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Breastfeeding, You need to know

Posted on: 10/02/2017 00:00 By Bellema

Kathleen Huggins

Registered nurse and lactation consultant

Kathleen Huggins, R.N., M.S., IBCLC, is the author of The Nursing Mother's Companion; The Expectant Parents' Companion: Simplifying What to Do, Buy, or Borrow for an Easy Life With Baby; and New Lives: Nurses' Stories About Caring for Babies. She is coauthor of The Nursing Mother's Guide to Weaning; Nursing Mother, Working Mother; 25 Things Every Nursing Mother Needs to Know; and The Nursing Mother's Companion Breastfeeding Diary. Now a retired registered nurse and lactation consultant, Huggins owns the maternity and baby store Simply MaMa in San Luis Obispo, California. She also serves on BabyCenter's Medical Advisory Board.

               Can the herb fenugreek increase a mom's milk supply?

               Does breastfeeding deplete a mom's iron supply?

               How do I breastfeed once my milk has dried up (relactation)?

               How much milk does a baby need in the first few days?

               I still breastfeed my 18-month-old son. My mom thinks this is strange. Is it?

               I'm flat-chested. Can I breastfeed?

               My baby seems drunk after every feeding. What's going on?

               Should I drink whole milk while I'm breastfeeding?

               Should I supplement breast milk with formula?

               What should I do if the thought of breastfeeding in front of others makes me uncomfortable?

               Will breastfeeding help make my uterus shrink to its pre-pregnancy size?

Can the herb fenugreek increase a mom's milk supply?

Yes. Women have used the spice fenugreek since ancient times in the Middle East, North Africa, and India to stimulate milk flow. Research has shown that fenugreek can increase milk production as much as 900 percent, although no one knows exactly how. The oil contained in fenugreek seeds is believed to play a role in boosting milk supply.

At my breastfeeding clinic in San Luis Obispo, California, I recommend fenugreek to women who aren't producing enough milk. Nearly all mothers report an increase in their milk supply within 24 to 72 hours after taking the herb. Most find that they can stop taking the herb once their level of milk production goes up as long as they make sure that both breasts are being completely emptied every two to three hours. Fenugreek will not improve low production when the breasts are not being well drained.

You can buy fenugreek capsules containing ground seeds at most health food stores. The capsules of brands I am aware of contain either 580 or 610 mgs of the spice in each. A bottle of a hundred capsules costs around seven or eight dollars. Although some brands recommend that you take one capsule three times a day, this dosage is too low to adequately improve milk production. In our clinic, we recommend two or three capsules three times a day. You may also drink fenugreek tea, but it has an unpleasant bitter taste and is not considered as potent as taking the herb directly.

Few women have bad reactions to fenugreek, although you will notice a maple syrup-like odor to your urine and sweat. In our experience with hundreds of women, a handful developed diarrhea that quickly subsided when the amount was decreased or they stopped taking the herb. Two asthmatic mothers said it aggravated their condition, an interesting reaction as fenugreek is thought to help asthma by decreasing mucus production (in fact, many natural healers use fenugreek to treat coughs, bronchitis, and sinus problems for this very reason). If you are diabetic, use this herb with caution as it can lower blood glucose levels. And if you are pregnant, you should not take fenugreek since it may stimulate the uterus, causing contractions. There are no apparent side effects in babies whose mothers take the herb.

Does breastfeeding deplete a mom's iron supply?

No, breast milk takes very little iron from your body — about 0.3 milligrams per day.

Most women ingest about 14 mg of iron per day. This iron loss is similar to what your body loses during menstruation. And since most nursing mothers aren't menstruating for at least the first few months of breastfeeding, you shouldn't be too concerned. Still, eat a healthy, well-balanced diet rich in fruits, vegetables, and lean meats. And if you have a history of iron deficiency anemia, speak to your doctor about taking supplements.

How do I breastfeed once my milk has dried up (relactation)? 

Bringing back full milk production depends on the age of your baby, the amount of time that has passed since weaning, and how forgiving your breasts are! Is your baby willing to latch on to your breast and suck for at least a couple of minutes? If so, then start by nursing her every two hours during the day and evening. Night nursing seems to have a strong influence on milk production, so consider sleeping next to your baby so that she will nurse often during the night. Of course, you will need to supplement with formula after most feedings until your milk supply gets back up to speed and is able to provide everything your baby needs. Offer her an ounce less formula than you typically do so she nurses often.

If your baby is no longer willing to latch on, consider renting a fully automatic electric pump with a double pump kit. See a lactation consultant about a nursing supplementer, which delivers formula to your baby through a soft tube while the baby is latched on to your breast, to help entice your baby to nurse.

Taking the herb fenugreek, which has been used for centuries for a variety of ailments including low milk production, can also bring your milk back up. If you use pancake syrup, you already are ingesting fenugreek (though probably not enough to boost milk production), since pancake syrup is nothing more than corn syrup and fenugreek. Fenugreek stimulates the sweat glands (you will notice an increase in sweating, and your sweat may have a maple aroma) — and the breast is a modified sweat gland, which may be why fenugreek is so effective. Mothers generally notice an increase in milk production 24 to 72 hours after first using the herb.

We generally recommend taking two or three capsules three times a day. Teas are a weak form of the herb. Fenugreek capsules can be purchased in most any health food store for around $7 to $9 for a bottle of 100 caps.

When you feel like you are beginning to produce milk again, it's important to monitor your baby's weight frequently. This will help you determine whether you should decrease or eliminate the formula supplements. If your baby is less than 4 months old, make sure that she is gaining at least an ounce a day before cutting back on the supplements. Cutting back a couple of ounces every 24 hours and then checking the baby's weight gain is a reasonable way of cutting back

How much milk does a baby need in the first few days?

