MAKING MORE MUMMY MILK, NATURALLY...

By Pinky McKay International Board Certified Lactation Consultant and best-selling baby care author

Page 1

You know breast is best, don’t you? You want to give your baby the best but you worry:

• do I have enough milk (I’ll explain how you can tell if your baby is getting enough in this free eBook) ?



• will my milk ‘dry up’, my mother’s did (please be assured there is no connection between your mother’s breastfeeding experience and your own and when you were a baby there wasn’t a lot of good breastfeeding information available);



• my baby is growing so quickly, how will I keep making enough milk as he grows bigger ( actually you don’t have to make more and more milk after the first couple of months because your baby’s growth rate will slow and your milk composition - that, is the balance of fats, proteins and nutrients - will change to support his growth)?

If you are worried about low milk supply, you aren’t alone – recent studies show that the number one reason women say they give up breastfeeding is because they don’t think they have enough milk. Often this is due to poor advice and a lack of support, rather than an actual low milk supply or problems that can’t be sorted with the right help when you need it. If you do have a low milk supply or you get off to a difficult start with breastfeeding and it takes a while for your milk to ‘come in’, your situation can almost always be improved with appropriate support. In this eBook, I am going to give you some ‘breastfeeding basics’ so you can relax and enjoy your baby without worrying about your milk supply. I’m also going to give you some tips to increase your milk supply so you can boost it up easily, without a whole lot of stress.

Page 2

Do I have enough milk? When a breastfed baby cries, you will probably have well-meaning people commenting, ‘are you SURE you have enough milk? Or, ‘he sounds hungry.’ You are also likely to get comments like’ are you feeding, AGAIN?” This is enough to sow the seeds of self-doubt that can see you reaching for the bottle (of milk, that is). Please be assured that most women DO make enough milk for their breastfed baby- as long as they understand a few basic s. Sadly though, there is a lot of misinformation around that undermines breast-feeding mothers – from advice to space out feeds and putting babies on strict feeding schedules to topping babies up with formula (before even considering if there is a feeding issue). This advice can also have you worrying about your milk supply, especially if your baby seems to want to feed more often than these schedules advise. However, it is the schedule that is faulty, not you or your baby: babies naturally feed from 10 to 12 times in 24 hours during the early days. It can help you to accept this frequent feeding if you see it as practice for your baby and your body: frequent feeding is important for your baby to learn to coordinate sucking swallowing and breathing and for you to establish a healthy milk supply. As your baby and your body adapt and the early engorgement (swelling) of your breasts settles down (around 3 to 12 weeks after birth) your breasts will become softer and this can also cause you to wonder, am I losing my milk. If your baby feeds well, and you are allowing him to feed when he shows hungry signals, you eat healthy foods and drink according to your thirst, you will continue to make enough milk.

Page 3

True low milk supply True low milk supply, where mothers are unable to produce adequate milk despite good breastfeeding management, is rare but also often treatable. Reasons can include retained placenta, excessive loss of blood during the birth, hypothyroidism (which can be corrected with medication) or polycystic ovarian syndrome. Very rarely, inadequate breast tissue can also result in low supply. Baby-related reasons for low milk supply include poor attachment or insufficient time at the breast. This can be due to a sleepy baby, strictly scheduling feeds, supplementing with formula, overuse of dummies or anatomical issues such as tongue-tie. Thankfully, these issues can be overcome with proper management and support. If you have any concerns about breastfeeding, I strongly recommend consulting a Board Certified Lactation Consultant – sooner rather than later because things can spiral downwards quickly if you don’t get the right help early. You can either find a private lactation consultant at www.lcanz.org or visit a hospital lactation clinic where a trained breastfeeding specialist can observe your baby feeding and take a history of your health and your baby’s so they can assess what is happening and work out an appropriate plan to increase your milk supply.

