I'd also like to add my 0.2 ml worth in here. How can the mother
know if the baby is taking all the milk she's making, ie
breastfeeding effectively? Firstly, a baby who isn't doing very well
will usually go to the breast, take a very few gulps/swallows with
eyes open, and then as soon as the flow reduces, close the eyes and
mainly flutter-suck, only to wake and protest if taken off the breast
(when mom assumes the baby has had enough and _that's_ why he's going
to sleep.....). If the mom puts the baby back to the breast the same
thing happens again - a few swallows, then he just hangs out at the
breast again. This can go on for hours, with the mom assuming that
the baby is "breastfeeding", but he's really not ..... So at the end
of the breastfeed, when the mom perceives that the baby has finished,
she can "test" whether the baby has taken a good quantity of milk by
expressing a drop or two of milk by hand. If there are jets of
watery looking milk, then the baby has _not_ finished - he simply
doesn't have the energy to breastfeed effectively. On the other
hand, if there are only a few creamy-looking drops of milk left, then
that's the sign that the baby has breastfed effectively and taken
most of what mom is making.
So I would usually suggest the following management plan to a mother
wanting/needing to increase her breastmilk supply (the mother who has
jets of milk left _after_ breastfeeding .....)
1. Breastfeed for no more than 20-30 minutes, using alternate
massage and switch-nursing and stimulating the baby to stay awake and
keep swallowing - the _stop_ breastfeeding (allowing baby lengthy
times at the breast when there is little swallowing going on is
simply wasting everyone's time).
2. Immediately after breastfeeding, feed the baby any previously
expressed breastmilk as a top-up, in the quickest, easiest possible
way (no slow-flow teats, use the fastest teat the baby can cope with)
3. "Settle" the baby - this can be done by putting baby back to
breast, and allowing him to comfort/flutter-suck and go to sleep.
4. As soon as possible after feeding, pump/express both breasts
perhaps twice each, using massage too, to maximize let-downs and
output. Store any EBM, no matter how small the quantity, for the next top-up.
5. Breastfeed again and repeat the above when the baby wants to feed
again, but breastfeed/drain the breasts thoroughly at least every 3
hours around the clock (if the baby is sleeping and can't be woken,
then the mom can pump/express instead, keeping the EBM for top-ups
later in the day).
It's the frequent, thorough drainage of the breasts which will
re-stimulate breastmilk production. When a baby is breastfeeding
very ineffectively, his weight gain may be very low, or remain
static, or he may even lose weight. As he becomes weaker, his
breastfeeding performance becomes worse and worse, so that drainage
of the breasts becomes more and more ineffective, and it is this,
more than anything else, which suppresses the mom's milk supply. The
above protocol can reverse everything if the mom can be persuaded to
keep on keeping on. When she first starts, the quantity of milk
expressed/pumped after breastfeeds may be very low - but really good
drainage of the breasts very frequently can kick-start the whole
process, and I've seen this work soooo well! I usually suggest moms
keep a chart of the times of breastfeeds, urine/stool output, EBM
expressed, top-ups given (both EBM and if necessary ABM), daily
totals of everything, so that - over time - she can see that her milk
production is starting to increase a little, and later, a lot! This works!
Pamela Morrison IBCLC
Rustington, England
Rachel writes,
>Cathy Genna writes, in response to this question:
>"If the baby is not feeding effectively, and that's the likely
>reason for low supply, I encourage moms to pump right after bf. If
>the baby is taking pretty much everything mom can make, then I
>encourage her to pump about 45-60 mins after the feeding, so she can
>spike her prolactin again and remove milk to stimulate the breast."
>
>I would add that if the baby is taking pretty much everything mom
>can make, *and* is willing and able to feed effectively again 45-60
>minutes later, I encourage mother to skip the pumping and let the
>baby earn its keep by doing the dreary, tiresome work of stimulating
>milk supply itself. The quicker mother and baby can get together
>without a pump in between them, the happier we (mother, baby and me) all are.
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