Transcript: Exclusive Breastfeeding After Early Supplementation
The Boob Group
Exclusive Breast Feeding After Early Supplementation
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[Theme Music]
ROBIN KAPLAN: When a mom is told in those early postpartum days that her little one is going to need supplementation, so many questions may run through her mind. Am I making enough milk? What can I supplement with? And how long do I have to do this for? Today I’m thrilled to welcome a new expert to our show. Her name is Elizabeth Myler and she is a registered nurse and an international board-certified lactation consultant with Mahala lactation and perinatal services in New Jersey and Pennsylvania. Today we are discussing exclusive breastfeeding after early supplementation. This is The Boob Group episode 95.
[Theme Music/Intro]
ROBIN KAPLAN: Welcome to the Boob Group broadcasting from the birth education center of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I’m your host Robin Kaplan. I’m also an international board-certified lactation consultant and owner of the San Diego breastfeeding centre. Did you know that you can find over 90 free episodes of The Boob Group on our website? Our topics range from treating sore nipples to tricks when breastfeeding in public to breastfeeding newborns, infants and toddlers. You can also find wonderfully written blog and articles by our team of mommy bloggers. Don’t miss out on all of these breastfeeding resources and make sure to check out our website which is theboobgroup.com. Make sure to check that out today. So today we are joined by three lovely panelists on the studio. Ladies will you please introduce yourselves.
CYNDI SMITH: Yes my name is CYNDI and I’m 34 and I’m a speech therapist. I have one little boy who is 7 months and his name is Clark.
SARAH STREET EVERIST: Hi I’m Sarah. I’m an attorney. I’m 31 and I have my first daughter her name is Violet and she will be six months tomorrow.
ROBIN KAPLAN: Awesome.
CARA BARKER: My name is Cara. I’m 24 and I’m a stay-at-home mom and I have one little boy and he’s almost 4 years old and his name is Nathaniel.
ROBIN KAPLAN: 4 months old yeah?
CARA BARKER: Yes.
ROBIND KAPLAN: Okay perfect. And I’d like to introduce Mj our producer. Mj will you share a little bit about with our virtual panelist program is?
MJ FISHER: Yes. Well our virtual panelist program has become quite awesome I think because of our listeners and everyone online is just being really helpful to the others that are commenting online. It’s kind of like a little sneak preview of our show before it releases. Because just like our in the studio panelist here our virtual panellists are making time to be online, they’re sharing their experiences, they’re reading others comments and questions and actually engaging with them with support, tips, advice and you know just empathy. It’s you know sometimes we just need to know we’re not alone so it’s just an extension of our show in what we are here to do which is support each other. So if you’re not local or if you just can’t be in the studio, you can still be a part of the show, give your opinions and we may even read your comment while we record. So just check out theboobgroup.com under the community tab for more info on our VP program and possible perks for participation.
ROBIN KAPLAN: Awesome. Thanks Mj.
[Theme Music]
ROBN KAPLAN: Before we get started with today’s show, here’s breastfeeding oops from one of our listeners.
ERIN: Hi my name is Erin and I have a 9 month old little boy and this is my boob oops ex. We recently went to San Diego Zoo for my company picnic and I had only once before breastfed in public and that in itself was an adventure. So that day I didn’t anticipate breastfeeding at the zoo. However my son became very fidgety and desperately wanted the comfort. So we found what at that time was a very secluded part of the zoo and we sat down on a couple of the benches and of course I never use a cover at home because I’m just breastfeeding at home so my son doesn’t like a cover. And at the age of 9 months he’s well strong enough to get rid of that cover.
So I’m breastfeeding, I’ve got the cover, I’m fighting with him the cover and all of a sudden I realize that 3 tour buses have pulled off not 20 feet away from me and everybody is exiting and coming to look at the exhibit that I’m sitting in front of. So of course I’m trying to look very calm and not part of the exhibit. But my son he’s pulling and pulling and I realized that this just isn’t going to work. And then to my horror I turned to my left and two of my male colleagues have sited themselves at the picnic table next to us and are trying to nonchalantly look away. But it’s very obvious that they’ve seen me and I was mortified and my husband came over and he tried to cover me up and yeah that’s I just turned around and said oh hi guys as if nothing had happened. But that was my boob oops at the San Diego Zoo.
[Theme Music]
ROBIN KAPLAN: So today on The Boob Group we’re discussing exclusive breastfeeding after early supplementation. Our expert Elizabeth Myler is a registered nurse, an international board certified lactation consultant with Mahala lactation and perinatal services in New Jersey and Pennsylvania. Thanks for joining us Beth and welcome to the show.
ELIZABETH MYLER: Oh thank you so much for having me. Hi mom!
MJ FISHER: Hello.
WOMAN: Hi!
ELIZABETH MYLER: I love this forum. I think it’s terrific.
ROBIN KAPLAN: Oh thank you. So Beth in the early days of a baby’s life, what are some of the most common reasons why supplementation would be recommended?
ELIZABETH MYLER: Well I think in the first distinction that I just want to point out, you did mention my background as a nurse, it’s the difference between sort of necessary and unnecessary supplementation. So I think we need to just get out there right out front that there are some babies and mothers for whom supplementation is life-saving and very necessary. But here in the US and in many other industrialize countries in the world the vast majority of dermasence who are exclusively breastfed don’t need supplementation and we’re not feeling so great with that.
So about 24% of babies here in the US are supplemented in the first two days of life. And our goal in the US is to get that down on 14%. But we do need to tease out the difference between the infant reasons and the mother reasons. So for babies, the necessary reasons for babies would be hypoglycemia, jaundice or hyperbilirubinemia, significant dehydration, weight lost greater than 10%, there are some rare inborn areas of metabolism which prevent babies from being able to be exclusively human milk fed and there are some congenital malformation and other illnesses.
That’s the baby side and then the mommy side we can have a mother who is extremely ill postpartum, extreme blood lost, a mother who’s milk just doesn’t come in in the expected time, we called that delayed lactogenesis, that’s the fancy term and we believe in the US that actually one in 3 mothers are experiencing delayed lactogenesis. This is really common in the US. A mother who had a prior breast or chest surgery or a mother who’s on a certain medications. There are very few, mostly they’re chemotherapeutic cell mother who’s on in chemotherapy or a mother who clinically has not enough glandular tissue. We call that mammary hypoplasia. So those are the reasons in a quick nutshell.
ROBIN KAPLAN: Okay and what are mom’s options for supplementation and what advice do you have from choosing the type of supplement to use?
ELIZABETH MYLER: We have a lot of different options and I think that you know one of the most important things is that we kind of teased out the contents. So what are we going to use? The amount that we’re going to give? And then the method that it’s given. And then we’re going to talk about some of these things. But we’re lucky to have some great guidelines from the academy of pediatrics and also from the surgeon generals called the Action on Breastfeeding, from UNICEF and also the academy of breastfeeding medicine. And they’ve kind of developed a hierarchy for vast choices of supplementation. And this is really based on the research for what protects human babies and mother the most. Alright so there’s a list of 5.
So our first choice for supplementation is going to be mother’s own milk. Our second choice is going to be pasteurized donor human milk and this can really be hard to find in many cases. And that’s a complicated topic. I know you guys have had it there people come in and talk about donor human milk right?
ROBIN KAPLAN: Absolutely.
ELIZABETH MYLER: Okay. Our third choice is going to be our hypoallergenic or the hydraulize protein formulas. The fourth choice is going to be the elemental or amino acid-based formulas. And our final and last choice is going to be the standard cow’s milk-based formula and unfortunately in the here in the US and really globally that’s usually the first go to the babies are offered. The amount of supplementation is probably as important if not more important than what is being used. And we got some really great new research about how overfeeding in the first 8 days of life is linked to obesity later in life. So [inaudible] did some really great research on this. And it’s something that I don’t think we think about very often you know that we can do something In these early days on the baby’s life that could have such a huge impact on them as an adult.
