Breastfeeding/Lactation Consultant

Please don't judge your milk supply by what you pump. That is a really invalid way to judge your supply and as a matter of fact the amount you are getting is actually quite large. Can you tell me why you are pumping so soon, were there some bf concerns or problems getting started?

You can tell the baby is getting enough milk by watching the baby's weight and diapers? The "gold standard" is the baby's weight gain. If the baby is gaining well then the baby is getting enough milk. The "silver standard" is the baby's diapers. Almost always if the baby is having at least 5-6 sopping wets and 3 to 4 palm sized poops each 24 hours, in the baby between 6 days and 6 weeks, that indicates a good intake of milk.

There are lots of things that moms sometimes use to judge milk supply that are understandable but not valid. For example, what you pump isn't a good indicator of supply b/c most moms pump less than the baby can get and pumping volumes tend to decrease as the baby gets older even when overall supply isn't changing. Additionally the pump only works on suction, whereas the baby uses suction, compression, and a milking action of the tongue. Judging milk supply or intake by the baby's behavior isn't a good indicator either b/c babies are sometimes fussy and seem hungry when they are getting plenty of milk and others are quiet and withdrawn but appear satisfied when they aren't getting enough. Judging by the sensation or frequency of let down doesn't work either b/c let down sensation and frequency generally reduces as the baby gets older too and there are wide variances from mom to mom with regard to sensation of let down.

It also doesn't work to time the feedings to judge milk intake. We know from having special scales that allow us to calculate breast milk intake during a feeding that babies can take a variety of amounts in similar feeding times. It doesn't always follow that the longer the feeding the more milk was taken.

So the rule of thumb in the healthy term baby who is growing well, is to allow the baby to tell you when she is hungry. She will make mouthing movements, make little sounds, move her hands near the mouth, or cry. Crying is actually a late feeding cue and it's generally best to respond to the earlier cues that occur before the crying. Begin bf first, don't change the diaper first unless you have a special situation where you need to wake the baby. Alternate the breast you start with, latch the baby comfortably and allow the baby to determine the end of the feeding. Don't take the baby off the breast to switch sides. You will know the baby is done when she comes off the breast on her own or is not sucking for at least a minute or so. After the first breast you can burp if the baby needs it (and they don't always need a burp) change the diaper and see if the baby wants the other breast. Changing the diaper mid-feeding helps to arrouse the baby and see if the baby really wants that second breast. Many babies will only take one breast and this is fine.

If your baby has been checked by the ped and the ped is happy with the weight pattern and if the diaper count is good, your supply is already fine. So again, the main criteria for judging milk supply is diapers and weight. All the other methods, though logical sounding, are not valid.

HTH to reassure you.
Warmly
Kathy

My son often falls asleep while nursing so I rub his head or change his diaper to wake him.  At what point can I determine that he is satiated and done v. just sleeping?

Also, how do I know he's done on one side?  He will eat then pacify himself all day if I'd let him.  How can I tell he's actually finished?  And, if he only eats on one side at a feeding, how do I keep from getting engorged on the other side if it's 2-3 hours (or more hours if at night) until the next feeding?

Wow, you must have been searching for posts, the original in the thread is from 2003! I hope you are finding some good information and you find the board very helpful.

Here’s more about normal breastfeeding patterns.

What's a normal breastfeeding routine?

http://parenting.ivillage.com/baby/bbreastfeed/0,,8n69dpmw,00.html

If you aren’t sure if the baby is done at the breast do a breast compression. Hold your breast near the chest wall and squeeze sort of pushing toward the nipple but not sliding your fingers closer. Hold for 20-30 seconds and then release. Do this a few times and it should get the baby sucking deeply again. If the baby doesn’t start to suck deeply and rhythmically again the feeding is over on that breast. You can opt to offer the other side or not. It’s ok if the baby takes only one breast per feeding.

If you are getting engorged on the unused breast it’s ok to pump a little just enough to get comfortable. Over time the breasts should adjust and you will not have so much filling of the unused breast. If you are returning to employment outside the home you can freeze what you pump for later.

Here’s some more general information to help you get off to a good start with breastfeeding.

Is my baby getting enough milk?

http://parenting.ivillage.com/baby/bbreastfeed/0,,8rr83zjm,00.html

Why is my baby fussy and what can I do?

http://parenting.ivillage.com/newborn/nbreastfeed/0,,8znwfldp,00.html

Also, since position and latch is so important to ensure effective suck here’s some information on that.

Position and latch post:

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=77538.10

How do I know my baby is latched correctly?

http://parenting.ivillage.com/baby/bbreastfeed/0,,9jw927vm,00.html?ice=iv|hy|pp

Please get back as much as needed for more information

I was on kellymom.com and workandpump.com and there was a link from one of them to this question. I didn't even realize it was 4 years old!

Anyway-my son is 15 weeks old and is getting better at taking bottles at day care, but I am not sure how much he is getting when I nurse him in the morning and at night. He has always been a slow nurser, and somewhat inefficient, so I regularly do breast compressions, but I still am not sure how much he's getting. I know a lot of it is non-nutritive, but how can I be sure he's getting enough? I don't time it (although in the morning I have about 40 minutes)-so is it better for him to do 10/10/10/10 or 20/20 or just one side until he's done?

