Today’s Podcast

Episode 128 FAQ 9  Milk is in Now  Day 4 – 14

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From Day 5 to Day 14, it would be fairly normal for your baby to be interested in both sides per feeding. You always want to let your baby finish feeding from one side and when done, always offer the second side. If your baby falls asleep after the first side, I would suggest a diaper change, either real or fake, to see if you can rouse your baby and then offer the second side. If after 15 minutes of trying, with a very sleepy baby, then I would say just leave your baby be, until he or she shows hunger cues again.

It would be fairly common for your baby to have feedings that are inconsistent as far as frequency goes and as far as time spent breastfeeding each feeding. Some babies literally do follow what some books say: Feeds for 15 minutes on each side, every 3 hours and sleeps the whole time in between. If this is what your baby is doing and he is full and has normal output, then this is his normal. If your baby breastfeeds every 2 hours for 3 feedings in a row and then sleeps for 4 hours before waking up to feed again, is full from feedings and has normal output, this is his normal.

The reason we don’t get too hung up on specific times and frequencies is because mothers are individuals, with different milk supplies and you all have different babies with different degrees of effectiveness at breastfeeding.

Some mothers have an abundant supply, enough to feed several other babies. If this is the case, you will usually hear your babies gulping at the breast and they literally can be done after 15 minutes on one side only and happily sleep for 3 hours. While this does happen, it is not the norm, particularly in the first 2 weeks of life. It would be more common for your baby to be interested in both sides per feeding and more likely that they are breastfeeding for 20-30 minutes on each side per feeding.

Remember all that we talked about with regards to nutritive sucking behavior.  You will want to be sure that your baby is actively drinking/transferring milk.  Keeping up a good sucking rhythm, that nothing is hurting with breastfeeding and you are sure your baby is getting enough food. Once you know this, you can begin to rely on your baby’s signs that they have had enough, rather then let the clock tell you they are done.  I often say to moms:  watch the baby, not the clock. Anyone who tells you specific feeding frequencies and specific time at the breast, is a person who is not well educated in normal breastfeeding.  Please do not listen to them.

I find that mothers tend to focus on the wrong things when assessing how breastfeeding is going. They focus on how often their baby is feeding, if they take both sides or not, how long a feeding lasts, how long in between feedings. Rather than focus on the time or which breast and for how long, I need for you to focus on: Is the latch good? Is it comfortable? Is your baby spending quality time at the breast sucking nutritively and transferring an average volume in an average time frame?

In other words, you can chart that your baby came to the breast 9 times in one day, you can document how long your baby stayed on each side and if you get in the right amount of feedings the books say and your baby spends the right amount of time the books say, you will feel breastfeeding is going well.

However, your baby spending 15 minutes at breast sleeping, is not the same as your baby spending 10 minutes of good quality sucking. Your baby spending 15 minutes at breast and you are crying in pain is not the same as 15 minutes at breast in total comfort. Your baby spending 15 minutes at the breast feeding and you having a much softer breast when they are done is not the same as your baby spending 15 minutes at the breast, with your breast being just as firm as when they began.

My hope is that you are beginning to learn what it is that you should be focused on when assessing how breastfeeding is going.

Ultimately, what we are looking for is this:

Is your baby having good nutritive sucking quality at the breast.

Can your baby get enough milk with each breastfeeding to keep him satiated for 2-3 hours. Is breastfeeding comfortable for you and does your baby seem to be comfortable at breast during the feeding? Is your baby having the normal amount of output and having about 8 feedings a day?

If the answer is yes to all this, breastfeeding is going well for you and this will probably be confirmed at your next pediatric visit when your baby is weighed.

There is a normal rhythm to his feeding and he should not be sleeping at the breast, you should not need to be nudging your baby to stay awake to feed. You should not need to use tickling or blowing on their face or wet wash cloths to keep them wake to feed. Sleepy babies at breast means poor feedings and this is a huge red flag for you to get expert help.

