Today I am going to talk about a subject that just annoys the bajeezers outta me. It just drives me insane.
Moms are being given very specific advice on how to breastfeed and this advise is not taking into consideration every mother and baby pair but rather treating all mothers and all babies alike.
It has moms deciding how long their babies should stay feeding at the breast.
It has moms timing their babies at the breast.
It has moms deciding to only offer one breast per feeding.
It has moms worried if their baby is getting enough “fat” in their milk.
It has moms worried if their baby is getting too much “fat” in their milk.
What am I talking about?
Well I am talking about mothers being told to only offer one breast per feeding. So, they are starting out their breastfeeding relationship only offering one side per feeding session. It is only Wednesday and half of the mothers that I have met with this week, have been practicing one side per feeding.
While each of the moms may have a different set of circumstances and reasons that they schedule a lactation consult with me, what they do have in common is that their milk supply is low and their babies are not gaining nearly what they should & they have been told to offer only 1 breast per feeding. Some have begun to supplement with formula, some have begun pumping and putting their milk in a bottle and feeding this to their baby. And there are always the mom or two who come to me, totally frustrated and ready to give up and literally will tell me,,, if you can’t make this all better today, if this can’t be fixed today… I am not sure I can continue.
And believe me I get it. I totally get it. This is heartbreaking and frustrating and anxiety producing. Moms are totally spent at this point, their hormones are going crazy, their babies are crying nonstop, perhaps they are in pain and the worst part is that there babies are not gaining well & this alone can put most mothers in a major depression.
When I ask moms if they know why they were told to do this, they all answer quite enthusiastically, They say, yes, I was told to do this so I can make sure my baby gets all the hind milk for each feeding as this is who they will gain weight.
Well I have to say that If I were a new mother and told this by Drs. or Nurses or read it online or given this advise by a family member, I would totally follow this as I want my baby to gain weight.
So much has been written about how the breast makes milk and how there is a higher fat content to human milk and moms are then wanting to make sure their babies get enough of the fattier content so their babies gain and grow well. Moms are sometimes having breastfeeding challenges and the answer they are told is to make sure their babies get the fattier hind milk. They are given strict rules, either by something they read or by a healthcare provider or by a friend or family member, about how frequently to feed their baby, how long to leave them on each side, whether they should offer just one side or both sides per feeding. Strict rules and normal breastfeeding usually do not go together.
What’s the real deal? I am going to do my absolute best to simplify this for you and help you to understand that you should not over think the fat content of your milk. People are now thinking that the breasts literally makes two kinds of milk – The first kind is the foremilk. The second kind is the hind milk.
It is not two different kinds of milk, but merely tells us at what point in the feeding the milk is…. foremilk is the milk that a baby drinks at the beginning of the feeding and this tends to be more watery and a higher level of lactose which are the natural sugars in human milk. Hind milk, is the milk that comes near the end of the feeding and tends to by higher in its fat content. But because this is a constantly changing fluid, how much higher in fat is it really? The truth is, we just don’t know.
That is where the description of foremilk and hind milk, begins and ends. Since every mother and every baby are different, and since every mother and baby pair are different, and since feeding behaviors are different, milk storage capacity is different, and feeding frequency of babies are different, the only thing we can be sure of as far as the fat content goes is that the amount of fat in the milk gradually changes as the baby feeds.
Here is what happens. As milk is produced, the fat globules tend to stick to each other and to the walls of the alveoli in the breast tissue. Between feedings, the milk collects in the breast. It gradually moves toward the nipple and leaves more of the fat stuck further back in the breast. The more time in between milk being removed, whether it is by baby or pump or hand expression, the lower the fat content of the milk available to the baby at the beginning of each feeding.
I will repeat that last part… the more time in between milk removals the lower the fat content tends to be at the beginning of each feeding.But here’s the deal, since the breast is the invisible container and we cannot see how much watery milk and how much fattier milk our baby got during that feeding & even if we did, we cannot predict how much overall volume our baby wants from that particular feeding, how are we to think we are smarter than the baby?
Meaning, can the baby get full in 10 minutes on one side? 20 minutes on one side. need both sides for a half hour? How do we know the volume and the fat content for each particular feeding… their are a lot of things we just do not know for sure, but one thing we do know for sure is that no one knows how long it takes for our babies to get enough of the fattier hind milk or how much higher in fat it usually is.
The problem comes in when moms are being told specific instructions about how frequently to feed their babies, how long on each side to feed their babies… one or both sides.There seems to be a trend of moms being told that their babies are not getting enough of the hind milk, OR are getting information from well meaning breastfeeding helpers from the day their baby is born, to only feed one side per feeding,, all in the name of being sure their baby gets enough of the fattier hind milk.
Why am I up in arms about this advice? Because, because, because, the first 6 weeks are of utmost importance in building a good supply, establishing a good supply of milk that meets your babies needs. After that, it is largely maintenance of the good supply you have established.
When others keep their babies on one side per feeding, they run the risk of limiting the overall volume that their body makes. So, they are now diagnosed at 2 weeks or 3 weeks or later as a mom with low supply. Now, outside of any specific medical reason why she should have a low supply, this business of keeping a baby on one side per feeding, is responsible for many of the mothers I work with, having a low supply
The more frequently and efficiently the milk is removed from the breasts, generally the more milk it will make. And what are moms in the business of doing the first 6 weeks, building a good supply for their baby. By putting them only to one side, you are basically telling your body how much milk to make, rather than trusting that your baby, if following his or her cues, that your baby will tell your body how much milk to make.
