Pumping

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I'm Told that my Breastfed Baby Needs to be Supplemented.... What Should I Do?

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Being told that your breastfed baby needs to be supplemented can feel extremely overwhelming and can often feel like quite a blow to the self-esteem.  You might be concerned about your milk supply and if your baby will prefer the bottle to your breast. You may feel confused as to why your baby isn’t gaining the appropriate amount of weight while breastfeeding.  

So, let’s talk about the reasons why a baby might need to be supplemented and how to do this without sabotaging your milk supply and your breastfeeding relationship.

 

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What is a supplement?

A supplement is anything in addition to what your baby receives from your breast while breastfeeding.  Babies can be supplemented with: 

Mom’s own pumped milk (if baby is not removing her milk well enough)

Donor milk (from a milk bank or from another breastfeeding/pumping parent)

Formula

How do I know if my baby truly needs supplemental feedings?

Babies are expected to gain a certain amount of weight based on their age.  So, if a baby is NOT gaining that expected amount, additional supplementation is often recommended.  Here are the weight gain expectations for the first year of baby’s life:

Initial weight loss in the first few days of life - no more than 10% of baby’s birth weight

2 weeks - baby should be back to birth weight (or very close, if he/she lost more than 10% in the first 2 weeks

2 weeks - 4 months - baby should gain about 7 ounces per week

4 months - 6 months - baby should gain about 4-5 ounces per week

6 months - 1 year - baby should gain about 2-4 ounces per week

Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  

Some common medical issues that can arise shortly after birth that may lead to supplements are prematurity, low birth weight, poor feeding, low blood sugar levels (hypoglycemia), elevated bilirubin levels (jaundice), dehydration, excessive weight loss or poor weight gain.  After those first few weeks, some common reasons for supplementation are baby not removing milk well while breastfeeding (due to tongue tie, reflux, very long feeding sessions) and a low milk supply. In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  Next we want to assess mom’s milk supply to make sure that she is producing enough milk for her baby. Sometimes all it takes are a few modifications to the baby’s feeding routine to help baby start to gain weight. Other times it requires a lactation consultation (done by an IBCLC) to assess baby’s feeding and mom’s milk supply for the cause for baby’s low weight gain.

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What if I can't express enough milk for my baby?

First you’ll want to make sure that you have everything you need to express your milk.  If using an electric pump, make sure the pump flanges fit correctly and that you are pumping for about 15 minutes after breastfeeding.  Some moms let down for the pump easily. Others find that they prefer a hand pump or hand expression. You will want to find what works best for you.

In those first few days after birth (when milk production has not quite yet surged), it can be a bit challenging to express a measurable amount of milk.  In this case, sometimes baby might need to be supplemented by donor milk or formula.

Once your mature milk is in (after those first few days), you might want to meet with an IBCLC to put together a breastfeeding/pumping plan to see if you are able to express enough milk for your baby, as well as increase your milk supply, if necessary.  If you are not yet able to express enough milk for your baby’s supplemental feedings, donor milk or formula would be recommended.  

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Do I have to use a bottle when giving my baby supplemental feedings?

Not at all!  There are several ways to supplement a baby.  Each way has its pros/cons and will be determined by what works best for you and your baby.

Cup feeding is great for older babies, as well as some younger babies who will not take a bottle

Finger feeding is great for the first few weeks of life, as the flow is slow and your finger can help organize your baby’s sucking rhythm.

Supplemental nursing systems (SNS) allow your baby to be supplemented at the breast so that he/she still thinks everything is coming from you!  The SNS has a tube that slips into your baby’s mouth, at the breast, to provide the supplement at the same time baby is breastfeeding. This works best when baby is latching/breastfeeding well and mom is trying to increase her milk supply.

Bottles are definitely an option, as well.  You will want to offer a bottle in a baby-led (paced) manner so that your baby doesn’t begin to prefer the ease and flow of the bottle, compared to your breast.

