Feeding On Demand

Nursing on demand can be a wonderful thing. Let us remember that nursing on demand means allowing your baby to feed at the breast as many times as he wants and for as long as he wants.

I want to emphasize that this does *not* mean allowing your baby to go long periods of time without nursing.

On average, a newborn baby in the first 24 hours of life will nurse about 4 times. Most of the time these babies turn out fine, and mom can go on to have a good nursing relationship. BUT, following these guidelines to the best of your ability (what works for YOU!) is extra insurance that your nursing relationship will start off excellent. Ideally, you want to encourage your baby to eat at least 10 times in 24 hours. 

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The more your baby nurses;

  • the faster your milk volume will increase.
  •  the faster your baby will expel meconium which harbors bilirubin, that can increase the chance of pathologic levels of bilirubin (leading to jaundice) if not expelled. 
  • the less likely you will suffer from rock hard engorged breasts when your milk increases in volume between days 3-5.
  • the less likely your baby will be readmitted to the hospital for jaundice, hypoglycemia, dehydration, hypernatremia, or excessive weight loss.

What if my baby won’t wake up to eat?

In the first hour or two after birth is when baby will be more alert and willing to nurse. After this, it is common for them to be really sleepy for several hours. In fact, a newborn will typically sleep for about 20 hours in the first day of life. It is still important to watch for early hunger signs such as stirring in their sleep, licking their lips, and bringing their hand to their mouth. Crying is a late hunger sign. Bring your baby to breast if your baby is exhibiting these signs. Ideally, you want your baby skin to skin for as long as possible, this helps facilitate the breastfeeding experience.

What if my baby still won’t eat after watching for hunger signs?

There are quite a few options you can do to ensure your baby is being fed. According to the literature, it is not necessary to supplement a baby in the first 24 hours. These guidelines I am explaining are an ideal situation and should be a goal for establishing breastfeeding. If your baby won’t nurse you can still express your breast milk. It is most effective to do hand expression while your breasts are mainly producing colostrum. Try to do hand expression every 2-3 hours, the same you would do if your baby was nursing. You can hand express into a spoon or in a little plastic medicine cup. You can then use a dropper to feed your baby your expressed colostrum, or save it for a later time. You can also use a manual breast pump, a personal breast pump, or a hospital grade double electric breast pump. Have your IBCLC verify that the flanges fit your breasts correctly, and teach you how to assemble the pump. It is imperative that you don’t use high suction on the breast pump before your milk increases in volume. Using high suction can damage your nipples, breast tissue, cause the nipple to swell, and ultimately cause pain. A very gentle, soft suction stimulation is all that is needed. You most likely won’t get much with the breast pump. This is okay, and it’s normal. To maximize production with a breast pump, use hands-on pumping. This is when you massage and compress your breast as you’re pumping. Express your milk every 2-3 hours, until your baby is able to nurse. Colostrum is thick and syrupy, and can be difficult to express. It takes practice!


Keeping track of nursing in the beginning is helpful for everyone, but why should you worry about it? It helps let us know how nursing is going when no one is there to help you. If we see that baby is nursing frequently for a decent amount of time, and you aren’t having pain, and baby isn’t losing weight excessively, then we have more puzzle pieces to say, “Yes, nursing is going ok for you!”
However, if we see that baby isn’t nursing frequently, is having very short nursing sessions (less than 10 minutes), you’re reporting pain, baby is losing more weight than normal, or is starting to jaundice, then we have those puzzle pieces to get you the extra help that you need. Hopefully from an IBCLC!
Minimizing bumps in the road early on will help establish breastfeeding and prevent negative breastfeeding experiences for you. Nursing isn’t always easy! As an IBCLC, I made a vow to myself not to let these moms and babies fall through the cracks. We must be vigilant, listen to you, and look at the entire picture in order to be most helpful to you.
I hope you’ve found this infograph to be helpful! Let me know if you have any questions.

Edited to include: Explanation of delayed onset of milk production.

There are several risk factors for why milk takes longer to increase in volume. Risk factors include; cesarean birth, excessive IV fluids, first child, traumatic birth, long birth, hormonal issues, and anatomy issues. This list is not 100% complete as there are a lot of risk factors involved. Frequent nursing isn’t a guarantee that your milk volume will increase faster, or even in the normal time frame (3-5 days after birth). If you aren’t noticing significant breast changes by day 3 or 4, make sure you consult with an IBCLC to evaluate your specific situation. In some cases, supplementation may become necessary if milk doesn’t increase in volume between days 3-5. It is not normal for it to take longer. It may be common, but it is *not* normal, and there are specific interventions to help in these situations.

http://kellymom.com/ages/newborn/when-will-my-milk-come-in/

Feedingondemand

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Circumcision Harms Breastfeeding

Before I delve into explaining why circumcision harms breastfeeding, I thought I would take the time to thoroughly define what circumcision is. Circumcision is the surgical removal of the prepuce, also known as the foreskin. The foreskin is protective tissue that covers the glans of the penis. This prevents the glans from becoming hard and keratinized as it is meant to be an internal, self-cleaning organ. It also serves several other functions, to learn more about the functions of foreskin click here. Circumcision is most often times done in the hospital, sometimes just hours after birth, or done for religious reasons on the 8th day of life. It can also be performed later in childhood for cultural reasons or as an adult for medical reasons, which is pretty rare.

