I of course know that the study of one is not a study at all, but since I
only birthed one this time it's all I had to work with. <smile> Since I have
been very curious about the very issue of weight and intake and changes based
on age as opposed to weight and the issue of increased supply vs constant
supply after initial established lactation, I enjoyed using my own newborn as my
subject.
This concept has always been very hard for me to wrap my head around.
Surely my 13 lb babes needed more milk at birth than the 6 lb babes? It seemed
logical and obviously is logical to many as nurses are constantly telling moms
their big babies just can't be satisfied without that supplement as they are
just too big and need more milk. I always accepted the concept of smaller
volume in the early days as it is logical regardless of babes size that
ability to acclimate to feeding would be better in smaller amounts. It was as they
got older that the idea of needing less could be true seemed hard to accept.
Thinking of all those years of 'growth spurt' talk and 'increase the supply
by nursing more', etc., this train of thought had been ingrained in me. It
was very difficult to accept the research or evidence. And really, while I
believe in evidence based, I also believe in clinical experience and the
statistical variation of research still allows for no absolutes and within that
could still think it necessary that the larger the babe, the larger the amount
of feed needed.
How exciting to have my very own homebirth newborn and a BabyWeigh at my
bedside! Haha. So, I began my little own study of one. Her birthweight was 11
lbs 10 oz, and as I was also interested in the idea of weight checks at 24
hrs instead of immediately at birth, I checked at 24 hrs and she was only 11
lbs. She had passed so many meconium stools I was not the least bit surprised.
I did not do pre/post feed weights in the first 3 days, but did do 24 hr
weight checks. She went down to 10 lbs 13 oz by day 3. Which, when compared
to birthweight is a lot, but when compared to 24 hr weight is not much at all.
She stayed that weight for 2 days even though her voids and stools were
more than adequate. I did pre and post weighs for all her day time feeds but
admit that those middle of the night feeds I did not always remember to do.
They were on average only 1 oz per feed. I would hand express more and try to
feed it to her with a syringe, she would spit up all of it! Only keeping
down the 1 oz she originally took. My iron was extremely low and my breast
simply were not feeling full, so being the nut I am, I was hand expressing after
every feeding and trying to get her to take more. She refused. She was having
issues with sucking and thinking her LC mom would let her clamp and pinch
with her high palate with a bubble, but she was wrong. So, I would finger feed
her to teach her to keep her tongue more properly placed, and still I could
not get her to accept more than that one ounce. I was expressing an easy two
or three, but she simply would not keep it in her. Within a few days her
suck was fine, my pain was gone and she was eating about every hour and a half
with some stretches of 3 hrs.
She continued at this for a full 2 weeks. She was not back to birthweight
at 2 weeks, but was back to her 24 hr weight. Still, I kept thinking this
can't be right. Surely since she is so big she must need more milk. I have
always had babes that were big (except the twins who were average singleton
weights each) and she was nursing pretty much in the same pattern. By 3 weeks
she was back to birthweight, and at the same time started to take in 2 1/2 oz
per feeding for most feedings with 3 oz being an occasional exception. She
fed every hour and a half or so, and I still had plenty of milk left...I
expressed an ounce easily after she finished and that was with hand expression.
What I found very interesting is that my supply did in fact increase, even
though she did not necessarily take what was there. My breast began to feel very
full and sometimes uncomfortable as my iron levels rose. (They were low due
to postpartum bleeding and I was put on iron supplements.) As I was able to
walk without getting dizzy, I was also making more milk. Soon I was feeling
full between feedings and leaking. Still she was not taking more than the
amount she always had. (Luckily my older child was happy to help out.)
I am fairly sure the breast is capable of increasing production after that
one month mark. I know that I was able to increase my supply with my twins
from almost nothing to a full supply and that was past the one month mark. I
think if the ability to produce more milk was over at a set time then
logically women who are trying to increase production are wasting their time. Why
bother working on a low supply if women are locked into a production
capability by one month. I still think that babies do create an ebb and flow so to
speak in the mother's supply. I think that amount changes feeding to feeding
and day to day. I think that is part of the problem with the formula fed babes
in that they do not get to have the variation in milk and are not able to
control how much milk they take. (Or some do---they just spit it all back up.
And others don't.)
I think this because on the occasion she did take in 4 ounces, she spit up
an ounce of it. I made the 4, she only wanted to keep the 3. Sometimes, she
would spit up the entire feeding and feed again immediately and only take the
2 oz she wanted....which means I made 6 oz, she only kept 2. Another very
interesting note, she did NOT gain her weight every 24 hrs. Instead, she would
gain, stay the same for a day or two, then have another gain, stay, gain,
stay gain. Always with more than adequate stools and voids. I was going
through 10-15 diapers a day.
This experience has helped me get a better grasp of the concept of milk
production and intake stabilization and the idea that babies do not need the
amount of milk those charts say they do when moms are trying to decide how much
breastmilk to leave for a feeding. I still think mothers are capable of
increasing their supply after the 2 months, and that if babies were not having
enough intake when the supply increases they will increase what they take too.
I think the research is interesting, but I think it is only a piece of the
puzzle. There is a variation in women's capacity for storage and a range of
capacity for production. And with that, there is also those babies who eat
far too much at a feeding and some who are far too content with too little. I
also think that even if the variation is only a couple of ounces, that is
still a change. So, if a baby is consuming 700 ml at 3 months, and at 6 months
is consuming 760 or a bit more, statistically that may be insignificant, but
for that one baby it is an ounce or two more per day. It is an increase
even if only a half ounce here and there. Also, many babies do just fine without
starting solids at 6 months, so the idea that babies do not consume more
breastmilk when we would be expecting them to consume solids to complement the
breastmilk also seems to interfere with the idea that milk intake amount is
constant based on the amount taken at 2 months.
I think that as long as we are looking at baby growth parameters of normal
with any amount of formula or solids we do not have a complete picture of what
the average biological norm is. I am not sure we could even realistically
have a complete picture regardless as genetics and other factors play in growth
also. My 13 lb babies did not weigh 26 lbs at 4 months or 6 months...and I
am glad too because that would have been back breaking. But, my 9 lb baby did
weigh 20 lbs at 4 mnths and my twins doubled their birthweight at 6 months,
but that was still below the weight my 13 pounders weighed at 6 months who
had not doubled. I am thinking there is much more to the picture of health
than a number on the scale.
I enjoyed using my Veronica Rose and continue to do so. Every couple of
weeks I spend a few days doing pre and post weights and see if she is starting
to take in more milk over a 24 hr period. I am coming up on the time to do it
again and she is not almost 5 months old. I will be very interested to see
the amount of milk she is taking and will not be starting solids at 6 months,
as I never did before with any of my children so will be interested to see
if she increases her intake then.
Again, I know this is only a study of one, but she was a big baby. I do
wish I had this scale and thought to do this with all of my children! Haha. I
did it with the twins out of necessity and am wishing I did it with the
previous child to have a comparison. Maybe I will have that 8th baby and see if it
varies with child....
Take care,
Pam MazzellaDiBosco, IBCLC, RLC
Davie, FL
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