Expert: Sally Wendkos Olds - 6/15/2009

Question
I'm breastfeeding exclusively. My son just turned 2 months old. For the last two weeks he has been eating like he's in a constant growth spurt. He's pooping and peeing plenty so I'm not sure if my milk supply is really low since he's doing that just fine. He seems content between feedings but will often eat every 2 hours or less during the day and at night has 1 4 hour stretch and then eats every 2 hours again. He's about 15 lbs so he's a big guy. My concern is why he might be eating so frequently and why he won't sleep a longer stretch. I have not menstruated yet since birth and have heard that your supply can dip a bit with menstruation. is it possible for it to dip when you would typically have a menses even if you don't actually have one? Should I be concerned that my supply could be low for some reason? To give an outlook he'll eat every 1 1/2 hours until about 10 am or so (he wakes probably between 5:30-6am daily) He then starts going every 2 hours until about 3pm. He then eats probably every hour most days until about 7pm when he eats one last time and sleeps until about 11-11:30pm. He then eats and sleeps until about 2 and then eats and sleeps until 4 and then does one last 2 hour stretch before getting up at around 6am. This seems quite frequent for someone his size. I could understand if he was doing the hourly feedings to "tank up" for the night time but he's only sleeping that one long stretch and after that he eats most often every 2 hours until morning. Needless to say it's exhausting. I bottle fed my first two children so this is all new to me. Any advice or tips? Please help!


Answer
Dear Michelle,

First, congratulations for giving your son the best start in life by breastfeeding him!

It's a little hard to say what's going on with your baby. He may be going through a growth spurt.  This is a relatively common time for one. Many two-month-old babies want to nurse very often, every couple of hours, like your baby. Be reassured -- this shouldn't last for very long.

Your son seems to be thriving, so your situation does not seem to arouse concern -- except that I know you would love a good night's sleep! If this pattern keeps up, you may want to consult a lactation consultant, who could watch the baby nursing and see whether he is latching on well, and could also weigh the baby before and after a feeding to help determine your milk supply.

One idea might be to pump your milk for a feeding or two. For one thing you'll get a sense of how much you're producing, although remember that even the best breast pump cannot get as much milk as a vigorously nursing baby. For another, perhaps the baby's father (or someone else) could feed the baby at 4 am with a bottle of your pumped breast milk, which would let you get a little rest.

In case your milk supply has decreased a little bit, I'm attaching an excerpt from my book (see below) with suggestions for building it.

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).