Expert: Sally Wendkos Olds - 4/16/2011

Question
Hello,

My baby is three months old. She has had a rough start with a very serious birth defect and spent 11 out of 13 weeks of her life in the NICIU. Because of all her problems, she has oral aversion. She has an NG tube that we feed her with. I have been pumping since she was born to provide milk for her. She needs more calories than the average baby so my breast milk is either fortified to make it a higher caloric content or is mixed with 24 calorie formula.

She was just in the hospital for two weeks. That was a very stressful time for me and I wasn't pumping regularly. Prior to this, my left breast seemed to be constantly engorged and difficult to get milk out of but my right breast used to produce what I thought was a fair amount. Now, my left breast is practically flat and my right breast isn't producing anything compared to before. I had my left nipple pierced in college (a very poor idea, I know). Is this why my left breast became so engorged? I felt I had to constantly squeeze my breast and milk it to make anything come out.

How much milk should I be producing to feed a three month old baby? She is fed through an NG tube so I have no concept of the amount I could be producing. In addition, what can I do to bring my milk back? I am only getting a couple of ml's from my left breast and about an ounce out of my right. What can I do about my left breast constantly becoming engorged? I'm desperate to give my child what's best for her.

Thank you.

Answer
Dear Daniele,

First, congratulations on the birth of your baby, on your efforts to give her your good breast milk, and on all you are doing for your daughter.

Because of your baby's special needs, you can't go by the usual caloric requirements.  In addition since she is fed by NG tube, I can't tell you the amount of breast milk the baby should be able to take.  This might be the reason the doctors are fortifying her milk with 24 cal formula. Please don't feel guilty over your nipple piercing -- that probably does not have anything to do with your milk supply issues now. I talk about nipple piercing in my book (see below), and it's usually not a problem for women who later want to nurse.

Any milk that you are able to give your baby is wonderful -- please don't stress yourself trying to meet any certain amount. You and your baby have been going through a very stressful period, but it sounds as if she is getting good treatment. In my book I talk about all the issues you're having -- engorgement, clogged ducts, pierced nipples, and building milk supply. I can't give you all of that information here, but I will attach the section on increasing your milk production. I hope that some of the suggestions are helpful.

Meanwhile, it would be a good idea for you to see a lactation consultant, who can watch you nursing your baby and can offer help with all your issues.

Best of luck,

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and available in most public libraries, bookstores & La Leche League chapters.
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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 milk supply.
• Wake your baby, if necessary, to feed him more often -- about every two to three hours during the day and at four-hour intervals during the night.
* 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. Or at least put your feet up. 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. Although people often want to help, they may not know just what you need. It may help to post a running To-Do list on your refrigerator for all to see.
* 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, in the early weeks 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 drinking enough? 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 from a bottle, 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—usually at about four to 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 a couple of ounces of formula in the bottle first before nursing him. This practice, which reverses previous guidelines for supplementation in the order of breast-followed-by-supplement, has become more widely recommended in recent years. This reversal satisfies the baby’s immediate hunger and gives him the nourishment he needs, but ensures that he will get his final sense of fullness from breast milk, and associate this good feeling with his mother. Another way of supplementing is to use a nursing supplementer, a device that lets your baby suckle at your breast (thus stimulating your milk production) while at the same time receiving formula (see page 328 for a description).
  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).