Why Your Newborn Does NOT Need Formula For The First Two Days of Life

It is crucial that moms and dads understand why hospitals push formula on their babies and why, in most cases, it’s not necessary and only interferes with the natural process that has worked for humans for thousands of years.  Here is a great article on the subject at www.alternet.org by Linda Bergerson, M.S.

I’d love to read any comments you may have.  Was your baby given formula in the hospital and why?  Do you feel it was necessary, after reading this article?  If it makes you mad, say something!  Write a letter to the hospital and your local newspaper.  Your voice needs to be heard!

And remember, wherever you are in your baby’s stage of life, you did the best you could with the information and support you had, so no guilt here, mamas!  Rock on…

What is Craniosacral Therapy (CST)?

“As the twig is bent, so grows the tree.”  Dr. William Sutherland

by Tomi Knutson, CMT

Craniosacral therapy is a healing modality that grew out of Osteopathy, the ancient art of bone-setting and it has a long history of development through the life and work of AT Still and WG Sutherland. It is a gentle hands-on method of evaluating and enhancing the function of the craniosacral system. This physiological system helps protect and assist the delicate tissues of our central nervous system and is comprised of the bones of the head, spine, face and mouth as well as the fascia and more delicate membranes and fluids contained within. Like the heart, the craniosacral system has a regular rhythm, only slower and more subtle. Just as the heart pumps needed blood to the rest of the body, the craniosacral system pumps important fluid–cerebrospinal fluid (CSF)–between the brain and spinal area.  By listening into the craniosacral rhythm, the CS Therapist is able to assist the body in releasing restrictions in the craniosacral system which in turn help the heart, mind and spirit to access it’s own innate wisdom and heal itself.

During the birthing process the infant undergoes a complex physiological transition, as does the mother.  This natural process is often interrupted.  As a result, the infant can come into the world with birth-related trauma and an unfinished story. By tuning into the infants craniosacral system, and listening to the birth story the Craniosacral Therapist helps the infant and parent(s) complete their birth process and story together. As mom and baby are intimately linked, the resolution of this story helps baby feel more at ease within itself, more bonded to its parents and more ready to handle the big world out there.  In tandem, for mom (and partner), completing this process results in increased levels of bonding and attachment, deeper fulfillment and therefore more confidence in their role as parents.

 

Common reasons parents seek Craniosacral Therapy:

  • Well-being of infant
  • A suggestion made by a friend, Bodyworker, Doctor or Lactation Consultant
  • The infant is “fussy,” “grunty,” or seems unhappy
  • One or both parents are anxious or worried all the time
  • Sleeping concerns for baby or parents
  • Breastfeeding challenges, including tongue tie or tight jaw
  • The infant’s breathing is labored and/or not consistent
  • Digestive issues; including Colic, Reflux, Constipation
  • A difficult birth; due to long labor or pushing stage, Cesarean Delivery, or use of instruments
  • Infant has a tendency to turn its head to one side, or Torticolli
  • Infant’s head is misshapen, and/or has bumps or ridges, etc.

 

Craniosacral Therapy helps older kids with:

  • Braces
  • Headaches/Migraines
  • TMJ Syndrome
  • Puberty:  handling hormone changes and big emotions
  • Emotional distress
  • Hyperactivity
  • Parent/child conflicts
  • Loss of family member or pet
  • Adoption and/or blended families

Craniosacral Session: The session begins after a thorough consultation and typically lasts an hour. It is preferable both parents attend each session. It is expected the infant will need to nurse during the session and the practitioner will make necessary accommodations available. The number of sessions recommended depends on the needs and responsiveness of the infant. Infants and children can experience a deep state of calm and well-being and may fall asleep on the table. Parents often report that their child appears relaxed and peaceful for days after the session, with a cumulative effect over a number of sessions.

Your Newborn’s Stomach, Days 1-10

Your Newborn’s Stomach, Days 1-10

The chart below shows the average size of a newborn’s stomach and how much milk it can hold at birth. Now you can see why your colostrum, or early milk, is more than enough to fill your newborn’s tummy.

But there is more. Researchers have found that on Day 1, the newborn’s small stomach does not stretch to hold more, as it will even a day later.

Countless hospital nurses have learned the hard way that on the first day when newborns are fed an ounce or two by bottle, most of it tends to come right back up. The walls of the newborn stomach stay firm, pushing out the extra milk rather than stretching to hold it.

