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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).
1.
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, or the one available
at the websites below 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 that show you how to best latch
a baby on.
2.
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.
3.
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.
4. 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.
5. 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.
6. 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.
7. 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.
8.
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. 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?
- Babies learn to breastfeed
by breastfeeding
- Mothers learn to breastfeed
by breastfeeding
- The baby continues to
get your milk
- The baby won't reject
the breast
- There is more to breastfeeding
than the breastmilk
9. 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 five or six months
of age).
10. 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.
11. Domperidone
is a possibility. It is not a panacea
(a magic bullet). Check the handouts on
Domperidone.
Questions? (416) 813-5757 (option 3) or
drjacknewman@sympatico.ca or my book Dr.
Jack Newman’s Guide to Breastfeeding
(called The Ultimate Breastfeeding Book
of Answers in the USA)
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
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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