Lack of output is a huge red flag. By Day 5, you should be able to feel the weight of their pee diaper and the coloring should be clear to light yellow. If there is not much pee or it is a dark color or has a strong odor this is a sign of not getting enough and possible dehydration, so another red flag. By Day 5, your baby should have already gone through 4 days of frequent stooling with the colors and consistency changing from the early dark black and sticky meconium to a lighter brown and less sticky to a very definite 2-3 quarter size stools on Day 5 that are yellowish in color and cottage cheese or seedy in consistency. Lack of stools and dark stools are all a red flag.

Please do not let anyone convince you that this is okay. This is a warning sign that tells you to meet with an IBCLC to ensure that all is going well and to pick up any signs that that breastfeeding is not going well and rectify it ASAP.

Remember we talked about the fact that your baby should not lose more than 7 oz in the first 4-5 days? And 7 oz is on the higher end of weight loss. Well, now your baby should be gaining from the 5th day on. He should be gaining enough so that he is back to birthweight or within an ounce or 2 at 14 days.

One more, very common breastfeeding behavior that we often see develop in the first few weeks is cluster feeding. If you don’t know about or understand cluster feeding, this can really throw you off.

Cluster feeding: is when babies bunch feeds close together at certain times of the day. You may begin to worry that you don’t have enough milk because they literally give you hardly any break between one feed to the next. This cluster feeding session usually happens for 3-4 hours, usually happens in the evening and usually follows a longer sleep period. While there are many theories as to why cluster feeding happens, the truth is, we really don’t know why. Some will say that it is your babies way of boosting your supply, and yet I have seen some moms with enough milk to feed 3 other newborns have many cluster feeding sessions.  We just know that if your baby typically spaces out all other feedings, is happy most of the other times, has normal output, weight gain and is otherwise breastfeeding well, then cluster feeding is nothing to be concerned about. Once you are sure everything else with breastfeeding is going well and you have these consistent cluster feeding sessions once a day, It is more about how to respond to the cluster feeding times, rather than thinking something is wrong that you have to fix.

Whether the reasons for the cluster feedings – whether it is because the supply is lower during this time, or whether the flow is slower during these times, or whether it is just a time period that you baby wants to be held and cuddled or rocked and swayed, does not matter so much. What matters is that you understand that this is very normal newborn breastfeeding behavior and that you understand that it may last a few days, a week or a few months.

Now you know that it is normal, you are saying to yourself, how can I possible deal with this, particularly at the end of a very tiring day? Well, knowing that it is normal, that alone, usually takes a huge weight off mothers shoulders as they typically feel they are doing something wrong or they don’t have enough milk. Once you have determined that you have a good supply, your baby is gaining well, breastfeeding is comfortable and you recognize this for what it is – cluster feeding sessions…well Knowing this is normal, can help to reduce your stress a few notches.

Taking a break to talk to you about how I can best help you.  I am very excited to finally be in a position to expand my services and offer the best that I have to give to woman all over the world. For so many years I have used all my years of experience in counseling moms about pregnancy, birth, postpartum and breastfeeding and I have used this knowledge to work with and counsel woman locally.

Over the years, one of the  most common complaint that I hear from moms about their pregnancy, birth, breastfeeding and postpartum experience is that there were so many things they wish they would have been told.

Things like:  I did not know my options during pregnancy… dr or midwife, home, birthing center or hospital birth, what childbirth classes best fit your personality and philosophy toward health and life, what about birth doulas and pp doulas, common pregnancy problems that are not talked about, really preparing for the birth and I dont mean just what items to take with the birth to you or how to get through labor, but a shift in mindset way of preparing, where your partner fits into all this.  Lots of people need guidance and I provide this for you.  Many moms and dads find that they are in a state of shock when it comes to newborn parenting and the emotions of postpartum, how this affects their life as a couple, how interaction between family and friends needs to be adjusted… and one of the biggest subjects is all things having to do with breastfeeding.

