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Monday, January 2, 2012

A Common Breastfeeding Issue and Tip to Deal With It

As the mother of an infant, two of the most money saving things I do are cloth diapering and breastfeeding, because food and diapers are things babies go through very quickly, and the expense for formula, bottles, and diapers can add up very quickly.
I've successfully breastfed 2 kids until 19 months; neither of them has ever tasted a drop of formula in their lives, despite having an issue or two or three at the beginning of nursing each one of them, and I've fortunately had a decent start to nursing this time around. While I realize that every woman's body is different, that some people either don't want to nurse or their bodies are incapable of providing enough milk for their baby, or don't nurse for a variety of other reasons, I've learned a trick or two about successful breastfeeding from lactation consultant friends of mine that I wanted to pass on, because it may help some women who want to nurse be able to have a successful nursing career and hopefully save themselves the tremendous outlay that formula feeding would entail.

I've had friends tell me that they'd love to nurse, but their babies are still hungry all the time, that they're fussy, and that it seems that they don't have enough milk to satiate their babies. I've heard other women say that there is something wrong with their milk, that they have only “skim milk”, and that causes their babies to not gain enough weight, so their doctors recommend giving their kids formula to fatten them up.
Yes, there are women who don't have enough milk, and women that their babies do need supplemental bottles of formula in order to thrive, but this isn't about them. Usually, when I talk with these friends, I ask them why they think they don't have enough milk, or why they think their milk is “bad”, and they elaborate for me why they think that.
Then, I asked them a question that often clarified for me that most likely what they thought about their milk supply was not only incorrect, but was actually the opposite of what they assumed, and it was a problem that was easily correctable, and there generally was no need to switch to formula.

Because this has happened to me so frequently, I felt the need to share this information with all you readers, so that it can either help you have a successful nursing career, or so that you can encourage other people who think there is a problem with their milk or their supply, and they feel like they have no choice but to give up nursing. I have to point out that I am not a lactation consultant; if you're having issues with nursing, don't rely on this post alone to help with your nursing issues- please pay a visit to a lactation consultant.

What was this question I asked that would often clarify everything?




When your baby nurses, and after a few seconds or up to a minute, when you have let down, what happens? Does your milk dribble out, or does it generally spray really powerfully, perhaps even a few feet or across the room?
If the answer is that you have a powerful, strong spray of milk when you have “let down”, your problem most likely isn't too little milk, it's too much milk. This powerful letdown is called overactive milk ejection reflex (OMER) and often goes hand in hand with a foremilk/hindmilk imbalance, also known as oversupply.

I have OMER and a foremilk/hindmilk imbalance and when I first nursed my eldest, Lee, I was having problems. I'd nurse and nurse and nurse him, and he'd constantly be fussy, and never really appear to be satiated. Or he'd nurse for a little bit, and only a short time later, again he's want to nurse- he was constantly hungry.
I didn't know what to do. Was there a problem with my milk? Why did my milk look watery? Would I have to give up nursing, even though it was something I felt really strongly about, not to mention not really being able to afford formula? Why was Lee constantly fussy?

Fortunately, I belonged to a forum with a section devoted to nursing, and I posted about my plight and learned some really heartening information. A few lactation consultants and women knowledgeable about nursing there started asking me questions about my let down, and about the color of my baby's poop, and then taught me something really interesting and amazing.

Women's breasts are actually quite special in their ability to produce milk. When giving a baby formula, throughout the feeding session, the baby is getting the same exact type of formula. Not so with nursing.

When your baby first starts nursing, he'll be getting something called foremilk, a watery, liquidy milk that is high in lactose (milk sugar) and low in fat. This works wonderfully to quench a baby's thirst. As the nursing session continues and the baby empties out your store of foremilk in the breast, he'll start receiving something called hindmilk, a high fat, high calorie, thick, creamy type of milk. This hindmilk is what helps your baby pack on weight, and also satiates the baby, as fat is what makes us feel full and stay full. (Remember my post about losing weight from a while back?)