Will my baby ever be able to fully breastfeed after supplements?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term problems that are resolved relatively quickly with good treatment.  Premature babies grow and get stronger, and typically get better at breastfeeding around their due dates or shortly after.  A baby who is having difficulty with breastfeeding immediately after birth will often be ready for breastfeeding within a few days after birth.  If breastfeeding challenges linger for more than a few days, an IBCLC can help identify the reasons and set you on a path for reducing and hopefully eliminating supplementation as soon as possible. In the meantime, expressing your milk in addition to breastfeeding will help maintain and build your milk supply as challenges resolve.  

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When can I stop supplementing?

Part 2 will discuss how you’ll know it's time to wean from supplements and helpful tips for doing so. 

For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby

When Breastfeeding Doesn’t Go As Planned 

Low Milk Supply: Donor Milk, Milk Banks, and Formula

Partial Breastfeeding: When Supplements are Needed

Why Has My Pumping Output Decreased?

I love when we receive emails with questions that our blog readers could benefit from!  Here is a question from one of our mamas who is wondering why her pumping output has decreased.  

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Hi Robin!

I met with you awhile back when I first went back to work to set up a good pumping schedule.  It has worked like a charm these last 6 months.  Thank you for that!

My little guy is about to turn one and I’ve noticed a big reduction in my pumped breast milk the last few weeks. I’ve gone from pumping around 25 ounces of milk/work shift to around 15 oz.  It feels like it happened overnight. I’m just wondering if you have any suggestions on things I can do to get milk back or if this is just a normal progression.  I’m not ready to give up breastfeeding yet, but want to make sure he is getting enough milk.  He has been eating ALOT of solid food for about 5 months, so I’m sure this has had an impact on my supply :-(

Thanks for your time!

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Check Out These Lactation Rooms at the San Diego Airport!

Traveling just got easier for breastfeeding and pumping moms traveling through the San Diego International Airport!  Just in time for the holidays, right?

Last month, the San Diego Nursing in Public Task Force was contacted by a local breastfeeding mom, Emily Mest, who frequently travels through the San Diego International Airport for work.  Here is Emily’s story, which set the wheels in motion to make breastfeeding and pumping easier for all moms traveling through the San Diego airport.

Work. Pump. Repeat. with Jessica Shortall

In honor of World Breastfeeding Week 2015, we are sharing inspirational stories from breastfeeding/working moms.  Today’s story is a special interview with author, Jessica Shortall.  Jessica is an entrepreneurial mother of two, with a career dedicated to the intersection of business and doing good. She's been a Peace Corps Volunteer, a non-profit co-founder, the first Director of Giving for TOMS Shoes, and an LGBT advocate. She's the author of Work. Pump. Repeat: The New Mom's Survival Guide to Breastfeeding and Going Back to Work.

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Jessica, what inspired you to write this book?

When I had my first baby, I was the first woman at the start-up where I worked to have a baby on the job. And my first business trip was a week in rural Nepal when my son was 5 months old. I was totally panicked about how to manage pumping and working, especially with such extreme travel, but I assumed that, as with everything on parenting, there was a book that would tell me exactly how to do it. I couldn't find what I needed: an intensely practical, non-judgmental, and approachable resource. I realized that if I wanted that to exist, I'd have to write it myself. So I set myself on what would become a five-year journey (my baby just turned five!!) of interviewing hundreds of working, breastfeeding moms and sharing their stories, their hacks, their triumphs, and their struggles.

Breastfeeding Memoirs: Third Time's a Charm

In honor of World Breastfeeding Week 2015, we are sharing inspirational stories from breastfeeding/working moms.  

Today’s story was written by Lilly Penhall.

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Being a freelance contractor has its benefits to a work-at-home mom, that’s for sure. Flexible schedule, control over your workflow, and a certain sense of freedom comes with working for your own business instead of someone else’s. However, when it comes to maternity leave, freelancers don’t have the advantage of six weeks of paid leave that some employers offer. I returned to work two weeks after the birth of my daughter, who is now 18 months old, and started working only ten days after my son was born in June. To complicate matters, I was determined to breastfeed my babies.

