Expert: Sally Wendkos Olds - 2/21/2009

Question
QUESTION: I start to pump every 3hrs everyday so me mother and husband can help
feed the baby. At night sometime they supplement a formula for one feeding.
The problem now that baby is used to being bottle feed with my milk she
won't take the breasts anymore she seems fussy at the breasts and cry at
the breast. I can only pump 2.5oz on the double pump in 20min which isn't
enough to feed her since she eats 3oz and up now per feeding. Does not
nursing directly stop the milk supply?at this rate the amount I pump won't
meet her demand and she seems to hate the breasts now. What should I
do? I'm so tired from pumping ever 2-3hrs everday and not getting lots of
milk. Feel like I want to give up pumping now not to mention pumping hurts
too. Btw baby is four weeks old only.

ANSWER: Dear Christy,

One suggestion I make in my book (see below), which I forgot to include in my last answer to you is to feed your baby some way other than the bottle temporarily, like the Lact-Aid or Medela nursing supplementer. Your local La Leche League leader or lactation consultant should be able to tell you where to get one or how to put together a homemade version. Briefly, this is how these work:

These devices deliver milk to a baby while the baby is suckling at the mother’s breast. The two most commonly used methods are the Supplemental Nursing System (SNS)™ made by Medela, Inc., and the Lact-Aid Nursing Trainer™ System. Whichever one you choose should be used only under the supervision of an experienced lactation specialist, and your baby should be closely monitored for healthy weight gain. These devices are helpful to a baby who is latching on well; if there is a latch problem, you need to seek a different solution.
  With the Medela SNS a thin plastic tube runs from a plastic bottle hung upside down (to take advantage of gravity) from a strap around the mother’s neck. The end of the tube is placed next to the mother’s nipple and held there with surgical tape. Or you can place a small Band-Aid on your breast and run the tube under where the gauze is to avoid taping and re-taping the tube. As the baby nurses at his mother’s breast, he simultaneously suckles the tip of the nursing tube and the mother’s nipple, and his efforts are rewarded by the flow of milk via the tube. Bottles come in different sizes to accommodate premature babies and those with cleft palate or other feeding problems.
  The Lact-Aid consists of a soft, presterilized plastic bag that contains milk. The bag is attached to a plug that in turn is attached to a slender nursing tube. The filled and assembled supplementer is worn on an adjustable neck strap in the mother’s nursing bra between her breasts.
  In both these systems, the baby suckles the breast and the tube simultaneously, receiving milk as soon as he starts to nurse. Because of the way the system delivers fluid to the baby, it provides a type of oral patterning that helps to improve or train the baby’s suckling skill and coordination. Meanwhile, the device helps to increase the mother’s milk supply, since the baby is stimulating her breasts more effectively. Throughout, the baby is getting the nourishment he needs, and both mother and baby are able to enjoy the experience of nursing at the breast, with all the warmth and intimacy that are such a rewarding part of breastfeeding.

This way your breasts will continue to produce milk and your baby will be able to get it. Then you can gradually wean the baby away from the device and totally onto your breasts.

If you do want to continue to pump until your baby gets back on the breast to keep up your milk supply, you can feed the pumped milk to your baby in a cup, a teaspoon, or a medicine dropper.

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 pediatrician Laura M. Marks, M.D.





---------- FOLLOW-UP ----------

QUESTION: SO it is not suggested to feed the baby with bottle at this point? i am planing to wean the baby to formula in few more weeks.
Sorry if my question was clear, is pumping not helping to build up the supply? i was planning to pump and feed with bottle.

Answer
Hi Christy.

Yes, pumping can help maintain milk supply, but from what I understood of your question, you are not getting enough milk from pumping. However, if you plan to wean your baby soon to formula, you might as well continue feeding her with bottles. Get what you can from pumping and supplement with formula. Be sure to monitor her weight gain, and her diaper output. I'm attaching an excerpt from my book (see below) to see whether your baby is getting enough nourishment.

Best wishes, 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 pediatrician Laura M. Marks, M.D.

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Is My Baby Getting Enough Milk?
This is the big question to which every mother wants a resounding YES! answer. Fortunately, there are some solid criteria so you may be able to answer the question yourself. The following checklist is adapted from one that Dr. Marvin S. Eiger (coauthor of the earlier editions of this book) suggested that his patients follow.
  Your baby is probably getting enough to eat if you can answer yes to all of the following questions. If you cannot, call your baby’s doctor right away.

