FAQ: How can I increase my supply so I can stop supplementing?

Of all the questions we hear from new mothers, this is one of the most common. There are a number of reasons that a mommy may end up supplementing her breastfed baby's intake with formula, but many mothers and pediatricians prefer babies to be exclusively breastfed, if possible. Here are some key pieces of information and basic steps you can take to help achieve exclusive breastfeeding for your child.

1) Call a lactation consultant. Every situation, every family, every mother, and every baby is unique. There is no one-size-fits-all fix, so if you're having any difficulty with breastfeeding or your milk supply, the first thing you should do is set up an appointment with a lactation consultant as early as you can. Lactation Consultants are trained to recognize latch and positioning problems, tongue and lip ties, and many other problems that can hinder your breastfeeding relationship. Don't balk at the cost: it often takes only one visit to point you in the right direction, and in the long run, it's much cheaper than buying formula!

2) Breastfeeding is a supply-and-demand system. Particularly at the beginning, as you establish your supply, the only thing that will regulate how much you make is the frequency with which you completely drain the breast. A baby (even a newborn with a wonky latch) will always drain the breast more effectively and efficiently than a pump, which means that a nursing baby will stimulate your supply more than the pump will. If you've been relying mostly on pumping so far, that could be one reason why your supply hasn't caught up yet. Limiting feed times or adhering to a strict schedule instead of feeding on demand can also cause supply to lag.

3) An additional problem that might be going on if you're supplementing is a bottle preference. It's less work for a baby's mouth to get milk/formula from a bottle than it is to get it from the breast (literally, the tongue has to make a completely different motion), so many babies who are bottle-fed develop a bottle preference and become frustrated at the slower flow of the breast. A problem that comes with that is that they can drink more fluid in less time from the bottle, meaning their stomachs (which are TINY and usually can only hold an ounce or two as newborns) expand faster than they would were they drinking from the breast. And finally, breastmilk is metabolized much faster than formula, meaning a breastfed baby is hungry more often than a formula-fed baby.

As long as your baby can get his food from somewhere other than your breast, he won't be stimulating your production enough to increase your supply.

4) As long as your baby can get his food from somewhere other than your breast, he won't be stimulating your production enough to increase your supply. The most effective solution is also the most upsetting: Stop giving baby formula and offer the breast as often as possible. If he still wants to nurse after 40min, let him! If he wants to nurse again only a few minutes later, let him! If he wants to nurse 3 times in 2 hours, let him! Even if you think you have no milk left, you usually do, and better, if he really does manage to suck you dry, that means he's getting the fat-rich hindmilk, which is great for his weight gain! AND having him nurse you completely empty will send your supply into overdrive..... odds are you'll be engorged within 24 hours!

5) Some mothers who have been in this situation often recommend going into a quiet, dark room and just nursing for hours, some recommend trying skin-to-skin, some recommend co-sleeping, and so on: you'll find what works for you. And keep in mind that fussiness is not always hunger..... if she cries after eating, it could be gas, a wet diaper, tiredness, the desire to be held or swaddled, or just frustration. Keep in mind that your baby is likely to be upset and crying the first few days that you withhold the bottle, but as long as she's having regular wet and dirty diapers, she is healthy and there's no need for concern.

Make sure you are in communication and agreement with a pediatrician you trust at all times while transitioning your baby's diet, both for your child's safety and for your own peace of mind.

Keep calm and nurse on, mamas!

The Vanishing Finish Line

Before my son was born, I obsessed over the birth process. I read every book, every website, haunted message boards, practiced yoga and meditation, spent weeks drafting a birth plan, and so on. Then, the day came, and through an unexpected set of circumstances, I got my perfect birth. I was sitting there in the hospital, snuggling my squishy little 6lbs 15oz burrito and basking in the glow of having finally crossed the finish line, when I overheard a nurse saying "....his latching score is pretty low...."

Wait, what?

And it suddenly hit me that with all my preoccupation of how to bring this baby into the world, I hadn't given a single thought as to how I was supposed to keep the little squirt alive! Oh sure, I'd put a breast pump on my registry and somehow managed to pick up a couple of nursing bras, but had I read a thing about breastfeeding? NOPE.