I am going to take a moment here to state that there are definitely situations where a mom truly cannot make enough milk for her baby. She has a medical condition known, or unknown that is preventing her from building a supply that meets her own needs. This is not the mom and baby that I am referring to.
I am also going to say that there are times when moms have an overabundant supply of milk and her baby may be getting an overload of lactose which tends to make babies more gassy and fussy and it may help to manage the feedings in a pro-active way to help reduce her overall supply, however, if we put these particular situations aside and talk about the average mother and baby pair that myself and my peers see in the early days, where none of the above is an issue, what we so often are seeing is mothers who are told from the very beginning to only feed their baby from one breast per feeding to ensure their babies get enough of the hind milk. Or So, where her baby is gaining really great and perhaps well above what is expected, in both cases, she is told to feed from one breast per feeding.With the mom who is just starting out, this may lead her to not make enough for her baby.Because this mom is being diligent and paying close attention to the rules she has been given by well meaning helpers, she is doing anything but putting her baby on the other breast during the same feeding session. The mothers I see are holding and rocking and doing their best to help their babies go to sleep while waiting a few hours until they put them on the other side. Moms are giving babies pacifiers to keep their babies calm while they are waiting to put them on the other side. Some babies seem to be okay with only getting a partial feeding. What happens in a relatively short period of time ( the first few weeks of life), it is realized by pediatric visit that their baby is not gaining well. So, they are then advised to supplement feedings with formula. Or they are pumping and putting that milk in a bottle and giving it to their baby.
Now, does it makes sense to NOT offer both breasts per feeding, but begin supplementing with milk in a bottle?Here’s the thing, if your baby is losing weight, I totally agree your baby needs more.But I want to see MORE coming directly from your breast.Just offer the other side, for every single feeding. And do this from the very beginning.If your baby turns you down, it is likely that they are full and getting enough In the early days, most mothers who have an average supply and baby who is breastfeeding well, will find that their baby is interested in both sides most feedings.When I am working with a mother and I have had the opportunity to rule out many other possible reasons for low supply and poor weight gain & I learn that they are just putting their baby on one side and they tell me that they were told to do that so their baby can get all the hind milk, I will then say to the mom:
How long do you have to keep your baby on the same side, until they get the fattier hind milk?
At what point in the feeding do they get the hind milk?
If your baby is sleeping at the breast can they get the hind milk?
How much hind milk does your baby need to get.
You see where I am going with this and very quickly the mom gets it too!
Moms will always answer – “I don’t know” to all of the above questions.
You realize that there is no magic number or magic anything that tells the breast to all of a sudden start making a large volume of fattier hind milk.My job is to then explain to mom about how the breasts make milk, the gradual change in the content of the milk and how it is an ever changing fluid from feed to feed and from beginning to end of each feeding.
We experiment. I show them that their baby only got 1 oz from the left side, explain to them how much a baby needs to get per feeding ( which is usually twice as much, or more then they got from that one side) and suggest they offer their baby, the other breast. Almost always the baby shows an interest and almost always mothers are truly shocked to see their babies feed with gusto. They now realize why there baby is either losing weight or not gaining as well as they should.
If their babies need 30 oz a day to gain well and they are only getting 15-20 from one breast per feeding, it all of a sudden becomes crystal clear to them that their babies are fussy because they are hungry. It becomes clear to them that more than likely their baby is not colicky, but rather crying loudly and frequently because they are hungry. It becomes clear to them that their babies are not gaining well because they are only getting half a feeding. It becomes clear to them that they have low supply because they are short changing themselves. They are literally telling their body how much milk to make, when it should be the babies job to decide that.All because some well meaning breastfeeding helper, does not realize how the breasts make milk & does not trust in the process of breastfeeding.
The good news is that if this mom comes in early enough and gets help and this is her only issue with making enough milk, we can usually turn it around, and sometimes in a matter of a few days or a week or so. It may take some work of not only putting their baby to both breasts, but doing some additional pumping and perhaps takings some herbs, but a highly motivated mother will do it.Once they are 8 weeks or longer postpartum, it becomes more difficult, a lot more work, and longer to help build their supply. Some moms are back to work at this point. Some are just so tired and now lack the motivation to follow a care plan. Other moms are depressed over this and are in not such a great place emotionally to work hard at it. Some babies have become so use to the bottles and or formula that they have started refusing the breast.
So, you see, some people think what is the big deal. Why do I get crazy over this kind of mismanagement of breastfeeding?
Why? Because it puts moms and babies through a very frustrating, lonely and depressing time period when they should be enjoying new motherhood.
Why? Because sometimes the breastfeeding is lost as moms are unable or unwilling to put in the extra hard work to build their supply.
Why? Because some moms do put in the hard work and effort and do not see their supply build.
So, yes, when the breastfeeding is lost, because mom was given crappy advise, the wrong advise for the wrong reason, it totally pisses me off. For now, what I really want you to know is that you really want to be darn sure that you have a very good reason for only offering one breast per feeding and that you have a pretty darn good reason for purposefully lowering your overabundant supply by following one side feedings. Breastfeeding mothers really understand that their milk is a very important commodity and that you don’t want to mess with mother nature for the wrong reasons.
For a handout which states simply what I have said in this blog, click here.
For the podcast show I did on this subject, click here