ROBIN KAPLAN: Is there a good resource for where what numbers we should be using for how much a baby should be supplemented based on their age?
ELIZABETH MYLER: There’re several resources and I know that you had I think you’re going to put a link to Kellymom. I don’t know if you have the link to the Academy of Breastfeeding Madison. They have protocol number 3 which is all about supplementation in the early days.
ROBIN KAPLAN: Yup
ELIZABETH MYLER: And I think you know what moms really do need to know is that what a baby needs on day 1 is not the same as what a baby needs on day 3, 4, 5 and so on. So these are critically you know important differences that moms are not often explained.
ROBIN KAPLAN: Okay we’ll definitely link to those on our website. Thank you so much.
ELIZABETH MYLER: Yeah.
ROBIN KAPLAN: So ladies I’d love to open this up to our panel. So what were the reasons that you had to supplement your baby in the beginning? Cyndi.
CYNDI SMITH: Well I do have a C-section and during my C-section I lost a lot of blood and had to have like large amounts of blood transfused. So it definitely impacted my milk supply and just the fact that I was separated from him for so long. And so I mean he was given a bottle before I even came out of recovery so I definitely think that was the major factor in my little milk supply.
ELIZABETH MYLER: Actually and that really emergency C-section, in particular, is one of the biggest risk factors for supplementation. And then with your hemorrhage you’ve got two of the biggest.
ROBIN KAPLAN: Absolutely. Sarah how about you?
SARAH STREET EVERIST: So I have kind of a double whammy so thought it was tongue-tied and so that kind of made my little milk supply and then kind of have a little bit of an interesting I have congenital breast [inaudible] so I have a breast implant on one side. So milk never really came in fully on one of my breast and it just so happen that Violet really preferred the breast where the milk didn’t come in so much. And when I saw my original lactation consultant as I should in the hospital she said oh don’t worry about it. It is fine, you’re milk is coming in don’t worry she can have that one and unfortunately it didn’t work that way and she had lost an entire pound when we came in for our first weight check.
ROBIN KAPLAN: Oh wow. That’s scary.
SARAH STREET EVERIST: Yeah she had lost something like nearly 15% of her. And I had a C-section as well but it was planned just it was breached.
ROBIN KAPLAN: Okay. How about you Cara?
CARA BARKER: We had a home birth and so when we took him for his first 3 day appointment, he was fine. And then about a week later he had another check-up and he had lost more weight than they wouldn’t have like. And he wasn’t gaining weight back as quickly enough so the doctor asked us to start supplementing. So we did and we later found out that he had a tongue tie which we had have revise and an upper lip tie as well. So we’re continuing with the supplement that hoped to quit soon.
ROBIN KAPLAN: Awesome. Beth what are the different ways that a mom can supplement her baby? So we have 3 moms in here who had to supplement often in the beginning. And so is one method preferred over another?
ELIZABETH MYLER: Well we have lots of different choices here and I think that the key to making a good choice for an individual mom depends on the age of the baby and the capability of the baby and the ease of use for the mother. I think that for many mothers a combination of that of method is truly what works best to help them reach their ultimate goal. So you know bottles are usually the most common because they’re the most easily available. And here in the US, cleaning them is generally not a problem. But we have syringes, spoons, finger feeding methods and even at breast supplementation. And then you know breast supplementation is usually for the longer-term supplementation needs with larger volume.
What I was really interesting just hearing the said different stories there because in all the research that have done on those two the delay and first breastfeeding and maternal infant separation for any reason it’s probably the biggest risk factor for ultimate self supplementation but then you guys also all had these various other problems that and you guys are really hit with. Sounds like you came into this very well educated and yet still had so many different challenges to go. So I really sympathize with that.
ROBIN KAPLAN: We’ve some amazing panellist on our show. It’s truly wonderful.
ELIZABETH MYLER: Yeah.
ROBIN KAPLAN: Dedicated mommas.
ELIZABETH MYLER: Right.
ROBIN KAPLAN: Beth for mom who decides to supplement at breast or finger feed, where could she get the supplies from?
ELIZABETH MYLER: There are lot of different companies that make these devices. They’re relatively easy to find now with just a simple search on Google or Amazon. The smaller volume devices so if you’re you know dealing with really early newborn that only need you know half an ounce to maybe an ounce and a half or two ounces. That device is going to be anywhere from like 20 to 40 bucks. And the larger ones are probably closer to 60 dollars. Again if you’re going to use an [inaudible] breast supplementation device you know the baby really does need to be able to latch.
For finger feeding you know they don’t have to. But I would say that the cheapest device is a neonatal feeding tube. We also use this device to caterterise babies. It’s can be used as a nasal gastric tube it’s called a five French and the abbreviations is FR/CH and this retail for like one to two bucks a piece. They can be inserted into a bottle or attach to a syringe or again just used on the finger to finger feed. And I can give you you know later on some websites where you can find this at that one to two dollars a piece price range I’d like to use. There’s a lot on my practice because they’re cheap. It’s something that you can try without this you know large economic commitment.
ROBIN KAPLAN: Sure and a lot of paediatrician offices I know in San Diego will have those as well as lactation consultants definitely have them. So if you’re working with a lactation consultant that would be something that she should be able to provide as well.
ELIZABETH MYLER: Absolutely.
ROBIN KAPLAN: For the mom who decides that bottle feeding is easier for her for offering to supplement, is there a way that she or family member can do this in a breastfeeding friendly manner or so that way breastfeeding can also be continued to be work on as well.
ELIZABETH MYLER: Definitely. I think the first thing is to really be tuned in to developing a trusting feeding relationship with your baby. Babies have to learn how to coordinate sucking, swallowing and breathing. And they have to do this seamlessly and it’s not always easy for all babies. So the first thing that I want to say about bottle feeding is that learning to do a pace bottle feeding technique can make all the difference in the world. And this is a technique in which the bottle is delivered with a slow flow nipple using frequent pauses you know in between swallowing.
And there is a technique for holding the bottle in more of a horizontal manner than a vertical manner so that the baby really has a lot more control about the volume that he or she receives with each suck. And I think of sort of five steps to that to delivering that bottle and I don’t know if we have time to go into those five steps real quick but…
ROBIN KAPLAN: Yeah go for it.
ELIZABETH MYLER: I’m happy to. So the first thing that we want to do is we want to wait until the baby opens wide like a yawn. And one of the best ways to stimulate that baby to open is to just place the nipple right underneath the nose above the upper lip. And then you want to allow the baby to accept the bottle into their mouth. You don’t want to just poke it in and ram it in. And then you want to lay the nipple tip onto the tongue.
So we want to make sure that that tongue will cover the bottom portion of the gum if possible and for those babies of tongue-tied oh those mothers of tongue-tied babies, you guys may have notice really early on that your baby’s ability to you know extend their tongue and lift their tongue and just move their tongue were truly compromise from the beginning. But next we want to latch the baby deeply on to the base of that bottle nipple so the mouth stays open as widely as possible and that’s you know called the gape. And then we want to pace that feeding like I said before by giving the baby frequent pauses in between their swallows.
ROBIN KAPLAN: Thank you that’s such great tips for offering the bottle well. Really really appreciate you going into that. Ladies I would love to ask you as well, how did you supplement in the beginning did and how did you come to choose that method? Cyndi.
CYNDI SMITH: In the hospital they initially gave us bottles but then I wanted to really work on breastfeeding and the latching so they gave us the supplemental nursing system. And we just used that at home as well but it just became we are supplementing so much that we did go back to the bottles.
ROBIN KAPLAN: Okay.
CYNDI SMITH: And then he was able luckily he was able to go back and forth pretty easily.
ROBIN KAPLAN: Between breastfeeding and bottle feeding?
CYNDI SMITH: Yes.
ELIZABETH MYLER: Yeah and I find in my practice that’s really very common for moms to use multiple devices.
