Expert: Sally Wendkos Olds - 5/29/2007

Question
My daughter is now 4 weeks old and I didn't begin breastfeeding her until she was 3 weeks.  I have rented a pump to try to help increase my supply quicker for her and have noticed an increase when i pump.  I am nursing her as much as possible and have now cut out formula.  How do i know if i'm supplying her with enough milk? Sometimes, I have to give her the milk I have pumped inbetween feedings.  I'm going back to work in 4 weeks, will i have enough to pump and feed her when i go back and how do i make sure i do??

Answer
Dear Jenny,

Congratulations for giving your daughter the finest food in the world -- your breast milk.

You did the right thing by renting a breast pump. It should help you increase your supply of milk. However, the best way to build up milk supply is the frequent, vigorous suckling of a hungry baby. I suggest that you nurse your baby as often as you can for the next four weeks, even waking her if she sleeps longer than three hours.

What you are doing is known as relactation. I am attaching a brief excerpt from my book (see below) about this process. I am also attaching an excerpt with suggestions for building your milk supply. I wrote an entire chapter in the book specifically for working moms, and another whole chapter all about pumping, storing and feeding breast milk, so I can't include all of that. I would suggest reading either my book or another good book about breastfeeding to get more suggestions about the best way to make this the best experience for you and your baby.

Good luck!

Sally

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.
------------------
  RELACTATION AND NURSING AN ADOPTED BABY
Sometimes a woman decides, or is advised, not to breastfeed her newborn infant; or she begins to nurse and then stops for one reason or another. Then, as soon as one week or as late as several months later, she wants to nurse -- either because her baby has grown stronger and is now able to nurse, because he has a digestive or allergic problem that makes it difficult for him to take formula, or for some other reason. In such a case, it is often possible to initiate breastfeeding. This process is known as relactation.
  In other cases, women who have adopted babies have been able to lactate, even if they have never been pregnant or have not been pregnant for years. This process is called induced lactation.
  Neither of these endeavors is easy; both call for a great deal of time, effort, and dedication. Both also require very close observation of the baby to be sure he is gaining weight properly. Many women who have made the effort, however, have been happy with their decision, especially if they look at it not for its value as a feeding method, but for how it can enhance the mother-baby relationship. This is the most important aspect of this kind of nursing. If you hold up quantifiable measures like the amount of milk you produce, the ability to provide all of your baby's milk, or the length of time you nurse your baby, you may be disappointed and frustrated. Based on several studies of women who have done this, the guidelines given in Box 16-2 should help you and your baby to achieve a happy nursing relationship.
  
BOX 16-2 SUCCEEDING AT INDUCED LACTATION OR RELACTATION
  * Ask yourself why you want to do this. If you'll be happy with the experience of nurturing your baby at your breast, and not necessarily nourishing him from your breast, you're likely to have a more positive experience than if you have your heart set on providing a set amount of milk. It's very rare for all of a baby's nutritional needs to be met with induced lactation and may even be difficult with relactation.
  * Be prepared for a stressful first few weeks, during which time your baby may resist suckling at the breast, your milk may be slow in coming in, and you'll be nursing almost constantly around the clock and supplementing your baby's diet with formula.
  * Find a support system, consisting of people who will encourage and help you through the difficult days. These people can include your husband, doctor, lactation consultant, La Leche League leader, and, most important, another woman who has done what you want to do, either relactated or nursed an adopted baby.
  * You'll find it easiest to relactate if your baby is under three months old.
  * Expect initial resistance from your baby, who is used to getting milk some other way. It may take ten days or longer for him to nurse well, but after that he is very likely to become an avid nurser. Don't give up too soon.
  * Nipple stimulation is the most important mechanism for bringing in your milk. The best kind of stimulation is your baby's suckling. Other techniques include breast massage, nipple rolling, and hand expression or breast pumps. (Expressed milk can be fed through a nursing supplementer.)
  * Nurse your baby frequently, whenever she shows any signs of hunger, such as increased alertness or activity, smacking her lips, making sucking motions, or moving her head around in search of the breast. Do not wait until your baby begins to cry, which is a late sign of hunger. In one study, most of the relactating babies nursed eight times a day, at intervals of two to three hours, with two night feedings. (This is an average; some babies need to nurse more often than this at the beginning.) The average duration of each feeding was about 20 to 25 minutes.
  * The most popular form of supplementing the baby's diet is the use of a nursing supplementer (available from Medela -- see Chapter 15 and the Resource Appendix). This ensures your baby of adequate nutrition while providing stimulation to your nipples. Many women who considered their experience highly successful continued to use a supplementer throughout the course of breastfeeding.
  * It is extremely important to have your doctor follow your baby carefully for adequate weight gain. The suggestions given in Box 6-4 in Chapter 6 will help you and the doctor assess whether your baby is being well enough nourished for healthy development.

TECHNIQUES THAT ARE HELPFUL INCLUDE:
* Increasing your fluid intake and the amount of protein in your diet;
* Resting as much as possible, and lying down to nurse when you can;
* Asking your doctor to prescribe some other drug, like chlorpromazine or theophylline for the first week or so;
* Stroking your baby while she's nursing to help you relax and let down your milk.
* Providing as much skin contact as possible between you and your baby. (See the description of "kangaroo care" earlier in this chapter.)
* Also see the suggestions given in Chapter 15 for encouraging a baby who's gone "on strike" to nurse.

TECHNIQUES THAT ARE NOT HELPFUL INCLUDE:
* Keeping the baby hungry to try to encourage him to nurse;
* Using nipple shields;
* For adoptive mothers, trying to stimulate the breasts with the nursing infants of friends (the babies usually refuse to suckle at a breast that's not producing milk).

For some of the situations in this chapter -- the ones that require separation from your baby -- you will want to collect your milk to give to her. The next chapter describes the different ways you can do this and offers suggestions for making it easier to give your baby the benefits of breast milk even during those times when she cannot nurse directly.
---------------------------
BOX 10-2:  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 following suggestions 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 sometimes to deliver your milk more often, or pump or express milk between feedings.
  *  Pump from one breast while your baby is nursing from the other.
  *  See a lactation specialist if your baby is not suckling well or nurses only a few minutes at a time. This may indicate serious problems.
  *  Cut back on your schedule. Do less. Rest more. Nap at least once a day, more often if you can manage it. Maybe you can close your eyes while riding the bus to work or lie down while your older children play quietly nearby. 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. Ask visitors not to come for a few days unless they're people who will wait on you, not expect you to entertain them.
  *  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.
  *  Take extra Vitamin B complex. Some nursing mothers have found that one to three teaspoons a day of brewer's yeast helps.
  *  Make a special effort to relax, as suggested in Box 10-3. 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.
  *  Believe in yourself and trust your body. The most effective milk producer of all is the stimulation of your breasts by a nursing baby.

NOTE:  Do not offer your baby formula. A few ounces soon turn into a 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.
  The only exception to this is if your baby is sick or so small that his health is endangered, and if your baby's doctor (not your friends or relatives) feels that he absolutely needs a supplement. If so, offer it through a nursing supplementer (see Chapter 15 and the Resource Appendix), a dropper, or a spoon.