Page 4

Is my baby getting enough milk? If your baby is solely breastfed (no other foods or fluids are given), you can be confident that she is getting enough milk if she is gaining weight (has regained her birth weight by 2 weeks of age and gains an average of 150 grams a week); has a growing length and head circumference; is having at least six to eight pale (dark urine is a sign of dehydration), wet (cloth) nappies (or at least five full/heavy disposable ones) every day (scarce amounts of concentrated urine mean your baby does need more breast milk); passes a soft yellow stool at least once a day (after the first six to eight weeks some breastfed babies will only poo every few days – as long as your baby is otherwise thriving, this is normal for a breastfed baby). If your baby gains weight slowly, consider are you comparing her weight gains with non-breastfed babies? An article published in Essence, the Australian Breastfeeding Association magazine (Volume 42, Number 6) explains: Breastfed babies have different metabolic rates and different sleeping patterns. Artificially fed babies on average have higher intakes of energy and as a result are heavier. One study (Dewey, 1998) explains some of the differences between breastfed and artificially fed infants. The average weight gain of breastfed babies is lower, even after complementary foods are introduced. The length gain is also less in some studies. Growth in head circumference does not differ by feeding mode. Breastfed infants are generally leaner at 12 months of age. Evidence suggests that there are no adverse effects to the slower weight gain of breastfed infants; they do not differ in activity level and they experience less illness and have enhanced cognitive development. If you are concerned about your breastfed baby’s size, it would be helpful to check out the World Health Organisation Growth standards as these are based on breastfed babies as the ‘norm’. Also, whether your baby is large or small, it is worth considering whether this could be influenced by genetics – asking your own mum and your mother-inlaw for your and your partner’s baby books could provide reassurance that your child is simply following a family pattern.

Page 5

Making milk The basic rule of producing enough breast milk is to understand that the more milk you remove from your breasts, the more they will make. Babies regulate the volume and composition of your milk by their sucking and by how often they feed. As your baby sucks at your breast, he stimulates milk production. And as an empty breast makes milk more quickly than a full breast, milk production speeds up or slows down according to your baby’s hunger levels. (This is particularly important to remember when your baby has a growth spurt and wants to feed more often for a few days to keep up with his needs. Although it is fairly common for babies to have growth spurts and corresponding appetite increases at two weeks, six weeks and three months, these can happen at any time). Babies will also step up feeds if they are exposed to a bug –it’s as if their tiny bodies ‘know’ they need a boost of the immune protective factors in your milk. If you are worried that your baby is hungry, offer the breast again, even a few minutes after the last feed. If you offer a bottle as a top-up, he won’t suck the whole amount of milk from your breasts and they won’t get the message to increase the supply. So, next time, you will offer another bottle, and so on, until the decreased sucking causes your milk supply to dwindle and you find your baby is weaned.

Page 6

Helping your milk to flow Each time you begin to feed your baby, his sucking action will stimulate the nerve endings in your nipple, sending a message to your brain and causing the hormone oxytocin to be released. The oxytocin causes the cells around the milk glands to contract and squeeze out the milk. When this ‘let-down’ or ‘milk-ejection’ reflex occurs, you might feel a tingly ‘pins and needles’ sensation in your breasts, your breasts may become firm, you may notice milk leaking from the breast your baby isn’t feeding from, or your baby may suddenly start gulping as your milk flow speeds up. Your let-down reflex can be inhibited by pain or stress – for instance, if you feel worried about whether you have enough milk, if you are sitting in an uncomfortable position or perhaps if you feel you are being ‘watched’ by others. You can aid your let-down by relaxing, taking slow deep breaths, listening to soothing music or stroking your baby’s body as you begin to nurse. As the let-down is a conditioned reflex, you may also find that it helps to have a drink of water at each feed time; as you sip your water and relax, your milk will flow naturally.

Page 7

Hungry or thirsty? Whether he is wanting to feed because he is hungry or simply thirsty, your baby will be able to regulate the type of milk he needs, if you allow him to set the pace. The composition of breast milk changes throughout the course of a feeding. The first (‘fore’) milk, is rather like skim milk. This will quench your baby’s thirst, which is why he will often have very short, frequent feeds on hot days (if you feed your baby according to his needs, he won’t need bottles of water). As the feed progresses, the milk’s fat content increases and more closely resembles whole milk. Hunger will be satisfied by longer sucking periods when your baby gets the fatty ‘hind’ milk (like a rich, creamy desert) that is squeezed down into your ducts by the let-down reflex. Your baby needs to finish (empty) the first breast before she moves on to the second, in order to get the hind milk. If she chooses to drop off your breast after feeding from only one side, try burping her and/ or having a little play and a nappy change, then offering her the other side before you put her back to bed. This way, she might sleep longer before waking for another feed. If she is truly satisfied after only one side, you may need to express a little from the second breast, for comfort.