ROBIN KAPLAN: It makes it easier when you have a couple of different options. So that way there is not a stressed that one has absolutely has to work.
SARAH STREET EVERIST: And we definitely use I think all of the methods that you mentioned. We started out at the breast because I remember going into the lactation consultant when they wait her and crying hysterically. They were like whoa it’s okay and so they gave me the frenching thing and we did it at breast and then me and my husband at all hours would finger feed her because she had a really hard time with the out breast device even though she was nursing, she wouldn’t, we couldn’t really thread it into her little mouth.
ROBIN KAPLAN: Yeah.
SARAH STREET EVERIST: So we did a lot of finger feeding and then we did that exclusively for the first 3 weeks and then when my husband went back to work, I said I can’t really finger feed because it would take a good hour to kind of get everything going. I was like I can’t do this in the middle of the night. So we slowly transition in the bottles.
ELIZABETH MYLER: Yeah that’s not sustainable. Yeah tough!
ROBIN KAPLAN: How about you Cara, how did you end up supplementing your son?
CARA BARKER: We began with the bottle before we even saw you for a lactation consultant and then after the visit with lactation consultant we did the out breast supplementation. But as you know it takes a long time and sometime it gets frustrating so we just ended up switching back to the bottle and we do the peast feeding. So that’s kind of how we’re doing it now. After I breastfeed them I’ll do the bottle.
ROBIN KAPLAN: Okay perfect. And Mj did one of our virtual panelists want to share anything?
MJ FISHER: Yes! Pipa Hartridge says that she did cup feeding with formula and whatever breast milk that she could express. She chose cup feeding as the least likely to be confusing for the baby. And the fact that it was super cute was an added bonus.
ROBIN KAPLAN: Alright.
ELIZABETH MYLER: It’s amazing how they can lap it up you know. That’s if they can like move their tongue.
ROBIN KAPLAN: Yeah.
WOMAN: Yeah I know if they can move their tongue totally.
ROBIN KAPLAN: Alright when we come back. We will discuss with Beth the ways that a breastfeeding mother can protect her milk supply while supplementing and how to know when she can actually stop supplementing. So we’ll be right back.
[Theme Music]
ROBIN KAPLAN: Alright well welcome back to the show. We are here with Elizabeth Myler and we are talking about exclusive breastfeeding after early supplementation. So Beth, are all slow flow nipples, bottle nipples the same?
ELIZABETH MYLER: No Robin they are not the same and I think that all of the moms would probably agree but buying a bottle today is like a dizzying experience. You walk in to the babies- so you target and there’s like 12 new ones on the shelf every day and they all say that they are perfect for the breastfed baby.
ROBIN KAPLAN: Yeah.
ELIZABETH MYLER: So I think you know the first thing to think about is that choosing a bottle really depends on the baby’s capability. But there’re two main features that I’m going to be looking for in a bottle. Number one is that you know it at least does need to say that it’s for [inaudible] you’re the newborn. And number two is that it has a gradually widening from the length of the nipple tip out to the base of the bottle. And that is against presevered the baby’s gape, the baby’s ability to open wide.
I really-really love Amy Peterson and Mindy Harmer’s book Balancing Breast and Bottle. They did some really great research on lots of different types of bottles and especially the one that said that they were so slow. And they measured you know drips per second on different angles and they also kind of debunk the you can’t just hold it upside down and watch the drips come out. I mean a lot depends on you know the baby and how they latch and attach and their suction strength and all of those things but I really-really find her book to be helpful both for lactating consultants and for moms.
ROBIN KAPLAN: Absolutely and so when a mom is offering supplementation, how can she protect her milk supply? To make sure that it continues to increase the way that it needs to.
ELIZABETH MYLER: For most moms who are going to be supplementing you know longer than a couple of days. Pumping with sufficient frequency and effectiveness is going to be a really-really important part of what she needs to do. But we do know that if she can combine pumping with hands-on massage and hand expression we really Jane Morton showed that this really can increase her milk supply and even increase the fat content of her milk. Because hand expression allows her to really access the higher-up ducts where some of the fats can collect.
So that’s pretty cool but I also believe in relaxation techniques and other techniques that can stimulate a mother’s milk ejection reflex and that can be different for each mom. And skin to skin contact with her baby is almost always a key part of the plan for keeping her milk supplies strong. When we need to and when this is appropriate the last gags or substances that increase mom’s milk supply they can be culinary like food, they can be herbal like plants or they can even be prescription medications can be all be used chiefly with good results if we’re being careful to target a mother’s specific milk supply difficulties and working with an IBCLC, birth certified lactation consultant who’s experienced and knowledgeable about these things can really go a long way to helping mom.
ROBIN KAPLAN: Definitely and while she’s pumping, do you recommend a certain type of pump and how often she should be pumping?
ELIZABETH MYLER: For me usually the pump is going to mean a hospital grade pump so when I say pumping with sufficient frequency and effectiveness you really need a work horse you know if you’re doing the car analogy you know a pinto is probably not you know a pinto that’s 20 year’s old you know might not really get you where you need to go. And you do might just need a Cadillac. You need a pump that is really designed to be used 10 to 12 times a day you know long term and enough with a hospital grade pump is supposed to do.
But we also really want to be sure that mom is fitted properly for correct pump parts so the flange size needs to be right. We want to make sure that her tubes are clean and new and you know that every other aspect of her pump is working well. There are some case in which a mother, this is a baby driven problem that the diet is having and in those cases sometimes the mom has a really strong milk supply and she can get by when using a new double electric consumer-grade pump. But we do want to look at that and make sure that the pumping pressure is in the desired range.
ROBIN KAPLAN: Okay. Ladies did you pump while supplementing and how often were you’re doing this?
ELIZABETH MYLER: Oh yes! Tell us about it Sarah.
SARAH STREET EVERIST: I pumped every single time I breastfed. And so it was I think we tracked it. It was 12 times a day including the middle of the night and my lactation consultant said, Sarah you do not have the odds on your favour. So if you want to do this, you’re going to have to be really committed. And so I would get up and I would pump for 20 minutes 2 in the morning when everyone else was sleeping. And I did that until…
ELIZABETH MYLER: Including the baby right?
SARAH STREET EVERIST: Yeah everyone was sleeping but me I mean I’ve got some fun Facebook time and so got some alone time. It was nice but we pump a lot well we...
ROBIN KAPLAN: How long did you do that for?
SARAH STREET EVERIST: Over a month?
ROBIN KAPLAN: Wow.
SARAH STREET EVERIST: So it was a big commitment. I remember going to the lactation consultant and she said you breached the point now where I think we can drop the middle of the night pumping. And I was like oh thank god.
MJ FISHER: For your sanity right?
ROBIN KAPLAN: Absolutely. How about you Cyndi, how long did you pump while supplementing and for how long? How often how long?
CYNDI SMITH: Yes we definitely pumped because he was also tongue-tied as well and so we had other issues and I mean we did just major pumping I didn’t pumped that much. I pumped probably like 4 to 8 times a day in addition to breastfeeding like 8 to 10 times a day. And I gave myself a break at night and that was probably for about 2 and a half months a long time so yeah.
ROBIN KAPLAN: How about you Cara?
CARA BARKER: Well I personally hate pumping.
ROBIN KAPLAN: I hate pumping to now.
CARA BARKER: So the most I probably did was about 3 or 4 times a day. And I’m done about 2 times a day so we’re still going but I just like I don’t like it.
ROBIN KAPLAN: Yeah. You’re ready to get rid of it?
CARA BARKER: Yes.
ELIZABETH MYLER: Oh my gosh we tend to call this like the hamster wheel. And you feel like you never going to get off it. Oh you’re just constantly going.
ROBIN KAPLAN: And it’s the guide of the hamster wheel. We’re hoping more than anything that you get to stopped as soon as possible to.
ELIZABETH MYLER: Yeah.