Top 6 Tips for Protecting Your Milk Supply While Traveling for Work

We had this terrific question posted on our Facebook page:

“Dear Robin,

I leave tomorrow for a four day work trip and I can't take my baby with me. She has 6 feedings a day (one of those at night) so I'll be doing a good amount of pumping while I'm gone. Do you have any tips, specifically for pumping at airports and/or on planes? I'll be on a red eye there and a direct flight on the way back.”

Absolutely!  Just because you have to travel for work doesn’t mean that you can’t protect your milk supply while you are gone.  

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Here are my top 6 tips for protecting your milk supply while traveling for work

American Airlines: Please change your policy about checked pumped breastmilk!

A few weeks ago, the San Diego Nursing in Public Task Force was contacted by Theresa Morawski Pulickal about an incident she needed help resolving with America Airlines.  Theresa has already done an amazing job advocating for herself and almost completely resolved the situation she had with the airlines, but she needs your help to change American Airline's policy regarding transporting breast milk.  She doesn’t want another mother to have to deal with the challenges she dealt with a few weeks ago. 

Here is her story.  

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I am trying to change an American Airlines policy after an experience I had traveling from Puerto Vallarta to Phoenix to San Diego a few weeks ago. While in Puerto Vallarta, I pumped breast milk for my child home in San Diego. He was not traveling with me. At the Puerto Vallarta airport I was told by the TSA agents that I could not carry my breast milk on the plane. I tried to tell them that the rules in the US state that it's okay to carry pumped milk onboard the plane and it could be tested, but they gave me a firm ‘NO’. I took my breast milk coolers to America Airlines (AA). I told them I was told to check my breast milk by the TSA agents. The American Airlines ticket agent generated a check bag tag and said it would cost $499MXN pesos. I asked if the could be waived, as it is breast milk. I told them I was not expecting a fee. They said, no, because the baby was not with me and that it was company policy to charge a fee and that he (the AA Agent) didn't agree with it either, but had to charge me.  I paid the fee, as it was very important to me to bring home my milk. I checked the bag to Phoenix. In Phoenix, I spoke to the AA customer service representative. The agent told me that they should not have charged me for the bag in Puerto Vallarta, but he was unable to reimburse at his location. He told me there is no one to call and I would have to make a claim online through the comment/compliant website. I picked up my bag and went through TSA in Phoenix to San Diego with no problem. They looked at my milk and tested the cooler bag. I was allowed to carry on. 

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How Can I Pump Enough for my Baby When I’m at Work?

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Written by Ashley Treadwell, IBCLC

Going back to work can be a very stressful time for many new moms.  It’s difficult to leave your baby for the first time.  You may feel nervous about returning to a job you’ve been away from for months.  Your schedule/routine may have changed due to child-care arrangements.  Plus, if you’re anything like me, none of your work pre-pregnancy work clothes fit yet!  A concern that often adds to this stress is the fear that you may not be able to pump enough for your baby’s bottles while you’re at work. Some moms find that they are constantly playing a game of catch-up, trying to keep up with their baby’s intake while with the caregiver.  Below are some things you can do to improve your ability to keep up with your baby’s needs.

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Help a Mama Out: Tips for Talking with your Boss about Pumping

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'Help a Mama Out' Topic of the Week:

Tips for Talking with Your Boss about Pumping

What's your best tip for discussing your pumping rights/schedule with your boss? 

Shelly Hovies Rogers: Be assertive with your rights, but be flexible and willing to work with your boss and coworkers.  I found my workplace to be quite accommodating to me when I nicely, but matter of fact, told them what I needed.  Also, although I didn’t have to quote the state law, I familiarized myself with it, just in case I needed to use it. 

Kelly Reyes: Before I left for maternity leave, I discussed my need to pump with my boss and then HR, just to make sure we were all on the same page.  When I had issues with the way the ‘wellness room’ schedule was being managed, my boss went to bat for me and fixed the problem that day! 