“The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity.”

Circumcision is a painful procedure (even with anesthetic) and begins with the foreskin being grasped with forceps and the opening being forcefully stretched open. Then a metal probe is inserted into the foreskin opening which tears the foreskin away from the glans which is adhered to the glans like your nail is on your finger or toe. After that a cut it made down the middle of the foreskin with scissors. Then the foreskin is crushed, clamped (if using gomco), and cut off by a scalpel.

To see a video of a circumcision click here.

Could you imagine just being born (or even as an older baby or child) and then being subjected to this treatment? Even with anesthetic this procedure is extremely traumatic for a baby to go through. So how does this directly relate to breastfeeding? Let me explain…

There is a physiologic process that your body goes through in order to successfully begin and maintain lactation. How you manage breastfeeding can make or break your chances of meeting your breastfeeding goals. Breastfeeding already can get off to a rocky start depending on how the labor and birth went. The longer an epidural is in place the greater chance that hormones necessary to start lactogenesis stage 2 will be diluted and not function as effectively. Because epidural medication lowers blood pressure, intravenous fluids must be given to maintain blood pressure. This can cause fluid volume over load which leads to 3rd spacing. This causes your feet, legs, nipples, and other parts of your body to become swollen. This can make it really hard for baby to latch on correctly to feed, leading to nipple trauma, pain, and ineffective milk transfer. Epidural rates in America are really high, so this is already a potential “bump” in the road to a good start at breastfeeding.

Milk volume begins to increase between days 3-5 after birth. This will happen regardless if a mother chooses to nurse her baby or not. The important factor here for a breastfed baby is keeping that baby on the breast as frequently as possible. Ideally the baby should nurse 10+ times per day, and this is for multiple reasons.

  1. Babies are born with a high suck need, which serves two main functions. Recall, “My baby is using me for a pacifier!” I’m sure you’ve heard that said a lot. It’s normal. The more the baby sucks on the breast and consumes that protein rich colostrum, the faster the baby will conjugate their excess bilirubin, preventing pathologic levels of bilirubin, which, if left to accumulate turns into jaundice. Sucking causes peristalsis which helps to excrete the newborn’s meconium, which is full of bilirubin, and is a process necessary to avoid jaundice.
  2. Frequent nursing (10+ times in 24hrs) during lactogenesis stage 1 (the time period before milk increases in volume) helps to ensure a healthy long-term milk supply. Prolactin is a hormone that circulates in your body (that can be diluted by excess fluid volumes during labor) that helps stimulate milk production. Stimulation of your nipples and breasts tell prolactin to plug into prolactin receptor sites located in the breast. The more early and effective nursing that the baby does, the more this hormone will go to the right place within the breast. And this is essential for having a good long-term milk supply.

Now that you’re familiar with the physiologic process of the beginning stages of breastfeeding, and what circumcision is, I will connect the two in the following list…

  1. Circumcision requires time spent away from the mother. Usually an hour before the procedure, and 2 hours after to monitor the baby for excessive bleeding. When a newborn is not breastfeeding they should be skin to skin with mom or dad. This enhances the bond between baby and parents and helps to establish their delicate and new microbiome. It also helps milk increase in volume faster.
  2. Circumcision is a traumatic event that compromises the bond between mother and child.
  3. Some facilities require fasting before the procedure to prevent aspiration from vomiting due to severe pain. This keeps the baby from breastfeeding as much as they should be.
  4. Most baby boys that are circumcised are very hard to wake after the procedure.  Sometimes they will not eat for 6-8 hours!
  5. Urination on the raw open wound in the diaper causes extreme pain which can disrupt breastfeeding due to pain.
  6. Research has clearly demonstrated that pain adversely affects breastfeeding during the early stages.
  7. Most of the time doctors will give the baby a pacifier to cope with the pain of circumcision, and pacifiers should be avoided in the early weeks, until breastfeeding has been established.
  8. Pumping in place of the baby nursing is not as effective.
  9. Ineffective nursing can lead to decreased milk volume.
  10. The baby depends on minuscule, consistent feedings of colostrum in order to thrive in the early days. Inadequate caloric intake can cause the baby to be too sleepy to eat, which can lead weight loss of greater than 10%.

“Newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.” – American Academy of Pediatrics

A breastfed newborn baby should be breastfeeding 10 or more times per day. This is best practice to ensure an adequate long-term milk supply and to prevent hyperbilirubinemia, hypernatremia, and hypoglycemia.

“The pain of circumcision causes breastfeeding problems in some babies. After this procedure, a baby may have trouble settling in at the breast, may refuse the breast, or may shut down and be unresponsive.”

Mohrbacher, Nancy. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Plano: Hale, 2010.

If a baby is not nursing for 6-8 hours because they are exhausted from going through the pain of circumcision…

If a baby is not stimulating the breast helping the milk to increase in volume…

If a baby is not nursing they are not causing peristalsis within their gut to get rid of meconium…

If a baby is not eating it can lead to dehydration and hypoglycemia…

Not only does circumcision harm breastfeeding, it harms the child.

Gentian Violet

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Gentian violet is a popular remedy for oral and nipple candidiasis (thrush) in the breastfeeding world. There are some things to consider about this medication in order for you to make an informed choice.

Gentian violet is derived from coal tar and is not meant to be ingested. Gentian Violet
It is carcinogenic and potentially toxic to mucus membranes which can result in ulcers in the mouth and throat. Gentian Violet Use While Breastfeeding

It is imperative that if you choose this to use to treat thrush while breastfeeding you do not use the 2% concentration, 1% has been the recommended dosage. Jack Newman has an article dedicated to the proper usage of gentian violet. Using Gentian Violet

What are some other ways to bring yeast back to normal levels?
Fluconazole medication in combination with all purpose nipple ointment.
Nystatin, although candida albicans has become resistant to this medication.
“Raw Apple Cider Vinegar diluted 50/50 with water and adding 1-2 drops of grapefruit seed oil extract. Mom then uses a qtip to paint the areas directly 3-4x/day” –Dr. Ghaheri
Avoiding excessive amounts of sugar and processed foods.
Acidophilus

These are just *some* of the ways to treat thrush. Make sure to link up with your healthcare provider and an IBCLC to see which treatment would be most effective for you!

Is placing your baby in sunlight enough to treat jaundice?

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Is putting your baby by the window good enough to treat jaundice? Maybe if they only have slightly elevated levels of bilirubin. Let us examine the evidence behind this ever so famous suggestion. *this is not medical advice, ALWAYS consult with your baby’s pediatrician*

“Putting your baby in sunlight is not recommended as a way of treating jaundice. Exposing your baby to sunlight might help lower the bilirubin level, but this will only work if the baby is completely undressed. This cannot be done safely inside your home because your baby will get cold, and newborns should never be put in direct sunlight outside because they might get sunburned.” Neonatal Jaundice: to sun or not to sun?

“In their original description of phototherapy, Cremer et al demonstrated that exposure of newborns to sunlight would lower the serum bilirubin level. Although sunlight provides sufficient irradiance in the 425 – to 475nm band to provide phototherapy, the practical difficulties involved in safely exposing a naked newborn to the sun either inside or outside (and avoiding sunburn) preclude the use of sunlight as a reliable therapeutic tool, and it therefore is not recommended.” (Cremer RJ, Perryman PW, Richards DH. Influence of light on thehyperbilirubinemia of infants. Lancet. 1958;1(7030):1094–1097)

“The practice of placing jaundiced infants under sunlight to reduce discoloration is a cultural health belief in most communities and appears to be effective in many anecdotal reports. In fact, midwives, nurses, doctors and pediatricians were identified to be the main professional sources of this belief [1]. In an in vitro experiment, it was found that sunlight was 6.5 times more effective than phototherapy in the isomerization of bilirubin compared to a phototherapy unit [2]. However, there are no appropriate controlled trials comparing the efficacy of sunlight to no treatment or artificial light therapy in jaundice [3]. Delayed treatment of severe jaundice in an otherwise healthy baby can result in the development of kernicterus – a complication causing brain damage as result of bilirubin deposition in the central nervous system [4]. Hence, withholding phototherapy would be unethical in controlled trials. We should not recommend sunlight for routine treatment of jaundice as this would encourage parental misconception that home therapy is adequate and result in delayed healthcare seeking behaviour. Moreover, there are concerns of adverse effects of sunlight exposure causing skin tanning, sunburn and hyperthermia.” Neonatal Jaundice: To sun or not to sun?

Anything done in vitro (tests done outside of the body in regulated conditions) is going to be almost always different when trying to replicate the results in vivo (things that happen within the body).

