Reply from Lactation Consultant - Interesting

This is very useful response from medula on my question about breast feeding.  Some of this info may be useful for others.

Also contact details at the bottom if anyone else has questions to ask and don't have direct access to a lactation consultant.


=========== QUESTION ===========
My baby is 2 1/2 weeks old. She was 3245 g at birth. At her 2 week checkup she was 3600g. Am breastfeeding and expressing using a medula portable pump (bought in Hong Kong). Feed baby in morning (1 side) express the other plus finish whatever baby doesn't. She drinks up to 4 1/2 oz (or whatever I could express) midmorning. Then I go home lunchtime to feed her. Now in afternoons she drinks all I can pumps/breastfeed her (so I have to take her to work so she can demand feed). I need to get some milk stored (I would prefer to leave her at home inthe afternoons), but so far haven't been able to becuase she drinks all that I have and asks for more. I let her feed. Then I pump till nothing more comes out!

How to I get my milk supply up? I really don't want to supplement with formula (am sure that will make supply issue even worse). Am having a hard time with this at the moment.


=========== ANSWER ===========
Dear Sally,

Thank you for writing. I am a Lactation Consultant and help Kathleen answer emails. Sally, your baby is over eating milk from a bottle. Most newborns only need about 2 to 2.5 oz. from a bottle. It is also common that they feed 10-12 times in 24 hours, so continuing to bring her to work with you would be good for supply. It is very difficult to store milk ahead for a newborn. I am astonished that you are already back at work. What type of pump are you using? I would recommend using a double pump, because of your full-time employment.

I'm sending you some information on what she needs and some good times to pump when you are home with the baby. While you are at work, I'd recommend pumping at least every 3 hours that you are away from her, including travel time.

Here is the amount of milk your baby needs:

Before babies weigh about 10 pounds (4.5 Kilograms), and while they are still in the early days, and especially if they are playing catch-up with growth, they may take 2.5 ounces (75 mls) of milk per pound of body weight per day. For example, multiple the babies’ weight, say 7 lbs, times 2.5 oz (75 mls) to get about 17.5 oz (525 mls) of milk needed each day. After babies are about 10 lbs., (4.5 Kg) until they begin solids, they take about 19 oz to 30 oz. (570-900 mls) a day. This amount does not increase or decrease much. Split into 8 feedings, this is about 3-4 oz (90-120 mls) of milk per feeding.

Babies will often take more milk out of a bottle, but this is because they are trying to satisfy needs for food and sucking, and because they are sucking for comfort, and cannot help but consume milk while doing so. After the first several months, their growth rate slows a bit, and they have a more efficient metabolism. This is why they continue to need about 19-30 ounces or 570 ccs-900 mls milk each day until they start solids, regardless of their weight.

Some ways to slow down the amount that the baby is consuming out of a bottle are to use slow-flow nipples and to slow down the pace the feedings, so that feedings take longer. Ways to do this are 1) hold the bottle more horizontally; 2) let the nipple fill with air from time to time during the feeding and 3) use methods of comforting the baby other than food. Examples are these are rocking and walking with the baby, carrying the baby in a sling or other carrier, etc…Some caregivers switch from feeding the baby with a bottle to a cup, as even small babies can be cup fed when the mother cannot be there. Babies often consume less milk from a cup. Mothers may be concerned that babies will take in air when the bottle nipple is not filled with milk. This is true, but babies will simply burp up the excess air.

A baby who is fed with bottles may over consume milk from a bottle. This is a very common problem. This is because bottles flow at a constant rate, and abnormally fast. Babies can drink ounces over what they need because they love to suck and will eat far more milk than what they need because of this. In contrast to bottles, the breast flows at an uneven rate. Babies can suck as much as they want at the breast and not be overfed, because the milk comes out very slowly towards the end of the feeding. Obesity is less of a risk in babies who are breastfed, and this advantage continues at least into childhood and the teen years. Some of this is the breast milk itself, but how the baby receives the milk—by breast or by bottle--is thought to also be important.

Once breastfeeding is well established, usually around four weeks, here are some good times to pump while you are at home with the baby:

Early in the morning, when the breasts are usually fuller, after you have fed the baby.

When the baby feeds only on one breast, and is then satisfied. The milk has already "let-down," or started to flow in the other breast too, so this makes pumping easier. Then the next time you feed the baby, start on the side that you pumped first. We recommend this because no pump is as good as a baby in getting milk from the breast, so this helps to keep the supply in both breasts more or less equal. Then switch to feeding on the fuller breast.

Night pumping is good, if you happen to be awake.

You can try pumping partway between feedings or after the baby feeds, and then put these small amounts together to make a feeding for the baby.

For most mothers, the worst time to pump is the late afternoon and evening hours, as the milk supply is naturally lower then, and babies are fussier and need to be held more.

Depending on the need for stored milk, some mothers pump once a day, every day, in addition to feeding their baby the usual feedings, to encourage their breasts to produce more milk.

At first, many mothers can only pump a small amount, sometimes less than an ounce. This often increases in time with practice.

We recommend that mothers pump for two minutes after the milk has stopped flowing.