A breastfed baby takes small but increasing amounts of milk over the first few days.

Studies of large numbers of breastfed babies suggest that on average they consume about 1/2 ounce of colostrum per feeding in the first 24 hours, 2/3 ounce per feeding by 48 hours, and one ounce per feeding by 72 hours, when mature milk production begins. At four days of age, most breastfed babies are taking about an ounce and a half at each feeding, and by five days two and a half ounces or more.

Of course, when you're nursing, it's impossible to know the precise amount of milk that your baby gets at each feeding. The most reassuring signs of adequate intake in the early days include the passing of meconium and transitional stools. Babies urinate very little in the first few days. Your milk production should begin by 72 hours postpartum starting with a noticeable change in your breast fullness.

Hearing your baby swallow and feeling your breasts soften during feedings are reassuring signs. By his fifth day of life, your baby should be having yellow or mustard-colored stools and wet diapers every few hours. Babies normally shed ounces in the first few days of life, but weight loss should be no more than 10 percent of the baby's birth weight. By five days of age, a baby begins gaining weight, at least an ounce a day. By 10 to 14 days of age, most babies have regained their birth weight.

I still breastfeed my 18-month-old son. My mom thinks this is strange. Is it?

Breastfeeding an 18-month-old probably is pretty strange to your mom. Keep in mind that when you were born, very few mothers nursed for more than a few weeks, if at all.

Now we realize that breast milk is essential to a baby's developing brain and nervous system, and that it provides a crucial boost to your baby's immune system. In 1997, the American Academy of Pediatrics (AAP) came out with a strong statement encouraging breastfeeding for at least the first year of life — and beyond.

What benefits are there to continued nursing after the first birthday? In December 1997 the AAP reported that at 12 months, a baby's immune system is about 60 percent developed. Breast milk, which even after a year is still loaded with protective antibodies, is a nutritious, healthy snack for a toddler — especially if she's a picky eater.

No one knows as well as you do how breastfeeding can help to soothe your child when she's hurt, comfort her when she's upset, and help her fall asleep. Your breast has a bit of magic that your mom may never understand.

I'm flat-chested. Can I breastfeed?

Being small-breasted generally has little impact on a woman's ability to make enough milk for her baby.

In early pregnancy, most women's breasts grow about a cup size or more. This growth reflects the development of milk-making tissue within the breast and is a sign of adequate milk production in the future.

Keep in mind that the size of your breasts is determined by a combination of the milk-making tissue and the fat surrounding it. The amount of fat around the breast is commonly believed to make the difference in size from one woman to the next.

My baby seems drunk after every feeding. What's going on?

Many newborns look drunk after a wonderful, satisfying feeding. I delight in watching a tense, hungry nursling transform into a relaxed and limp little being. Don't worry, just enjoy!

Should I drink whole milk while I'm breastfeeding? 

Milk and other cows' milk products are a good source of calcium. But frankly, you don't need to drink milk at all if you don't enjoy or tolerate dairy products. And you certainly don't need to drink whole milk when you're nursing. Unless a mother is undernourished and has very little fat in her diet, consuming extra fat seems to have little effect on the fat content of her breast milk. Eating a healthful diet, maintaining good nutrition, and nursing often should ensure that your baby gets enough breast milk — and fat.

Should I supplement breast milk with formula?

If your baby is not gaining weight as expected, meaning at least an ounce a day, you may need to supplement. It's preferable to supplement with your own pumped breast milk. You can rent a fully automatic electric pump and pump for five minutes after each of your feedings and offer this milk to your baby. Not only will this provide some or all of the supplement your baby needs but the pumping helps stimulate your milk production. Consulting with a lactation consultant is a good idea if your baby is not gaining weight.

If your baby is gaining well, supplementing is not necessary. The assumption behind giving a supplement is that you're not producing enough milk. Supplementing with formula is often the beginning of the end of breastfeeding. Very soon, one bottle leads to more bottles and eventually to a dwindling milk supply.

Often a fussy baby will make a mother worry that she has too little milk or milk that is unsatisfying. So long as your baby is gaining weight well, be assured that your milk is more than adequate. Speaking to a lactation consultant about some of the causes of fussiness in young babies may be helpful.

What should I do if the thought of breastfeeding in front of others makes me uncomfortable?

You aren't alone! I think most first-time mothers worry about nursing when away from home. The truth is, those first few weeks can be revealing. However, with time and practice, you can develop a technique that is so discreet you'll feel comfortable breastfeeding your baby in almost any situation. 

When you start breastfeeding, you'll probably expose a large portion of your breast as you learn how to get your baby to latch on. After a couple of weeks, most mothers find that their baby has better head control and can latch on more easily, so they don't have to show as much skin.

What to do? Wear a top that can be lifted up easily; use a sweater, jacket, or blanket over your shoulder to hide your breast. Practicing in front of your partner helps build your skill and confidence.

You can always carry a bottle of expressed milk if you are too uncomfortable to nurse when you're out. Or, like many mothers, you may discover that the sound of your baby's cry makes your concerns about feeding in front of others disappear.

Will breastfeeding help make my uterus shrink to its pre-pregnancy size?

Yes. When you breastfeed, the pituitary gland secretes the hormone oxytocin, which primarily acts to contract smooth muscle such as the sacs of milk in your breast. Contraction of the milk sacs causes your milk to move to the front of the breast, making it available for your baby. You'll probably feel this as the "letdown" reflex. With each feeding, oxytocin also causes the smooth muscle cells in the uterus to contract, enabling the uterus to shrink to its pre-pregnancy size. Oxytocin has one other important effect: inducing loving feelings in moms toward their babies. That's why it's sometimes called the love hormone. 

Posted on: 10/02/2017 00:00 By Bellema

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