ROBIN KAPLAN: It’s not something we like to recommend for sure. We want you to spend time with your baby so good for you for keeping it up for so long. Beth how would a mom know that she can actually start weaning from supplementation and pumping?
ELIZABETH MYLER: So it depends. If she’s exclusively pumping, let’s say she’s not doing much breastfeeding at all. It’s going to be easier for her to figure out you know what her true milk supply is and how much she’s making. The desire goal is going to be about 750 to 800 millilitres a day. So that’s about 25 to 27 ounces. And sometimes a little bit it has a little bit more as the baby you know gets older than a few months old. But if a mother is partially breastfeeding, it can be really challenging for her to gauge how much milk she’s actually producing on a daily basis. And how much milk the baby is getting from her.
So again working with an experience IBCLC is really advised because we’ve got we have to know how well the baby can actually remove this milk that the mother is actually making. So I like to recommend that moms start by really carefully tracking how much supplement they’re giving and then in a general rule that I think it’s pretty conservative and pretty appropriate is that she try and reduce that supplement by only about an ounce per day total not for feed but an ounce per day for several days.
And go about it that way. She can monitor diapers but you need to keep in mind that diapers are really only relevant if a baby is under a month because many baby you know breastfed babies and formula babies to they’re going to space out vowel movements and we can’t rely on that anymore. So weight checks at least once a week while a mom is decreasing supplementation. I think it’s really-really key to their success and be keeping them on track.
ROBIN KAPLAN: And stopping by support groups to I know most of the support groups I think all of them in San Diego except I don’t know if [inaudible] meetings have scales but all the hospital based one…
ELIZABETH MYLER: No they really don’t.
ROBIN KAPLAN: Yeah. But those hospital based once and private practice once and lactation consultant once typically have a scale so you can actually see what the transfer looks like from baby from breast. So that can be really helpful.
ELIZABETH MYLER: Yeah absolutely.
ROBIN KAPLAN: So you’ve mention kind of tapering off at the one ounce per day for a couple of days that start that weaning process. What other tips do you have for weaning off the supplementation and getting back to exclusively breastfeeding?
ELIZABETH MYLER: So again it really depends on the individual problems that this mother-baby is having. So I think I guess I could start for babies who are really kind of refusing to feed at the breast either sometimes or even all of the time and mom is really trying to you know let’s say she’s gotten her milk supply where it needs to be but she’s really trying to work on getting that baby to breast more often.
Skin-to-skin contact with her baby is the answer to so many of these difficulties. I think I know I tend to call it the baby reboot button you know. Just spending as much time as you possibly can just with baby in the kitchen you know on your chest against you is really-really key. The next thing I think is to really be aware of the instance arousal states and the hunger queues. So keeping baby with you, wearing the baby, catching baby right when they’re starting to wake up and possibly you know doing more frequent smaller feeds really this can do a lot for milk supply and also to really just get a baby back completely to breast.
For baby who’s been tongue-tied and really is just transitioning to being able to remove milk well, there are other tools and tricks of the trade, again I really advise you to work with an experience and recommended IBCLC but sometimes nipple shield and other tools that can help draw out a nipple are good transitional tools for babies who’s still bottle feeding just needs more encouragement to do more feedings at the breast. But positioning is important too so you know when baby comes to breast, having that baby read and assimilate back breastfeeding condition can help babies and mothers get back to doing more breastfeeding and less bottle feeding.
So sometimes I advise that moms actually bottle feed the baby in a laidback breastfeeding position and do sort of a switch but then again the milk needs to be there as well.
ROBIN KAPLAN: Sure. Ladies how long did you need to supplement for? Are you still supplementing or were you able to wean off of it and how did you know when to do that? Cara how about you?
CARA BARKER: We’re still supplementing and we’re working with you Robin. We’re slowly weaning down to once ounce every other feeding so it’s getting there. Just hard work.
ROBIN KAPLAN: Absolutely. How about you Sarah?
SARAH STREET EVERIST: So we were really fortunate and we were able to stop supplementing so I don’t’ she has been exclusively breastfed for nearly four months now so we were able to wean her off supplementing on about 8 weeks and before then we were kind of my husband made this really intense chart of like how much the baby was getting of donor milk and how much I was producing.
ELIZABETH MYLER: Right, I’ve seen the excel chart.
SARAH STREE EVERIST: Oh yeah it was very-very intense and so I remember the day kind of a lion’s cross and she was getting more of my milk than of the donor milk and then eventually we got to a point where she was getting all of my milk and so at that point the lactation consultant said I know this is going to be really really-really scary but I want you to cut down on pumping and I want you to just put her on the breast and keep weighing her and you know at that point we’ve been doing weighing so we knew that things were in upward motion and so it was a very scary but a very happy day.
ROBIN KAPLAN: How about you Cyndi?
CYNDI SMITH: We supplemented for about 2 to 2 and a half months. We also get very detailed data on my app on my phone and so I would keep track of how much he took how much formula he took and then how much expressed breast milk he would take from all of the pumping. And I remember the first day like I went to Robin support group and I was like yesterday he only had one ounce of formula all of the other you know supplementation was the expressed breast milk and she was like well tomorrow don’t pump and just put him on the breast and he did it. That was the end of our formula.
ROBIN KAPLAN: That’s nice.
CYNDI SMITH: So it took us a long time but we got there and so…
ROBIN KAPLAN: Super dedicated.
CYNDI SMITH: That was like 5 months ago.
ROBIN KAPLAN: Wow. That’s awesome. Beth, you know Sarah brought up a really good point that emotionally a mom might feel really scared to trust that her baby is able to get enough just from her so any tips for how she can began to trust her body and her ability to exclusively breastfeed.
ELIZABETH MYLER: Well actually and I think that your panelists really hit the nail on the head for this one and I think frequent check-ins you know with her breastfeeding helpers are going to just be you know often the absolute best thing to do so I think most moms the last thing we want is for her to become disappointed in her abilities you know by showing up at that weight check that maybe we spaced out a little too far and feeling like she’s been derailed again.
So really just everything that they’ve all said about just this gradual transition are really-really key to keeping things strong and being patient you know and knowing that this can take a long time and although days can sometimes feel like years in the grand scheme you know that this baby time really does passes very-very quickly and so you have to really celebrate your small victories and like the mom said you know when you realize that you know that you’ve been able to cut out of supplement I mean that you need to go have a latte, go call your best friend, go you know to celebrate this small victories because they really not small at all.
They’re huge and they take a lot of commitment and you’re just you’re on your way and you have to just believe that with each day of that effort and staying close to your baby and keeping that baby fed you know most moms will be able to get there.
ROBIN KAPLAN: Awesome. Well thank you so much Beth and to our panelists for sharing this incredible information about getting back to breastfeeding after early supplementation. Really appreciate your time.
ELIZABETH MYLER: Oh Absolutely. Thank you so much for having me.
ROBIN KAPLAN: Sure and for our Boob Group club members, our conversation will continue after the end of the show as Beth will discuss tips for when a baby’s pediatrician is recommending a little bit a little too much supplementation. For more about our Boob Group club, please visit our website at www.newmommymedia.com .
[Theme Music]
MJ FISHER: Here’s a comment from one of our listeners. This is from Daina Schmidt and she left this on our Facebook page. I just listen to and shared episode 16, Tight Frenula and Breastfeeding. As an international board-certified lactation consultant and mother of two children who had tongue ties I can appreciate the mother’s stories and experiences with breastfeeding a tongue-tied baby. I also really enjoyed Dr. Ochi’s discussion of posterior tongue tie as well as frenotomy and after care especially the acupuncture which I never knew about. Thank you so much for you episode.
[Theme Music]
ROBIN KAPLAN: That wraps up our show for today. We appreciate you listening to The Boob Group.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Parent Savers for parents with newborns, infants and toddlers
• Twin Talks for parents of multiples.
•
Thanks for listening to The Boob Group; Your judgment-free breastfeeding resource.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com .
