Common Breastfeeding Questions and Problems - Article Four

Does My Breastfed Baby Need Extra Water and Vitamins?

Breastfed babies do not need extra waters, as formula-fed babies do. Your breast milk is very high in water, while formula is more concentrated. Extra water is discouraged, not because of the water itself, but because of the possibility of nipple confusion and breastfeeding disharmony if babies are given water in a bottle in the newborn period.

A healthy term baby who is getting enough breast milk does not need vitamin supplements, unless recommended by your doctor for your baby's special nutritional needs. When baby is around nine months of age, your health care provider may recommend a multivitamin with iron if baby's blood count or diet is low in iron.

Increasing Your Milk Supply

Our three-week-old baby doesn't seem to be gaining as much weight as she should, and I don't feel I have enough milk. How can I increase my milk supply?
Most delays in milk production are the result of one or several of the following: improper positioning and latch-on, interference in the harmony between mother and baby, a tired mother in a busy nest, or scheduled feedings. Go through the following steps.

Weigh baby more frequently. Consult your doctor and arrange to bring your baby into the office for a weight check twice a week.

Seek assistance. Consult a lactation specialist to review your positioning and latch-on techniques and to evaluate your baby's suck.

Get support. Contact breastfeeding and mothering organizations such as your local La Leche League.

Avoid negative advisers. "are you sure she's getting enough milk?" "I couldn't breastfeed either. . . ." You don't need discouragement when you are trying to build up your confidence as a new mother. Surround yourself with supportive people. Breastfeeding is a confidence game.

Check your nest. Is your nest too busy? Temporarily shelve all commitments that drain your energy from breastfeeding your baby.

Take your baby to bed. Feed nestled close to each other. Nap nursing and night nursing are powerful stimulators of milk production, since the milk-producing hormones are best secreted while you are asleep.

Undress your baby during feeding. If she is small (under 8 pounds/3.6 kilograms), you need to keep baby warm by placing a blanket around her, but still allowing tummy-to-tummy contact. Skin-to-skin contact helps awaken sleepy babies and stimulates less enthusiastic feeders.

Increase the frequency of feeding. Give at least one feeding every two hours, and wake your baby during the day if she sleeps more than three hours. If you have a sleepy baby, let her sleep nestled against your breasts. This skin-to-skin contact stimulates milk flow.

Think baby, think milk. While you are feeding, stroke and cuddle your baby, using a lot of skin-to-skin contact, a custom called grooming. These maternal behaviors stimulate your milk-producing hormones.

Sleep when your baby sleeps. This requires delaying or delegating the many seemingly pressing household chores. If you are blessed with a baby who feeds frequently, you may think, "I don't get anything done." But you are getting something done. You are doing the most important job in the world -- mothering a human being.

Nurse longer. Don't limit the length of baby's feedings to a certain number of minutes per side. Give baby the chance to finish the first breast before switching to the second. He needs to get the high-fat hindmilk on the first side. This low-volume, high-caloric milk helps babies grow and rewards them for their sucking. If you switch breasts after only a few minutes, baby will get only the watery foremilk from both sides. This fills baby's tummy but may not give him enough calories to put on weight. Longer nursing stimulates more milk-ejection reflexes and brings more fat down to baby.

Try switch feeding. In the traditional method of breastfeeding, you encourage your baby to suck as she wishes at one breast (usually around ten minutes) and to complete her feedings on the second breast, reversing the process on the next feeding. Switch feeding, also called the burp-and-switch technique, operates as follows: Let your baby suck at the first breast until the intensity of her suck and swallow diminishes and her eyes start to close (usually three to five minutes). Don't watch the clock, but watch your baby for thee signs that she is losing interest in continuing to suck on that breast. As soon as these signs appear, remove her from the breast, burp her well, and switch to the next breast until her sucking diminishes again; stop, burp her a second time and repeat the entire process back to the first breast and then to the other again. This burp-and-switch technique encourages a creamier, high-calorie hindmilk to be released because the milk-ejection reflex is stimulated each time you switch. This technique is particularly effective for the sleepy baby, the "nipper-napper," who does not feed enthusiastically. The frequent switching keeps her awake, and the burping makes more room in the tiny stomach for more milk.

Try double feeding. This technique operates on the same principle as switch feeding, increasing the fat content of your milk and giving baby a greater volume of hindmilk. After you feed your baby and she seems content, burp her and carry her around in an upright position for ten to twenty minutes. Then offer her the breast again. With less air in her tummy, there will be room for more milk, and the milk that is there and ready for her in your breasts will be high in fat. You'll be topping her off with more of what she needs to grow. The longer you wait between feedings, the lower the fat content of your foremilk.

Wear your baby. Carry baby in a sling as often as you can between feedings. The close proximity of baby to your breast not only stimulates more milk production but also reminds baby to feed. When she roots toward your breast, breastfeed her in the sling. Some babies feed better on the move.

Massage your breasts before and during feedings. Gentle breast massage before a feeding can help stimulate your milk-ejection reflex, so that the milk is ready and flowing when baby latches on. Compressing the breast during feedings helps move the milk down toward the nipple, mimicking a milk-ejection reflex. You can use this technique to encourage baby to nurse longer. When his sucking slows or he seems to be losing interest, use the hand that is supporting the breast to massage milk down toward the nipple. You will notice baby start to swallow and suck more actively as the milk flows into the breast's sinuses and out the nipple. Work your hand around the breast so that all the ducts get this extra stimulation.

Attempt to relax during breastfeeding. The milk-ejection reflex can be inhibited if you are physically and emotionally tense. Use the relaxation techniques you learned in childbirth class, use pillows, have someone rub your back, visualize flowing streams, play soothing tapes, feel confident in yourself.

Try herbal teas. Natural remedies to increase milk production are based more on folklore than on real evidence. If you like herbal teas, now would be a good time to try one that purports to help increase milk supply. Whether these teas really help physically or psychologically is irrelevant. So try them -- relax and enjoy.

There will be more articles to come on Common Breastfeeding Questions and Problems.