All posts by sarah

The Advice That I Give to New Moms

There are some things that I’ve learned from others through commonly repeated advice. Other things I’ve had to learn on my own. The following is a short list of things to keep in mind about some common situations that new breastfeeding mothers frequently face, and that I wish I had known in the very very early beginning of things. This advice is much less about the “how to” of breastfeeding and more the “how to” of dealing with how everyone around you contributes or detracts from your breastfeeding experience.

1- Everyone will have advice. Most of it will be terrible. Only accept help from those who have met or exceeded your minimum goals. You wouldn’t learn to drive from the uncle that failed his driving test three times and still doesn’t have his license. Don’t accept advice from the people that gave up after 3 weeks, 3 months or whose babies “weaned” before a year. Unless their advice comes in the form of “I learned after the fact that I was sabotaged by xyz. AVOID DOING THAT AT ALL COSTS!” Tip learned: Only take advice from those that managed to do what you wish to manage to do.

2- Nurses are NOT lactation consultants. And often hospitals that say they have a lactation consultant on duty 24/7 are lying. Test the theory. On a hospital tour? They say they have a LC on duty 24/7? Ask to meet her. She busy? Ask to lay eyes upon her in all of her LC-glory. And ask about what certification she has. Lactation Consultants are not all created equally and people are pretty lax on what they call a Lactation Consultant sometimes. I learned this the hard way when on night two with my second son who was refusing to latch after a non-LC nurse “helped” him latch on with the most terrible and aggressive methods.. I walked down to the nurse’s station and asked to see the LC and was told that if I was worried I could just give formula. Right. 24/7 LC. Perhaps there was and I just got Nurse Cranky. I shall never know. My son never got formula. I hand expressed and finger-fed him until my mother got into town the next day, and latched him on as best as I could. My mom helped me relax and once we were out of the hospital the booger latched on and went on to nurse for 3 years. Tip learned: Nurses are not LC’s. You will likely have to hire your own LC. Bring phone numbers. Or be otherwise-well-educated. And stubborn.

3- Any family member that claims that they cannot bond without a bottle will not bond WITH the bottle. Some people are insecure and have been tricked/conditioned into believing that they have to provide nourishment for a baby to like them. Bogus. This mostly guarantees that mom’s going to end up dealing with all sorts of issues with supply, nipple confusion, shredded nipples, bottle/flow preference, etc. And that family member that needed the bottle to bond? Chances are pretty good that their bond is going to involve them handing an angry screechy baby back to you after the bottle milk runs out. No. Bonding is EVERYTHING BUT the feeding. It’s the comforting, the rocking, the dancing, the soothing, the singing, the reading-to, the baby-wearing, the offering of the pinky as a pacifier, the holding, the loving, the talking-to, the walking-with, the snuggling, and baby understanding that if they cry that family member will come to pick them up, will recognize their feeding cues (rooting, mouth o’s) and will bring baby to the source of baby’s food. Mom. The most bonded people I have ever seen are those who didn’t feed the baby from a bottle. The only person that I ever pumped for “for bonding purposes” was the least bonded person that I ever witnessed in my life. Tip learned: Bottles do not equal bonding.

The “One Ounce Per Hour” Rule

One of the frequently asked questions of breastfeeding is “How much milk should I leave my baby while we are separated?”

The answers that I’ve seen vary. The answer that I subscribe to is “The One Ounce Per Hour Rule”.  (Which could be better described as the 1-1.25oz/hour rule).

The one ounce per hour rule is based on the average daily requirements of a breastfed infant who will take in 25oz/day of milk. (This does not vary much between one and six months). While amounts might be more or less during exclusive pumping / bottle feeding, the “One Ounce Per Hour” rule is considered the standard for shorter periods of mother and infant separation.

This method is the “breastfeeding friendly” method that is most likely to lead to longer term breastfeeding success. Other methods that allow on-demand feeding from bottles or that follow amount guidelines for formula fed babies often lead to supply decrease and early weaning or supplementation of non-human milk.

I’ve heard a lot of moms say that they are anxious about the one-ounce-per-hour rule of feeding a breastfed infant while separated from mom. I understand it. I was anxious as a new mom, too, and wanted to leave MORE than my baby needed because it hurt to leave him and I wanted to make sure he would be happy and satisfied while I was away.

The thing is.. It’s not starving your baby and it’s not letting your baby go hungry. It’s something your baby is already used to. The supply in your breasts is not static. It goes up and down across the day. Your baby is already used to this.

Your baby eats the same amount each day between one month and when solids are introduced. (A bit more during growth spurts- but this should happen at mom’s breast, since her supply has to scale.) This amount for breastfed babies averages out to 25oz/day with some babies eating as little as 19oz/day. Your supply is not static across the day, it increases and decreases across the day, so baby learns to nurse more during high supply hours, and less during low supply hours (which are typically in the evening)

What the one ounce per hour rule does is it encourages baby to view the bottle feeds as “low supply”, and mom-feeds as “high supply” and baby nurses more with mom and less with the bottle. Baby’s needs are met, not exceeded. More than one ounce per hour means baby finds bottle = high supply, breast = low supply, and starts fussing for more bottle, less mom. This means mom is stuck pumping HUGE amounts of milk.

This causes problems because the pump is ineffective. It’s like trying to siphon water out of a well with a drinking straw. It’s tedious, it’s boring, it’s a pain in the butt. Mom’s breasts let down easily to an eager baby, and noooot so well to a pump. 1-2oz per pumping session is actually EXCELLENT output. If baby is downing 2oz/hour or more than one ounce/hour? Mom would have to pump constantly at work to make up for it.

Better to convince baby that the bottle has a rotten supply and that it’s easier to gorge off mom. Easier on mom, easy enough on baby, and baby’s needs are more than met with the ounce per hour.

Sources: Average Intake of Breastmilk (Kellymom)

*** Important caveat: As with all “rules” there are exceptions. If mom and baby are routinely separated from each other during ALL of the highest supply hours of mom’s day and are only together briefly, the one ounce per hour rule might not work and baby may need more frequent feedings during separation. View the rule as a guideline and as a possible warning sign that your caregiver is overfeeding the baby or giving bottles that are too large/too frequent. It may not be the amount that is a problem but the bottle size. Maybe baby will do better with more frequent 2oz bottles. Maybe your pumping sessions need to be longer or more frequent in order to get milk of the right composition for what baby needs while separated. Never follow ANY rule that doesn’t work for your child.