Expressing milk: how to maximise output

This video is reproduced from Stanford School of Medicine web site:
Click on the video to start it.



This material was developed by Jane Morton, MD Clinical Professor of Pediatrics at Stanford University,and produced for educational purposes only. Copies of the full video "Making Enough Milk, The Key to Successful Breastfeeding. . . Planning for Day One " may be purchased. Please visit www.breastmilksolutions.com for more information.

Self diagnosing your breastfeeding problem

Living here in Japan without much support in our own language, and with so much information freely available on the internet, self-diagnosing your own breastfeeding problems seems easy and economical.

The trouble is that there is a lot of dubious information out there, and it can be hard to sift through it all to get to the good stuff when you have a crying or hungry baby on your knee, and you need a few more hours sleep yourself.

Getting qualified expert help may be crucial to the success of your breastfeeding relationship, so I encourage you to make contact with a real live person if you can, rather than to rely on articles from the internet alone. Years of experience helping real live mothers and babies with their specific breastfeeding situations counts for a lot when it comes to helping you and your baby. Having someone listen to exactly what is happening in your life with baby can help zoom in on the real problem, and following up with some well-referenced internet reading can be a good way of confirming your options.

La Leche League's network of trained volunteer Leaders all over the world helps mothers by phone or email, and discussion meetings are held in many different countries. Here in Japan we have English speaking Leaders in Tokyo, Sendai and Wakkanai, and occasionally there are Leaders on the US military bases. See here for contact details.

There are more international Board certified Lactation Consultants (with the intials IBCLC after their name) around the world now than ever before, and this past year alone, Japan has almost doubled the number of IBCLCs, to 270. As the qualification becomes more and more recognised as the gold standard in breastfeeding management and care, then we will hopefully see more and more staff in hospitals and clinics getting certified. It is a rapidly growing profession and it is very exciting to see improvements in the level of skill and care provided. For IBCLCs in Japan go here or here.

In the meantime, I continue to hear stories every week of parents who were given wrong advice or misinformation and the breastfeeding relationship has suffered as a result, maybe even ended prematurely. Parents are understandably disappointed (sometimes angry) when they hear that there may have been other options.

One example that comes to mind is the common advice by doctors in Japan to wean for 3 days while taking antibiotics. This is usually just wrong. There are many antibiotics which are perfectly safe to take while breastfeeding, and anyway, weaning is not something that can be done "cold turkey" for 3 days...then you would end up being very engorged and possibly even with mastitis from milk stasis, and a severely depleted supply when breastfeeding resumes. Telling the mother to wean for 3 days can have devastating consequences . And what about the baby? What will the baby drink for those 3 days? We know formula changes the way your baby's body works, and why would you do that unnecessarily for antibiotics? A tiny little bit of antibiotics in the milk has far less impact on your baby's health than 3 days of formula. Dr Thomas Hale has written an excellent book called Medications and Mother's Milk to which your doctor can refer to ascertain the safety of medications while nursing.

Another example is when a mother who is concerned about low milk supply is told by her doctor to "pump her milk to see how much she has". A mother expressing her breast, by hand or machine, is nothing like a baby drinking breastmilk directly! For a mother already worrying, being able to express only a few drops just confirms her fears, and is not productive to the ongoing breastfeeding relationship. Expressing milk does not give an accurate picture of the available milk. It would be more constructive for the doctor to educate the mother about ways of knowing her baby is getting enough. (We can judge if baby is getting enough milk by checking the urine and stool output, and by ensuring baby is breastfeeding frequently enough, not by measuring the mother's ability to efficiently express her milk, which is a learned skill in itself.)

It is incredible how much is misunderstood about fully breastfed babies and the way women's breasts work. Perhaps it is because the doctors and nurses have so little experience with successfully breastfed babies that they don't really have the faith or the belief that it is possible to fully nurture a child with breastmilk alone. Or perhaps it is just a general reflection of our society that doesn't value breastfeeding and the special relationship between a mother and baby. But if any of us can read articles on the internet and be informed about current breastfeeding topics and developments, you would hope that a health professional working with mothers and babies would also be keeping up-to-date too.