BOX
Judging Intake by Output
Day of Baby’s Life   Stools per Day*   Color of Stool      Size of Stool
1 to 2         1 to 2         blackish, tarry      from a smudge to
about 1 Tablespoon each   

3 to 4         3 to 4         brownish-blackish   about 1 Tblsp. each   
  
4 to 6         4 to 6         brownish-yellowish   about 1 Tblsp. each

6 to 30         8 to 10 (normally)    yellowish       1-2Tblsp. or more
         after each feeding)

30 and later      may be infrequent    yellow        variable          (up to 10 days
without a stool)

*If mother’s milk is a day or two late coming in, as is common with first-time moms, adjust the chart accordingly.

END BOX

Your Baby’s Urine and Stools
The evidence in your baby’s diapers is the most important sign of his or her adequate milk intake.

• Does your baby have the number, color, and size of stools described in the box above at the appropriate ages?
  Your baby should be having regular bowel movements in a quantity of at least one tablespoon (one-half ounce) or more. Some babies have a stain in the diaper after almost every feeding. After the first few days, they should be yellow and loose, with small curds. They may smell and look like yogurt, or like a mix of cottage cheese and mustard. They should be fairly messy to clean up. (Sorry about that!) But they don’t stain as much as the b.m.’s of formula-fed infants.
  If a baby over five days old is passing dark or hard stools or fewer than those listed in the table, this is a sharp warning that she is probably not getting enough nourishment. If your baby is two weeks old or younger and goes two days without having a bowel movement, call your doctor since this may signal a problem.
  However, if your baby is one month or older, is nursing well, and shows no change in appearance or behavior, there is no cause for alarm if he goes up to ten days without a bowel movement, even if he has been having them every day up till now. You can wait for four or five days without a stool before calling your doctor, and the likelihood is that the doctor will reassure you that healthy babies of this age often change their bowel habits abruptly and that there is nothing to worry about.
For a helpful chart illustrating how your breastfed  baby’s bowel movements may look and how you can keep track of them, go to http://www.lactnews.com/ddiary.html . You can download one copy of  “Diaper Diary”  or buy pads of 50.

• By the third or fourth day, does your baby have six or more very wet diapers per day, with colorless or very pale urine?
  Today’s disposable diapers are so absorbent that they rarely feel wet. To check for urination, pinch the bottom of the diaper; if the padding does not spring back to its original shape, the diaper is wet. Also, if it’s wet it will feel heavy. If you’re willing to sacrifice one diaper you can pour a couple of ounces of water on it and then heft it to see what a wet diaper feels like. Another technique is to put a tissue inside the diaper and see if that gets wet. Or you could use cloth diapers for the first few weeks. (They make good burping cloths – and, eventually, great dust cloths.)
  If you see a pink or reddish "brick dust" stain on your baby’s diaper after the first couple of days of breastfeeding, this may mean that he is not getting enough milk. This kind of stain is caused by the formation of uric acid crystals in concentrated urine. It’s common within the first couple of days because the baby is not taking in sizable amounts of colostrum, but if you see it after the fourth day you will want to call your doctor to see whether your baby is gaining enough weight.

Your Baby’s Appearance and Behavior
• Does your baby seem satisfied and content for an average of two to three hours between feedings in the first month or two?
• In the first month or two, does your baby nurse eight to twelve times in every twenty-four-hour period, for ten to twenty minutes on each breast?
• After three days of age, when you open your baby’s mouth during a nursing session, can you see milk inside and is the inside of your baby’s mouth pink and moist?
• Is your baby’s skin soft, supple, and resilient?
• Does your baby have bright eyes, good color, an alert manner, and a smooth head, with no dent that might indicate a sunken fontanel (the soft spot on a baby’s skull)?
• By the third month, is your baby nursing six to eight times in a twenty-four-hour period, and does the baby seem contented for up to five or six hours at least once during the twenty-four hours?

Your Baby’s Weight
• At your baby’s first doctor’s visit, was her initial weight loss less than  percent of birth weight? (Breastfed babies should normally have an office visit within twenty-four to forty-eight hours after early hospital discharge, then at seven to fourteen days of age, again at one  to two months.)
• Did your baby regain birth weight by two to three weeks of age?
• Is your baby gaining an average of from 4 to 6 ounces a week (about one-half ounce a day) or a pound a month? These are averages: different babies gain at different rates and the same baby’s growth is variable from week to week. Weight gain should be measured from the baby’s lowest weight since birth, not birth weight.

Your Nursing Experience
• Can you hear swallowing sounds when your baby is at the breast, in a ratio of one or two sucks per swallow for the first five or ten minutes of nursing?
• Do your breasts feel fuller before a feeding and softer afterward?
• When you nurse from one breast, does milk drip from the nipple of your other breast? Can you feel the tingling of a let-down reflex as you begin to nurse? The presence of either of these signs affirms that your milk is flowing, but their absence does not mean that it is not.