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Here
is the way I suggest mothers proceed for "insufficient milk
supply" (actually, most mothers have lots or could have
had lots, but the problem is that the baby is not getting
the milk that is available).
1. Get the best latch possible. This needs to
be shown by someone who knows
what they are doing. Anyone
can look at the baby at the breast and say the latch is good.
The accompanying diagram, or the one available at the websites
below shows how to get a good latch.
If a mother has plenty of milk, the latch does not have
to be perfect. But,
if the milk supply is decreased, the baby will get more milk if
he is latched on better. Get
good “hands on” help. Videos
can be seen that show you how to best latch a baby on.
2. Know how to know the baby is getting milk. When a baby is getting milk (he is not getting milk
just because he has the breast in his mouth and is making
sucking movements), you will see a pause at the point of his
chin after he opens to the maximum and before he closes his
mouth, so that one suck is (open mouth wide-->pause-->close
mouth). If you wish to demonstrate this to yourself, put
your index or other finger in your mouth and suck as if you were
sucking on a straw. As you draw in, your chin drops and stays
down as long as you are drawing in. When you stop drawing
in, your chin comes back up. This pause that is visible at
the baby's chin represents a mouthful of milk when the baby does
it at the breast. The longer the
pause, the more the baby got. Once
you know about the pause you can cut through so much of the
nonsense breastfeeding mothers are being told—such as
“Feed the baby twenty minutes on each side”. A
baby who does this type of sucking (with the pause) for
twenty minutes straight might not even take the second side.
A baby who nibbles (doesn't drink) for 20 hours will come off
the breast hungry. You can see this “pause” on the videos.
3. Once the baby is no longer drinking on his own, use compression
to increase flow to the baby. Compression can be particularly
helpful, but don't forget trying to get the best latch possible
first. Babies tend to pull at the breast when the flow of
milk is slow, so it is useful to know how to know the baby is
actually getting milk and not just sucking without getting milk.
When the baby no longer seems to be getting milk, and is sucking
without getting milk, this is when to start
compression, while the baby sucks, but does not drink.
Keep the baby on the first breast until he doesn't drink even
with compression. See
handout #15 Breast Compression. You can see this how to
use compression on the video.
4. When the baby no longer drinks even with compression, switch
sides and repeat the process. Keep going back and forth as long
as the baby gets reasonable amounts of milk at the breast.
5.
Try fenugreek and blessed thistle.
These two herbs seem to increase milk supply and increase
rate of milk flow. There
is more information on the handout #24 Cabbage Leaves,
Herbs, Lecithin.
6.
In the evening when babies often want to be at the breast for
long periods, get help to position the baby so that you can feed
lying down. Let the baby nurse and maybe you will fall asleep.
Or rent videos and let the baby nurse while you watch.
7. It is not always easy to decide if a baby needs
supplementation. Sometimes applying this Protocol for a few days
gets the baby gaining more rapidly.
Sometimes more rapid growth is necessary, and it
may not be possible without supplementation. If possible, get
banked breastmilk to use as a supplement if you can. If not
available, formula may be necessary. However, sometimes slow but
steady growth is acceptable. The main reason to worry about
growth is that good growth is one sign of good health. A baby
who grows well is usually in good health, but this is not
necessarily so. Neither is a baby who grows slowly in poor
health, but physicians worry about a baby who is growing more
slowly than average. Growth
charts are frequently interpreted poorly.
A baby who follows the 10th percentile line is
growing as he should be. Too
many people, including physicians, believe that only babies on
the 50th percentile or higher are growing normally.
Not true. Growth charts were developed on information based on
information gathered about normal babies.
Somebody has got to be smaller than 90% of all
other babies. Somebody
normal.
8. If it is decided to supplement, the best way is at the breast
with a lactation
aid. Introduce the supplement with a nursing
supplementer (lactation
aid), not bottle, syringe, cup or
finger
feeding. See handout #5
Using a Lactation Aid at the website below. Supplement only after steps 3
and 4 above and the baby has nursed on at least both sides.
Why is it better to use the lactation aid?
- Babies
learn to breastfeed by breastfeeding
- Mothers
learn to breastfeed by breastfeeding
- The
baby continues to get your milk
- The
baby won't reject the breast
- There
is more to breastfeeding than the breastmilk
9.
If the baby is older than three or four months, and
supplementation appears to be necessary, formula is not
necessary and extra calories can be given to the baby as solid
foods. First solids may include: mashed banana, mashed avocado,
mashed potato or sweet potato, infant cereals, as much as the
baby will take, and after the baby has nursed, if he is
still hungry. Even
at this age giving bottles when the baby is not getting much
from the breast will often result in breast rejection.
If you must give formula, mix it with the baby’s
solids. Giving
solids at three or four months if everything is going well is
not recommended, and even if the weight gain is slow, there are
several ways of getting the baby more breastmilk that can be
tried before adding solids.
Solids should normally be started when the baby is
showing interest in eating solids (usually around five or six
months of age).
10.
If your baby was gaining well for a few months and now is not
gaining well, see the handout #25 Slow Weight Gain After the
First Few Months. Reasons
for a decreased milk supply are listed there.
Fix what you can, and then follow this Protocol.
11. Domperidone is a possibility. It is not a panacea (a magic
bullet). Check the handouts on Domperidone.
Questions?
(416) 813-5757 (option 3)
or
drjacknewman@sympatico.ca or
my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate
Breastfeeding Book of Answers
in the USA)
Handout
B: Protocol to Increase Breastmilk Intake by the Baby
Jack Newman, MD, FRCPC. © 2005
Revised: January 2005
This
handout may be copied and distributed without further
permission,
on the condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violate.
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