Remember what the nurse said about his latching score? Yeah. Suddenly my boob was a "sandwich" and nurses were jamming my baby's face onto it, handing me a little tube of Lanolin and telling me that I might feel "sore" for a few days. I don't know about you, but when I hear the word "sore," I think of how my muscles ache after a long run, or how my toe feels when I stub it, or how my head feels when I bump it getting out of the car.

None of those is comparable to the feeling of having a tiny and adorable yet voracious little monster chew on your heretofore mostly-untouched nipple as if his life depends on it (because, in fact, it does). I told the nurses, "It hurts" and they said "It shouldn't hurt if he latches right." After a brief visit from a lactation consultant who assured me everything looked good, we were headed home. Where was the finish line now?

As I write this now, I'm looking over the New Mother's Nursing Journal that the hospital gave us and which we used for the first month of K's life to track feedings and wet/dirty diapers. Next to "Feeding Time" is a column for "Comments." Here is a sampling of what appears in that column in the first two weeks of my breastfeeding career:

This image and header by Susan Holstein Photography.

Hurts me!
Very difficult stop-start, painful
Stopped short due to nipple pain
Hellish feeding, so much pain
Bloody nipple :(
painful
super-hungry, painful! :(
OW
Ow again
Owwww....

.... and my personal favorite:

HOLY HELL

I told my husband that I would rather give birth ten more times than let our son near my nipple again (thankfully, I didn't follow through on that threat). I dreaded every feeding, and screamed and cried each time he latched. I remember being absolutely furious at the idea that this was supposed to be some kind of bonding experience for me and my baby, because I honestly felt like breastfeeding was inhibiting bonding. Worst of all, his weight gain was way behind where it should have been.

Craving some reassurance that this was just a phase that couldn't possibly last, I turned to my online mommy group for support. Upon hearing my woes, the more experienced mothers said: "Don't worry, the pain goes away after the first 4-6 weeks." I was horrified: I wasn't sure I was going to survive the next HOUR, so a month sounded like an eternity! The finish line seemed farther away than ever.

And then, when my little boy was only eight days old, this happened:

My memory of this period is so fuzzy (read: repressed) that I actually only remember one formula feeding, but the journal says he had several within a 24-hour period. With the benefit of hindsight and experience, I know now that I was on a slippery slope, seriously risking my supply and any continuance of our breastfeeding relationship. At the time, however, I only knew that I absolutely could not continue without sleep and a break for my poor nipples. I fed my sweet baby that first bottle of formula myself, crying the whole time, then handed him to my husband and went to bed. It could have been the end for us.

Fortunately, my very next entry in the book says "Back to the breast!" I wasn't dropping out of the race just yet. We visited a lactation consultant who noticed K's tongue tie and recommended we get it clipped immediately so that he could better transfer the milk (and it would be less painful for me). It took only a couple of days to get the appointment, but even that brief wait was agonizing.

After resolving the tongue tie, I was looking forward to the blissful and painless feedings that would surely begin.... and while it was a tiny bit more bearable, I still winced and yelped more often than not. My little boy was now two weeks old and still not back up to his birth weight. I knew that my supply was not our problem: our newborn was a heavy sleeper, whom we often had to wake to eat. I needed to get him on the breast more frequently, but I was terrified of the pain.

At the suggestion of a friend, I set up camp on the couch with a giant bag of trail mix and started watching through all of Doctor Who. I had decided to stop looking for the finish line, to stop looking beyond anything other than the current feeding. I told myself that my only job was to sit in one place and let my baby eat, with minimal flinching, if possible. And that's what I did, all week.

When K was three weeks old, my family came to visit. In a valiant attempt to do what normal people without newborns do, I accompanied them out to lunch and on the way, I stopped by the breastfeeding center to weigh my son. I remember unwrapping his skinny little limbs and removing his heavily wet diaper, praying he wouldn't pee on me. The numbers on the scale spun and settled: 6lbs 15oz. I had gotten my baby back to his birth weight.

It was a victory and a wonderful relief, but I decided then that it wasn't the finish line. "Heck, I might even go all the way to three months!" I thought. Recently, we passed nine months of exclusive breastfeeding. K has never had another drop of formula since that one day, his growth on-track and his health "perfect," according to his pediatrician. I don't know where the finish line is now - a year, two years? - but I no longer care. I'm too busy enjoying the journey.

A Little Situation

Before Bugs made me a mama, I would see newborns snuggled up with their mom or dad and I'd run up and politely ask to take a peek.  I'd get that "what a sweet baby!" giggle and I'd say something that I thought was appropriate-- something like, "oh my goodness! She (or he) is sooooo tiny!!"