[00:40:39]
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Episode Transcript
The Boob Group
Exclusive Breast Feeding After Early Supplementation
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
ROBIN KAPLAN: When a mom is told in those early postpartum days that her little one is going to need supplementation, so many questions may run through her mind. Am I making enough milk? What can I supplement with? And how long do I have to do this for? Today I’m thrilled to welcome a new expert to our show. Her name is Elizabeth Myler and she is a registered nurse and an international board-certified lactation consultant with Mahala lactation and perinatal services in New Jersey and Pennsylvania. Today we are discussing exclusive breastfeeding after early supplementation. This is The Boob Group episode 95.
[Theme Music/Intro]
ROBIN KAPLAN: Welcome to the Boob Group broadcasting from the birth education center of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I’m your host Robin Kaplan. I’m also an international board-certified lactation consultant and owner of the San Diego breastfeeding centre. Did you know that you can find over 90 free episodes of The Boob Group on our website? Our topics range from treating sore nipples to tricks when breastfeeding in public to breastfeeding newborns, infants and toddlers. You can also find wonderfully written blog and articles by our team of mommy bloggers. Don’t miss out on all of these breastfeeding resources and make sure to check out our website which is theboobgroup.com. Make sure to check that out today. So today we are joined by three lovely panelists on the studio. Ladies will you please introduce yourselves.
CYNDI SMITH: Yes my name is CYNDI and I’m 34 and I’m a speech therapist. I have one little boy who is 7 months and his name is Clark.
SARAH STREET EVERIST: Hi I’m Sarah. I’m an attorney. I’m 31 and I have my first daughter her name is Violet and she will be six months tomorrow.
ROBIN KAPLAN: Awesome.
CARA BARKER: My name is Cara. I’m 24 and I’m a stay-at-home mom and I have one little boy and he’s almost 4 years old and his name is Nathaniel.
ROBIN KAPLAN: 4 months old yeah?
CARA BARKER: Yes.
ROBIND KAPLAN: Okay perfect. And I’d like to introduce Mj our producer. Mj will you share a little bit about with our virtual panelist program is?
MJ FISHER: Yes. Well our virtual panelist program has become quite awesome I think because of our listeners and everyone online is just being really helpful to the others that are commenting online. It’s kind of like a little sneak preview of our show before it releases. Because just like our in the studio panelist here our virtual panellists are making time to be online, they’re sharing their experiences, they’re reading others comments and questions and actually engaging with them with support, tips, advice and you know just empathy. It’s you know sometimes we just need to know we’re not alone so it’s just an extension of our show in what we are here to do which is support each other. So if you’re not local or if you just can’t be in the studio, you can still be a part of the show, give your opinions and we may even read your comment while we record. So just check out theboobgroup.com under the community tab for more info on our VP program and possible perks for participation.
ROBIN KAPLAN: Awesome. Thanks Mj.
[Theme Music]
ROBN KAPLAN: Before we get started with today’s show, here’s breastfeeding oops from one of our listeners.
ERIN: Hi my name is Erin and I have a 9 month old little boy and this is my boob oops ex. We recently went to San Diego Zoo for my company picnic and I had only once before breastfed in public and that in itself was an adventure. So that day I didn’t anticipate breastfeeding at the zoo. However my son became very fidgety and desperately wanted the comfort. So we found what at that time was a very secluded part of the zoo and we sat down on a couple of the benches and of course I never use a cover at home because I’m just breastfeeding at home so my son doesn’t like a cover. And at the age of 9 months he’s well strong enough to get rid of that cover.
So I’m breastfeeding, I’ve got the cover, I’m fighting with him the cover and all of a sudden I realize that 3 tour buses have pulled off not 20 feet away from me and everybody is exiting and coming to look at the exhibit that I’m sitting in front of. So of course I’m trying to look very calm and not part of the exhibit. But my son he’s pulling and pulling and I realized that this just isn’t going to work. And then to my horror I turned to my left and two of my male colleagues have sited themselves at the picnic table next to us and are trying to nonchalantly look away. But it’s very obvious that they’ve seen me and I was mortified and my husband came over and he tried to cover me up and yeah that’s I just turned around and said oh hi guys as if nothing had happened. But that was my boob oops at the San Diego Zoo.
[Theme Music]
ROBIN KAPLAN: So today on The Boob Group we’re discussing exclusive breastfeeding after early supplementation. Our expert Elizabeth Myler is a registered nurse, an international board certified lactation consultant with Mahala lactation and perinatal services in New Jersey and Pennsylvania. Thanks for joining us Beth and welcome to the show.
ELIZABETH MYLER: Oh thank you so much for having me. Hi mom!
MJ FISHER: Hello.
WOMAN: Hi!
ELIZABETH MYLER: I love this forum. I think it’s terrific.
ROBIN KAPLAN: Oh thank you. So Beth in the early days of a baby’s life, what are some of the most common reasons why supplementation would be recommended?
ELIZABETH MYLER: Well I think in the first distinction that I just want to point out, you did mention my background as a nurse, it’s the difference between sort of necessary and unnecessary supplementation. So I think we need to just get out there right out front that there are some babies and mothers for whom supplementation is life-saving and very necessary. But here in the US and in many other industrialize countries in the world the vast majority of dermasence who are exclusively breastfed don’t need supplementation and we’re not feeling so great with that.
So about 24% of babies here in the US are supplemented in the first two days of life. And our goal in the US is to get that down on 14%. But we do need to tease out the difference between the infant reasons and the mother reasons. So for babies, the necessary reasons for babies would be hypoglycemia, jaundice or hyperbilirubinemia, significant dehydration, weight lost greater than 10%, there are some rare inborn areas of metabolism which prevent babies from being able to be exclusively human milk fed and there are some congenital malformation and other illnesses.
That’s the baby side and then the mommy side we can have a mother who is extremely ill postpartum, extreme blood lost, a mother who’s milk just doesn’t come in in the expected time, we called that delayed lactogenesis, that’s the fancy term and we believe in the US that actually one in 3 mothers are experiencing delayed lactogenesis. This is really common in the US. A mother who had a prior breast or chest surgery or a mother who’s on a certain medications. There are very few, mostly they’re chemotherapeutic cell mother who’s on in chemotherapy or a mother who clinically has not enough glandular tissue. We call that mammary hypoplasia. So those are the reasons in a quick nutshell.
ROBIN KAPLAN: Okay and what are mom’s options for supplementation and what advice do you have from choosing the type of supplement to use?
ELIZABETH MYLER: We have a lot of different options and I think that you know one of the most important things is that we kind of teased out the contents. So what are we going to use? The amount that we’re going to give? And then the method that it’s given. And then we’re going to talk about some of these things. But we’re lucky to have some great guidelines from the academy of pediatrics and also from the surgeon generals called the Action on Breastfeeding, from UNICEF and also the academy of breastfeeding medicine. And they’ve kind of developed a hierarchy for vast choices of supplementation. And this is really based on the research for what protects human babies and mother the most. Alright so there’s a list of 5.
So our first choice for supplementation is going to be mother’s own milk. Our second choice is going to be pasteurized donor human milk and this can really be hard to find in many cases. And that’s a complicated topic. I know you guys have had it there people come in and talk about donor human milk right?
ROBIN KAPLAN: Absolutely.
ELIZABETH MYLER: Okay. Our third choice is going to be our hypoallergenic or the hydraulize protein formulas. The fourth choice is going to be the elemental or amino acid-based formulas. And our final and last choice is going to be the standard cow’s milk-based formula and unfortunately in the here in the US and really globally that’s usually the first go to the babies are offered. The amount of supplementation is probably as important if not more important than what is being used. And we got some really great new research about how overfeeding in the first 8 days of life is linked to obesity later in life. So [inaudible] did some really great research on this. And it’s something that I don’t think we think about very often you know that we can do something In these early days on the baby’s life that could have such a huge impact on them as an adult.
