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Online Chats about Breastfeeding
Wednesday, September 20, 2006 and Tuesday, October 10, 2006
Welcome to this chat with Mercy's experienced lactation consultant, Claudia Barber. To get started, why don't you tell us about your background, Claudia?
Claudia: I've been helping families breastfeed for almost 30 years, first as a La Leche League leader, then as an International Board Certified Lactation Consultant, and now as an RN as well. I also have four breastfed children, who provided my most important education.
Q. My baby nurses every 2-3 hours around the clock and my mother tells me I don’t have enough milk or the baby would be sleeping longer in between. How do I know my baby is getting enough?
A. Most babies in the early weeks nurse at least that often -- we actually want them to breastfeed at least 8 - 12 times a day. The more the baby nurses in the first few weeks, the more milk you will have, not just then but for as long as you wish to breastfeed. Many people are used to bottle-fed babies, who typically eat every 3 - 4 hours, and assume breast babies aren't getting enough. The best way to tell your baby is eating well is to look at the following: Does she nurse at least 8 - 12 times a day. In the first 5 - 6 weeks, does she have at least four bowel movements and 6 - 8 good, wet diapers in 24 hours? Does she sleep contentedly, but if you need to wake her to eat, is she easy to rouse? Does she have quiet, alert times when she interacts with people, but isn't fussy? Then, too you can look at weight gain and developmental stages, but of course, you won't notice those from day to day.
Q. What can I do to make more milk?
A. Assuming your baby is breastfeeding well, the best way to make more milk is to breastfeed more frequently. Full breasts make milk slowly; emptier breasts make milk more quickly. If you're doing that for several days and don't notice an increase in supply, please give us a call, either at Mercy On Call (800 358 2767) or the lactation office at 339 3975 (you'll probably get our voice mail and we'll call you back).
If your baby isn't nursing well, we need to correct that and probably have you do some pumping to protect and increase your supply in the meantime.
Q. How much fluid should mom drink during the day? Does that make a difference?
A. You should "drink to thirst," that is, drink enough, and often enough, to avoid feeling thirsty. A good way to tell is that your urine is pale and plentiful -- if it's not, try to drink more water. Generally, the amount you drink has little effect on the milk supply, unless you drink so little you're dehydrated, or 'way too much.
Q. My baby is 2 weeks old and it still hurts when she nurses. Is this normal?
A. Many women experience some mild tenderness in the first week or two, usually just when the baby starts to nurse. In fact, it's called latch-on tenderness. It usually has pretty much faded away by two weeks, but some women notice a little ouch at almost every latch-on for as long as they nurse. Does this sound like what you're experiencing, or is it different, hurting worse or lasting throughout the feeding, for instance?
Q. I know babies have growth spurts; how do I know when my baby is having one?
A. With some babies, it's really obvious. The first one usually comes sometime between day 6 and day 10, and the baby has, or had, settled into a somewhat predictable eating pattern. Then wham! He suddenly acts like he's starving and wants to eat constantly. Some babies will nurse once an hour for several hours, take a nap, and then do it all over again. After about two days of this, all that nursing has increased your supply to meet the baby's new need, and he'll be able to go longer between feeds again.
Other babies are already breastfeeding so frequently that mom really doesn't notice the growth spurt until she weighs the baby. There are other growth spurts in the first several months, but that first one is the one that often worries parents.
Q. How long can you store breast milk?
A. Fresh milk is good in the refrigerator for 5 - 7 days; frozen milk should be used within 24 hours of being defrosted. Times vary for milk kept in the freezer, from two months to at least a year, depending on how cold the freezer is.
Q. My baby is six weeks old and I have to go back to work. How do I prepare for that?
A. First, make sure your employer makes whatever accommodations you need for pumping at work, unless you plan to use formula while you're away from the baby. You need a private place to pump (not the restroom) and flexible time in which to do it. Be sure you buy a quality double electric breast pump if your employer doesn't provide one. (Many insurance policies now cover part of the cost.) Good pumps typically cost about $300; the cheap ones are a waste of money. Do some pumping before you return to work, both so you're comfortable with the pump and so you have a small supply of milk in the freezer. Have the baby's father or a grandparent teach baby to take a bottle -- if you have difficulties, give us a call, we have a bag of tricks to try. Once you're back at work, you may have additional questions; if you leave us a detailed message and your home phone number, we can give you some information on your answering machine and not bother you at work.
Q. Do you have any suggestions for handling leaking?
A. There are many brands of nursing pads on the market, and some work better than others. If you're out in public and starting to feel full, you might want to find a quiet place and nurse the baby, to keep from leaking. If you're without the baby, try pressing the palms of your hands against your nipples for 30 - 60 seconds. Leaking is a much bigger problem for some women than for others; it tends to be worst with your first baby. Not leaking does NOT mean, all by itself, that you don't have enough milk.
Q. Will using a pacifier take away my baby's urge to nurse?
A. A pacifier can temporarily satisfy a baby's sucking need, so she quiets and goes to sleep -- that's why they're called pacifiers, because they pacify babies. The problem is, the baby probably needed to eat, and now she's asleep, having missed out on her feeding, and not having stimulated mom's breasts to make more milk. In the early weeks, pacifier use should be limited so baby gains weight well and mom establishes a good milk supply. However, if your nipples are tender, a pacifier can help meet baby's sucking needs until your nipples feel better.