I told you that to tell you this:  Before I began touring the country and performing with my husband, I worked for nearly 6 years at a children's gym.  So, when Bugs was born, I anxiously anticipated her 4 month mark so that I could begin taking her to classes there.  And it was fun!  She loved it and I loved it.  

Until we were getting our shoes on to leave.

It started with that comment that I once deemed totally appropriate and harmless.  The exchange went as follows:

Mom 1:  Oh, she is soooo tiny....how old is she?

Me: 4 months yesterday.

Mom 1: Oh...wow, my friends 1 month old is bigger than her.

Me: *blank stare of confusion*

Mom 2: How much did she weigh when she was born? Was she a preemie?

Me: She was only 5 days early.  She weighed 7 pounds, 2 oz.

Mom 2: Oh, so she was average sized then.

Me: Yeah, I guess....she's my first.

Mom 1 to Mom 2: She's definitely not on the charts.  

Mom 2: *shakes head*

Me: But...but....she's hitting all her milestones.

Mom 3: What does her pediatrician say? Is he worried?

Me: He hasn't said anything.  Her weight is lower than a lot of babies her age, but that can be normal in breastfed babies.  Sometimes they have slower weight gain, sometimes quicker.  I think every baby is different.  And I heard there is a chart for exclusively breastfed babies that's a bit different.

Mom 3: Oh, is she ONLY breastfed.???

Moms 1, 2, 3 (paraphrased): RICE CEREAL! FORMULA! METABOLISM ISSUES! SUPPLEMENT! SOLIDS! DIGESTION PROBLEMS! OATMEAL! BOTTLES! NOT ENOUGH MILK!!!!!

Say what?!?!  Yeah Bugs, my feelings exactly.

So, I packed up the Bug and headed home and directly to my computer where I proceeded to Google the bejeezus out of every growth chart,  every breast feeding website and Facebook page and every blog where a mother had a "tiny" baby. 

But, trust me when I tell you that if a baby is small, the mama knows this.  I knew it.  Bugs' pediatrician knew it.  It was never a cause for concern since she was healthy, hitting all her developmental milestones (sometimes earlier that average) and was an all around happy baby.  But, the onslaught of the Mommies 1, 2 & 3 made me doubt what I already knew to be true--she was getting everything she needed from "only" breastfeeding.

But I did learn an important lesson--much like dealing with pregnant women, the only truly appropriate thing to say is how wonderful they are!  Every pregnant woman needs to hear that they're beautiful and every new mom should get to hear how adorable her baby is and what a blessing she holds in her arms...no matter how light or heavy.

What is your favorite comment that you have received about your baby?

Diagnosing A Posterior Tongue Tie

My son was born 16 days early after my induction due to pre-eclampsia. While our breastfeeding relationship seemed to be off to a good start, two weeks later and I was in a world of pain! I honestly believed that if spy agencies used breastfeeding as a method of torture there would be no secrets left to tell! I kept calling Lactation Consultants until I found one that was able to see me right away – something needed to be done because there was no way bleeding, cracked nipples were normal! Our latch looked good so the LC took a closer look inside L's mouth. She immediately diagnosed him as having a bubble, or high, palate. L would not let her get a good look under his tongue but I had been told in the hospital he did not have a tongue tie so we didn’t think that was the issue.

Because he was a late pre-term he lacked buccal fat in his cheeks – so, along with the bubble palate, we thought we had found the issue. I began using a nipple shield and was told that in a few weeks, when the fat started growing in his cheeks, nursing would get better. From that point on our lives were dependent on that silly little piece of silicon. I couldn’t go anywhere without it – in fact, I got nervous if I didn’t have one immediately within arms reach.

Lucas was also eating pretty constantly – if he went more than 20 or 30 minutes without eating he’d start screaming. Each nursing session was also at least an hour. He was constantly falling asleep at the breast and I would have to pat his little bum to get him to keep eating. My life revolved around breastfeeding.  I didn’t mind it, but I had friends with babies only a few weeks older than L and that was NOT the breastfeeding relationship they had with their children. I tried to remind myself every baby was different, but something just didn’t seem right.  

