Friday, July 23, 2010

How much breastmilk should I put in each bottle?

If you're nursing baby full time (no bottles of expressed milk or other supplements), you generally don't know and don't have to worry about how many ounces of milk your baby is getting in a day.  As long as baby is gaining well and having plenty of wet and dirty diapers, all is well!

When it comes to prepping bottles of expressed milk, the biggest question is always 'How much do I need to send?'  There are charts out there that will give you a break down, but generally these are complete and utter C.R.A.P. for your baby - don't give them a second look!  Why?  Because, they're based on the average needs of a formula fed baby, not a breastfed baby.  I've said it before, but it bears repeating:

This doesn't mean that the amount of milk you put in your baby's bottle will never change - it probably will - but it's not going to go up drastically from 3 to 6 to 10oz. of milk.  What will often happen is this - baby will start out at 2-3mo drinking about 2oz every 1.5 to 2 hours gradually increasing such that by 6 months she may be drinking 3.5-4oz, every  2.5 to 3.5 hours and generally hold steady thereafter.  If baby is at daycare for 8 hours a day, her schedule may start out as 5 - 2oz. bottles (10oz/day) and end up as 3 - 4oz bottles (12oz per day).  Not a huge change, right?

The numbers I've given are approximate but based on the amounts that all 3 of my exclusively breastfed babies would drink each day.  So, how do you decide how much to send in those bottles?  You want baby to have enough, but don't want to waste precious milk, right?  Start with the fact that the average breastfed baby consumes between 19 and 30oz of milk a day, with 25oz per 24hrs as the generally accepted average.  Now count up the approximate number of times that baby feeds during the day, and divide that into the first number.  For example, a baby nursing 8 times a day will be getting an average of 3oz per feed (25 ounces a day/8 feeds a day = 3.1 ounces per feed) - so that's a starting place for you to work with.  For a great calculator that you can play around with, see here.

As baby starts to go longer between feeds or starts to feed less often during the night, the average amount per feeding will need to be increased somewhat.  For example, my youngest child (now 6 months old) is also my best nighttime sleeper, averaging only one feed per night (compared with 2-3 for her older siblings as infants), and so she takes in larger bottles than they ever did - but those bottles are still only about 4 - 4.5oz each.  Many exclusively breastfed babies will never drink more than 3-4oz in one sitting, all the way through their first year of life.  It's this fact that is partially credited for the fact that breastfed babies are at lower risk of obesity - they never get used to having large volumes of food and don't 'stretch' out their tummies early in life.

Baby still seems hungry after a bottle of 3-4oz?  Look for a post soon on how to determine if baby is really hungry, or just being overfed.

Thursday, July 15, 2010

Can I buy a used pump?

When it comes to purchasing a pump, putting out the big bucks can be tough.  Sure, we all know that pumping is a whole lot less expensive that formula feeding, but not many of us can spend $150 - $300 on a single item without second guessing ourselves.  If you're shopping online for the best deal on a breast pump (and who isn't?), it doesn't take very long to come across ads for used pumps.

"Only used twice!"  "In like-new condition!!"  "Great deal - 75% off!"

It's tempting to want to save money by buying used  - I love a good deal as much as the next mom- but don't do it!  There are only 2 things you should never ever buy used for your baby - car seats and breast pumps. Nearly all consumer grade pumps (i.e. all of those except hospital rentals) are single user medical products.  Sharing a pump with another woman (or buying used) subjects your baby to a small but very real risk of contracting a serious illness, like HIV, Hepatitis B, HTLV-1 and Candidiasis (thrush), to name a few. A good rule to live by:

If you wouldn't let a woman you don't know nurse your baby, don't use her breast pump!!

Thursday, July 8, 2010

Feeding Your Baby: Choosing and Introducing the Bottle

Before you return to work, you will need to introduce your baby to the bottle - that's obvious, right?  But when?  Too soon, the experts warn, and your baby may develop the dreaded 'nipple confusion' (something that many experts believe should be termed nipple preference).  Too late and you risk the stress of a baby who so prefers mom that she won't drink from a bottle at all! And what kind of bottle is best for a baby who with be both bottle and breastfed?  So many things to consider and decide.

