Episode 131     

Now on to todays show. This is the second to last FAQ. We sure have come a long way from the first FAQ where I talked about what an IBCLC is and why I became one. Sometimes, despite everything that you have learned. Despite following everything that you know about early breastfeeding, well, sometimes you can get off to a rocky start. There are actually quite a few reasons why you can struggle with early breastfeeding. Here are some possible scenarios that you might find yourself dealing with a baby who is not breastfeeding well:

1. Probably the most common reason for a hard start is a premature birth. When babies are born early it can make it more difficult for them to breastfeed.
2. The reasons can be numerous so it is not helpful at this point to conjecture. What we really want to do is say.. okay, this is the situation, now what do we do about it.
Ohhh, I love this question because it is probably one of the most easiest questions I get to answer.

The situation is: You are a mom who just had a baby. Your baby needs your milk, but cannot get it directly from the breast.

Your first priority is to follow another one of my mantras, and that is:

1. Feed the baby and protect the milk supply. First choice is always your milk. If you do not yet have enough milk then it is Donor milk. More hospitals can access donor milk. If your baby is not having any health issues and is in the room with you and it is In the first 24 hours, you can try offering your milk from a spoon or a cup or a syringe. If your baby is still not interested in breastfeeding, using a bottle with a slow flow nipple is best. You will want to provide a paced feeding with your baby in an upright position. If your baby needs medical care in the NICU, and not able to breastfeed or bottlefeed, you will be given further information on how your baby will feed.

2. Anytime the baby misses a feeding and gets milk from another method, you are going to need to remove the milk from your breasts. Hand expression is the best way to do this in the early days. I have a handout specific for this on the show notes page. It walks you through exactly what you need to do. If you are in the hospital, the IBCLC or a Staff nurse should be able to help you with this also. If this is not an option, then you will want to use a hospital grade pump and pump for 15 minutes, both sides at the same time. For the purposes of this conversation regarding removing the milk, I will be using the word “pumping”, which to me means removing the milk whether by a breastpump, manual or electric or by hand expression.

It cannot be said enough times in several ways: It is very important for you to begin removing the milk for your baby. If your baby is still not breastfeeding by the second day, you will want to be pumping about 8 times a day. This is very important in establishing a good supply. Your baby should breastfeed within the first 6 hours of birth. If not, you will need to remove the milk and continue on a routine basis, until your baby is breastfeeding well.

Do not become discouraged from the first few pumping sessions. It will be normal for you to get a few drops. As you continue pumping, your body will respond from the stimulation and the volume will increase. Ten drops the first pumping is likely to be 20 drops a day later. By the third day, you will likely be pumping about half an ounce and the volume will continue to increase each day. See below regarding average intake of newborns. On the show notes page you will be able to access a handout on pumping for a baby who is not breastfeeding. It will include some pumping tips as well.

Here is some information to get you started on bottlefeeding. You will find that there are many opinions on how to go about supplementing a baby. I believe that if a baby who does not need medical care, can be with the mom, and yet still will not breastfeed or breastfeed well, and does need milk on a regular basis, that after the first 24 hours, paced, upright feeding with a bottle is best, at least until you can meet with an IBCLC, who will then evaluate your situation and may change the feeding plan. You will want to learn as soon as possible why your baby is struggling to feed. Sometimes it is an fix and other times there is more to it. What I want you to know is that it is normal for a baby to want to latch on and breastfeed. Anytime they are not and it has been longer 48 hours, a good evaluation is necessary to get you on a feeding and pumping plan that is best for you and your baby.

Bottles have gotten such a bad rap that some people stay away from them, even when it does not make good sense. The biggest concern I hear is that since a bottle is nothing like the breast and since the milk comes so fast, the baby will get use to the bottle and reject the breast.

While there is definitely some truth to that, I ask you to take a look at the syringe or the cup or the spoon that you are using. Does that look anything like the breast? The way your baby needs to open their mouth and use their tongue when drinking from a syringe or cup or spoon is that anything like what they need to do at the breast? The answer to both questions is No.
In the show notes, you will find links that demonstrate bottle feeding in an upright position and a paced feeding session. These two actions are helping to slow down the feeding.

3. Offer baby approximately the same amount as they would get at the breast. Day one: 5-7 ml per feed. Day two: 7-12 ml per feed. Day three: 12-20 ml per feed.

4. These are just guidelines. If your baby takes a bit less or a bit more, this is fine. You just want to be careful to provide a paced feeding and not overfeed.

5. An average full term baby gradually increases intake until they are taking about 30-45 ml by day five.

7. When offering milk from a bottle, hold baby sitting upright and pace the feeding. Ask RN to teach you. In between feedings do your best to spend as much time skin to skin with your baby.

8. Stay positive. As long as you have a well fed baby and are removing the milk on a regular basis and increasing your supply, you can always work on breastfeeding. Do not be concerned about putting your milk in a bottle and feeding it to you baby. This is just temporary until your baby is old enough to transfer milk from the breast.

9. Just because you are needing to supplement, does not mean that you stop trying to breastfeed. If at all possible, each feeding time should be started by offering your baby the breast. However, if your baby either just cries or falls asleep or it has been 10 minutes since feeding session began, that is about the time you want to offer your baby milk until he is full. It does not help your baby learn how to breastfeed when you are spending long periods of time trying hard to coax your baby to feed. All while they re crying, arching their back, pushing away, or falling asleep at the breast. The goal is lots of skin to skin to keep your baby famiiar with the breast, to always try at the beginning of a feeding, however, if no signs of feeding in 10 minutes, please do not make your baby wait a long t ime before feeding. Starving your baby will rarely help them breastfeed. If your baby is hungry, but will not breastfeed, there is probably a reason yet to be uncovered and this is what your focus should be on. Finding out what the problem is and fixing it. Not spending days and days with a baby refusing the breast.

And yes, my parting words on this subject, are like a broken record.
Feed the baby.
Protect your supply.
Seek help from an IBCLC if it has been longer than 24 hours with no breastfeeding.

Of course you are going to keep working on breastfeeding until you can get in to see someone. And what if your baby does start breastfeeding? Hooray for you and Hooray for your baby. If you are new to breastfeeding, it is probably best to keep your appointment. New parents always have many questions. You will benefit greatly from having a sit down with an IBCLC to review position and latch, ensure that it is optimal, discuss normal newborn breastfeeding behavior and so many more topics that are new to you.

Be sure to check out the show notes page for additional handouts discussed in this show.

Upright paced feeding link.

If your baby is not breastfeeding well
https://www.allaboutbreastfeeding.biz/files/ifyourbaby.pdf

Video on hand expression – https://vimeo.com/65196007