Out of frustration, I finally called the pediatrician and they scheduled an appointment. They asked about my supply, thinking that may be the issue, but I was pumping 4-6 oz AFTER feeding him in the morning so that was ruled out; my son didn’t spit up so they ruled out reflux, the breast did calm him so they said it wasn’t true colic. After 20 minutes I was told I had a fussy baby and I was feeding him too much (He had gained 1.2lbs in about 2 and a half weeks – but remember he was eating constantly and attached to my breast about 16 hours per day). I was told to only feed him for 15-20 minutes per side and then wait at least 2 hours before feeding him again. The pediatrician said that the first few days would be rough but that my baby would “adjust.”

I hated that advice but I felt pressured into doing what the pediatrician told me to do. Those next few days were torture. I’m pretty sure there is video of my husband and I with the baby in the kitchen with the microwave fan on, the water running, us “shhh-shing” and squatting with our 8 week old. Those videos will certainly be used against us at some point in the future! After two days I knew this wasn’t really working and started to feed him more frequently again but not constantly. We began giving him bottles at night and he’d chug 5 or 6 oz if we let him. He made such funny noises when he’d take the bottle (another red flag we totally missed by the way!).

At the 9 week mark Lucas started losing weight. I had also began to have the most horrible pain in my breasts, which I eventually realized was blocked or plugged milk ducts. Literally every two or three days I’d be in the hot shower, massaging my breast and pumping like crazy. I even began taking Lecithin (which does help with plugged ducts in case you were wondering!).

Finally, after posting all of this on a Mommy Group board that I belong to one of the women suggested a posterior tongue tie. My mom, who is amazing and was doing her own research, came up with that same theory. Once we came up with this theory I started doing a ton of a research on the subject. Here is what I learned:

First, posterior tongue ties can be extremely difficult to diagnose. Because breastfeeding became less popular than bottle feeding many years ago a lot of pediatricians are not skilled at discovering anything other than the obvious “snake” tongue or “1 and 2″ tongue ties. **Oh, I should mention there are 4 “levels” of tongue ties.  The first two are very obvious and easy to see, the 3rd and 4th are considered posterior and make diagnosis difficult. 

If you look closely you can see the dip in L's tongue where it was connected

Second, tongue ties and lip ties are considered hereditary. My brother had a tongue tie that was clipped as a baby as well as a lip tie that was not corrected and my father’s brother still has a pretty significant lip tie.

Third, tongue ties, lip ties and bubble pallets are typically related – meaning if you have one, there is a good chance you have another.

And fourth, in order to breastfeed correctly, babies need full movement of their tongue – they need to create a seal around the nipple, preventing slippage, and proper drainage of the breast. A tongue tie prevents this – hence the pain, low weight gain and even plugged ducts you’ll see below.

So what are these tongue tie symptoms? I’ll highlight the ones we had in an effort to save you from reading too much!

• Sore, damaged, cracked nipples that do not go away after the first few weeks of breastfeeding
• Mis-shappen nipples after feeding (flat or pinched typically)
• Frequent feeding
• LONG nursing sessions – an hour or more at times!
• Slow or no weight gain or excessive weight gain (quick explanation – because baby is eating all the time and constantly getting the high calorie foremilk they can gain weight excessively but if feedings are “limited” like was suggested to us they will not gain weight or begin to lose because they aren’t getting enough food)
• Reflux
• Hiccups
• Fussy at breast
• Tense and unable to relax when feeding – think clenched fists, tension in head/neck, etc.
• Colic
• Baby only takes short naps and never sleeps peacefully
• Cannot maintain a seal on breast/bottle – a lot of leakage
• Infrequent swallowing
• Constant need to suck – at breast, on a bottle, paci, fingers, etc.
• Mastitis or recurrent blocked milk ducts
• Supply issues
• Nursing blister on baby’s upper lip
• Green stools
• Unable to maintain a latch at breast
• Noisy feedings – baby makes clicking or popping noises at breast and bottle, loud swallows, etc.
• Excessive gas
• Gagging
• Weak or lazy suck
• Baby falls asleep when feeding constantly
• Snoring when sleeping
• Scoop in the tongue
• Unorganized suck/swallow pattern – doesn’t suck/swallow but rather you get suck, suck, suck, swallow, breathe.
• Excessive drool (not related to teething)

Obviously we had a lot of things going on so I wanted to get into the pediatrician right away! I was pretty sure I had figured out our issue but I needed confirmation and a solution.

Was it a posterior tongue tie?  Finish reading our story here.