ROBIN KAPLAN: Is there a good resource for where what numbers we should be using for how much a baby should be supplemented based on their age?
ELIZABETH MYLER: There’re several resources and I know that you had I think you’re going to put a link to Kellymom. I don’t know if you have the link to the Academy of Breastfeeding Madison. They have protocol number 3 which is all about supplementation in the early days.
ROBIN KAPLAN: Yup
ELIZABETH MYLER: And I think you know what moms really do need to know is that what a baby needs on day 1 is not the same as what a baby needs on day 3, 4, 5 and so on. So these are critically you know important differences that moms are not often explained.
ROBIN KAPLAN: Okay we’ll definitely link to those on our website. Thank you so much.
ELIZABETH MYLER: Yeah.
ROBIN KAPLAN: So ladies I’d love to open this up to our panel. So what were the reasons that you had to supplement your baby in the beginning? Cyndi.
CYNDI SMITH: Well I do have a C-section and during my C-section I lost a lot of blood and had to have like large amounts of blood transfused. So it definitely impacted my milk supply and just the fact that I was separated from him for so long. And so I mean he was given a bottle before I even came out of recovery so I definitely think that was the major factor in my little milk supply.
ELIZABETH MYLER: Actually and that really emergency C-section, in particular, is one of the biggest risk factors for supplementation. And then with your hemorrhage you’ve got two of the biggest.
ROBIN KAPLAN: Absolutely. Sarah how about you?
SARAH STREET EVERIST: So I have kind of a double whammy so thought it was tongue-tied and so that kind of made my little milk supply and then kind of have a little bit of an interesting I have congenital breast [inaudible] so I have a breast implant on one side. So milk never really came in fully on one of my breast and it just so happen that Violet really preferred the breast where the milk didn’t come in so much. And when I saw my original lactation consultant as I should in the hospital she said oh don’t worry about it. It is fine, you’re milk is coming in don’t worry she can have that one and unfortunately it didn’t work that way and she had lost an entire pound when we came in for our first weight check.
ROBIN KAPLAN: Oh wow. That’s scary.
SARAH STREET EVERIST: Yeah she had lost something like nearly 15% of her. And I had a C-section as well but it was planned just it was breached.
ROBIN KAPLAN: Okay. How about you Cara?
CARA BARKER: We had a home birth and so when we took him for his first 3 day appointment, he was fine. And then about a week later he had another check-up and he had lost more weight than they wouldn’t have like. And he wasn’t gaining weight back as quickly enough so the doctor asked us to start supplementing. So we did and we later found out that he had a tongue tie which we had have revise and an upper lip tie as well. So we’re continuing with the supplement that hoped to quit soon.
ROBIN KAPLAN: Awesome. Beth what are the different ways that a mom can supplement her baby? So we have 3 moms in here who had to supplement often in the beginning. And so is one method preferred over another?
ELIZABETH MYLER: Well we have lots of different choices here and I think that the key to making a good choice for an individual mom depends on the age of the baby and the capability of the baby and the ease of use for the mother. I think that for many mothers a combination of that of method is truly what works best to help them reach their ultimate goal. So you know bottles are usually the most common because they’re the most easily available. And here in the US, cleaning them is generally not a problem. But we have syringes, spoons, finger feeding methods and even at breast supplementation. And then you know breast supplementation is usually for the longer-term supplementation needs with larger volume.
What I was really interesting just hearing the said different stories there because in all the research that have done on those two the delay and first breastfeeding and maternal infant separation for any reason it’s probably the biggest risk factor for ultimate self supplementation but then you guys also all had these various other problems that and you guys are really hit with. Sounds like you came into this very well educated and yet still had so many different challenges to go. So I really sympathize with that.
ROBIN KAPLAN: We’ve some amazing panellist on our show. It’s truly wonderful.
ELIZABETH MYLER: Yeah.
ROBIN KAPLAN: Dedicated mommas.
ELIZABETH MYLER: Right.
ROBIN KAPLAN: Beth for mom who decides to supplement at breast or finger feed, where could she get the supplies from?
ELIZABETH MYLER: There are lot of different companies that make these devices. They’re relatively easy to find now with just a simple search on Google or Amazon. The smaller volume devices so if you’re you know dealing with really early newborn that only need you know half an ounce to maybe an ounce and a half or two ounces. That device is going to be anywhere from like 20 to 40 bucks. And the larger ones are probably closer to 60 dollars. Again if you’re going to use an [inaudible] breast supplementation device you know the baby really does need to be able to latch.
For finger feeding you know they don’t have to. But I would say that the cheapest device is a neonatal feeding tube. We also use this device to caterterise babies. It’s can be used as a nasal gastric tube it’s called a five French and the abbreviations is FR/CH and this retail for like one to two bucks a piece. They can be inserted into a bottle or attach to a syringe or again just used on the finger to finger feed. And I can give you you know later on some websites where you can find this at that one to two dollars a piece price range I’d like to use. There’s a lot on my practice because they’re cheap. It’s something that you can try without this you know large economic commitment.
ROBIN KAPLAN: Sure and a lot of paediatrician offices I know in San Diego will have those as well as lactation consultants definitely have them. So if you’re working with a lactation consultant that would be something that she should be able to provide as well.
ELIZABETH MYLER: Absolutely.
ROBIN KAPLAN: For the mom who decides that bottle feeding is easier for her for offering to supplement, is there a way that she or family member can do this in a breastfeeding friendly manner or so that way breastfeeding can also be continued to be work on as well.
ELIZABETH MYLER: Definitely. I think the first thing is to really be tuned in to developing a trusting feeding relationship with your baby. Babies have to learn how to coordinate sucking, swallowing and breathing. And they have to do this seamlessly and it’s not always easy for all babies. So the first thing that I want to say about bottle feeding is that learning to do a pace bottle feeding technique can make all the difference in the world. And this is a technique in which the bottle is delivered with a slow flow nipple using frequent pauses you know in between swallowing.
And there is a technique for holding the bottle in more of a horizontal manner than a vertical manner so that the baby really has a lot more control about the volume that he or she receives with each suck. And I think of sort of five steps to that to delivering that bottle and I don’t know if we have time to go into those five steps real quick but…
ROBIN KAPLAN: Yeah go for it.
ELIZABETH MYLER: I’m happy to. So the first thing that we want to do is we want to wait until the baby opens wide like a yawn. And one of the best ways to stimulate that baby to open is to just place the nipple right underneath the nose above the upper lip. And then you want to allow the baby to accept the bottle into their mouth. You don’t want to just poke it in and ram it in. And then you want to lay the nipple tip onto the tongue.
So we want to make sure that that tongue will cover the bottom portion of the gum if possible and for those babies of tongue-tied oh those mothers of tongue-tied babies, you guys may have notice really early on that your baby’s ability to you know extend their tongue and lift their tongue and just move their tongue were truly compromise from the beginning. But next we want to latch the baby deeply on to the base of that bottle nipple so the mouth stays open as widely as possible and that’s you know called the gape. And then we want to pace that feeding like I said before by giving the baby frequent pauses in between their swallows.
ROBIN KAPLAN: Thank you that’s such great tips for offering the bottle well. Really really appreciate you going into that. Ladies I would love to ask you as well, how did you supplement in the beginning did and how did you come to choose that method? Cyndi.
CYNDI SMITH: In the hospital they initially gave us bottles but then I wanted to really work on breastfeeding and the latching so they gave us the supplemental nursing system. And we just used that at home as well but it just became we are supplementing so much that we did go back to the bottles.
ROBIN KAPLAN: Okay.
CYNDI SMITH: And then he was able luckily he was able to go back and forth pretty easily.
ROBIN KAPLAN: Between breastfeeding and bottle feeding?
CYNDI SMITH: Yes.
ELIZABETH MYLER: Yeah and I find in my practice that’s really very common for moms to use multiple devices.
