I am sitting down today to write about a serious issue intimately related to breastfeeding. There is an enormous amount of pressure placed on new parents to breastfeed. I acknowledge that the known science supports breastfeeding as the ideal feeding choice for newborns. Breastfeeding provides more than nutrition and medical benefits to the lactating parent and infant. It also is a powerful bond between a parent and their baby.
That bond is also formed when bottle feeding in many different forms. There are many reasons why a parent may not breastfeed. It may be a personal choice. Breastfeeding can include struggles which make the journey difficult. I have a full time job assisting parents in their goals so I understand the hurdles that can and do exist. The bottom line is this. If a parent is bottle feeding it is not my place to judge or place guilt on that parent. Society should not place guilt on them either. If they desire assistance in reaching breastfeeding goals, I am there!
Our country is a paradox when it comes to messages to new parents and breastfeeding. The initial message is, "Breastfeed, it's the best for baby". Some parents are shamed for not breastfeeding. At the same time the support for breastfeeding in the US is seriously lacking. There is still no paid leave for lactating parents in the US. Many people struggle with adequate time to pump, clean areas to pump and harassment during pumping. Insurance companies are required to cover Lactation counseling but they still often find loopholes around this. Parents have to wait until they deliver their baby to request their electric breast pump from their insurance companies. This leaves them without a pump for a week or more after discharge from the hospital. People continue to face harassment when breastfeeding in public. Lack of knowledge about normal breastfeeding leads to misinformation flowing from many sources. This can lead to early cessation of breastfeeding.
Our culture is one of isolation for many new parents. Many people have no family support nearby or limited support. Many have never seen anyone breastfeed before. This produces a larger learning curve when initiating nursing. Support groups, friends, IBCLC's and other support professionals are needed in greater amount and accessibility. If a parent is struggling due to these issues, we need to rally behind them and support them in their breastfeeding goals.
We know this is sometimes difficult and parents are left to struggle alone often. This needs to change.
Choosing a feeding method for your baby is an emotional and complicated decision which may evolve and change over time. And honestly it is none of my business why a parent chooses one method over another. I am there to provide education and support for all parents on their journey. A new parent's emotional health is paramount in the post partum period and beyond. We have to discuss choices, challenges and feelings openly. No one has the right to judge a person's individual decision to breastfeed, bottle feed or formula feed. We must support our new parents in their decisions and celebrate their strength in knowing themselves and their goals.
This is a call to action to improve breastfeeding support, and new parent support and education. We can do better together.
Let's talk about Triple Feeding. Triple feeding is when a Lactating parent breastfeeds, pumps and bottle-feeds at every feeding. Does that sound exhausting? It is! It is necessary sometimes but it is something I recommend only when truly needed. There are very important points to keep in mind if you are on this care path. First let's review some reasons why this may have been recommended.
1. Excessive newborn weight loss
3. Sleepy at breast
4. Late pre-term challenges (babies born between 34-37 weeks)
5. Ineffective suck pattern at breast
6. Difficulty latching
(This list is not exhaustive)
The first important point is timing:
Newborns eat every 1-3 hours so Triple Feeding often can feel like parents have no break at all. I recommend keeping the whole cycle or process of the feeding to 40 minutes or less. This means, breastfeeding, pumping and bottle-feeding all in 40 minutes. This becomes a challenge when the baby is actually improving and nursing better and longer. In this scenario, we don't limit their time on the breast. But if your baby is simply asleep despite adequate waking techniques, trying to wake them for an hour is counterproductive. Give the nursing a good attempt but if its been 10 minutes, and your baby is still not latching well, you can move on to the bottle portion of the feeding. There will be many times to breastfeed in the future. Luckily babies reflexes to suck and find the breast are present for months.
