Breast Feeding

Underfeeding

Underfeeding in a breast-fed baby can creep up on you very gradually in a way which is unfairly difficult to spot. What often happens is this: having got breast-feeding started, your milk supply is plentiful during the first two or three weeks while you are getting plenty of rest and not (we hope) worrying too much about the rest of your household. The baby settles down to some kind of feeding pattern (although it is as likely to be two-hourly as four-hourly!) and you rightly assume that demand and supply are dovetailing nicely.

But eventually you have to step back into running your household again. Many mothers embark on a spurt of activity instead of getting back into the rhythm gradually. Whether it happens when the baby is two weeks old or four weeks old, suddenly taking up all your old activities plus caring for the new baby is bound to make you very tired.

Getting tired and harassed tends to reduce the milk supply. And meanwhile the baby is growing. He needs more milk this week than he did last, so if your fatigue means that there is less available, he is bound to be hungry. His hunger is easy to cope with: you just let him suck more often. But one of the reasons you are tired and harassed is that he needs such frequent feeding. The more other things you want or need to do the harder it becomes to let the baby suck whenever he wants to.

This kind of situation is not easy to spot. The baby's behavior may not tell you very much because discontent and crying, a tendency to wake only two hours after his last feeding and a demand for two feedings in every night, are not new behaviors. They seem like his unsettled behavior in the newborn period, so you may not realize that he would be settling by now if he were not hungry. The behavior of your own breasts may also mislead you. You probably wake each morning with more milk than you know what to do with and in urgent need of a clean nightgown! So how can your baby be short of milk?

The answer is that your supply is copious when you have been resting, but gets less and less adequate as your busy day wears on. If you think carefully back over the past few days you will probably recognize a pattern of your baby being content for reasonable periods between each feeding you give him - from, say, 4am to 4pm - but getting less and less contented from 4pm until you have had your first good sleep of the night. In busy households your milk will often be at its lowest for the baby's early evening feeding because it follows that chaotic couple of hours during which older children need picking up from school, the house needs tidying and supper must be cooked.

What to do depends on how much you want to go on breast-feeding. If you do want to, then the baby has to be given the chance to make more milk for himself, just as he did at the very beginning when you were getting breast-feeding going. The milk is stimulated by his sucking. The more often he sucks, the more milk you will make. When his frequent sucking has built up the supply until it meets his needs, he will suck less often. It is a beautifully simple system and it really does work. But remember that it will take at least two weeks to make a real difference to the baby. He will need the first week to stimulate you to make the extra milk he needs. It is only in the second week that you can expect to get a nice surprise from the scales and to find yourself caring for a calmer and more contented baby.           

Keeping Up the Milk Supply

Once you have got your milk supply up to the level where it meets your baby's needs, you will want to make sure that it remains ample. As well as offering him the breast whenever he seems to be hungry, a few other things will help you both:  

More rest for you, especially toward the end of the day.

This is important. Discipline yourself to rest for a while each afternoon, however difficult it may be to make arrangements for older children or to resist the waiting chores. 

Expressing any milk left over from feedings

early in the day when you have got plenty. The baby probably cannot drink all that is available to him then, but if you empty the breasts for him they will produce more at the next feeding. 

Taking the time and trouble to drink when you are thirsty.

The baby will be taking more than a pint of fluid from you. While it will not help your milk supply to flood yourself with fluid, it does help to make sure that you really drink what you need. If there's no time for tea or coffee, at least take a drink of water. 

Taking the time and trouble to eat properly.

As long as your diet is adequate the quality of your milk will be fine. Your body meets your baby's needs first, now, just as it did while you were pregnant. But if that diet is only just adequate, the fact that the baby's milk is using up a lot of calories, protein and vitamins may leave you short. And that will make you you feel tired and droopy: less able to cope with the demands being made on you. 

Some Things Will Not Help . . .

Worrying

We do not entirely understand how worry and anxiety affect physical functions such as breast-feeding, but there is no doubt that they do. Many mothers see this most clearly if they try to feed the baby in circumstances which are too public for them to feel relaxed: the breast is full, the baby sucks, but tension prevents the "let down" reflex, so the milk does not flow in response to the stimulation of the sucking. As farmers say when dealing with a nervy cow, "you have to gentle her or she won't let it down." You have to try to "gentle" yourself, relax, go easy on yourself.  

Trying to keep the baby to a schedule,

even if it is one which he seemed to have settled on for himself a week or so ago. Your breasts must have the stimulation of extra sucking if you want them to produce extra milk.

Giving the baby a bottle-feeding as well.

If you give him a bottle he will be less hungry; he will not therefore instruct your breasts to make the full amount of milk he needs. The time for complementary bottles is after you have decided that you cannot or do not want to bother to produce more milk.

Leaving a baby-sitter to give occasional bottles of formula.