  • On Day 1, a newborn’s stomach can hold about one-sixth to one-fourth of an ounce (5 to 7 ml) per feeding. Not surprisingly, this amount of colostrum is ready and waiting in the breast.
  • By Day 3, as the baby gets many more of these small feedings, his stomach expands to about the size of a ping pong ball to hold more milk.
  • By Day 10 it is the size of an extra large chicken egg.

Is it a good idea to give a newborn more milk at each feeding to try to stretch out the stomach sooner? No. This is not a case of more is better. Many small feedings set up a healthy eating pattern right from the start. Experts tell us that it is healthier for adults to eat smaller amounts more often, and the same is true for babies and children. Coaxing a baby to take more milk may lead to overfeeding. If feeling overfull at feedings becomes the norm for a baby, this may lead to unhealthy eating habits that contribute to childhood obesity later.

 

This is general information and does not replace the advice of your physician or healthcare provider. If you have a problem you cannot solve quickly, seek help right away.

Every baby is different, and your baby may not be average. If in doubt, contact your physician or other healthcare provider. 

Is It Baby Blues or Postpartum Depression?

BABY BLUES: Symptoms tend to be milder and last for a few days or weeks and include sadness, crying, feeling inadequate, overwhelmed and exhausted.

POSTPARTUM DEPRESSION AND ANXIETY:Postpartum depression involves symptoms that may be more intense and longer lasting than the baby blues and include sadness, anxiety, inability to cope, hopelessness, feelings of being trapped, fear of hurting yourself or your baby, excessive concern or lack of concern for your baby, withdrawal from family and friends, inability to sleep even when the baby does and significant weight loss or gain.

 

With adequate support and intervention, postpartum depression and anxiety can be resolved quickly.  Connect with quality resources as soon as possible.

 

Resources for Postpartum Adjustment:

 

San Francisco Bay Area Local Therapists:

  • For a psychologist, I highly recommend Dr. Jessica Michaelson at 510-545-2147 or Dr. Gina Hassan at 510-644-1097
  • Rachel Tucker is a licensed Marriage Family Therapist (#77642) who does home visits to help moms and dads with postpartum depression and other issues.  She’s also loves working with elementary school-aged kids.
  • Natashia Fuksman provides private practice psychotherapy as a Marriage and Family Therapist Registered Intern #77703 in Berkeley and Lafayette offices serving individuals, couples and families.

 

There are good books on Postpartum Depression, especially by Dr. Shoshana Bennett

How Much Milk Should I Expect to Pump?

by Nancy Mohrbacher

Do you ever second-guess your milk production after pumping? Do you compare it with the volume of milk your friend or neighbor pumps? Do you compare it with the milk you pumped for a previous baby? Before you start to worry, you first need to know how much pumped milk is average. Many mothers discover—to their surprise—that when they compare their own pumping experience with the norm, they’re doing just fine. Take a deep breath and read on.

 

Expect Less Milk in the Early Weeks

If the first month of exclusive breastfeeding is going well, your milk production dramatically increases from about one ounce (30 mL) on Day 1 to a peak of about 30 ounces (900 mL) per baby around Day 40.1 Draining your breasts well and often naturally boosts your milk during these early weeks. But at first, while your milk production is ramping up, expect to pump less milk than you will later. If you pumped more milk for a previous child, you may be thinking back to a time when your milk production was already at its peak rather than during the early weeks while it was still building.

 

Practice Makes Perfect

What should you expect when you begin pumping? First know it takes time and practice to train your body to respond to your pump like it does to your baby. At first you will probably be able to pump small amounts, and this will gradually increase as time goes on. Don’t assume (as many do) that what you pump is a gauge of your milk production. That is rarely the case, especially the first few times you pump. It takes time to become proficient at pumping.  Even with good milk production and a good-quality pump, some mothers find pumping tricky at first.

 

Factors That Affect Milk Yield

After you’ve had some practice using your pump and it’s working well, the following factors can affect your milk yield:

  • Your baby’s age
  • Whether or not you’re exclusively breastfeeding
  • Time elapsed since your last breastfeeding or pumping
  • Time of day
  • Your emotional state
  • Your breast storage capacity
  • Your pump quality and fit

 

Read on for the details about each of these factors.