Q. How much can I bottle feed and still breastfeed?
A. That depends on your baby: many babies can go back and forth between breast and bottle without difficulty, but many others develop nipple confusion, or nipple preference, and begin to hold out for the bottle. If you want to breastfeed, it's best to avoid bottles for the first 2 - 4 weeks, both to get your supply well established and because nipple confusion tends to be less of a problem as baby gets older.
Q. I was wondering how a milk protein allergy would affect my twins breast feeding. I would like for them to be able to continue nursing until they self wean, but was wondering if they would be lacking certain nutrients because I can no longer consume milk.
A. Your babies will be fine without your drinking milk -- you don't have to drink milk in order to make good, high-quality milk. For your own sake, you probably should take a good calcium supplement. Check with your health care provider about it. And be a little slow about introducing solids -- one food sensitivity in the family may mean there are more.
Q. I used to go to the breast feeding support group on Thursdays but once school started, I am no longer able to attend.
A. There are other resources available to you. The local La Leche League group meets the second Thursday of the month at 7:00 p.m. and is similar to the Mercy group -- we actually modeled our group on LLL. There are also on-line support groups: www.lalecheleague.org has chat rooms about various topics, and leaders arewell educated and current with ther information. Some of the women who come to the Mercy group use other sites as well, but I personally can't vouch for them.
Q. I know that it can take up to a month before the protein is gone from my milk. At one point during group, I know some mothers mentioned that they mix their older milk that has the protein in it with newer milk without the protein. Doing this cuts down on the amount of protein found in the milk. At what point can I stop doing this? Or should I just wait the full month?
A. Do you mean the cow's milk protein? If so, you might want to wait until the babies have had a couple of weeks without any dairy protein in their diets, and then try the mixing method the other moms told you about. If you see any signs that they're not tolerating the mixture, you could wait 2 - 3 weeks (with the dairy-free milk in the meantime) and try again. As they get older, they weigh more and their digestive systems are more mature, you may find they can handle the mixture better. If not, you might consider donating your milk that has dairy in it to the Mother’s Milk Bank at the University of Iowa.
Q. Do you have any advice for sore nipples?
A. lot depends on why they're sore. In the first week or two, many women experience mild tenderness, usually just when the baby begins to nurse. In fact, it's called latch-on tenderness. It usually fades away by around two weeks, but some women notice a little ouch at almost every latch-on for as long as they breastfeed. However, if you're having major tenderness, especially if it lasts most of the feed, and/or if you have blisters, tiny bruises, or cracks in your nipples, baby is doing something wrong. If you give us a call at 339 3975, or 800 MERCY IC, we can set up a time and have you come in for help. We do this all the times, there's no charge for it, and everyone is welcome no matter where you had your baby.
Q. Any suggestions for how my younger children can get involved with this experience?
A. If you can, talk to them ahead of time about all the things they can do to help; even an 18-month-old often can bring you a diaper, or share her blanket with baby. Older kids can be responsible for bringing you a drink, answering the phone, holding baby's hand or foot, anything you can think of. I often suggest that just before you think baby will need to eat, get big brother a snack and a drink and change his diaper or help him with the bathroom, so those needs are met. Then keep a stack of his books by your nursing chair so he can feel included while you and baby are snuggling. (You may need to have him turn the pages the first few weeks.) If he's too active for that, try a basket of toys he only gets to use during nursing time, and change them out from time to time, so they stay interesting. Early schoolager children can be encouraged to read to you and baby; babies love the sounds of siblings' voices, and it's a good way to encourage reluctant readers as well.
Q. Could you give some advice to mothers thinking about going back to work and how to prepare for that?
A. First, make sure your employer makes whatever accommodations you need for pumping at work, unless you plan to use formula while you're away from the baby. You need a private place to pump (not the restroom) and flexible time in which to do it. Be sure you buy a quality double electric breast pump if your employer doesn't provide one. (Many insurance policies now cover part of the cost.) Good pumps typically cost about $300; the cheap ones are a waste of money. Do some pumping before you return to work, both so you're comfortable with the pump and so you have a small supply in the freezer. Have baby's father or a grandparent teach baby to take a bottle -- if you have difficulties give us a call, we have both so you're comfortable with the pump and so you have a small supply in the freezer. Have baby's father of a grandparent teach baby to take a bottle -- if you have difficulties give us a call, we have a bag of tricks to try. Once you're back at work you may have additional questions; if you leave us a detailed message and your home phone number, we can give you some information on your answering machine and not bother you at work.
Q. Does Mercy offer some type of support groups or classes?
A. There's a prenatal breastfeeding class offered every month; most are the second Thursday evening of the month, but in February and November we offer the class on a Saturday morning. We encourage you to bring a support person, whether baby's dad, a grandparent, or a good friend. We've never had a class where just one father was present, if anyone's nervous about coming!
We also have the Breastfeeding & More Group, which meets every Thursday at noon. A few women come while they're pregnant, but most come with their babies. We have a scale, if you want to weigh your baby, a lending library, and most important, 12 – 15 other moms to exchange ideas with. The group is facilitated by a lactation consultant, or other experienced OB nurse, but the support from the other moms is really important. Fathers, grandparents, older siblings, and friends are all welcome. You can register for the class by calling Mercy On Call at 800-358-2767. The group is free: no need to register or be on time. Both the class and the group are open to everyone, regardless of where you deliver your baby.
Q. Can you provide some contact information if parent's have questions about breastfeeding?
A. The lactation number is 339-3975 or call 800 MERCY IC and ask for the lactation consultant. Another good way to reach us in through Mercy On Call, 800-358-2767. If you feel your call is urgent, please call your baby's doctor, or the nursery at 339-3580.
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