How does your baby feed? One indicator of how well a baby is feeding is their sucking action. Think about how you suck from a straw: as you suck in a mouthful, your chin drops down, as long as you are ingesting fluid. Similarly, as your baby sucks at the breast, it will look as though he is pausing (with his chin down) between ‘chomps’, as he sucks in milk. The longer this pause, the bigger the mouthful he will be getting and the more milk he will be drinking. A baby who is sucking effectively (as opposed to ‘nibbling’) may finish a feed quite quickly, so be guided by your baby’s sucking rather than by how long he feeds at the breast.

Page 8

Watch your baby, not the clock Trying to impose a strict feeding schedule, rather than watching your baby’s cues, is not only likely to result in unnecessary crying, but may be a risk to her health. When you compare a baby’s needs to those of an adult (who is generally not trying to gain weight – at least, not to double or triple their current size!), it is easy to understand that expecting a baby to eat according to a strict regime, which restricts the duration and quantity of feeds, is not only unrealistic and unkind, but can also contribute to a failure to thrive. Consider how often you eat, drink, nibble, snack or sip through an average day. Did you know that you would be having a cup of coffee at four o’clock this afternoon, or did you just feel like one? Did you tell your work colleagues you wouldn’t be able to have lunch with them at midday because you are not scheduled to eat until one o’clock? Doesn’t your hunger and thirst change according to the weather and your activity level? As adults, we eat and drink according to our own body signals, not a predetermined schedule – and so should babies. In fact, the average baby needs to breastfeed 8–10 times a day, and up to 12–14 times a day during growth spurts! If your baby suddenly seems to be hungrier than usual, follow his lead. His hunger may be due to a growth spurt or another factor such as an impending illness (babies who are coming down with a bug tend to increase feeds, as though they know they need a boost of protective antibodies). If you respond to your baby’s hunger cues, your milk supply will catch up with your baby’s increased demand. Take it easy for a few days, offer skin-to-skin cuddles (which will help boost your breastfeeding hormones), allow unlimited access to your breasts – if you have support, take baby and a good book to bed with you – and remember, the more your baby sucks, the more milk you will make. Soon, your baby will settle down into a more predictable rhythm again.

Page 9

Is it a growth spurt? Now and again, most babies will have a ‘frequency day’ (or several), when they need to feed more often to temporarily boost your milk supply. This may also be called a ‘growth spurt’, which neatly explains your baby’s appetite increase. This doesn’t mean that you are running out of milk. If you follow your baby’s lead and let him suck more often for a few days, your breasts will catch up with the increased demand and things will settle down again. Take it easy and remember that the more your baby sucks, the more milk you will make. Conversely, if you offer a top-up bottle, your baby won’t need to empty your breasts and they won’t get the message to increase milk production. It can be reassuring to know that although your baby will have appetite increases, where he will need a bit more milk for several days, your breasts are not going to have to produce an ever-increasing volume of milk as your baby grows. In fact, your milk volume will stay about the same (around 750–800 ml) from the end of the first month until your baby begins on solid foods. This is partly because of changes in milk composition as your baby grows and also because his rate of growth slows down by around 50 per cent by four to six months.