Your baby’s age

How much milk a baby consumes per feeding varies by age and—until one month or so—by weight. Because newborns’ stomachs are so small, during the first week most full-term babies take no more than 1 to 2 ounces (30 to 60 mL) at feedings. After about four to five weeks, babies reach their peak feeding volume of about 3 to 4 ounces (90 to 120 mL) and peak daily milk intake of about 30 ounces per day (900 mL). Until your baby starts eating solid foods (recommended at around six months), her feeding volume and daily milk intake will not vary by much. Although a baby gets bigger and heavier between one and six months of age, her rate of growth slows down during that time, so the amount of milk she needs stays about the same.1 (This is not true for formula-fed babies, who consume much more as they grow2 and are also at greater risk for obesity.3) When your baby starts eating solid foods, her need for milk will gradually decrease as solids take your milk’s place in her diet.3

Exclusively breastfeeding?

An exclusively breastfeeding baby receives only mother’s milk (no other liquids or solids) primarily at the breast and is gaining weight well. A mother giving formula regularly will express less milk than an exclusively breastfeeding mother, because her milk production will be lower. If you’re giving formula and your baby is between one and six months old, you can calculate how much milk you should expect to pump at a session by determining what percentage of your baby’s total daily intake is at the breast. To do this, subtract from 30 ounces (900 mL) the amount of formula your baby receives each day. For example, if you’re giving 15 ounces (450 mL) of formula each day, this is half of 30 ounces (900 mL), so you should expect to pump about half of what an exclusively breastfeeding mother would pump.

Time elapsed since your last milk removal

On average, after an exclusively breastfeeding mother has practiced with her pump and it’s working well for her, she can expect to pump: About half a feeding if she is pumping between regular feedings (after about one month, this would be about 1.5 to 2 ounces or 45-60 mL) A full feeding if she is pumping for a missed feeding (after one month, this would be about 3 to 4 ounces or 90-120 mL)

Time of day

Most women pump more milk in the morning than later in the day. That’s because milk production varies over the course of the day. To get the milk they need, many babies respond to this by simply breastfeeding more often when milk production is slower, usually in the afternoon and evening. A good time to pump milk to store is usually thirty to sixty minutes after the first morning nursing. Most mothers will pump more milk then than at other times. If you’re an exception to this rule of thumb, pump when you get the best results. No matter when you pump, you can pump on one side while nursing on the other to take advantage of the baby-induced let-down. You can offer the other breast to the baby even after you pump and baby will get more milk.

Your emotional state

If you feel upset, stressed, or angry when you sit down to pump, this releases adrenaline into your bloodstream, which inhibits your milk flow. If you’re feeling negative and aren’t pumping as much milk as usual, take a break and pump later, when you’re feeling calmer and more relaxed.

Your breast storage capacity

This is the maximum amount of milk available in your breasts during the time of day when your breasts are at their fullest. Storage capacity is based on the amount of room in your milk-making glands, not breast size. It varies among mothers and in the same mother from baby to baby.5 As one article describes, your largest pumping can provide a clue to whether your storage capacity is large, average or small.6 Mothers with a larger storage capacity usually pump more milk at a session than mothers with a smaller storage capacity. If you’re exclusively breastfeeding and pumping for a missed breastfeeding, a milk yield (from both breasts) of much more than about 4 ounces (120 mL) may indicate a larger-than-average storage capacity. On the other hand, if you never pump more than 3 ounces (90 mL), even when it has been many hours since your last milk removal, your storage capacity may be smaller-than-average. What matters to your baby is not how much she gets at each feeding, but how much milk she receives over a 24-hour day. Breast storage capacity explains many of the differences in breastfeeding patterns and pump yields that are common among mothers.7

Your pump quality and fit

For most mothers, automatic double pumps that generate 40 to 60 suction-and-release cycles per minute are most effective at expressing milk.

Getting a good pump fit is important, because your fit affects your comfort and milk flow. Pump fit is not about breast size; it’s about nipple size. It refers to how well your nipples fit into the pump opening or “nipple tunnel” that your nipple is pulled into during pumping. If the nipple tunnel squeezes your nipple during pumping, this reduces your milk flow and you pump less milk. Also, either a too-large or too-small nipple tunnel can cause discomfort during pumping. Small-breasted women can have large nipples and large-breasted women can have small nipples. Also, because few women are completely symmetrical, you may need one size nipple tunnel for one breast and another size for the other.