If you are breastfeeding and you are worried about anything in relation to your baby, as well as your doctor, get in touch with LLL or an IBCLC, and go over your concerns with them. Use them as a sounding board, for an instinct check. Sometimes what looks at first glance like a possible medical problem may just require a minor breastfeeding "tweak". Sometimes your baby may be doing something like refusing solid foods, or suddenly waking more at night or being very gassy. Check in with your LLL Leader or local IBCLC about these, as sometimes even if it doesn't look breastfeeding-related it might be! And sometimes, just talking to an experienced mother can help you decide if you should get a qualified opinion on things.

There is no substitute for your human resources who specialise in breastfeeding...we will do everything we can to support you and get you heading in the right direction, to reach your own breastfeeding goals. Providing you with the best information, the most up-to-date and reliable resources is what we do. Yes, this is a shameless plug...we LOVE what we do!!

Here is a helpful link to show how baby should latch on to the breast. Notice the mother's fingers do not appear on the breast on the side where the baby's lower jaw will attach. A good latch will ensure baby gets lots of milk, and then mother's breasts will make lost of milk too.

The mystery of mother's milk

Happy New Year!
If you are here because you saw us in the January 2007 edition of Tokyo Families magazine, welcome! For people outside Tokyo, my article from their latest edition, the Mystery of Mother's Milk can be read online. This blog and my classes are also listed, along with other post-natal resources.

Making milk is easy!

Download the flyer "Making milk is easy! 10 steps to make plenty of milk " from the Massachusetts Breastfeeding Coalition - available in English, Spanish, Portuguese, Italian & French.

To supplement or not?

Some doctors are not as supportive of breastfeeding as you would wish. If you are having problems, and the doctor advises supplementing with formula without really investigating how and why breastfeeding is not going as well as it should, you may like to check out the information from the Academy of Breastfeeding Medicine. These are protocols written by doctors for doctors on important topics like supplementation (in English and Japanese) based on protecting the breastfeeding relationship. You might even consider sharing the information with your doctor.

Of course your doctor wants to see your baby growing and thriving, but in Japan the supplements are too often a quick-fix solution. Somewhat surprisingly, supplements are routinely offered at many hospitals if a mother complains she is too tired and wants to sleep after the birth. This is just bad practice. Everyone is tired after having a baby...but you learn to breastfeed by breastfeeding, not by having someone else take care of your baby and feed supplements. Then the mothers complain they don't have enough milk, but your breasts don't continue to produce milk if you don't use it! This is known as the "use it or lose it" principle.

Supplementation with formula changes the gut flora in the baby, and can seriously affect your baby's health both now and in the future (allergies, diabetes, ear infections...the list is very long) so it is not something that should be approached lightly. Supplementing with the mother's own milk is always a better first choice, and if supplementation is indicated, mothers need good advice and support on how to express and use their own milk. "Just one bottle won't hurt "...or will it?

To increase your baby's breastmilk intake, also see Dr. Jack Newman's recommendations and contact a local Lactation Consultant or your local La Leche League Leader.

Baby poop

Eeeeew, yucky topic, I know, but it is amazing how people have had so little exposure to this natural function that they don't know what is normal, and baby comes along, and panic sets in.
Newborn babies first pass meconium, a thick blackish tarry poop, which is very sticky. It has been collecting in the baby's gut in utero. Often the hospital or clinic staff change those diapers/nappies, but sometimes it is Dad's job, lucky guy.

As baby takes in more breastmilk, the poop will become lighter, first becoming a greenish colour after a day or so, then becoming more yellowish, as baby gets more milk. By about Day 5 you should see baby with more copious stooling patterns, and the poop will be mustardy coloured and LIQUID. The poop will sometimes have curdy bits that look like cottage cheese, sometimes it will be more watery, and sometimes it may even have a greenish tinge to it. None of these things are cause for concern.

