Expert: Sally Wendkos Olds - 4/14/2009

Question
Sally,

My daughter is 4 months and we have been very lucky that she has mostly slept through from around 11pm.  Recently she began waking in the night and I felt that she was genuinely hungry so began supplementing with formula for her last two feeds (she took around 3oz at each).  She began to sleep through again until this week.  I have expressed my milk in the afternoon and evening feeds and seem to be producing a maximum of 4oz (total from both breasts) at this time.  Am I producing enough?  Is it time to stop?  Should I use more formula at the 2pm aswell as the 6pm and 10pm feed.

Many thanks
Katie

PS Her weight is spot on for her age born 9lb9oz now 16lb14oz a week or so ago

Answer
Dear Katie,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

No, it is not time to stop nursing. It is time to nurse more frequently.

I'm not sure why you are expressing milk in the afternoon and evening -- if it is not because you have to be away from your baby (work, school, etc.), it would be much better for you to nurse her at those feedings. Even the best breast pump cannot extract as much milk as a vigorously nursing baby, so the amount your baby is getting at her feedings is most certainly more than you get when you express.

If you do have to be away during those afternoon and evening feedings, I would suggest that you nurse more frequently when you are home. This is the best way to increase your milk production. I am attaching an excerpt from the manuscript for the newest edition of my book (see below) for increasing milk supply. See Dr. Smillie's recommendations regarding supplementing with formula. I hope that some of these suggestions will help.

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.
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Ways to Build Up Your Milk Production
New mothers sometimes fear that they won’t have enough milk to feed their babies. They hear stories about other women who “didn’t have enough milk,” and they worry that they might be in this category. But when you look closely at the situations of these other women, the problem can almost always be ascribed to lack of information, lack of encouragement, or faulty nursing technique by either mother or baby. You need to tell yourself that millions of other women nurse their babies, and you can, too. Following one or more of the suggestions below should increase your milk supply within a few days.
• Nurse your baby more frequently for several days, using both breasts at each feeding. This is the single best way to enhance your flow of milk.
• Wake your baby, if necessary, to feed him more often.
* Pump or express milk between feedings. But don’t get discouraged if your pumping yields as little as half an ounce of breast milk. Your baby is almost certainly getting more than this. Even the best pump is less effective than a vigorously nursing baby. (More about pumping in Chapters 16 and 17.)
• See a lactation specialist if your baby is not suckling well or nurses only a few minutes at a time.
• Cut back on your schedule. Do less. Rest more. Nap at least once a day, more often if you can manage it. Ask someone else to help with marketing, cooking simple meals (or getting take-out food), and doing basic laundry. Most people like to help a new mother, so take advantage of this willingness now. You can always reciprocate later on.
* Even though everyone wants to see the new baby, ask visitors not to come for several days -- or even weeks -- unless they’re people who will wait on you, not expect you to entertain them. Let your answering machine take phone calls – which you can return later when you’re not so tired. Well-meaning family and friends can wear out the new mom.
• If you can, take an occasional day or two off from work or from other obligations (by, for example, having someone come in to care for your other children) so that you can focus only on nursing your baby.
• Check your diet. Are you eating enough? Are you eating the right foods? Are you drinking enough fluids? Some women find that eating or drinking more seems to produce more milk. Keeping a glass of water or juice near the spot where you nurse is a good idea. You don’t need to drink any more than you need to meet your thirst, but some nursing moms find that they are thirstier than usual.
• Make a special effort to relax, as suggested in the box on page tk. Of course, this is hard when you’re concerned that your baby isn’t getting enough milk—but the more you can relax, the more milk your baby is likely to receive.
• Develop a few affirmations that you can repeat to yourself, such as: “I am a bounteous supplier of milk for my baby”; “I am doing the best thing I can as a mother”; “My baby is growing fit and healthy from my milk”; “My milk is my baby’s perfect food.”
* Visualize your baby at a little older age, looking well fed and  happy.
* Galactogogues: Virtually every culture in the world has recommended certain foods or substances to nursing mothers, in the belief that they help to make milk. In China, nursing mothers have been urged to eat “a mixture of pork fat and red gram (a type of bean), cuttlefish soup, shrimps’ heads in wine, and a special sweet wine made from glutinous rice, given together with the larvae of the blow-fly.” In India, it’s garlic, tamarind, and cottonseed; in France, powdered fennel; and in Nepal, chicken soup, buffalo milk, butter, and rice. In the U.S. vitamin B complex, brewer’s yeast, and the herbs fenugreek (also called fenugeek) and blessed thistle are sometimes recommended, as is the controversial prescription drug domperidone, which has not been approved for any use by the U.S. Food and Drug Administration. (See Chapter 10 and the Websites Appendix for more about drugs and lactation.)
  Cheston M. Berlin, Jr., M.D., a professor of pediatrics and pharmacology who has an interest in drugs and lactation, has concluded that the effects of such potions may be largely psychological. The mother thinks that a certain substance will increase her milk supply, so she relaxes and has a good let-down reflex, thus “proving” its value.
As we have stated, though, the best way to build up your milk supply isn’t what you eat. It’s what—and how much—and how often—your baby eats. The cutting edge research of Dr. Peter E. Hartmann’s Australian team (discussed in Chapter 3) has  confirmed what many breastfeeding experts have known for years: that emptying the breast is the best stimulus to milk production. The more often you nurse your baby and the more vigorously she nurses, the more milk you’re likely to have.
• Believe in yourself and trust your body.

Note: Do not offer your baby formula while you’re building up your milk supply. A few ounces soon turn into a full bottle, which soon turns into several bottles, until you find that you’re producing even less milk. If your baby is drinking formula, he is not stimulating your breasts and thus not doing the most effective thing that will increase your supply of milk. In most cases, a breastfed baby should not be offered a bottle until nursing is well established—by at least six weeks of age.
  The only exception to this is if your baby’s doctor (not your friends or relatives!) feels that he absolutely needs a supplement. Your doctor may be worried if your baby is sick, dehydrated, so small that his health is endangered, or if he is not gaining enough weight. Any one of these conditions may leave him without enough energy to nurse vigorously and thereby stimulate your milk production. If you do supplement with formula, you might try offering the bottle first before nursing him. Christina Smillie, M.D., a pediatrician and board-certified lactation consultant, recommends this reversal of the usual order of breast-followed-by-supplement so that the baby’s immediate hunger will be satisfied and that he will receive necessary nourishment – but that he will get his final sense of satiety from breast milk, and associate this good feeling with his mother. See Chapter 6 for suggestions for bottle-feeding the breastfed baby.
  Once breastfeeding is well established, you may want to give your baby an occasional bottle of breast milk or formula. Ideally, you should wait until your baby is six months old to feed anything besides your good breast milk  (see Chapters 11, 12, and 17).