You know you have a good pump fit if you see some (but not too much) space around your nipples as they move in and out of the nipple tunnel. If your nipple rubs along the tunnel’s sides, it is too small. It can also be too large. Ideally, you want no more than about a quarter inch (6 mm) of the dark circle around your nipple (areola) pulled into the tunnel during pumping. If too much is pulled in, this can cause rubbing and soreness. You’ll know you need a different size nipple tunnel if you feel discomfort during pumping even when your pump suction is near its lowest setting.

 

What About Pump Suction?

Mothers often assume that stronger pump suction yields more milk, but this is not true. Too-strong suction causes discomfort, which can inhibit milk flow. The best suction setting is the highest that’s truly comfortable and no higher. This ideal setting will vary from mother to mother and may be anywhere on the pump’s control dial. Some mothers actually pump the most milk near the minimum setting.

 

Hands-on Pumping

Hands-on pumping is one evidence-based strategy to increase milk yield while pumping.  Click here for a post describing this effective technique.

Worries are a normal part of new motherhood, but you can make milk expression a much more pleasant experience by learning what to expect. For many mothers, pumping is a key aspect of meeting their breastfeeding goals.  A little knowledge can go a long way in making this goal a reality.

 

References

1Butte, N.F., Lopez-Alarcon, & Garza, C.  (2002). Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant During the First Six Months of Life. Geneva, Switzerland, World Health Organization.

2Heinig, M.J. et al. (1993). Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING study.  American Journal of Clinical Nutrition,  58, 152-61.

3Dewey, K.G. (2009). Infant feeding and growthAdvances in Experimental Medicine and Biology, 639, 57-66.

4Islam, M.M, Peerson, J.M., Ahmed, T., Dewey, K.G., & Brown, K.H. (2006).  Effects of varied energy density of complementary goods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children.  American Journal of Clinical Nutrition, 83(4), 851-858.

5Kent, J. C. (2007). How breastfeeding worksJ Midwifery Womens Health, 52(6), 564-570.

6Mohrbacher, N. (2011). The magic number and long-term milk production.  Clinical Lactation, 2(1), 15-18.

7Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the dayPediatrics, 117(3), e387-395.

Will My Baby Get Artificial Baby Milk in the Hospital?

You should know before you go to have your baby:  Hospitals should not routinely give breastfed babies any water, sugar water or artificial baby milk (a.k.a. formula).  They should support and educate parents on breastfeeding.

 

What is supplementation?

  • Feedings given in place of, or with, breastfeeding (which may include expressed breastmilk, artificial baby milk, or water).
  • Methods of supplementation include:
    • Using a syringe or dropper at the breast
    • Using a syringe with a feeding tube at the breast
    • Feeding with a spoon
    • Feeding with a cup
    • Feeding with a dropper
    • Finger-feeding with a dropper or a syringe with a feeding tube
    • Using a nipple with a wide base and slow flow

 

Does my baby need supplementation?

  • Healthy term newborns rarely need supplementation.
  • The American Academy of Pediatrics recommends that breastfed babies should not be given anything except breastmilk for at least 6 months unless medically indicated.
  • Breastfed babies are only offered supplements when medically needed.  For example: Low blood sugar, premature babies, excessive weight loss, or jaundice due to poor feeding.

 

What if my baby gets artificial baby milk or water that is not medically needed?

  • Giving any artificial baby milk changes the kind of bacteria in your baby’s gut/intestines.
  • The suck on a bottle is different from the suck on a breast.  If fed bottles in the first days of life, a breastfed baby may have later problems latching onto the breast.  You can try to minimize this by using paced bottle-feeding.
  • Artificial baby milk takes longer to digest than human milk.  It empties from the stomach slower than breastmilk.  This increases the time between breastfeedings.  If your breasts are not emptied often your milk production will go down.
  • Research studies have shown feeding a healthy term baby often without supplements encourages early milk production.  This will decrease the chance of jaundice and provide better weight gain for your baby.
  • Early use of artificial baby milk may increase the risk of allergies.
  • While any amount of breastfeeding is better than non, some of the benefits of breastfeeding are associate with exclusive breastfeeding.
  • Exclusive breastfeeding means nothing except breastmilk for the first months of life.
  • Most breastfed infants will not require any supplementary feedings, but if you have any questions, please ask your health care provider, lactation consultant or your baby’s pediatrician.