Expert: Sally Wendkos Olds - 12/13/2007

Question
I have a 6 week old with very irregular nursing patterns.  He nurses every 3 to 5 hours day and night.  Sometimes for 2 minutes, sometimes for an  hour.  Sometimes one side, sometimes both.  I can not make him nurse any more often.  He is happy and alert in between feedings (when he's not napping of course), has several wet diapers and at least one stool (varies in size) a day.  He was 8lb 6oz at birth and at 4 1/2 weeks weighed in at 11 lbs.  I am not worried about him, but I am worried about my milk supply.  I pump in the morning, at night after he is asleep, and usually once during the day.  The amount I get is different from day to day.  Yet, my supply seems to eb and flow...sometimes full and abundant, and sometimes near empty.  Also, my left breast produces much less than the right.  I pump this one more often, and nurse my son on this side first.  Will this one just always produce less?  I also have been taking fenugreek and a nursing tincture.  Is there any other way to get my supply up, and keep it up and increasing with his needs?  When is it safe to stop pumping so often?

Answer
Dear Jenny,

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

It sounds as if he and you are doing really well. Milk supply does vary from day to day and during various times throughout the day. Also, even the best pump does not get as much milk as a vigorously nursing baby. And it's quite possible that your left breast may continue to produce less milk than the right. This is not unusual, and for a while one breast may be larger than the other. If this bothers you, you can pad your bra on the smaller side. After you wean your baby, you won't have this lopsidedness.

As far as having a plentiful milk supply, if your baby is nursing well, that should be enough, and pumping should not be necessary unless you need to skip any feedings because of work or other reasons. I suggest skipping one pumping session a day and see how your baby does. If he still gains well and seems satisfied, drop another pumping. I'm attaching an excerpt from my book (see below) that gives suggestions on judging whether your baby is getting adequate nutrition.

There's no evidence that fenugreek really does anything to enhance milk supply although some people swear by it. And I'm not sure what you mean by a nursing tincture -- this is new to me, so I can't advise you on it.

But I repeat -- it sounds as if you are doing really well, so don't worry!

Regards,

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 Laura M. Marks, M.D.
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Your baby is probably getting enough to eat if you can answer yes to all of the following questions. If you cannot, call your baby's doctor right away.

Your Baby's Urine and Stools
The evidence in your baby's diapers is the most important sign of his or her adequate milk intake.
  * Does your baby have the number, color, and size of stools described in the Table below, at the appropriate ages?
  Your baby should be having regular bowel movements in a quantity of at least 1 tablespoon (1/2 ounce) or more. After the first few days, they should be yellow and loose, with small curds. They may smell and look like yogurt, or like a mix of cottage cheese and mustard. If a baby over five days old is passing dark stools or fewer than those listed in the table, this is a sharp warning that she is probably not getting enough nourishment.
  
  JUDGING INTAKE BY OUTPUT
DAY OF BABY'S LIFE      STOOLS PER DAY      COLOR OF STOOL
  1 to 2         1 to 2         blackish, tarry
  3 to 4         3 to 4         brownish-blackish
  4 to 6         4 to 6         brownish-yellowish
  6 to 30         8 to 10         yellowish
           (normally 1 after
           each feeding)
  30 and later   may be infrequent       yellow
           (up to 10-14 days
            without a stool)
  
* By the third or fourth day, does your baby have six or more wet diapers per day, with colorless or very pale urine?
  Since today's disposable diapers are so absorbent that they don't feel wet, you can check for urination by putting a piece of toilet tissue inside the diaper and then feeling that. Or pinch the bottom of the diaper; if the padding does not spring back to its original shape, the diaper is wet. Also, if it's wet it will feel heavy. Or you could use cloth diapers for the first few weeks. (You could let it be known that diaper service would be a wonderful baby present.)

Your Baby's Appearance and Behavior
  * Does your baby seem satisfied and content for an average of 2 to 3 hours between feedings in the first month or two?
  * In the first month or two, does your baby nurse 8 to 12 times in every 24-hour period, for 10 to 20 minutes on each breast?
  * After 3 days of age, when you open your baby's mouth during a nursing session, can you see milk inside and is the inside of your baby's mouth pink and moist?
  * Is your baby's skin soft and supple?
  * Does your baby have bright eyes and an alert manner?
  * By the third month is your baby nursing 6 to 8 times in a 24-hour period and seem contented for up to 5 or 6 hours, at least once during the 24 hours?

Your Baby's Weight
  * At your baby's first doctor's visit, was her initial weight loss less than 7 percent of birth weight? (Breastfed babies should normally have an office visit within 24 to 48 hours after early hospital discharge, then at 7 to 10 days of age, again at 3 weeks, and again at 6 weeks.)
  * Did your baby regain birth weight by two weeks of age?
  * Is your baby gaining an average of from 4 to 6 ounces a week (about 1/2 ounce a day) in the first month?

Your Nursing Experience
  * Can you hear swallowing sounds when your baby is at the breast, in a ratio of 1 or 2 sucks per swallow for the first five or ten minutes of nursing?
  * Do your breasts feel fuller before a feeding and softer afterwards?
  * When you nurse from one breast, does milk drip from the nipple of your other breast?   Can you feel the tingling of a let-down reflex as you begin to nurse? The presence of either of these signs affirms that your milk is flowing, but their absence does not mean that it is not.

NOTE: Do not test for hunger by offering your baby a bottle after a nursing. Many infants have such a strong urge to suck that they'll often take milk from a bottle even when they are not hungry. (Doing this may sabotage the course of breastfeeding, since some babies enjoy the ease of getting milk from a bottle and are less motivated to work a little harder at the breast. Furthermore, offering a bottle too soon can cause temporary nipple confusion, which you may need professional help to reverse.)