Why Weigh and Feed?

The most common task done during a lactation consult is weighing the baby. Often the baby is weighed before and after feeding. This practice is called many things: pre and post feed weights, PC/AC weights ( pre-consumption, after consumption), or weighted feeding. The purpose of this weighing is to determine how much milk the baby is transferring for that feed.

Human milk has roughly the same weight per volume as water: 1 gram per milliliter. We use this 1:1 ratio to get a pretty good idea of how well the baby is drinking at the breast. A baby who gains about 2oz after a feed too in about 2oz of milk from the breast.

The sensitivity of the scale used if a factor in determining the accuracy of the weighted feed. In this episode, Danielle meets up with Katherine Morrison IBCLC, CLC of Atlanta Lactation and Christie Coursey IBCLC of Breastfeed Atlanta to discuss scales, weighs, and how to decide on volumes to supplement based on weighted feeds.

Key takeaways from the video:

  • every baby should be fed to satiety at every feed
  • scales can give good data that needs to be examined along side data like diaper count and growth patterns
  • stool frequency and volume are important indicators of intake when scales are not available

Enjoy the video! Subscribe to our YouTube channel and comment to let us know what videos you’d like to see!

 

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Bringing Your Newborn Home

Bringing your infant home can be both exciting and scary. You may wonder what your family’s new normal will look like. Many refer to this period of time as the “fourth trimester,” or the period of time when mom and baby both adjust to their new physically separate states. This adjustment takes place over the course of several months. When your baby is first born he or she has no experience with the world beyond the womb. Certain things can facilitate the ease of this transition from the womb to your arms. Bonding is the name of the game during the first days home. “Eat, bond, sleep, repeat” becomes the new mother’s mantra.

    The natural habitat of the human infant is mother’s breast. Your baby will likely spend most of his or her time there for the first few months. Since newborn nutrition is such a large part of life with a new baby, taking a prenatal breastfeeding class is essential. You may wish to speak to an LC one on one to discuss your questions or concerns specific to your family prior to your baby’s arrival.  A prenatal breastfeeding consult is a helpful tool for preparing you with information about establishing the nursing relationship. Most of the time in Atlanta area hospitals, you will have the opportunity to receive a quick consult from a hospital lactation consultant prior to your discharge. This consult is generally brief. Many families still have questions and concerns regarding breastfeeding after returning home. Many new moms prefer to schedule home visits with their LC to stay in the comfort of  home during the recovery period.

 Breastmilk is digested in 90 minutes. Expect to nurse your baby 10-15 times per 24 hours. Many first time mothers worry that their baby nursing frequently is a sign that they do not make enough milk. This is usually not the case. Colostrum, or newborn milk, is present in your breasts starting early in the third trimester. It is nutritionally rich and very little is required to fill a new baby’s tiny stomach. If your baby experiences the common condition “jaundice” also called hyperbilirubinemia, colostrum is a powerful laxative that will help resolve it. Within the first few days your milk will transition to “mature milk.” Each time your baby nurses, it signals your body to make more milk. Frequent on-cue nursing during the newborn period generally equates to a robust milk supply in the long term. Exclusive breastfeeding or “EBF” and avoiding formula are common goals for many mothers. This goal is attainable with access to breastfeeding education and breastfeeding help if necessary.

    The best indicator of adequate intake is output. Normal diaper count is 6-10 wet or dirty diapers daily. In the first week, counting diapers can give you reassurance that your baby is indeed eating enough. Your baby should have at least one stool per each day of life. Day one- 1 poop, Day two- 2 poops, Day three- three poops, and so on. “Cluster feeding” or blocks of frequent nursing are common. Although nursing is frequent, it should never feel painful. Your baby will likely love to be held on your chest close to your breasts even when he or she is not nursing.

    Skin to skin contact is crucial for your newborn.  Skin to skin regulates the infant’s body temperature and blood sugar. It also facilitates important early neurological development. The simple act of holding your baby skin to skin stimulates production of hormones in both the mother and baby that keep everyone feeling relaxed and calm.  Your partner can help you with this important bonding process by doing things like screening phone calls, entertaining visitors, bringing you food and drinks, changing diapers, and caring for older children. Your partner should encourage you to rest as much as possible while your baby sleeps.

Newborn sleep gets a lot of publicity. When babies are born, they do not make their own sleep hormones. They receive their sleep hormones from their mother via breastmilk and suckling. This is why many babies nurse to sleep. Nursing to sleep is biologically normal and natural. Many people refer to babies “having their days and nights confused.” This is not the case. Babies are not born with a light/dark cycle. One will eventually develop with time, but during the newborn period frequent night wakings are to be expected.  Frequent waking to nurse is part of nature’s protection against SIDS. The American Academy of Pediatrics recommends a form of co-sleeping that is referred to as “rooming in” for the first six months of life as a measure of SIDS risk reduction. Sleeping in close proximity to your baby also allows to have a heightened awareness of your baby’s hunger cues throughout the night.

