Born2Nurse

BREASTFEEDING FAQs:

Q:  My pediatrician says my baby isn't gaining enough weight and wants me to supplement with formula!  What should I do? 

A:  The best way for your baby to gain weight is to nurse AT LEAST 20 minutes on the first side.  Then offer the second side.  It is important to nurse that long one one side first for the hindmilk to let down.  When you are nursing for the first couple months, the foremilk is very watery and sugary.  After 15 minutes or so, the fattier milk comes down.  This is what helps the baby gain weight.  This will also help gassy tummies. 

Q:  How can I tell if the baby is getting enough?:

A:  Let the baby tell you.  Babies give us signals to indicate their hunger levels.  As newborns, if their arms and fists are held tight, it means they are still hungry.  As the baby fills up, their arms and fists relax.  Hold the baby's free arm.  If you can lift it up easily, the baby is full.  If there is still a lot of resistance, he is still hungry! 

Q:  My newborn is very fussy and seems to have a lot of gas and tummy pain.  Everyone is encouraging me to switch to formula.  Should I? 

A: This is probably easily remedied.  For newborns, a common cause of gas is not what the mother is eating, nor that the baby is breastfed, it is because the baby is getting too much foremilk.  This makes for lots of gas.  To fix this, make sure the baby is nursing at least 20 minutes on the first side.  He may not even need the other side if he seems full.  The first 10-15 minutes is foremilk and then the hind milk comes in.  This fatty milk will settle a gassy tummy.  Another common problem is the baby is gasping ad swallowing too much air.  This will cause gas if the air isn’t burped out, but will also cause the baby to feel full and not get enough milk.  Try sitting the baby more upright instead of lying down.  If you think your milk is coming too fast, you can hand express a few squirts before latching the baby on to slow down the initial flow.  Also make sure the baby is latched on correctly (lips out).  This ensures he is not gulping air as he drinks.

After the first several weeks, your milk will “mix” faster, thus shortening the length of nursing (yes, you probably will not have to spend 40 minutes every 2 hours forever!).  After this happens and the baby is still gassy and fussy, it may be something you are eating.  Start with eliminating dairy for a week and see what happens.  Other problem foods may be garlic, onions, tomatoes, etc.

Q:  How long should I nurse on each side? 

A:  When the baby is new, nurse at least 10 minutes on each side or longer if baby wants.  Listen closely.  You should be hearing a suck, suck, swallow pattern for colostrum.  This will gradually change to a suck, swallow, and you should see the baby’s under-chin “filling” up.  After this, start to feed 20 minutes on the first side.  Even if the baby falls asleep, wake her up and re-latch.  Then you can offer the 2^nd side, like “dessert”.  Let the baby nurse 2^nd side however long he wants. 

After about 6 weeks, the baby may be getting enough in about 5-10 minutes on each side. 

Q: My newborn falls asleep while nursing after five minutes.  Should I let him sleep?

A:  NO!  MAKE SURE the baby is getting at least 20 minutes on the first side and offer second side.  Many times newborns will fall asleep before they are full.  This leads to frequent nursings, “snacking”, and too much foremilk.  If babies have jaundice, they will sleep more and may sleep even though they should be eating.  For the first few weeks, even if you are nursing on demand, make sure that it is demanded every 2-3 hours.  They can go one 3-5 hr stretch per day, and you can encourage that to happen at night. 

Here are some ways to wake a baby to ensure he is getting a full feeding:  Hold him skin-to-skin.  Mama can take off her top, and baby stripped down to a diaper.  Lay baby across chest.  If baby falls asleep at the breast, un-latch him, rub his back, stretch his arms up, or tilt him back and forth (like the old baby doll’s eyes that open and close).  Then try to re-latch.  Keep doing this until he gets a full feeding.  Then you can let him fall asleep.  (Don’t worry at this point about falling asleep at the breast habitually.  Just take advantage of the easiness!)

Make sure the nipple and aereola are into a wide open mouth.  The nipple has to be in far enough to trigger the suck reflex, or the baby will not get the signal to nurse and will just fall asleep. 

Q:  My newborn was nursing well every 2-3 hours.  Suddenly she wants to nurse every hour and I don’t think I am making enough milk any more!

A:  DON’T WORRY!  You are!  This is a natural process of supply and demand!  You have plenty of milk.  The baby is signaling to you that she needs more, and the way to make more milk is to demand more!  The more a baby nurses, the more milk you will make.  Most likely she is having a growth spurt, which happens every few weeks for the first months.  She may nurse and nurse for a couple days, and then go back to every 2-3 hours, and suddenly you find yourself with an abundance of milk! 

Q:  My pediatrician recommended that I pump after feeding to make sure I have enough milk.  Is this a good idea?  I am hardly getting anything out and am feeling sore and frustrated!

A:  Your baby is the best pump you have.  Artificial pumps don’t get out what baby can.  Not only is this not a good indicator (after all, the baby has already “emptied” your breast), but it robs the baby of a bit of milk in the short run, and causes an over abundance in the long run.

The best way to know you have enough milk is to learn from baby.  The baby should have at least 5-6 wet diapers, and 2-3 mustard yellow dirty diapers with “sesame seeds” and slightly mushy.  If you or your doctor is still concerned, try a weekly weigh-in (use the same scale each week).  But most of all, the baby should look and act well fed.  Is she filling out?  If she hasn’t gained quite enough, did she grow taller?  Is she hydrated?  Is she contented, not fussy or overly tired?