I teach it all the time. What post?
Janet Dombro, IBCLC
> On Jan 21, 2014, at 7:31 AM, Rowena Tucker <[log in to unmask]> wrote:
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> On Tuesday, January 21, 2014 9:24 AM, Rowena Tucker <[log in to unmask]> wrote:
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> Dear Janet, I read your post on Lactnet about the mom who has been giving formula and now has low supply. One thing that will help is to use the paced feeding method when she uses the bottle to feed the baby. That will help baby transition out of "fast food" mode and back to a more natural pattern. Here is a short description:
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> Hold the baby sitting upright (you may need to lean him about 15 degrees backward when she allows the milk to come forward) and very close to your side. You may have to hold the little hand that will wave in front of his mouth. Touch the bottle nipple to the area between the nose and upper lip (philtrum), baby will (should?may?) open and reach. Allow baby to draw the nipple into his mouth. Mom must not just put the nipple all the way into the mouth herself because she can't (usually) do that with the breast. After baby has settled on the breast, mom will leave the bottle tilted downward so that NO milk is in the nipple yet. Baby will suck suck suck wait, suck suck suck wait, suck suck suck wait, just as he would at the breast, waiting for the milk release. Baby will not swallow air, the air will go right out of his nose, just the same as if you were drinking out of a straw and your drink ran out. Then, tilt the bottle up so that NO air is mixed with the
> liquid. Allow several swallows, watching for signs of choking. Since Baby has been bottled since birth, he may not struggle to coordinate suck swallow breathe, but newborns do need to be watched. After several swallows, mom can tilt the bottle down and give a rest. Baby may not want a rest but the breast gives rests, so bottle feeding should come with rests. Others recommend removing the bottle for the rest, I advise *against* that, since, at the breast, baby takes the rest while still attached. Then repeat, swallows-rest, swallows-rest, swallows-rest, change sides. Repeat. I recommend bottle feeding baby only enough to calm the hunger but not enough to make him too sleepy and full to nurse. Mom should then offer the breast, and offer to nurse after EVERY bottle feed(until the bottle is not needed), super switch nursing, if possible (only until the supply is restored). That means, change sides every time baby stops swallowing, as long as baby will
> continue to latch. Offer to feed again in 1 1/2 - 2 hours, offering the bottle with the paced feed method, just long enough to interest baby in feeding, then super switch nurse. Mom will have to judge the transitions and sometimes will get it wrong and have to calm baby and start again. She may hand express and/or pump after feeds for 5-10 minutes, using the Stanford Medical School "hands-on pumping" method. The MOBIMotherhoodInternational website has an article about lactogenic foods: http://www.mobimotherhood.org/MM/default.aspx
> The Stanford web addresses are: http://newborns.stanford.edu/Breastfeeding/HandExpression.html
> http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
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> You may want to warn her away from hormonal birth control for now (the doctor may recommend it soon). She may need to hear that this is not the time to reduce her calories to start getting "her figure back". She should plan to feed the baby VERY often during the day, as often as he will latch, reducing the amount he gets by bottle slowly. She'll know if it's starting to work after about 4-7 days, and it may take several weeks for the supply to rebound. She may have already started getting out of the house or doing her usual routine and it may be hard to seem to go "backwards", by feeding so often again. She will need to realize that frequent feeds will be important for now, and she may need encouraging phone calls daily(?).
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> I think the galactogogues may help. Remember people often recommend a nontherapeutic dose (too low) so you may want to double check what and how much of it she decides to try. If someone has already decided to try a galactogogue, I have in the past recommended starting with part of a dose, watching to see if there is any side effect, then increase to the recommended dose, again watching for side effects.
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> Those are my best ideas. I am assuming she is not diabetic or hypothyroid. Good luck!
> Rowena Tucker PA, IBCLC
> Texas
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