ROBIN KAPLAN: It makes it easier when you have a couple of different options. So that way there is not a stressed that one has absolutely has to work.
SARAH STREET EVERIST: And we definitely use I think all of the methods that you mentioned. We started out at the breast because I remember going into the lactation consultant when they wait her and crying hysterically. They were like whoa it’s okay and so they gave me the frenching thing and we did it at breast and then me and my husband at all hours would finger feed her because she had a really hard time with the out breast device even though she was nursing, she wouldn’t, we couldn’t really thread it into her little mouth.
ROBIN KAPLAN: Yeah.
SARAH STREET EVERIST: So we did a lot of finger feeding and then we did that exclusively for the first 3 weeks and then when my husband went back to work, I said I can’t really finger feed because it would take a good hour to kind of get everything going. I was like I can’t do this in the middle of the night. So we slowly transition in the bottles.
ELIZABETH MYLER: Yeah that’s not sustainable. Yeah tough!
ROBIN KAPLAN: How about you Cara, how did you end up supplementing your son?
CARA BARKER: We began with the bottle before we even saw you for a lactation consultant and then after the visit with lactation consultant we did the out breast supplementation. But as you know it takes a long time and sometime it gets frustrating so we just ended up switching back to the bottle and we do the peast feeding. So that’s kind of how we’re doing it now. After I breastfeed them I’ll do the bottle.
ROBIN KAPLAN: Okay perfect. And Mj did one of our virtual panelists want to share anything?
MJ FISHER: Yes! Pipa Hartridge says that she did cup feeding with formula and whatever breast milk that she could express. She chose cup feeding as the least likely to be confusing for the baby. And the fact that it was super cute was an added bonus.
ROBIN KAPLAN: Alright.
ELIZABETH MYLER: It’s amazing how they can lap it up you know. That’s if they can like move their tongue.
ROBIN KAPLAN: Yeah.
WOMAN: Yeah I know if they can move their tongue totally.
ROBIN KAPLAN: Alright when we come back. We will discuss with Beth the ways that a breastfeeding mother can protect her milk supply while supplementing and how to know when she can actually stop supplementing. So we’ll be right back.
[Theme Music]
ROBIN KAPLAN: Alright well welcome back to the show. We are here with Elizabeth Myler and we are talking about exclusive breastfeeding after early supplementation. So Beth, are all slow flow nipples, bottle nipples the same?
ELIZABETH MYLER: No Robin they are not the same and I think that all of the moms would probably agree but buying a bottle today is like a dizzying experience. You walk in to the babies- so you target and there’s like 12 new ones on the shelf every day and they all say that they are perfect for the breastfed baby.
ROBIN KAPLAN: Yeah.
ELIZABETH MYLER: So I think you know the first thing to think about is that choosing a bottle really depends on the baby’s capability. But there’re two main features that I’m going to be looking for in a bottle. Number one is that you know it at least does need to say that it’s for [inaudible] you’re the newborn. And number two is that it has a gradually widening from the length of the nipple tip out to the base of the bottle. And that is against presevered the baby’s gape, the baby’s ability to open wide.
I really-really love Amy Peterson and Mindy Harmer’s book Balancing Breast and Bottle. They did some really great research on lots of different types of bottles and especially the one that said that they were so slow. And they measured you know drips per second on different angles and they also kind of debunk the you can’t just hold it upside down and watch the drips come out. I mean a lot depends on you know the baby and how they latch and attach and their suction strength and all of those things but I really-really find her book to be helpful both for lactating consultants and for moms.
ROBIN KAPLAN: Absolutely and so when a mom is offering supplementation, how can she protect her milk supply? To make sure that it continues to increase the way that it needs to.
ELIZABETH MYLER: For most moms who are going to be supplementing you know longer than a couple of days. Pumping with sufficient frequency and effectiveness is going to be a really-really important part of what she needs to do. But we do know that if she can combine pumping with hands-on massage and hand expression we really Jane Morton showed that this really can increase her milk supply and even increase the fat content of her milk. Because hand expression allows her to really access the higher-up ducts where some of the fats can collect.
So that’s pretty cool but I also believe in relaxation techniques and other techniques that can stimulate a mother’s milk ejection reflex and that can be different for each mom. And skin to skin contact with her baby is almost always a key part of the plan for keeping her milk supplies strong. When we need to and when this is appropriate the last gags or substances that increase mom’s milk supply they can be culinary like food, they can be herbal like plants or they can even be prescription medications can be all be used chiefly with good results if we’re being careful to target a mother’s specific milk supply difficulties and working with an IBCLC, birth certified lactation consultant who’s experienced and knowledgeable about these things can really go a long way to helping mom.
ROBIN KAPLAN: Definitely and while she’s pumping, do you recommend a certain type of pump and how often she should be pumping?
ELIZABETH MYLER: For me usually the pump is going to mean a hospital grade pump so when I say pumping with sufficient frequency and effectiveness you really need a work horse you know if you’re doing the car analogy you know a pinto is probably not you know a pinto that’s 20 year’s old you know might not really get you where you need to go. And you do might just need a Cadillac. You need a pump that is really designed to be used 10 to 12 times a day you know long term and enough with a hospital grade pump is supposed to do.
But we also really want to be sure that mom is fitted properly for correct pump parts so the flange size needs to be right. We want to make sure that her tubes are clean and new and you know that every other aspect of her pump is working well. There are some case in which a mother, this is a baby driven problem that the diet is having and in those cases sometimes the mom has a really strong milk supply and she can get by when using a new double electric consumer-grade pump. But we do want to look at that and make sure that the pumping pressure is in the desired range.
ROBIN KAPLAN: Okay. Ladies did you pump while supplementing and how often were you’re doing this?
ELIZABETH MYLER: Oh yes! Tell us about it Sarah.
SARAH STREET EVERIST: I pumped every single time I breastfed. And so it was I think we tracked it. It was 12 times a day including the middle of the night and my lactation consultant said, Sarah you do not have the odds on your favour. So if you want to do this, you’re going to have to be really committed. And so I would get up and I would pump for 20 minutes 2 in the morning when everyone else was sleeping. And I did that until…
ELIZABETH MYLER: Including the baby right?
SARAH STREET EVERIST: Yeah everyone was sleeping but me I mean I’ve got some fun Facebook time and so got some alone time. It was nice but we pump a lot well we...
ROBIN KAPLAN: How long did you do that for?
SARAH STREET EVERIST: Over a month?
ROBIN KAPLAN: Wow.
SARAH STREET EVERIST: So it was a big commitment. I remember going to the lactation consultant and she said you breached the point now where I think we can drop the middle of the night pumping. And I was like oh thank god.
MJ FISHER: For your sanity right?
ROBIN KAPLAN: Absolutely. How about you Cyndi, how long did you pump while supplementing and for how long? How often how long?
CYNDI SMITH: Yes we definitely pumped because he was also tongue-tied as well and so we had other issues and I mean we did just major pumping I didn’t pumped that much. I pumped probably like 4 to 8 times a day in addition to breastfeeding like 8 to 10 times a day. And I gave myself a break at night and that was probably for about 2 and a half months a long time so yeah.
ROBIN KAPLAN: How about you Cara?
CARA BARKER: Well I personally hate pumping.
ROBIN KAPLAN: I hate pumping to now.
CARA BARKER: So the most I probably did was about 3 or 4 times a day. And I’m done about 2 times a day so we’re still going but I just like I don’t like it.
ROBIN KAPLAN: Yeah. You’re ready to get rid of it?
CARA BARKER: Yes.
ELIZABETH MYLER: Oh my gosh we tend to call this like the hamster wheel. And you feel like you never going to get off it. Oh you’re just constantly going.
ROBIN KAPLAN: And it’s the guide of the hamster wheel. We’re hoping more than anything that you get to stopped as soon as possible to.
ELIZABETH MYLER: Yeah.