“In the late 1950s, phototherapy emerged as another potential treatment of jaundice. In 1956 at Rochford General Hospital in Essex, England, Sister J. Ward noted that sunshine decreased neonatal jaundice. Meanwhile, hospital biochemists noted erroneously low bilirubin levels in samples sitting in sunlight before processing.” A Tale of Two Hospitals: The Evolution of Phototherapy Treatment for Neonatal Jaundice

Listed below are 2 valuable resources for informing yourself about the management of jaundice.
ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant Equal to or Greater Than 35 Weeks’ Gestation
Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
Also be aware that there are several types of jaundice, all with their own style of treatments.

What should you do if your baby is jaundiced? Talk to your pediatrician and link up with an IBCLC. Some moms don’t like hearing that their baby needs to be supplemented, and that is totally normal. Supplementation doesn’t always mean formula, consider hand expression or pumping to provide your baby’s supplementation. Colostrum and breast milk clears excess bilirubin much more effectively and also doesn’t disrupt the very sensitive and immature microbiome in your baby’s stomach. Also ask your doctor about donor milk if you are not able to express enough milk to adequately supplement your baby.

Supplementation doesn’t equal “bottle” … there are many different ways of delivering supplement to your baby. You can tube feed at the breast, cup feed, finger feed, or use a dropper.
There are many ways to cope with a jaundice diagnosis. One of the best ways is arming yourself prenatally with information on how to deal with it so you know all of the options.

 

The TRUTH About Poop!

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I have heard a lot of misinformation regarding the normalcy of a breastfed infant’s stooling patterns lately. It’s time to clear that up in today’s post, The TRUTH about poop.

Misconception #1: “It’s okay for a breastfed baby not to poop.”
Truth: It depends on the age of the baby. After 4-6 weeks of age the composition of breast milk changes and this is why babies may poop less frequently. However, before 6 weeks it is very important to monitor your baby’s output. What is normal anyway?
Day 1: 1 stool/1 urine
Day 2: 2 stools/2 urines
Day 3: 3 stools/3 urines
Day 4: 3 stools/4 urines
Day 5: 3 stools/5 urines
Day 6: 3 stools/6 urines

After 6 days it levels out to 3 stools and 6 soaking wet diapers per day.

If a baby doesn’t poop at least once in 24 hours you should consult with your baby’s pediatrician and then a lactation expert to assess breastfeeding.

Misconception #2: “My baby isn’t pooping because breast milk is efficient and is completely absorbed.”

Truth: Again, age is a factor. What goes in, must come out. Output is a great way to monitor intake. We cannot know how much a breastfed baby gets in a feeding so making sure the baby is voiding appropriately is one way to know baby is getting enough to eat. Why is this so important? The number one reason for not meeting these minimums is inadequate milk intake.

Misconception #3: “The blue line in disposable diapers is enough to measure adequate urine output.”
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Truth: This is a very helpful tool no doubt that indicates whether or not your baby has dirtied their diaper. Another method that is helpful is placing a piece of toilet paper or Kleenex in the diaper. How wet is “soaking wet” … Did you know that these recommendations come from cloth diapers and not disposable? An example you can do at home to demonstrate a soaking wet diaper is to take 3 tablespoons of water and pour it into a diaper, cloth or disposable. Once you get a feel for what it’s supposed to be like you will be able to tell if your baby is urinating enough during the day.

In conclusion: These are the current recommendations for normal voiding habits for healthy newborns. YOU know your baby best. Trust your instinct mamas! Most babies meet these minimums just fine. If you feel like something may be up or you’re concerned you can always call and ask your care provider or link up with a Lactation Consultant. It’s important to keep this information in mind before saying that it’s ok for a baby not to poop. That may or may not be harmful advice depending on the age of the baby. We always want to make sure that when we give advice we do so safely. Your proper guidance may mean the difference between a baby failing to thrive and growing like a weed!

Did your baby ever have trouble meeting these guidelines? What happened? What would your advice be for moms in these situations?

Source: http://kellymom.com/bf/got-milk/supply-worries/enough-milk/
Counseling the Nursing Mother 5th Edition

About

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My name is Miranda Gallegos, I am an Internationally Board Certified Lactation Consultant (IBCLC) located in San Antonio. I enjoy helping women along their breastfeeding journeys and advocating on behalf of those who cannot advocate for themselves.

I am also a nursing student working towards my BSN degree and I graduate in May of 2017. I have two children ages 2 and 3, and I have been married for almost 5 years! I served my country in the United States Army for 5 years and I worked as a laboratory technologist.

My goal with this blog is to provide breastfeeding information as well as discuss issues surrounding pregnancy, child birth, motherhood, and human rights, all of which are very near and dear to my heart.

I also own 2 facebook pages if you would like to check them out!

The Sisterhood of Breastfeeding Support

The Peaceful Intactivists

*Disclaimer – nothing on this site is meant to be taken as medical advice. Please always consult with your healthcare provider and an IBCLC in your area. Anything posted on this blog are my interpretations of data and my opinions. I will do my best to stick with evidence based information and cite my sources.*