I have now opened the doors to offering these services world wide.  Just go to allaboutbreastfeeding.biz and you will see all the lovely details.

This combined with something new and excited that I will be unveiling the first week of January 2017, and I am one happy and excited person.  Stay tuned for the excitement that I will share the end of December.  For right now, let’s get back to the show.

Now that you know you can anticipate this behavior, you need to come up with a game plan on how to deal with it, rather than thinking you need to fix it. It becomes pretty clear to you that for a few hours, you probably can’t count on being able to do much of anything, except feed your baby. What helps:

  1. Babywearing – with your baby in a wrap or sling, he may be happier for a little longer. With your baby in a wrap, you may be able to eat dinner as your hands will be free.

2.Speaking of dinner, if this always seems to happen around dinner time, try eating dinner a half hour earlier than you might have              done. This way you are not getting hungrier and hungrier as your baby wants to nurse more frequently.

  1. Speaking of food, plan for cluster feeding by having quick and easy snacks that you can grab. Have all the makings for a protein shake in one spot so you can put it together in 5 minutes or less.
  1. Of course having someone in your household help you during this time period can be a huge help. They can make something for you to eat, bring you drinks, snacks. They can hold our baby, take your baby out for a walk for a short period of time to free you up to eat your dinner or take a shower in between quick feedings. If you have other children, it will be incredibly helpful if you have someone else who can take care of the other kids during this time each day.
  1. If your baby is not incredibly fussy and does not need to be rocked and sang to and just wants to feed frequently, what better time to plan on Binge watching one of your favorite shows.

As long as you are sure these are normal cluster feeding sessions with a baby that is otherwise breastfeeding well, you definitely do not want to offer your baby milk in a bottle. Moms tend to do this because of their own internal pressure or pressure from outside sources – when the thinking is that you do not have enough milk, there is a strong tendency to want to give milk in a bottle. Offering your baby milk in a bottle, means that he will get full from a large volume in a short period of time. This means that he will not be interested in coming to the breast so frequently. Sure this gives you a break, but at the same time, it will likely cause your supply to drop. Less breast stimulation, less milk. This will also undermine your confidence as you watch your baby gulp down a lot of milk. You and others will say see… he was hungry. Yes, he was hungry…. and your frequent feedings will ultimately satisfy his hunger and signal your body to make more milk.

Your take home points for Day 5 – 15 are:

  1. Knowing how to tell the difference between really good sucking behavior and good milk transfer and babies who are just hanging out at the breast, are one of the MOST important things for you to learn about breastfeeding. Without good milk transfer, your baby will not gain the proper weight and you will struggle with your supply.
  1. Understanding that breastfeeding should not hurt or cause sore nipples, cracked or bleeding nipples and ongoing engorgement. Painful breastfeeding, usually leads to poor milk transfer, and lack of weight gain and you will likely struggle with your supply. Painful breastfeeding frequently leads to chronic clogged ducts and breast infections.
  1. Understanding normal weight loss and weight gain and the time frame for this. Understanding normal output and color and volume and consistency of output is important information for you to have.
  1. And last but not least, the wonderful subject of cluster feeding. I will be honest and just put it out there that cluster feeding can be very difficult for some. Knowing that it is normal and having a game plan on how to respond to this behavior can make all the difference. Do educate your family members about cluster feeding and elicit their help during these few hours each day. By educating them of the normalcy of cluster feeding will help well meaning family members to continue to support you with breastfeeding, rather than suggest you offer supplements because your baby is so hungry.

 

Lori J. Isenstadt, IBCLC

Lori j Isenstadt, IBCLCLori Jill Isenstadt, IBCLC is a huge breastfeeding supporter.  She has spent much  of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years.  Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant.  She has been helping moms and babies with breastfeeding for over 25 years.  Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges.  She is an international speaker, book author and the host of the  popular itunes podcast, All About Breastfeeding, the place where the girls hang out.  You can reach Lori by email at: [email protected] or contact her via her website:  allaboutbreastfeeding.biz/contact

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