At birth, my little girls were pretty petite at just 4 pounds, 8 ounces and 5 pounds 14 ounces. The main focus became making sure they were getting enough and gaining weight. The smaller baby, Jolie Grace, missed the NICU for her weight by just 49 grams (a just about a tablespoons worth), so I became determined to keep her weight up so that they both could come home with me when I was discharged. In the beginning while my milk was still coming in and weight was of major concern I supplemented with about 1-2 ounces of formula or if I had pumped enough, breast milk, after each time they ate. I would nurse for just 15 minutes at a time so that they wouldn’t burn too many calories working to get the milk. The bottle was much easier of an effort and after 15 minutes at the breast, I would offer the bottle and they would eat just a little more. After the first month the girls improved at feeding, my milk supply became efficient, and my life got so much easier. It was tough feeding them once, and then feeding them both all over again.
To some breast feeding mothers, formula isn't ideal, but until you start producing enough milk for your baby or babies, it might just be the only option. That was hard for me to accept, but finally I came to grips that it wasn’t about me at all- it was all about making sure my babies had enough to eat and grow. With this realization my confidence increase and my anxiety levels dropped and I knew they were getting enough and that's all that matters.
Breastfeeding: Using Your Resources
If you are having difficulties with breast feeding, my number one pieces of advice- don’t stop offering the breast. The desire is that eventually your little one will get the hang of latching and in hopes to successfully breast feed, the baby needs that familiarity of nursing versus bottle feeding. That will not only stimulate more milk, but can be practice and encouragement for your little one, too! I was lucky that neither of my girls had an issue with latching, but I knew what to look for in an incorrect latch and quickly attempted to correct it. Which brings me to my next tip: Be sure contact your hospital lactation consultant and see about going in for her to help you. From the moment I arrived to recovery I started asking for my lactation consultant. I was really lucky for the support I had in the hospital from those LC's. At my request they came in every day I was there for at least an hour to help me learn what is a correct latch and what to look for and change if I started having troubles with feeding. They totally prepared me for when I was at home- and I was thankful because, even as prepared as I thought I was, I was still clueless.
The greatest increase in demand comes from pumping. I was hooked to that machine 8-10 times every day during the first 6 weeks or so. Because the girls’ mouth were small and were not successful in emptying my breasts during a feeding, I had to make my body think that they were so that the supply and demand theory would kick in and increase production. Eventually my body figured this out and started to produce enough for both girls and I didn't have to supplement with formula any more. Pumping soon after a feeding will help your body think that you still need more milk and, again, more milk will be produced. There are a ton of theories and ideas out there for how long you are supposed to pump. I've heard to pump 5 minutes after you notice the 'last drop', some say to pump at least 20-25 minutes and no less, others say just 10-15 minutes is enough. Personally, I would make sure to pump for at least 20 minutes, or until your breast feel soft and empty. Even though pumping so often in the beginning seems terrible, it's not forever. If I am at home, I pump just once a day in the morning after their first feeding. I can get anywhere between 5-8 oz after feeding them. During my work week I pump three times in my 8 hour day and express about 30 ounces total. There were times in the beginning that I would cry because I wasn't even getting 1/2 an ounce during a pump session. I worked so hard and couldn't get results to save my life. It's important for your body to believe you 'need' the extra milk and the stimulation from the pumping will promote more milk to be made.
Increasing & Maintaining Milk Production
Some things I've tried that didn't do much:
• Mothers Tea- To me it tastes and smells horrible. I didn't seem much change at all in my milk supply.
• Fenugreek- smells of maple syrup (it is the additive that is actually added to pancake syrup) and I didn't see too much of a change in my milk supply. I was taking 4+ pills a day and decided after finishing a bottle that it wasn't worth it to purchase again.
What works for me:
• Multi-grain Cheerios. No joke! I eat a bowl of Cheerios every night before bed and notice a huge change in my milk supply for the next day. There are studies that say oatmeal is helpful and since Cheerios are and oat based cereal I can see why it works for me.
• Stay hydrated. I can tell in my milk supply when I don't drink enough throughout the day. I try and drink at least 100mL/day of water alone. Not counting the water I get from fruits, vegetables and other food sources.
• Eating a balanced diet. Occasionally, a mother’s calorie or fluid intake can affect milk production. Excessive dieting can reduce milk supply, but sensible dieting is generally not a problem. I have read that it’s best not to do anything consciously to lose weight until after the second month. This gives your body enough time to successfully establish a healthy milk supply that is less likely to be adversely affected if your caloric intake is restricted. I had no problem dropping the baby weight, but I wasn’t doing so with effort.
o Breast feeding a singleton baby you need an additional 300-500 calories/day. Breastfeeding twins you need upwards of an additional 1,000 calories/day
o There are no foods that you should avoid simply because you are breastfeeding. It is generally recommended that a nursing mother eat whatever she likes, whenever she likes, in the amounts that she likes and continue to do this unless baby has an obvious reaction to a particular food.
The main thing needed to maintain an ample milk supply is simple –The more often and effectively your baby nurses, the more milk you will have.
My girls are eating more and more these days. They now eat between 5 and 6 ounces at each feeding. Between the two of them I need to pump almost 40 ounces while I’m at work. I cannot help but have a twinge of anxiety every time I increase each feeding amount. I am fearful I won't be able to keep up, but so far I haven't had any problems.
I expect that there may come a point that I'll have to supplement with formula and I'm okay with that. But, I'll still give them what I can of breast milk. What matters is that I am giving them what they need whether it be from breast milk or formula. Either way they are healthy and growing the way they need to. That’s definitely a success in my book.
Amber Massey is a Registered Dietitian with the Executive Health Program at Texas Health Harris Methodist Hospital Fort Worth and new Mom to twin girls.