Handout: Returning to Full Breastfeeding

Returning to Breastfeeding After Formula is Introduced

Presented by: Cathy Carothers, IBCLC, FILCAEvery Mother, Inc.

cathy@everymother.org

Learning Objectives: 1. Name at least two reasons why women begin formula supplementation.2. Identify at least three factors to consider when helping a mother transition to full breastfeeding

after formula supplementation has already begun.3. Name two strategies for helping a mother return to full breastfeeding.

Impact of Hospital Supplementation Babies delivered in community hospitals more likely to be supplemented. [Kurinij & Shiono

1991] Highest risk TIME for supplementation in the hospital is between 7 p.m. to 9 a.m., regardless of

when the baby was born. [Gagnon 2005] Study of Washington, D.C. WIC mothers found that 78% of breastfed infants were supplemented

during the hospital stay; 87% without medical indication. 20% were never told why their baby was supplemented. Most common reasons for supplementation were:

Perceived insufficient milk Belief baby was lactose intolerant because of fussiness To help the mother sleep

[Tender 2009] Babies supplemented in the hospital are 4x more likely to have weaned by 3 months of age.

Supplements given for medical reasons do NOT seem to impact duration. [Ekstrom 2003] The younger the baby is when supplements are given, the shorter the BF duration. [Hornell

2001] Supplements given on Day 1 are the biggest deterrent to continued BF duration [Bolton 2009]

Reasons Mothers Say They Began Formula Supplementation Hospital gave supplement (most do not give information on continued supplementation) Perceived insufficient milk

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Handout: Returning to Full Breastfeeding

WIC mothers who did not attend a prenatal breastfeeding class are 4.7 times more likely to supplement! [Tender 2009]

Changing the Paradigm: What if mothers began to view formula, not as a solution, but as a

TEMPORARY TOOL?

Milk Intake

Baby’s Age Average Milk/Feeding Average Milk/DayDay 1 (1st 24 hours) 2-10 mL

Day 2 (24-48 hours) 5-15 mL

Day 3 (48-72 hours) 15-30 mL

First Week (after day 4)

1-2 oz. (30-59 mL) 10-20 oz. (300-600 mL)

Weeks 2-3 2-3 oz. (59-89 mL) 15-25 oz. (450-750 mL)

Months 1-6 3-5 ounces (89-148 mL) 25-35 ounces (750-1035 mL)

(ABM 2009; Mohrbacher N & Kendall-Tackett K 2005)

Formula Changes Things!

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Handout: Returning to Full Breastfeeding

Stomach is at greater risk of allergy sensitization from non-human milks. Significantly alters gut flora. B-Lacta-albumin is an environmental trigger for allergies and diabetes. [Cantani 2003]

Returning to Exclusive Breastfeeding – A Good Detective: Asks the right questions Never makes assumptions Looks for hidden motives Examines the evidence Uses critical thinking to draw conclusions

Infant Assessment Baby’s age and birth wt. Lowest weight Scales used Breastfeeding frequency How baby takes breast Wet/dirty diapers Feeding cues given Swallowing heard Amount of supplements Type of birth (IV fluids? Epidural?) Hospital routines How soon after birth breastfeeding began Reasons baby was supplemented at the hospital and beyond Jaundice What else is baby eating/drinking What the doctor is saying Health/medical issues? (ex: heart issues? tongue tie?)

Maternal Assessment Breast changes during pregnancy/beyond? When did she feel milk volume increase? Postpartum bleeding? Was she engorged? How did she deal with it? Medications? Birth control? Previous breast surgery? PCOS? Unusual shaped breasts?

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Handout: Returning to Full Breastfeeding

Medical Indications for Supplementation Baby under 2 weeks > 10% below birth weight Baby has not regained birth weight by 2 weeks Stools have not turned yellow by 7 days of age No urine output for 24 hours Clinical signs of dehydration Baby 2 weeks to 3 months gaining less than 20 g/day or 7 ounces/week Preference for supplement is MOM Give supplement at the breast if possible

Decreasing Supplements… Reassure mothers this takes time! Support makes the difference. Smaller supplements more frequently. Allow baby to breastfeed first without supplement to better drain breast. First supplement to drop: the first morning BF. Decrease supplement by around 2 oz. every other day while increasing feedings at the breast. Monitor baby’s weight closely.

…While Building Production All suckling at the breast when possible Deep latch Increase frequency to 10-12x/day Allow baby to finish first breast first Drain breasts WELL!

Offer both breasts ~ twice! Breast compression and massage Power pumping (Cathy Watson Genna) Hands-on Pumping (Jane Morton)

Skin-to-skin contact Increases oxytocin levels Increases prolactin levels Increases milk production Even 1 hour of S2S/day helps increase production (Hurst 1997) Calms and soothes baby Gives baby greater access to the breast

Breastfeed at night Avoid pacifiers which can mask feeding cues

When Mom Chooses to Continue Supplementing

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Handout: Returning to Full Breastfeeding

Support makes the difference. Encourage mom to breastfeed before supplementing to better drain the breast. Smaller rather than larger volumes, when possible. Nurse during the night; supplement during day. Give the supplement at the breast, if possible. Use Mom’s Own Milk (MOM) if possible.

Talking with Mothers During early weeks many mothers report difficulty following instructions, remembering facts,

and keeping track of time – all governed by left brain. [Eidelman 1993] Mothers have enhanced RIGHT brain capacity – perhaps to connect with baby. [Schore 2001] Tune in to the mother’s EMOTIONS. Teach her why her baby fusses and cries. Affirm! Affirm! Affirm! Mothers may equate feelings about their milk with feelings about their life. [Chin 2009] Show her what she is doing right. Show her how her baby loves her. Power of Praise!

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Handout: Returning to Full Breastfeeding

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