The problem many women have (and I'm discovering more and more of my friends have this) with an oversupply/ foremilk/hindmilk imbalance is that their body produces an extra large amount of the watery, high lactose foremilk.
Why would this be a problem?
Well, a baby's stomach is only so big. Ever drink a really large glass or two of water before a meal, or had watery soup at the start of a meal and then not have much room left for food? This essentially is what happens with a foremilk/hindmilk imbalance. The baby's tummy gets filled with watery milk, and before he can get some of the fattier, richer, milk, he is full and has no room for any more milk, and stops nursing. The problem is that this watery milk, this “skim milk” is not filling, and within a short while, the baby is hungry yet again, and wants to nurse yet again. The baby also might not be getting enough calories to gain weight.
An additional problem is that the foremilk is high in lactose, milk sugar, which in excess quantities, can cause stomach upset in babies, fussiness, gas, and can cause green-ish poops or mucusy poops (or both), instead of of the standard mustardy yellow “seedy” breastfed baby poops.

Standard breastfeeding advice given to new moms used to be “Nurse your baby for 10 minutes on one side, burp the baby, then nurse for 10 minutes on the other side.” If a mom with an oversupply did this, she'd be giving her baby foremilk on one side, but before the baby could get to the richer hindmilk, he'd be switched to the other side to get even more foremilk, making the baby not get any of the more filling, fattier milk that he needs to stay sated and gain weight. Even for a mother without an oversupply, this is bad advice, because the child is less likely to get hindmilk, but for moms with an oversupply it is especially bad advice.
Fortunately, the standard nursing advice given today has been updated; moms are now instructed by lactation consultants to nurse on one side until the baby detaches, then burp the baby, and then offer the baby the second side. While this is certainly better than the old advice of ten minutes per side, this still isn't enough for a mom with an oversupply.

When a woman has a foremilk/hindmilk imbalance, she'll want to make sure that her baby is actually getting the hindmilk, and the way this is done is via a method of nursing called block feeding.
The most basic type of block feeding is that each nursing session, you only nurse the baby from one side. When the baby detaches, burp and then offer the baby the same side again. Only at the next feeding do you offer the baby the other side. This way, by the end of the nursing session, your baby hopefully will be getting the fattier, richer, more filling hindmilk.
Now, depending on how much of an oversupply you have, you may have to do even more to ensure that your baby gets hindmilk. One nursing session you'd offer the baby only one breast. The next feeding you'd offer the baby yet again the same breast, because your baby still hadn't emptied your breast of all the foremilk the first time, and the second session he's likely to get hindmilk. If you have a really large oversupply as I do, you may end up offering the same breast 3-5 feedings in a row, and only after that, offer the baby the other side for the next 3-5 feedings. Every mom has to find what works for her via trial and error, how many feedings in a row she should do on each side so her baby is satiated after and between feedings and no longer is fussy.

If you have an overactive letdown, you'll often find that your letdown becomes less forceful when you block feed, which can make things just a tad less awkward.

I'm going to point out here that I am not a lactation consultant in any way; my only training on this matter is my own personal experience. If you are having any problems nursing, its important to see a lactation consultant- it's money well spent, as you'll likely see a large return for your money by hopefully being able to successfully nurse your baby instead of needing to switch to formula, not to mention all the health benefits involved in nursing.

The point of this post is not to diagnose issues for you, but rather, to clue you in to what I've seen is a very common issue among my friends, so that you don't despair that your “milk isn't good” or that you “don't have enough milk”, even if that may be what it appears to be.

Did you nurse your kids? How long did you nurse them? Did you have any problems with nursing? What type of problems?
Do you either have an overactive letdown or oversupply or both, or know anyone who does?

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1 comment:

  1. I have the same kind of problem, but my baby doesn't want the hindmilk, he just wants the foremilk and is then finished. He won't drink the hindmilk.

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