an LLL chapter listed in your local telephone book. Or you can go to www.lalecheleague.org.

You don't have to discard leftover milk from a feeding. Freeze or refrigerate it in small quantities -- for example, you can freeze your milk in an ice cube tray and just thaw a little bit at a time. A fast way to thaw it is to put it in a bottle and run the bottle under lukewarm water, gradually raising the temperature of the water to hot. It should take about 4 minutes. Do not heat milk in a microwave! See the excerpt below for more about this. There is an entire chapter in my book about expressing, storing, and feeding pumped milk, so I can't put it all here, but you can pick up a copy of this or another book about breastfeeding at your local library. You can also go online to websites like www.pumpingmoms.org. But the fastest route to good help is to get a lactation consultant in person. The sooner you resolve these issues, the smoother your nursing will go for you and your baby.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.
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Offering Expressed Milk to Your Baby
Both you and anyone else who feeds your baby your collected breast milk need to know the following information, so you may want to photocopy these pages to have them handy.
  Don’t be alarmed by the appearance of stored breast milk. It often separates or turns yellow, either of which may be perfectly normal. If you’re not sure about the quality of the milk, taste it. If it tastes sweet and good, it’s fine. If there is any hint of an “off” flavor, you should throw it out. It’s possible that the milk has just picked up some odor or taste from other strong foods in your refrigerator or freezer. However, you don’t want to take any chances of giving your baby spoiled milk. So trust your senses and your own good sense: If you feel worried or uneasy, don’t give the milk to your baby.

Storage Times for Collected Milk
Basically, your collected breast milk will keep for several hours at room temperature if it’s covered; it will keep in the refrigerator for about two days; and if you want to keep it longer than that, you should freeze it.
  The following guidelines should assure safety and maximum benefit to your healthy, full-term baby. If you are expressing and storing milk for a preterm infant or a baby hospitalized for some other reason, you need to follow the recommendations of the institution where your baby is being cared for. Otherwise, you risk failing to have your milk given to your baby.
• To be given to baby within 30 minutes: No special storage needed. Can be kept at room temperature.
• To be given to baby within 6 to 10 hours: Pour into a clean container; cap tightly. If it’s convenient, refrigerate the milk. This is the safest course, even though human milk kept in a capped clean container does not grow bacteria at normal room temperature (66° to 72°F) because of its ability to slow the growth of bacteria. If the room temperature is higher than 72°, be sure to refrigerate it.
• To be given to baby within 48 hours (2 days): Pour into a clean container; cap tightly. Refrigerate at 40°F (4°C) or below.
• To be given to baby within 1 to 2 weeks: Pour into a clean container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze in refrigerator-freezer unit.
• To be given to baby after 2 weeks: Pour into a sterile container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze in refrigerator-freezer unit.
• To be given to baby within 3 to 6 months: Pour into a sterile container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze at 0°F
(-18°C) or below in the freezer of a two-door refrigerator or a deep freeze that is not opened often. Not all freezers stay cold enough for long-term storage. Check the temperature with a freezer thermometer at different places in the unit. The freezer should maintain a constant temperature of 0°F. If it keeps ice cream very solid, it is probably cold enough.
  If your freezer does not get this cold but does keep other frozen foods hard, keep the milk in the center of the freezer and use within three to four months. Frost-free refrigerators, which have a warming element, generally do not maintain 0°.
  To find out whether your milk thaws and then refreezes in your freezer, check by keeping an ice cube in a little jar; if you check it a day later and find that it has melted and refrozen, you’ll know that this has probably happened to your milk, too. If so, you’ll have to discard the milk.
  It’s best to use milk soon after collecting it. Ideally, you will not keep it longer than three months. For one thing, milk collected when your baby is two months old will not meet her needs as effectively when she is six months old.
• Keeping breast milk longer than 6 months: This is not a good idea. While instructions are sometimes given for keeping frozen milk up to two years, long-term freezing alters the chemical composition of the milk. (Some of the fats break down, and the milk loses some of its ability to fight harmful organisms.) Furthermore, you run the risk of contamination if you lose electrical power during that time and the milk thaws and refreezes.
• Do not refreeze milk that has defrosted: If frozen milk has started to thaw, refrigerate it immediately and use it within twelve hours.  

Defrosting Your Milk and Feeding Your Baby
• Avoid overnight thawing of milk.
• Do not leave frozen milk out at room temperature.
• About half an hour before feeding time take the container from the freezer and hold it under tepid running water. Gradually increase the temperature of the water to hot. Shake the bag or bottle gently as you warm it; this remixes the cream that has separated. (Since your milk is not homogenized, the fat rises to the top on standing. If you shake the milk too vigorously, you might turn this fat to butter.) It should take about four minutes to thaw four ounces of frozen milk. This method can also be used to heat refrigerated milk.
• Do not heat either breast milk or formula in a microwave oven. Vitamins and other components in the milk may be destroyed, glass bottles may crack or explode, and hot spots may occur, which could cause severe burns to your baby’s mouth or esophagus.
• Do not heat milk on the stove if you can avoid it. First, there’s a danger of overheating and destroying antibodies and nutrients. Second, there’s the chance that frozen milk will curdle. And then there’s the all-too-common scenario of the mother or baby-sitter warming milk in a pan of water on the stove, running to answer the phone or the door—and coming back to find the bottle or bag melted and the milk boiled into the bottom of the pan. No way to treat that liquid gold—or the baby waiting for it.
  However, if you do not have running warm water, put a bottle in a pan with warm water. Heat on medium heat, do not let the water boil, and do not leave the kitchen. Test the milk on the inside of your elbow; you should barely be able to feel it. If it feels warm, let it cool down to body temperature before feeding your baby.
• Roll or shake the bottle again gently before feeding.
• Use milk that has been defrosted but not heated within twelve hours. If the milk has been heated, use within thirty minutes.
• Discard any milk in the bottle that your baby does not finish at one feeding.
• Do not refreeze defrosted milk. If you can’t use it within the suggested time limit, throw it away. It’s painful to have to discard what seems like such a precious resource, but this milk is no longer the liquid gold it was before. There is a possibility that it might make your baby sick.
• If you have both fresh and frozen milk, give your baby the fresh milk and save the frozen for supplements and emergencies since freezing causes some loss of antibodies.
  The above measures sound complicated, but most women who express milk for their babies find that once they establish a routine, they are able to carry it off. If all the steps involved with expressing or pumping your milk do become too burdensome, it’s always possible, of course, to switch to formula. If you do make this switch, don’t be hard on yourself for the change. Instead, congratulate yourself for the efforts you have made and for your contributions to your baby’s health and well-being.