Marie Bishop: My best advice is to know the law and stand up for yourself and your baby.  In states, such as California, it is required by law that your employer provides a non-restroom space that is private for you to pump.

Meggin Dueckman: We just talked about it!  We’re all pretty close at work, so it was no problem.  I was the first of our staff to want/need to pump at work.  Mind you, here in Canada we get a year of maternity leave, so it’s not as common for people to want to pump as frequently when they return to work.  I only pumped 1 times a day at work, more for my own comfort!

Jamie Howell Swope: As a teacher at a school, it wasn’t an easy process, but I went in knowing the law and advised my principal ahead of time why I wanted to meet with her.  That way she had time to think about how to make it work, too.

Kat Picson Berling: I was really lucky in that 2 of my coworkers were pumping moms, so they had paved the way.  I told my boss that I was going to take 2 pumping breaks at x and y time and I will be in this office and it will take 15 minutes.  He was fine with it.  I’m not going to lie…. Because I had a cubicle at work, it was sometimes difficult to find a place to pump.  Even our HR coordinator wasn’t sympathetic for me.  Just make sure to know the law. 

Chantel McComber: My advice would be to put your fears aside.  Sometimes it’s hard as a working mom to ask for things because not everyone has them.  Remember that you are doing this for your health and your baby’s health and those are two things that should always come first.

Jennifer Haak: When I discussed my date of return, I told my boss that I needed a lock installed on my office door and I explained why.

Andrea Blanco: First, know your right.  Be sure that your company falls under those rights.  Then file that information away and try *not* to use it as it can be perceived as a threat (and no one likes to be threatened.)  Second, have a plan in place.  I find that if you’re willing to have the conversation in advance, go into it as sweet as possible, and have it all planned out as to how it will work for you (with consideration given to work environment/demands/pumping law.)  Then, it is much harder for your employer to say no. 

For the United States Lactation Accommodation laws, check out Break Time for Nursing Mothers

Help a Mama Out: Getting the Most Milk Out While Pumping

Alison: Massaging the breasts!  That’s the biggest helper for me.  Also, leaning over a bit, as gravity can sometimes help.

Nova: Crank it up if you can tolerate it.  If your pump has those little white membranes, change them once a month or so.

Sondra: Relax!

Melissa: Whenever I pump at work, I put a little coconut oil on the inside of the pump flanges.  This way the inside is lubricated and my areola doesn’t chafe alongside of the plastic flanges.

Laura: If I need to increase volume, I get into a pumping boot camp and spend an hour pumping with 10 minute intervals and 10 minute breaks.  Whenever I have a supply dip, this would bring it back within a day or so.  Also, I’ve had great output when I watch a comedy where I am laughing out loud.  And it never hurts to have my hubby give me a back massage just before pumping or during a break.  Also, my supply is related to my water intake, so I make sure to drink a minimum of 100oz per day.

Jen: Pump the full 20 minutes.  I always get a late let down of another ounce or so if I wait it out.  Also, a hands-free bra is a lifesaver!

Jennifer: A picture of my baby always helped when I was away from him.  Focus on him and how much you love him.

Ann: Relax for sure!  Lots of deep breathing and looking at photos of my sweet girl’s chubby cheeks.

Sarah: Staying hydrated (lots of water and coconut water) and pumping at the same times each day.

Stacy: Hands-on pumping (massage and compression), staying hydrated, and changing the cycle speed and angle of the flanges.

Veronica: Watching videos of my little one always made a big impact.

Lydia: Warm compresses, relaxed and comfortable, use the correct flange size and check the suction.

Pumpin' PalsAngelica: Pumpin Pals!  Made pumping so much more comfortable!

Ria: Massaging my breasts while pumping almost doubled the amount I could get!

Carmen: Hands on pumping!  See the Stanford pumping video about maximizing pumping.

 

Don't miss our Boob Group podcast episode about Maximizing Your Pumping Sessions!