Supplements in the newborn period are such a difficult judgment call,
and it would be great to get some consensus on recommended amounts. I
bring the topic up in my prenatal breastfeeding classes to point out
that, even when necessary, it's not a casual decision. And that,
whendeemednecessary, mothers should view supplements, not as a
confidence-buster, but as a tool to stabilize the situation, so she can
work on breastfeeding.
I also explain that newborns don't have any clue about bottles -- why
should they?. I've started using the belly-balls to illustrate that, as
the system was designed, the baby's stomach expands in harmony with the
expanding milk production across those early days, driven by *a lot* of
sucking. Babies come out (in the optimal scenario) as extremely
motivated little suckers, designed to jump-start milk production,
getting all that calming satisfaction on a nice soft breast and a thick,
concentrated flow in small steady amounts while they learn about
breathing and coordinating suck/swallow/breathe. If we play a nasty
trick on babies and provide a free-flowing bottle, they don't know how
to not to keep chugging -- it's almost as if those brand-new babies
aren't wired for "stop sucking when you're full" because under ordinary
circumstances, they can't overfeed on colostrum, and the more sucking,
the better.. Maybe learning to respond to satiety signals also develops
with the increase in production.
I add that people who *aren't* breastfeeding need a class to understand
their newborns, since they don't have the advantage of working with the
system-as-designed. How can they resist giving more than the
recommended small amounts because they worry the baby is starving
because it's sucking so avidly -- chugging down ounces as the misguided
little thing tries to send a strong message to get milk production up.
Since sooo many babies get early supplements for jaundice, hypoglycemia
or weight loss (and that's worth a lot of discussion), I try to arm
mothers -- if their baby is getting any ongoing supplement in that
newborn period to get pumping immediately to provide as much of the
"free milk" as possible, and to work toward getting things back in
balance, since the baby is likely to take so much from a bottle, conk
out, and thus really under-stimulate the incoming supply.
Pregnant mothers need to know that even if they plan to eventually
combine both breast and bottle to wait until after those initial
establishing weeks, since even with good motives, the baby's sucking
desire is going to make the formula/human milk equation increasingly
lopsided. Formula marketing is starting to stress this "both" option,
since it seems so friendly and "best of both worlds for you," while it's
often a one-way ticket to bottle-feeding if started in the newborn period.
Margaret Sabo Wills, LLLL, IBCLC, Maryland
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