Breasts which are left full of milk for several hours receive the signal "you have made more than is needed; make less." Once your supply is consistently adequate you will be able to use a bottle occasionally, but while you are trying to increase your supply it is better to take the baby with you when you go out or to leave expressed breast milk for him if you want to go alone. 

Patent medicines which claim to increase breast milk.

Like "tonics" and medicines which claim to increase your sexual vigor, most of these are merely multivitamins and magic. They probably will not do you any harm but unless your diet is very deficient in vitamins they will not do you any good either.

Birth control pills.

It is known that many decrease the milk supply. Discuss an alternative method of contraception with your doctor or family planning clinic. If the pills is the contraceptive you prefer, you will certainly be able to start it again when your baby is four to five months old. If you have breast-fed successfully for that length of time, the whole supply-demand situation will be perfectly adjusted and will override the slight lessening caused by the pill. Furthermore you will probably have started your baby on some extra foods by that time so that he will no longer be dependent on you for every single calorie he requires. 

If Things Don't Improve . . .

If you can dedicate two weeks to trying to increase your breast milk and your baby's contentment, you will almost certainly succeed. Almost every healthy woman can produce enough milk for her baby, irrespective of his size and hunger, but not all of these can do so while doing much else. Some women are happy to treat breast-feeding as an almost full-time activity for a few weeks; abandon all idea of "feeding times" or "sleeping through the night" and just concentrate on the baby. Other women don't want to or simply cannot. If you have a toodler or older child, already a little saddened by your absence for the birth and your new distraction from her, you may feel that being available to play with her, to take her out and to care for her as you used to do is just as important as breast-feeding. If there is nobody who can take care of your household and you, lying about most of the day while the baby cuddles and sucks and dozes may mean no food in the house, no clean clothes for anybody and loneliness for you. And if your nipples tend to get sore and the house is closing in on you, you may just feel that you've given breast-feeding your best shot and that's enough. Just as the original decision to breast-feed was necessarily yours, so the decision to carry on with exclusive breast-feeding whatever the cost must be yours too.

Do make a positive decision, though. You can ensure that your baby gets plenty of milk while reducing your time-commitment to breast-feeding by giving him complementary bottles of formula. But once you start regular complementary bottles there is a very high chance that the amount of milk he takes from the bottle will gradually increase, that the amount of breast milk you make will therefore gradually decrease and that within a couple of months you will be feeding him entirely from the bottle. It will not matter to the baby but be sure, before you begin, that it will not matter horribly to you.   

Complementary Bottles

Choose and prepare a bottle formula just as you would for a bottle-fed baby. Feed the baby from the breast as usual, but at the end of each feeding, when he has taken all he can from both breasts, offer him a bottle of the prepared formula. The amount of formula he drinks will be roughly the amount he still needs after taking all your breast milk. It may be nothing at some feedings, quite a lot at others.

If he is only willing to drink any formula after certain feedings of the day (it will probably be the late afternoon and evening ones when your milk supply is at its lowest), you need only offer bottles at those feedings.

It may be several days before the baby will accept the bottle. Babies who have settled to breast-feeding do not usually take easily to an artificial nipple. If yours refuses to drink any formula at all, you may not be clear if he is refusing it because he is already getting enough from the breast or because he dislikes the new method. The only way to be sure is to persist in offering the formula for at least five days. If he is hungry, the baby will have given in and accepted it within that time. If he has not accepted it, he is probably not hungry. Check on his weight gain, though. 

Disadvantages of Complementary Bottles

Complementary bottles tend to reduce breast milk 

Once the baby accepts the bottle and takes all the extra he needs from it, he will be hungry less often than before. Your breasts will receive less stimulation because will suck less often, so it will be difficult for you to maintain, much less increase, your supply. 

They tend to reduce your motivation to breast-feed.

Even if your baby is only taking a few ounces per day from a bottle, you still have the expense of buying and the trouble of sterilizing feeding equipment and of preparing formulas. You may soon feel that you are getting the worst of both worlds and might as well let breast-feeding tail off.

They tend to reduce the baby's motivation to breast-feed. 

Even if he is reluctant to begin with, a baby who has learned that milk comes out of bottles as well as breasts is likely to get "lazy" about breast-feeding - especially about bothering with that last half ounce which takes considerable sucking effort. As soon as the breast milk stops flowing freely he looks around for the bottle.

In theory you can breast-feed and give complementary bottles as necessary right through to weaning time. Some mothers actually do this. They are usually the ones who very much enjoy breast-feeding and are therefore prepared to take double trouble in order to go on. However, most mothers find that starting on complementary bottles means a gradual end to breast-feeding and a switch to full bottle-feeding.   

Overfeeding

You cannot overfeed a breast-fed baby unless you give something else as well as milk.

A hungry baby who has a mother with a copious milk supply and is not a very active type may get fatter than the baby next door who is also breast-fed. Don't compare them. He will not get too fat for himself unless you start adding solid foods before he needs them, or giving him too many sweet drinks.