As a mother and a pediatrician, before I get too far into this topic, I acknowledge that breastfeeding is not always the best choice, or even a viable option for every parent. Although breast milk is nature’s perfect food for infants and growing babies, I know that it is not possible for every mother to breastfeed her child, and I support all parents in their journeys to raising healthy, happy children regardless of how they are fed.
If you are a seasoned breastfeeding mama, these tips may seem obvious. But to my 26-year-old self, they certainly were not!
1. Pump and pump and pump some more. Especially in the first few days post-partum, pumping frequently is one of the most important things you can do to help your milk come in. I delivered my second baby via C-section, so my body did not get the usual signals to tell my breasts to get to work! Both baby and I were exhausted, so she was not interested in latching as frequently as she needed to in order to really get my milk supply going. Starting day 2, I made myself pump every 2 hours. Sometimes she would try to latch first, sometimes I would just give her what tiny amount I was able to pump for her. But it was what we needed to do to make sure she was fed and I was making milk.
I was able to avoid giving her any formula in those first days (even though her pediatrician was really pushing it on me) because I faithfully pumped every 2 hours. By day 4 of life she stopped losing weight, I was making adequate milk, and she went on to breastfeed just fine.
Knowing that I would be going back to work at some point, I made it a priority to pump 1-2 times per day during my maternity leave (on top of her normal feeds) in order to build a freezer supply of breast milk. I didn’t always want to do it, but at least every night, I pumped and stored away my milk so that if I had a drop in supply down the line, she would always have some milk in the freezer as back up.
Having a good, efficient electrical pump is so important. They can be rented from programs like WIC, or bought. Since I knew I’d be using it steadily for at least a year, I opted to buy mine.
2. Eat well, stay hydrated, and drink some Mother’s Milk Tea! Just as I pumped every 2 hours during those first few days, I also made sure to eat some good food and drink tons of water every two hours. My body was exhausted, in pain, and recovering from labor, C-section, and other complications, but I knew that I needed to get nourished and hydrated, and I had to flush out all the meds and toxins that were running through my system.
So I ate and I drank, even when I didn’t feel like it. I also had great success with Mother’s Milk Tea and drank a cup of this about 4-5 times per day for the first few weeks. I didn’t love the taste at first, but it grew on me, especially with some non-dairy milk and sweetener. Months down the line, whenever I felt like my supply was starting to wane, I made sure to have a cup or two of Mother’s Milk Tea each day and I was always able to recover.
3. Do not use any hormonal contraception. Not even the “mini-pill.” This was a big lesson I learned with my first. I was making bountiful milk for him when I had my 6-week post-partum visit. My OB/GYN said that since my milk supply was good, I could start any contraceptive option I wanted. In my naiveté, I chose to start a particular oral contraceptive pill because I wanted to get my acne under control (sad!). I really had no idea that it would affect my ability to breastfeed long-term, even though I was a medical student at the time (sad x 2!).
By about 4 months, I started making significantly less milk. So I started supplementing with formula, starting a vicious cycle that eventually led me to dry up completely. More on that in #4. With my second baby, I knew from the start that I would not take any sort of hormonal contraception.
Important point: I am not advocating for complete lack of contraception! There are very effective non-hormonal options out there. But if you want to continue breastfeeding throughout your baby’s first year of life or beyond, you will want to avoid taking hormones so that you maintain a strong milk supply.
4. Do not supplement with formula, even if you think your baby is still hungry after he nurses. If you think you are not making enough milk, there are many things to try before jumping to adding formula. First, are you misreading your baby’s cues? We often think they are hungry when they just want to suck on something to be soothed. Second, does your baby have 7-10 wet diapers per day, and soft, seedy stools? Third, is your baby gaining weight appropriately? If the answer to these questions is yes, your baby is probably getting enough to eat.
If your supply is truly waning, the solution is not to supplement with formula. It is to pump after each feed to stimulate supply, to feed/pump more frequently for a day or two, even to wake yourself up at night to pump when your baby is already sleeping through the night. All of these things will help stimulate your own milk production. Also try Mother’s Milk Tea (see #2 above).
If you still need help, see a lactation consultant for advice on supplements like fenugreek, malt, and maybe even metoclopramide (a prescription medication that stimulates lactation). After your baby is six months old, you will be able to introduce all kinds of exciting, filling foods to help keep your baby satisfied (like avocado and bananas!).
Adding formula will only send signals to your body that you can decrease the milk production… So then you will need to give more formula… So then you will make even less milk. And so the drying-up cycle will continue until baby is drinking all formula.
- Be careful with any medications you take, even over the counter medications.
When my son was about 4 months old, I caught a terrible cold. My stuffy, runny nose was unbearable so I took some pseudoephedrine, thinking nothing of it. I’m sure that this alone would not have made a huge impact, but when you combine it with the fact that I was taking oral contraceptive pills and starting to supplement with formula, I quickly found myself with a waning milk supply. Even though almost all medications are safe to take while breastfeeding (please consult your physician and weigh the risks and benefits of taking any medication while you are nursing), keep in mind that many medications have a drying or dehydrating side-effect profile, and that chronic or even acute use of some medications can have a negative effect on your milk supply.
6. And keep on pumping… If you spend any time away from your baby, particularly if you go back to work outside of the home, make sure you are finding and/or making time to pump at least every 3-4 hours (sometimes even more frequently), in order to make approximately 1-1.5 oz per hour spent away.
For instance, in my eight-hour workday, I did my best to make sure I was pumping around 8 oz of milk. This not only guarantees that your baby has fresh milk for the following day (and keeps you from digging too far into your freezer supply), but it also keeps you producing lots of milk.
With my first, I went back to “work” (clinical rotations in medical school) when he was 4 months old. Finding time to pump was not a priority for me at the time, which in addition to all the other mistakes mentioned above, caused me to lose my supply completely by the time he was 5 months old. With my little one, I was much more diligent with pumping. She never had a drop of formula, and we didn’t run out of freezer supply until she was almost 12 months old. Happy face!
|Dr. Jamilet Alegria, M.D., joined the CentreSpring MD team of providers in the fall of 2016 after spending years as a Pediatric Hospitalist at both CHOC Children’s in Orange County and at the Pomona Valley Hospital Medical Center Inpatient Pediatrics Unit in Southern California.|
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