Establishing Your Milk Supply
Before we ever leave our clients after a birth, we make every effort to get our mothers and babies to initiate that first latch. The goal is to always keep them together (skin to skin) with very little interruptions for as long as it takes until the connection has been made. Most of the time this is all that is needed to support the new mother and infants' breastfeeding relationship. If the birth was non-medicated, absent in complications or interventions, then the breastfeeding relationship is often more fluid. If the birth involved complications or interventions, the breastfeeding relationship can have more hurdles that come up, but they are addressable. Taking the mother's intentions and will into consideration, good support, proper information and solid nutrition will assist the breastfeeding relationship. As it becomes more established, it will eventually improve, and ultimately thrive.
Skin To Skin
The evidence is clear that when an infant is left at the mother's breast and given uninterrupted "skin to skin" time, the breastfeeding relationship becomes more organized. We encourage as much skin to skin as possible while in the hospital, and promote babywearing once home for the first 6 weeks. This is a simple and effective strategy that will prove fruitful.
When an infant is born, one of the best ways to help them get their glucose levels to establish are to get colostrum in their mouths within thirty minutes of birth. Sometimes, babies are so stunned by their birth, that they have locked jaws and are not ready to suck. We make a point to teach our clients and help them to hand express their colostrum into the infant’s mouth immediately, with or without signs of sucking. This is what we call sublingual feeding. The sublingual intake moves into the infant’s bloodstream faster than if it were in their belly. We just want to get as much colostrum as we can to sit in the infant’s mouth. The swallowing and sucking will come! When it does, the colostrum will be this child's first and best antibiotic!
The more an infant is given the opportunity to take their first latches at their mother's breast, the better. Sometimes, we add the principle of finger feeding. This is when the mother, or partner, takes their pinky or forefinger, and brings it to the infant’s mouth for them to latch on. This gives the baby an opportunity to suck, while role playing what we want to see them do at the breast. After about 30-60 seconds of this practice, we move the baby to the breast. We will often see great results. Remember, new babies love to suck. We want to see them at their mother's breast to comfort this instinctual need. This is nature’s way to creatively establish the mother's milk supply and aid a successful breastfeeding relationship. We discourage any sucking resources other than the mother's breast or the parents fingers, until the breastfeeding relationship is secure. This can take up to 6 weeks, sometime less and sometimes more.
The Perfect Latch
Breastfeeding is like learning to ride a bike… You get on ready and excited, then you quickly find that it is not as easy as other's make it look. You fall off and attempt to get back on. It's a little better this time, but you fall off again. Then, as you feel scared and uncertain, you dig deep within yourself and say, "I will do this." Guess what..? You will! It will take commitment, great support, faithfulness and grace. Grace for yourself and grace for your baby. Every baby starts with their own story, which will influence their latch. We do our best to help our clients feel comfortable with their efforts as they bring their little's to the breast. Some babies just seem to know what to do, and some babies need some extra support. It is important to understand that the perfect latch is a latch that is worked on through great observation of your infant’s cues and ways. It is worked on through time and patience. It is worked on.. and worked on.. and worked on.. and then suddenly you are riding your bike all by yourself without training wheels or someone pushing you from behind!
One of the most common disruptions to the breastfeeding relationship is conflicting information from varying care providers. One nurse will say, "Start pumping, you do not have enough milk," while the Lactation consultant will say, "You are doing great, it is day 3 and your baby is showing great output." Listen to your instincts! They are often spot on. Remember, we are all unique and creatively made, and so too is each breastfeeding mother. You are unique, creatively made and have exactly the perfect breasts for your baby, with the potential to have the perfect amount of milk for your child's individual needs. Your colostrum has been present since the first 14 weeks of pregnancy, preparing and readying itself to coat the stomach lining of your infant after birth. As it changes into a mature form of digestible human milk, you baby's stomach will be ready.
"I don't have enough milk"
It is all too common, that within days after a successful un-medicated birth, I hear our clients say, "I don't have enough milk." This is important to address and there are three things I consider while working to get to the root of the issue.
How old is the baby?
What kind of postpartum support does this mother have?
Is this a perceived or valid reality?
Top Three Standards
Although we appreciate the subjective approach of knowing if your baby is getting enough milk, we are drawn to a quantitative approach, valuing three standards: Wet Diapers, Dirty Diapers and Weight Gain!
1. Wet Diapers - We expect to see one wet diaper per day of life outside of utero. Day 1, at least one wet diaper. Day two at least two wet diapers. Day three, at least three wet diapers. Day 4, at least four wet diapers. You get the drift. Often, we will see more, but this is what we HAVE to see. We are also looking for clear, pale colored urine by day four. This indicates sufficient hydration. Always be aware that the standard diapers have more protection than we realize, so we suggest that you place a piece of toilet paper in the diaper so that when you change infant, you have a more accurate reading. Change diapers after each feeding, or at least every two hours.
2. Dirty Diapers - The infants first three days of stools are all about cleaning out their systems. They will move from thick, tar like stools called meconium to greenish in color, then brown. As the mother's milk begins to mature (which is often between days 3-5 of infant’s birth), the stools will become yellowish in color and seedy in texture, similar to seedy mustard. We expect to see yellowish stools by day 5 and beyond. Because breast milk is so high in protein, it is also a natural laxative and will digest quickly. The protein aids in caloric intake as well. Between weeks one and four the infant can be producing at least 2-3 stools per day, if not more. This is a sign of sufficient milk intake.
3. Weight Gain - It is normal for an infant to loose weight at a 5-7% level by days three and four. We want to see baby back at their birth weight or more by days 10 through 14. By day 5, we are looking for 2/3-1oz of infant weight gain. This is why we emphasize skin to skin, hand expression (compression) while nursing, and baby led feedings for the first 14 days.
Being that the AAP (American Academy of Pediatrics) encourages a newborn check 3-5 days after birth, we often find that babies are below their birth weight and mother's walk away afraid that they do not have enough milk. We encourage our families to schedule their appointments for day five rather than any earlier. Often, if all measures that have been mentioned above have been taken, Joyful Roots babies have exceeded their birth weights.
We really hope that as you process these basic principles that lead towards a healthy breastfeeding relationship between you and your newborn, that you are encouraged. May you feel freedom to thrive and engage in the newness of life as you observe your newborn and stay faithful to the process of learning new things!