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Protocol to Increase Breastmilk Intake by the Baby
("Not enough milk")
Handout B: Protocol to Increase Breastmilk
Intake by the Baby
by Jack Newman, MD, FRCPC. © 2005
Revised: January 2005
Here is the way I suggest mothers proceed for "insufficient
milk supply" (actually, most mothers have lots or could
have had lots, but the problem is that the baby is
not getting the milk that is available).
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Get the best latch possible. This needs
to be shown by someone who knows what they are doing.
Anyone can look at the baby at the breast and say the
latch is good. The accompanying
diagram shows how to get a good latch. If a mother has plenty
of milk, the latch does not have to be perfect. But, if the
milk supply is decreased, the baby will get more milk if he
is latched on better. Get good “hands on” help.
Videos can be seen at www.thebirthden.com/Newman.html
that show you how to best latch a baby on.
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Know how to know the baby is getting milk.
When a baby is getting milk (he is not getting milk
just because he has the breast in his mouth and is making sucking
movements), you will see a pause at the point of his chin after
he opens to the maximum and before he closes his mouth, so that
one suck is (open mouth wide--> pause-->close
mouth). If you wish to demonstrate this to yourself, put your
index or other finger in your mouth and suck as if you were
sucking on a straw. As you draw in, your chin drops and stays
down as long as you are drawing in. When you stop drawing in,
your chin comes back up. This pause that is visible at the baby's
chin represents a mouthful of milk when the baby does it at
the breast. The longer the pause,
the more the baby got. Once you know
about the pause you can cut through so much of the nonsense
breastfeeding mothers are being told—such as
“Feed the baby twenty minutes on each side”.
A baby who does this type of sucking (with the pause)
for twenty minutes straight might not even take the second side.
A baby who nibbles (doesn't drink) for 20 hours will come off
the breast hungry. You can see this “pause”
on the videos at www.thebirthden.com/Newman.html
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Once the baby is no longer drinking on his
own, use compression to increase flow to the baby.
Compression can be particularly helpful, but don't forget trying
to get the best latch possible first. Babies tend to pull at
the breast when the flow of milk is slow, so it is useful to
know how to know the baby is actually getting milk and not just
sucking without getting milk. When the baby no longer seems
to be getting milk, and is sucking without getting milk,
this is when to start compression, while the baby sucks, but
does not drink. Keep the baby on the first breast until
he doesn't drink even with compression. See handout #15 Breast
Compression. You can see this how to use compression
on the videos at www.thebirthden.com/Newman.html
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When the baby no longer drinks even with compression,
switch sides and repeat the process. Keep going back and forth
as long as the baby gets reasonable amounts of milk at the breast.
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Try fenugreek and blessed thistle. These two
herbs seem to increase milk supply and increase rate of milk
flow. There is more information on the handout #24 Cabbage
Leaves, Herbs, Lecithin.
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In the evening when babies often want to be
at the breast for long periods, get help to position the baby
so that you can feed lying down. Let the baby nurse and maybe
you will fall asleep. Or rent videos and let the baby nurse
while you watch.
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It is not always easy to decide if a baby needs
supplementation. Sometimes applying this Protocol for a few
days gets the baby gaining more rapidly. Sometimes more rapid
growth is necessary, and it may not be possible without
supplementation. If possible, get banked breastmilk to use as
a supplement if you can. If not available, formula may be necessary.
However, sometimes slow but steady growth is acceptable. The
main reason to worry about growth is that good growth is one
sign of good health. A baby who grows well is usually in good
health, but this is not necessarily so. Neither is a baby who
grows slowly in poor health, but physicians worry about a baby
who is growing more slowly than average. Growth charts are frequently
interpreted poorly. A baby who follows the 10th percentile line
is growing as he should be. Too many people, including physicians,
believe that only babies on the 50th percentile or higher are
growing normally. Not true. Growth charts were
developed on information based on information gathered about
normal babies. Somebody has got to be smaller
than 90% of all other babies. Somebody normal.
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If it is decided to supplement, the best way
is at the breast with a lactation aid. Introduce the supplement
with a nursing supplementer (lactation aid), not bottle, syringe,
cup or finger feeding. See handout #5 Using
a Lactation Aid at this website. Supplement
only after steps 3 and 4 above and the baby has nursed on at
least both sides. Why is it better to use the lactation
aid?
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If the baby is older than three or four months,
and supplementation appears to be necessary, formula
is not necessary and extra calories can be given to the baby
as solid foods. First solids may include: mashed banana, mashed
avocado, mashed potato or sweet potato, infant cereals, as much
as the baby will take, and after the baby has nursed,
if he is still hungry. Even at this age giving bottles when
the baby is not getting much from the breast will often result
in breast rejection. If you must give formula, mix it with the
baby’s solids. Giving solids at three or four
months if everything is going well is not recommended, and even
if the weight gain is slow, there are several ways of getting
the baby more breastmilk that can be tried before adding solids.
Solids should normally be started when the baby is showing interest
in eating solids (usually around six months of age).
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If your baby was gaining well for a few months
and now is not gaining well, see the handout #25 Slow
Weight Gain After the First Few Months. Reasons for
a decreased milk supply are listed there. Fix what you can,
and then follow this Protocol.
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Domperidone is a possibility. It is not a panacea
(a magic bullet). Check the handouts on Domperidone ( Domperidone
and Domperidone-2).
Questions?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
See the website www.thebirthden.com/Newman.html
for videos.
Handout B: Protocol to Increase Breastmilk Intake
by the Baby
Jack Newman, MD, FRCPC. © 2005
Revised: January 2005
This
handout may be copied and distributed without further permission,
on
the condition that it is not used in any context in which
the WHO code on the marketing of breastmilk substitutes is violated
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