ROBIN KAPLAN: It’s not something we like to recommend for sure. We want you to spend time with your baby so good for you for keeping it up for so long. Beth how would a mom know that she can actually start weaning from supplementation and pumping?
ELIZABETH MYLER: So it depends. If she’s exclusively pumping, let’s say she’s not doing much breastfeeding at all. It’s going to be easier for her to figure out you know what her true milk supply is and how much she’s making. The desire goal is going to be about 750 to 800 millilitres a day. So that’s about 25 to 27 ounces. And sometimes a little bit it has a little bit more as the baby you know gets older than a few months old. But if a mother is partially breastfeeding, it can be really challenging for her to gauge how much milk she’s actually producing on a daily basis. And how much milk the baby is getting from her.
So again working with an experience IBCLC is really advised because we’ve got we have to know how well the baby can actually remove this milk that the mother is actually making. So I like to recommend that moms start by really carefully tracking how much supplement they’re giving and then in a general rule that I think it’s pretty conservative and pretty appropriate is that she try and reduce that supplement by only about an ounce per day total not for feed but an ounce per day for several days.
And go about it that way. She can monitor diapers but you need to keep in mind that diapers are really only relevant if a baby is under a month because many baby you know breastfed babies and formula babies to they’re going to space out vowel movements and we can’t rely on that anymore. So weight checks at least once a week while a mom is decreasing supplementation. I think it’s really-really key to their success and be keeping them on track.
ROBIN KAPLAN: And stopping by support groups to I know most of the support groups I think all of them in San Diego except I don’t know if [inaudible] meetings have scales but all the hospital based one…
ELIZABETH MYLER: No they really don’t.
ROBIN KAPLAN: Yeah. But those hospital based once and private practice once and lactation consultant once typically have a scale so you can actually see what the transfer looks like from baby from breast. So that can be really helpful.
ELIZABETH MYLER: Yeah absolutely.
ROBIN KAPLAN: So you’ve mention kind of tapering off at the one ounce per day for a couple of days that start that weaning process. What other tips do you have for weaning off the supplementation and getting back to exclusively breastfeeding?
ELIZABETH MYLER: So again it really depends on the individual problems that this mother-baby is having. So I think I guess I could start for babies who are really kind of refusing to feed at the breast either sometimes or even all of the time and mom is really trying to you know let’s say she’s gotten her milk supply where it needs to be but she’s really trying to work on getting that baby to breast more often.
Skin-to-skin contact with her baby is the answer to so many of these difficulties. I think I know I tend to call it the baby reboot button you know. Just spending as much time as you possibly can just with baby in the kitchen you know on your chest against you is really-really key. The next thing I think is to really be aware of the instance arousal states and the hunger queues. So keeping baby with you, wearing the baby, catching baby right when they’re starting to wake up and possibly you know doing more frequent smaller feeds really this can do a lot for milk supply and also to really just get a baby back completely to breast.
For baby who’s been tongue-tied and really is just transitioning to being able to remove milk well, there are other tools and tricks of the trade, again I really advise you to work with an experience and recommended IBCLC but sometimes nipple shield and other tools that can help draw out a nipple are good transitional tools for babies who’s still bottle feeding just needs more encouragement to do more feedings at the breast. But positioning is important too so you know when baby comes to breast, having that baby read and assimilate back breastfeeding condition can help babies and mothers get back to doing more breastfeeding and less bottle feeding.
So sometimes I advise that moms actually bottle feed the baby in a laidback breastfeeding position and do sort of a switch but then again the milk needs to be there as well.
ROBIN KAPLAN: Sure. Ladies how long did you need to supplement for? Are you still supplementing or were you able to wean off of it and how did you know when to do that? Cara how about you?
CARA BARKER: We’re still supplementing and we’re working with you Robin. We’re slowly weaning down to once ounce every other feeding so it’s getting there. Just hard work.
ROBIN KAPLAN: Absolutely. How about you Sarah?
SARAH STREET EVERIST: So we were really fortunate and we were able to stop supplementing so I don’t’ she has been exclusively breastfed for nearly four months now so we were able to wean her off supplementing on about 8 weeks and before then we were kind of my husband made this really intense chart of like how much the baby was getting of donor milk and how much I was producing.
ELIZABETH MYLER: Right, I’ve seen the excel chart.
SARAH STREE EVERIST: Oh yeah it was very-very intense and so I remember the day kind of a lion’s cross and she was getting more of my milk than of the donor milk and then eventually we got to a point where she was getting all of my milk and so at that point the lactation consultant said I know this is going to be really really-really scary but I want you to cut down on pumping and I want you to just put her on the breast and keep weighing her and you know at that point we’ve been doing weighing so we knew that things were in upward motion and so it was a very scary but a very happy day.
ROBIN KAPLAN: How about you Cyndi?
CYNDI SMITH: We supplemented for about 2 to 2 and a half months. We also get very detailed data on my app on my phone and so I would keep track of how much he took how much formula he took and then how much expressed breast milk he would take from all of the pumping. And I remember the first day like I went to Robin support group and I was like yesterday he only had one ounce of formula all of the other you know supplementation was the expressed breast milk and she was like well tomorrow don’t pump and just put him on the breast and he did it. That was the end of our formula.
ROBIN KAPLAN: That’s nice.
CYNDI SMITH: So it took us a long time but we got there and so…
ROBIN KAPLAN: Super dedicated.
CYNDI SMITH: That was like 5 months ago.
ROBIN KAPLAN: Wow. That’s awesome. Beth, you know Sarah brought up a really good point that emotionally a mom might feel really scared to trust that her baby is able to get enough just from her so any tips for how she can began to trust her body and her ability to exclusively breastfeed.
ELIZABETH MYLER: Well actually and I think that your panelists really hit the nail on the head for this one and I think frequent check-ins you know with her breastfeeding helpers are going to just be you know often the absolute best thing to do so I think most moms the last thing we want is for her to become disappointed in her abilities you know by showing up at that weight check that maybe we spaced out a little too far and feeling like she’s been derailed again.
So really just everything that they’ve all said about just this gradual transition are really-really key to keeping things strong and being patient you know and knowing that this can take a long time and although days can sometimes feel like years in the grand scheme you know that this baby time really does passes very-very quickly and so you have to really celebrate your small victories and like the mom said you know when you realize that you know that you’ve been able to cut out of supplement I mean that you need to go have a latte, go call your best friend, go you know to celebrate this small victories because they really not small at all.
They’re huge and they take a lot of commitment and you’re just you’re on your way and you have to just believe that with each day of that effort and staying close to your baby and keeping that baby fed you know most moms will be able to get there.
ROBIN KAPLAN: Awesome. Well thank you so much Beth and to our panelists for sharing this incredible information about getting back to breastfeeding after early supplementation. Really appreciate your time.
ELIZABETH MYLER: Oh Absolutely. Thank you so much for having me.
ROBIN KAPLAN: Sure and for our Boob Group club members, our conversation will continue after the end of the show as Beth will discuss tips for when a baby’s pediatrician is recommending a little bit a little too much supplementation. For more about our Boob Group club, please visit our website at www.newmommymedia.com .
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MJ FISHER: Here’s a comment from one of our listeners. This is from Daina Schmidt and she left this on our Facebook page. I just listen to and shared episode 16, Tight Frenula and Breastfeeding. As an international board-certified lactation consultant and mother of two children who had tongue ties I can appreciate the mother’s stories and experiences with breastfeeding a tongue-tied baby. I also really enjoyed Dr. Ochi’s discussion of posterior tongue tie as well as frenotomy and after care especially the acupuncture which I never knew about. Thank you so much for you episode.
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ROBIN KAPLAN: That wraps up our show for today. We appreciate you listening to The Boob Group.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Parent Savers for parents with newborns, infants and toddlers
• Twin Talks for parents of multiples.
•
Thanks for listening to The Boob Group; Your judgment-free breastfeeding resource.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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