Page 10

Feeding to make more milk To boost your milk supply, your baby needs to be well attached and nursing efficiently. It can be helpful to get an expert such as your midwife, baby health nurse or a lactation consultant to check. If your baby isn’t attached properly and sucking effectively it can create a downward spiral – he doesn’t empty your breasts properly, so your body doesn’t get the message to produce more milk, he gets less and so a vicious cycle begins – he gets tired with the effort (try draining a swimming pool by sucking the water out with a straw!), so he becomes less interested in breastfeeding. Offer both breasts at each feed. As your baby slows his sucking, encourage him to drain the breast (and stimulate more milk) by compressing your breast so that milk flow is increased and encourages your baby to keep sucking. It is a bit like stimulating another ‘let down’. To do this place one hand around your breast, with your thumb on top and fingers below, or your thumb on one side and fingers on the other, high up on your breast (not near the nipple), and compress your breast. This action (press, compress, release) will help squeeze and drain more milk from the breast. As the milk flow increases, you will notice your baby swallowing more deeply. You can also try ‘switch feeding’: let your baby suck on one breast until he slows his swallowing, then switch sides, so that you end up switching several times during a feed.

Page 11

Boosting your milk-making hormones Skin to skin contact with your baby is one of the most effective things you can do to boost your milk production hormones. Also, by stripping your baby to his nappy only and holding him against your own bare skin as you feed, you will be encouraging him to stay awake and feed more effectively. If it’s a bit cold, pop a soft blanket over you both. This is lovely to do regardless of your milk supply as it helps with bonding and your baby’s development. If your milk supply needs a boost, snuggle with your baby skin to skin, give your baby unlimited access to the breast (let him nurse whenever he shows hunger signs – rooting with his mouth, turning towards your breast and making little noises that say, ‘I’m humgry’), eat nutritious milk boosting food – such as Pinky’s Boobie Bikkies, drink water or some of the beverages listed in the food section in this ebook and rest (take baby and a book to bed or put your feet up and watch a selection of DVDs), and you should notice an improvement within 24- 48 hours.

Your breastfeeding basket Instead of seeing feeding your baby as a chore, try to see this time as a special time of closeness with your baby and some ‘me’ time for you. Create a calm feeding space and prepare yourself a ‘feeding basket’ – include a water bottle, a good book, your phone, a pen and note pad (this is a good time to plan or write your ‘to do’ list but don’t be too ambitious!), and nutritious snacks – that’s why we created Pinky’s Boobie Bikkies as a yummy treat – because you can eat them with one hand as you feed your baby, knowing that you are eating healthy natural food and, best of all, you don’t have to cook them yourself!

Page 12

Do I need to express? When trying to increase their milk supply, many mums are advised to adopt a regime of feeding and expressing. Although this is sound advice when we consider the physiology of lactation (i.e. that an empty breast makes milk more quickly), in reality, this method often leads to feeding, settling and expressing, then finding it’s time to start all over again. Apart from the fact that a baby who sucks effectively will empty your breasts far more efficiently than any pump, the resulting exhaustion can be counterproductive. If your baby isn’t sucking effectively, or you are worried about needing to give your baby a top-up, try the following:

Expressing Try to work out a happy medium so that you do not find yourself in an exhausting cycle of feeding, settling and expressing. So, express for short periods of, say, 15–20 minutes several times a day (this may vary from a few times a day to every three hours – be advised by your lactation consultant), with perhaps one longer expressing session when it works best for you, such as after your baby is in bed at night and you are feeling more relaxed. A good rule of thumb when considering how often to express is to keep one feed ahead of your baby’s needs so that you balance rest, feeding yourself and feeding your baby, and have some expressed milk in the fridge as insurance if your baby needs a top-up (your own milk is better than formula for both your baby and your supply). If your breasts aren’t soft (drained), express after feeds; otherwise, express between feeds to keep your breasts as empty as possible so that milk production speeds up.

