Breastfeeding and Supplementing Breastfeeding Problems

I’m breastfeeding, but I think my baby is starving!

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How much did he weigh? How long was he? What were his Apgars? 

All of the numbers are enough to make you nuts!  We want to be able to see and measure everything, but with breastfeeding, this part can be super frustrating. All parents want to know how to know if their baby is actually getting anything when they’re breastfeeding. It’s easy to assume that if you’re struggling with breastfeeding that the baby isn’t getting any breastmilk. Below I’ve written a little sample convo between myself and a new mama about this problem. I outline exactly the recommendations I make to moms in this situation and offer tips and tricks to overcome it.

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The Situation:

3 day old baby.

First time mom.

Outpatient visit after discharge from hospital.

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Mom: My baby was breastfeeding well in the hospital, but the first night home was terrible. My baby acted like she was starving and I wasn’t making milk yet so I ended up giving her formula. Now I wonder if she was even getting anything from me at all.

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Lactitioner: First, a few questions:

  • How many diapers did your baby have each day?
  • Did your baby need to be supplemented in the hospital?
  • Was the baby jaundiced?
  • Did the baby lose a lot of weight?

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Mom: The baby had a lot of poop diapers on day one, but only one on day two. The pee diapers were fine. The baby never got supplemented in the hospital. No, the baby was not jaundiced. I was told her weight was ok.

Lactitioner: The diaper output sounds ok. Typically we are looking for at least 1 wet and 1 poop diaper on day one and 2 wets and 2 poops on day two. However, the first stools are meconium (looks like black tar/ made up of all the swallowed junk while in the womb), and there is a limited amount. If baby poops a lot on day one, he may poop less on day two. He’s not pooping out what he’s currently eating until the poop turns green then yellow.

 The pee diapers are indicative of hydration status. If the baby has the minimum number of diapers and the urine is light in color, that’s good. However, if the urine color is dark orange or red or even looks like little crystals, that indicates that the baby is dehydrated and may need to be supplemented. (Read here about supplementation.)

Newborn jaundice is either due to poor feeding or Rh incompatibility. I’ll write more about this in another post soon, but for now it sounds like your baby must have been feeding well if the bilirubin was not elevated.

All babies lose weight after delivery. The research tells us that up to a 10% loss from birth weight can be normal. However, most healthcare providers will want to evaluate feeding closely and intervene if the baby is approaching 8-9%. If you were told the weight loss was ok, you can assume that it was less than this and baby was getting something.

Mom: OK. Maybe she was getting something in the hospital, but why does she act starving now?

Lactitioner: The volume of colostrum that you’re making in the early days is small, which coincides with the small size of the baby’s stomach. Your milk should come in somewhere around days 3-5 (possibly on the later end if you had a c-section), but you’re still making enough colostrum before that to meet his needs. Each day the baby’s stomach stretches and the amount that she wants grows, as well. This coincides with your milk volume growing.

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Milk Supply

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Usually on the second night babies do what is called “cluster feeding”. (Read here about cluster feeding.) This has nothing to do with hunger, but more that the babies are looking for comfort. They usually suckle briefly and then fall asleep, but wake and fuss when removed from mom’s arms. This can go on for hours. I’ll repeat: This has nothing to do with hunger. She just needs some extra snuggles. By the third night the baby is ready for the milk to come in and they usually do some cluster feeding as one last push to the body to bring in the milk.

 Mom: So how do I know if it’s cluster feeding or that she’s starving?

 Lactitioner: Here are some signs to help you know the difference: 

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Cluster Feeding:

  • usually begins on the second night of life
  • short feedings followed by sleep
  • baby only happy with nipple in his mouth, not necessarily sucking
  • baby fusses when put down, displays feeding cues
  • may settle with a pacifier

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  • fussy or frantic throughout the feeding
  • wiggling a lot during the feeding
  • primarily quick, short sucks
  • few swallows heard
  • not content after feeding
  • if using a nipple shield: no colostrum in the tip of the nipple shield
  • doesn’t settle with a pacifier

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Feeding Cues

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Lactitioner: If you determine that your baby is actually hungry, here are the steps to take:

  • feed the baby (either expressed breastmilk or formula)
  • begin hand expressing or pumping every time you supplement the baby
  • have your feeding evaluated by the lactation consultant

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Moral of the story >>> Things to not do:

  • Don’t make any judgments on your milk supply based on whatever comes out with the pump. The pump isn’t as effective as the baby and isn’t a reliable indicator of your true supply.
  • Don’t assume you have a low milk supply and start taking all kinds of supplements to increase it. The vast majority of mothers I work with for “low supply” don’t truly have a low milk supply. If you’re concerned about it, talk to the lactation consultant. (Read here about milk supply.)
  • Don’t quit (unless you really want to, which is absolutely ok). The first few weeks are the hardest. Get help ASAP. Don’t wait. You’ll be glad you did. Sometimes I see moms in the outpatient clinic 5 times before they feel confident. Take advantage of it! (Find a lactation consultant here.)

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Have you had a similar experience?

I’d love to hear how you worked through the rough moments!

Let me know in the comments below.


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