Also, I used to be able to pump about 3oz per side per pump, and now I am lucky to get 1.5-2oz per side. I have upped my pumping sessions to 4 per day, and nurse him in the AM and PM, and am taking Mother's Milk, but what else can I do? I send 3 4oz bottles to day care but wonder if that's enough. He weighs about 16 lbs.

Sorry for all the questions but you are the most helpful person I have found in a while!! Thanks!!

I was on kellymom.com and workandpump.com and there was a link from one of them to this question. I didn't even realize it was 4 years old!

Ahhh, so that solves the mystery…………;-)

Anyway-my son is 15 weeks old and is getting better at taking bottles at day care, but I am not sure how much he is getting when I nurse him in the morning and at night.

If your baby is growing well (gaining weight appropriately) and making at least 5-6 sopping wets per day and his usual poopy pattern, then he’s getting enough. Don’t worry about try to ‘measure’ or estimate what he takes at each individual feeding. Look at the big picture.

He has always been a slow nurser, and somewhat inefficient

What makes you think he’s inefficient?

 so I regularly do breast compressions

That’s fine but when he’s no longer responding to the compression (resuming a nice deep suck) then the feeding is over. Don’t obsess over how much time he spends on the breast. What we know about breastfeeding intake is that it varies widely and the length of time a baby is on the breast is not always related to how much milk they are taking. Babies often can take larger amounts of milk in shorter feedings. Longer feedings don’t mean more milk.

but I still am not sure how much he's getting.

If he’s gaining ok and making 5-6 sopping wets per 24 hours you REALLY don’t need to worry about that! Honest………..trust me on this one!………….;-)

I know a lot of it is non-nutritive, but how can I be sure he's getting enough?

Via the diapers and weight only!

I don't time it (although in the morning I have about 40 minutes)-so is it better for him to do 10/10/10/10 or 20/20 or just one side until he's done?

Let him take the first breast until he’s done (not sucking any more and/or not responding with a deep suck after a compression or two). Then if he’s interested offer the second side using the same criteria to determine when he is done.

Also, I used to be able to pump about 3oz per side per pump, and now I am lucky to get 1.5-2oz per side.

That’s a totally normal and expected change as your baby gets older and as you rely more on a pump while you are away at work. Here’s more on that topic and what to do.

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=66599.5

I have upped my pumping sessions to 4 per day, and nurse him in the AM and PM,

Good, the more you bf and/or pump the more milk you’ll make.

and am taking Mother's Milk,

The mother’s milk tea is not really effective to increase milk supply. The most important aspect of increasing milk supply is taking more from the breasts. The best way to do that is via bf, the second best way is via a high quality pump. Even if you do opt to use herbs the tea is generally too weak to be effective. If you are interested in herbs the most common and widely accepted herb to use is Fenugreek. There is not good research but lots of anecdotal reports of its effectiveness. If you opt to use it you need to take 3 capsules 3 times a day. It will make your urine smell like maple syrup. You may not see results until 3-5 days and you still need to do the bf and pumping or it will not work. A few cases of allergic reactions have occurred, it can give you loose stools. And, it is thought to possibly lower blood sugar and cholesterol. As always talk to your doctor before starting any new herbal treatments.

but what else can I do? I send 3 4oz bottles to day care but wonder if that's enough.

How many hours per day are you gone from the baby? In general babies need about the equivalent of one ounce per hour (that number is true up to 6 months of age). Research has shown that babies who are bf directly take about 25oz of breast milk per 24 hours up to age 6 months. That’s where we get the ounce per hour figure. So if you are gone for example an 8 hour work day with 1 hour commute round trip that means you are separated (no bf) from the baby about 9 hours or maybe 10 if you figure you can’t always bf immediately before or after dropping the baby off. So for a 10 hour stretch of no bf 12 oz of ebm seems very reasonable and appropriate. You should not see this amount/need increase. As babies get bigger their caloric need per ounce of body weight actually declines, which is why as they get bigger they can still do fine on the same number of calories per day up to about 6 months.

So, the amount the baby drinks at daycare should be equal to about one ounce per hour, meaning that if it’s been about 2 hours since the last feeding we’d expect the baby to take about 2oz. If it’s been about 3 hours we’d expect the baby to take about 3oz. That number doesn’t change up to six months of age.

It’s important for your daycare provider to encourage the baby to drink the bottles slowly. Many times dc providers allow babies to drink too fast and that encourages the baby to drink more than he really needs or wants.

One way to slow the baby down and help him pace himself with the bottle is to have the dc provider take the bottle out of his mouth about every ½ to 1 oz and then give him a suck break on a pacifier for a few minutes, then a little more bottle, a little more suck time, etc.

When a baby drinks straight through it’s really hard for the baby to signal when he’s had enough. Additionally when the baby drinks fast he often takes more than he needs b/c his brain doesn’t have time to register he’s full before he gets overly full. Making the baby take breaks during the bottle-feeding helps the pace mimic breastfeeding and helps the baby take only what he needs.

He weighs about 16 lbs.

What was his birth weight? Is his pediatrician happy with his growth pattern? If I assume he was an  ‘average’ sized 7.5lbs at birth that is a very nice weight gain pattern.

Sorry for all the questions but you are the most helpful person I have found in a while!! Thanks!!

No limit on questions! Ask as many as you like. One thing that’s really cool about this board IMO is that when you ask a question it’s not just you getting the answer. You can be sure if you have this question that many others have also wondered about this and will benefit from hearing the responses.