3 3 3 Page 13

Medications to make milk If your milk is slow to come in perhaps after a long labour, a difficult birth or a caesarean, or if you have a low milk supply for some other reason, you can ask your doctor for prescription medication to help kick start your milk supply or boost your supply if other measures such as feeding more frequently and/or expressing aren’t working well enough. You will still need to apply all of the other measures though – remember the law of supply and demand: the more milk you remove, the more your body will make. Some mothers swear by herbal teas such as fenugreek or raspberry leaf and blessed thistle tablets to increase their milk supply. However, please consider that most herbal treatments have not been thoroughly researched, particularly in regard to breastfeeding. Being ‘natural’ doesn’t automatically guarantee safety and in some cases herbs have been linked to allergic reactions or fussiness in babies and adverse reactions in mothers. Fenugreek for instance, is commonly advised to enhance mother’s milk supply, however some mothers with asthma report that it worsened their asthma symptoms and some babies react by becoming windy and unsettled. You are also advised to use fenugreek with caution or avoid it altogether if you have a history of peanut or chick pea allergy because it is in the same family and may cause an allergic reaction in mothers who are allergic to these things. If you have diabetes or are hypoglycaemic, you are advised to use fenugreek with caution as it may result in hypoglycaemia in some mothers. If you are diabetic, only use fenugreek at all if you have good control of your blood sugar levels. If you do take it, you are advised to closely monitor your fasting levels and post-prandial (after meals) levels.

Page 14

Foods to help boost your milk A generally healthy diet with adequate protein, iron, B vitamins and essential fatty acids is important to maintain your energy levels and your milk supply. Remember, you need to heal your body after the awesome job of growing a baby and, regardless of your milk supply, you need to nourish yourself so you can feel strong and healthy as you do the most important job of all – nurturing and nourishing your breastfed baby! You will often hear that you need to drink milk to make milk – this isn’t true. In fact, too much milk could see a cranky baby if your baby happens to be sensitive to dairy proteins passing through your milk. Natural – and safe – drinks to boost your milk supply include coffee substitutes such as Caro, which are based on barley, a grain that is lactogenic (i.e. enhances milk production). These coffee substitutes usually also contain chicory or dandelion, plus malt – ingredients that are all lactogenic. Many nursing mothers are advised to drink Milo. However, as Milo contains chocolate and dairy milk, it may cause an unsettled baby, rather than a full contented baby. So, if you do drink Milo, remember, ‘all things in moderation’ is a sensible rule to follow– try a little and if your baby becomes squirmy with an upset tummy, eliminate it from your diet. There are some foods that do have a lactogenic effect (that is, they enhance milk production). For instance oats – which have no known adverse effects– are a healthy food, rich in whole grains and iron. These are the basic ingredient in Pinky’s Boobie Bikkies – along with other nutritious natural and organic foods that are also lactogenic.

Page 15

The ingredients in Pinky’s Boobie Bikkies are safe during pregnancy and while breastfeeding – the ingredients that nourish you will also pass through your milk to your baby and boost the available nutrients in your milk. For instance, Omega 3 essential fatty acids have been found to have a positive effect on your baby’s nervous system, helping him develop better sleep patterns, especially if mothers increase essential fatty acids in their diets during pregnancy and breastfeeding. Also, low levels of Omega 3 essential fatty acids have been linked to depression – so by including them in your diet you are boosting your body and your nervous system to manage the intense demands of mothering.

Page 16

Getting help We hope these tips have been helpful. If you do have concerns about how your baby is feeding, his health or your own health, please consult an appropriate health professional – either your doctor, maternal and child health nurse or an International Board Certified Lactation Consultant. Remember it is easier to fix things quickly when you have small concerns than when you have more serious issues.

About Pinky Pinky McKay, International Board certified Lactation Consultant (IBCLC), runs a private practice in Melbourne specializing in gentle parenting techniques. A sought after keynote speaker and best-selling author with 4 titles published by Penguin, including her recent book Parenting By Heart, she’s an expert source for media appearing regularly on major network TV and quoted in various publications. Information about Pinky’s books, seminars, private consultations and her free newsletter ‘Gentle Beginnings’ can be found on her website www.pinkymckay.com.au

Page 17

Pinky’s

E I B O O B S E I K K BI rally... u t a n , k il m y mm More mu

Essential nutrients to boost your energy and your milk supply Rich in whole grains, protein, B vitamins, minerals, iron and Omega 3 essential fatty acids All natural and organic ingredients No chemicals, GM foods or pesticides passing through your milk Locally made and packaged

Grab and go – because this time is too precious to spend worrying about your milk supply Available in Organic Oat & Vanilla or Organic Oat, Orange & Cinnamon flavours in packs of 10 bikkies

www.boobiebikkies.com.au

Page 18