Your new baby’s first days at home will likely seem like more of a whirlwind than pregnancy.  Prenatal breastfeeding education and accurate expectations of the newborn period can make this transition much more manageable for families. However, there will be times that you don’t know what to do. When in doubt just do less, nurse more, and call your LC!

Are My Breasts Empty?

Our lactation counselors are frequently told that the mother feels her breasts are empty or not full any more. This anxiety often causes mothers to end exclusive breastfeeding prematurely or begin supplementing with formula when it is not needed. One of the most common misconceptions about breastfeeding is that breasts, like tanks or bladders, fill and empty. Here are some facts about the way human lactation works to help nursing mothers understand what is going on in there.

Fact: Breasts contain glands, not bladders. Milk production is continuous.
Human milk is made by specialized cells called myoepithelial cells. Blood is supplied to these cells, and they turn blood into milk, drop by drop. The milk is continuously being produced by these cell as well as continuously reabsorbed into the blood stream. During periods of engorgement, the body tries to reabsorb the milk faster and slow down the production. When the baby is actively nursing or mom is actively pumping, the reabsorption is slower and production is faster. Breasts can never be empty until after the baby is fully weaned off breastfeeding.

Fact: Babies don’t take all of the available milk during nursing.
Using ultrasound, science has determined that babies take about 65% of the available milk in the breast during a feeding session. This is why pumping milk after feedings is recommended for mothers who are pumping and storing milk for future separations.

Fact: The more rapidly milk is removed from the breast, the more rapidly new milk is made.
When milk is being removed from the breast, the milk making hormone prolactin is highest. Frequency of nursing and pumping is key to making more milk. Women who “save up” or try to wait for the breast to feel full before nursing are actually lowering their prolactin levels. This is why supply and demand is the law for breastfeeding and making more milk. Moms who remove milk the most frequently will make the most breastmilk.

Fact: Even a hospital grade double electric breast pump cannot empty the breast.
Because milk making hormones peak during milk removal (nursing, pumping, or hand expression), the body will always rush to make more milk every time mom is pumping.

The Take Away

Continuous breastfeeding or breast milk removal is the key to high levels of milk production. If a mother is doubting her milk production capabilities, milk production is easily assessed by an LC at a home visit or office visit. LCs employ techniques like weighed feeds and latch assessments to determine how well the baby is “transferring” or getting enough milk. When in doubt, it is always better to nurse more and pump more. Supply and demand is the ruling principle of lactation. Feelings of fullness do not happen for all women who make a full milk supply. Feelings of fullness may come and go but do not indicate milk production levels or how well the baby is eating.

 

7 Things You Can Do Right Now with a Fussy Baby

When you have a fussy baby, the minutes feel like hours and it’s easy to panic. Don’t panic! Take control of the situation and help your baby adjust to life outside the womb. Set aside worries about allergies, diet restriction, and milk production. Get the baby calm, help mama get calm, and then call your lactation consultant.

Hop in the Bath
Babies love baths. Mommies often need one too. Co-bathing can calm and focus your baby. Babies who are frustrated at the breast often respond well to nursing in the bath. Bath tub nursing can halt a nursing strike, help a baby with a shallow latch relax and open wide, and help a mom who is having let down trouble. Safety tip: have another adult present to pass the baby in and out of the tub to mom to avoid slip and fall risk.

Magic Baby Hold
It’s magic. Hold the baby like this. Magic Baby Hold with Bill

This is a variation of the common tummy massages like bicycling legs, rubbing the tummy clockwise, or burping. This can help pass gas or ease a baby who seems constipated. Remember: constipation is hard dry stool, not infrequent stool.

Swing and Sway
Not just the baby swing. Babies calm faster in arms. Swing with your baby on your lap on your porch swing or glider. Wrap your baby in a sling or carrier and walk through the house. Babies like to be near a heart beat. Being skin to skin while swaying through the house is extremely soothing.

Nurse in a Carrier
Nursing in a carrier allows the baby to be upright and compressed. This helps with reflux symptoms and gas. Upright feeding can also ease the stress of fast milk flow or over-active let down. Babies with tongue or lip ties can often open wider because of the firm back support carriers provide while the head can move more freely. Sucking also helps relax babies and their GI muscles. More nursing helps them poop.

Play with Temperature
Take some frozen milk out and spoon feed it to your baby or put it in a mesh feeder. The cold is exciting and different for older babies, especially teething babies. Older babies may like to hold a frozen teething toy or a warm teething toy.

Get Outside
Even if the weather is crummy, just standing on the porch may change things. If you’re able to carry your baby for a walk, this is usually better than a stroller. The upright position and being near an adult care giver are more relaxing than a stroller.

Play with Texture
Let your baby touch something interesting and new. A tooth brush or cotton ball or sand or salt. Watch that these things stay away from the mouth. Novel sensory experiences can change your baby’s outlook pretty rapidly.

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