Expert: Sally Wendkos Olds - 7/6/2007

Question
I have an 11 week old boy.  I was planning on exclusively breastfeeding him but he got jaundice and we had to supplement formula when he was born.  He also was very sleepy on the breast and didn't feed well.  And I didn't seem to have a large milk supply.

Now I nurse him one to two times a day and the other feedings use half pumped milk and half formula.  I have made sure he gets at least some breastmilk at each feeding.

I know it's late now, but I would love to exclusively nurse him or occasionally use pumped milk.
Now i nurse or pump every 4 to 5 hours because that is the only way I can pump about 1 1/2 to 2 ounces on each side or nurse him so he's satisfied.  He eats every 2 to 3 hours during the day and every 4 to 6 hours at night.  
He latches on well and enjoys nursing but when my breast starts to empty he gets aggravated and doesn't seem to want to work at getting the milk when it's not as easy.
I have tried Fenugreek to increase my milk supply and it doesn't seem to make much of a difference.

If you have any advice on how to nurse my son so he is satisfied and stop using formula I would really appreciate it!


Answer
Dear Kelly,

First, congratulations on giving your son the best start in life by breastfeeding him. Remember, you did the best you can -- and some breastfeeding is better than no breastfeeding!

At this time, it may or may not be possible to  breastfeed your son exclusively, through a process known as "relactation." You seem willing to try, so I am forwarding an excerpt from my book (see below). There are also complete books devoted to this topic, one of which is by Elizabeth Hormann. If you are interested, I will send you information on ordering it.

Meanwhile, here are some suggestions.

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. 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.
  These devices deliver milk to a baby while the baby is suckling at the mother's breast. The most commonly used method is the Supplemental Nursing System (SNS)"§ made by Medela, Inc. It should be used only under the supervision of an experienced lactation specialist, and your baby should be closely monitored for healthy weight gain.
  With the 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. 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. The bottles come in different sizes, to accommodate premature babies and those with cleft palate or other feeding problems.
  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.
  * 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).