How many times a day do we expect babies to poop? When they are very little, they should be going several times a day, and the number of poops is pretty reliable as an indicator of whether baby is drinking enough breastmilk or not. If things are going well with breastfeding, you may see between 2 and 5 poops every day, sometimes more. If your baby is less than a month old and not stooling at least twice a day, it could be an indicator that baby is not getting enough breastmilk, and you should have someone observe your breastfeeding to be sure baby is actually transferring milk during the time spent at the breast. Lots of parents take their babies to the doctor at this point, wondering what to do about constipation.

Breastfed babies RARELY ever get constipated. In the first couple of weeks, if they are not stooling, it generally means they need more frequent and effective breastfeeding. More calories makes more poop. It is amazing how many doctors suggest using Q tips to get baby to poop. It is such a dangerous practice, and parents often go home and use that method each day to get baby to poop. A baby who doesn't poop should first be checked to be sure your baby is breastfeeding frequently and well.

Let's just repeat this: More calories more poop. Isn't it more important that your baby is getting enough breastmilk rather than focussing on getting the poop to come out?

Breastfeed at least 8-10 times a day, even more if you are worried. If you have been told by the hospital or clinic to breastfeed only 5 or 10 minutes per breast (a common practice in Japan), it is very likely this is contributing to your baby's shortfall of calories.

Breastfeed longer and as effectively as possible on one side first. Be sure you hear baby swallowing. Finish the first breast first before offering the other side. If baby is sleepy, you can burp or change him to help him wake up enough to take the other side.

For more details about poop colour, see Dr Jay Gordon's page

The final thing is, parents wonder when the baby will start to do more formed bowel movements. These start when baby begins solid foods. So enjoy the less odorous breastmilk poop while you can, because once babies are on solids, then everyone within a large radius knows when someone has done a poop...!!

Understanding your baby's signals

This week a woman was on Oprah who says she made the amazing discovery that babies communicate their needs with a primitive form of language.

This news is not really so amazing if you speak to experienced mothers. So many mothers are being encouraged to fix strict schedules and set boundaries and limits, to show the baby who is "in control", that they are depriving themselves of the special opportunity to listen to their baby, and to learn who he/she really is. Communciation between mother and baby does not need to be verbal: in fact one argument suggests that if you are waiting for baby to verbalise (even in that primitive language) then you have missed a whole lot of non-verbal signals that can tell you the same sorts of information, giving you a chance to respond earlier. Baby is hungry or tired or lonely or in pain...a mother who is listening notices these differences, and learns to respond in the way that best meets her baby's needs. Learning to listen to your own baby's cues can actually help you have an easier life as a parent.

Take feeding cues as an example. How do you know your baby is hungry? Generally the answer parents give is that the baby cries, but in fact, if you wait till then, you have missed those non-verbal cues. Crying is the last sign of hunger.

But don't babies breastfeed "on demand"? We imagine this "demand" to feed will be made in a "demanding" way....like "I want my dinner and I want it RIGHT NOW! WAH! WAH! WAH!" But if you respond sooner, before baby cries, breastfeeding will definitely go more smoothly.

Studies of crying in babies have found that the baby’s breathing, oxygen concentration, heart rate and blood pressure are all affected negatively by crying. Cortisol, a stress hormone, is elevated and baby’s sucking pattern becomes disorganized. The tongue is pulled up into the mouth during crying, whereas breastfeeding requires the tongue down and forward. With all this stress, baby takes longer to settle for a feed.

What about the “good” baby, who sleeps well and doesn’t make “demands?” “Good” babies may not get enough milk, inadvertently, because their mothers are waiting for them to cry! Crying is metabolically taxing for baby, and without enough food, baby may not have the energy to cry.

So what to look out for? Mouthing movements, sucking hands, rooting or other increased activity, even with the eyes shut, all indicate baby will be receptive to feeding. When parents recognize and respond quickly to these early hunger signs, babies don’t need to become really“demanding”and state their needs unequivocally!