The second point concerns duration:
This is a Short Term Care Plan! I educate my clients that they can proceed with Triple feeding for 48-72 hours. At that point, a re-evaluation by your (IBCLC) Lactation Consultant is necessary. The goal of Triple Feeding is to build and maintain your milk supply while addressing your baby's latch issues and keeping the baby fed and energized to learn to nurse. Milk supply will increase over 3 days with adequate stimulation and the baby has also potentially changed in that time. A Lactation Consultant (IBCLC) can re-assess your individual situation and recommend a more sustainable long term plan based on your needs. It is not wrong to continue this method for longer than 3 days. But it is a lot of work. Working with a knowledgeable IBCLC who can support you throughout this process is essential.
Triple feeding has a place in reaching lactation goals but it can also be discouraging as it is a lot of work. It is recommended for a short term period. During that time, you and your IBCLC will be finding the difficulty and taking actionable steps to improve that situation. As direct nursing improves, triple feeding gradually stops. Your Lactation Consultant can also help you figure out good time management and alternate methods if you find yourself engaged in triple for more than several days. Enlisting partners to complete the bottle portion of the feeding is helpful. Family members can also clean pump parts and prepare bottles. Reaching out for help and support is necessary!
This is the number one question I field every day. We can't measure what comes out of our breasts. We can't feel how much is going into our babies during a feeding. Our breasts go through so many changes and one's breasts can feel full, filling, engorged and soft. In all these cases, your baby can be taking in plenty of milk. So how is a new parent to know if the baby is receiving enough milk?
Luckily there are measurable, objective methods to determine if your baby is eating enough and growing adequately.
1. What goes in, must come out! A baby 7 days old and older should have a minimum of 6 wet diapers every 24 hours and 3-4 stools every 24 hours. In the first week after birth these numbers are smaller and should be carefully tracked. They are as follows:
Day 1: 1 urine, 1 stool
Day 2: 2 urine, 2 stools
Day 3: 3 urine, 2 stools
Day 4: 4 urine, 3 stools
Day 5: 5 urine, 3 stools
Day 6: 6 urine, 4 stools
Day 7: 6 + urine, 4+ stools
If your baby has less than the numbers above, you must call your Pediatrician. If your baby has more than these numbers, that is great! It is normal to see 8-10 diapers every 24 hours by day 7 of life. Usually by day 4 or 5 the stool also will change to a yellow color and become 'seedy' in consistency.
2. The baby's weight over time will tell you how the baby is doing while breastfeeding. Baby's can lose up to 7% of their birth weight in the first week of life. They should get back to their birth weight by day 7-10 days post birth. They usually will then gain 1/2 to 1oz a day after that in the first month of life.
Pumping is not an accurate method to evaluate how much your baby is taking from the breast.The baby, in general, will remove twice as much milk from the breast as even the best double electric pump can remove. Pumping is very different from breastfeeding. It is mechanical. Some women don't respond very well to a pump or may be using a pump that is not ideal for their breast. The size of the flanges and the suction power and cycles also effect milk removal amounts. Pumping is a great addition while breastfeeding in many circumstances but it is not a measure of how much your baby is transferring from your breast.
3. An additional method to evaluate your baby's intake is a direct measure during a feeding. A weight is done prior to nursing and then retaken after the feeding. The difference will be the amount your baby took from your breast. For example, if your baby weighed 3000 gm before the feeding, and then weighed 3045 gm afterwards, we can deduce that your baby took in 45 ml or 1 1/2 oz of breast milk during that particular feeding. Some people will want to have this evaluation done to make sure breastfeeding is going well or if they are experiencing any difficulties. An International Board Certified Lactation Consultant (IBCLC) will include this in their evaluation and observe a full feeding to develop a working care plan for you and your baby.
4. Observing your baby can also tell you if they are satisfied after a feeding. In the first few weeks of life, many babies are very sleepy in general and the following items are not reliable. When babies start a feeding, often their hands are clenched in fist. When they are full, their hands relax and their fists open up. Their body is very relaxed and they may sleep. If your baby continues to cry and display hunger cues after a long feeding especially more than once, you should seek help from your Pediatrician and an IBCLC.
I hope this blog will give you more confidence in breastfeeding. These are general educational guidelines. They are not to be taken as medical advice. Please reach out to a Doctor if you have any concerns about your baby's intake.