To help make the process easier, I've broken it all down for you into two categories, outlined below:

Choosing the Right Bottle
Nipple size and shape:  The most important factor in choosing a bottle is the size and shape of the nipple.  Breastfed babies are trained to open their mouths wide to achieve a good latch - so you want a bottle that mimics that same mouth positioning.  There are a number of good brands, including Born Free, AventMilkBank, Playtex Drop-Ins or any other bottle listed as 'wide-neck'.  Examples of narrower nipples to avoid include Medela, Dr. Brown's, and most of the generic or off-brand bottles.
Plastic vs. Glass: There has been a lot of press surrounding the presence of the chemical BPA in plastic baby bottles - it's been shown to cause significant reproductive problems in laboratory animals.  Most plastic bottles are now sold BPA free, but do make sure that any you choose are labeled this way.  An alternative to plastic is glass bottles.  These are 100% BPA-free, and also are likely free of the next 'unknown' plastic-based contaminants.  Generally these are very sturdy and some come with rubber covers that can reduce the likelihood of breakage.  However, they are more expensive (often much more) than their plastic counterparts, and no glass bottle can be made 100% shatter-proof against an older baby.
Sizes - bottles and nipples: Most bottles come in a small and larger size, typically 4-5oz and 8-10oz. Very few breast fed babies ever need more than 4oz per feeding, even at 10-11 months of age.  Knowing this, I recommend that you save your money and only purchase the smaller bottles.  When you're shopping, you'll notice that nipples come in a variety of flow rates, with 'faster flow' nipples recommended for older babies.  As with smaller bottles, breastfed babies only ever need the slowest, newborn flow nipples.  This is because a breastfed baby does not need larger volumes of milk as he gets older, and there's no need for hinm to guzzle down 4 oz of milk in a few minutes.  Just as with adults, there are benefits to consuming meals (and bottles) at a slower pace.
  Introducing the bottle
When to start: The general guideline for introducing a breastfed baby to his first bottle is that baby 1) must be well established with breastfeeding (proper latch, good suction, good weight gain and plenty of wet and dirty diapers) and 2) should be at least 2 to 3 weeks old.  Of course, if you need to be separated from baby before the 2-3 week mark you can introduce a bottle before this point - and in most cases your baby will learn to switch back and forth between breast and bottle just fine.  My oldest two started on bottles around 2.5 weeks of age, but my youngest had her first bottle at just 5 days old (I had to teach a class!) and is still nursing happily at almost 6 months old without issue.
How to start: Start with just an ounce or two of warm pumped milk.  Choose a time when baby is likely to be hungry - but not starving (or frantic!).  The best piece of advice is to have dad or another caregiver offer the bottle to baby.  A baby is more likely to accept bottle feeding from someone other than its mother - because he already associates mom with nursing directly from the breast and may be confused by the bottle.  This is a time when it is important to give up control!  Don't hover - don't even be in the room.  Go for a walk, go to the grocery store, take a nap, whatever it takes.  You will not be bottle feeding your baby, someone else will.  Hovering, worrying, or criticizing will not help matters - it is up to baby and daddy (or other caregiver) to figure this whole bottle thing out together.  Make sure that dad knows not to pressure baby - if she's not interested, save that milk and try again later in the day, or try again tomorrow with some fresh milk.  Under no circumstances should you try to starve your baby into accepting a bottle!
One you've established that your baby will drink from the bottle, you need to make sure to keep her in practice.  I recommend having someone else feed baby a small bottle (even a single ounce is fine) 1-2x a week until you return to work.  This will ensure that baby continues to be familiar with bottle feeding and won't resist it her first day of daycare.

Tuesday, July 6, 2010

Increasing Your Output: Tips for Pumping More Milk

For many moms, one of the most stressful aspects of working and pumping is the constant worry about pumping output.  While some women are blessed to be high producers, many women are not. The reason for this is:
  • Breastfeeding is a supply and demand relationship.  The more milk that is 'demanded' - removed from the breast by baby or pump - the more milk will be produced in the future.  This is due to two main physiological factors, 1)empty breasts make milk faster than full ones, and 2) empty breasts send reinforcing hormonal signals to the brain that increase their rate of production.
  • In the majority of cases, baby is better at removing milk from the breast than a pump.  It makes sense - our breasts evolved to be responsive to the action and feel of a suckling baby, not a vacuum pump. 
  • If a woman is not careful to ensure that she 'demands' as much milk by pumping as baby would by nursing directly, her supply will eventually decrease.
So, how can we meet that last criteria - 'demanding' as much milk with your pump as baby would if he were nursing directly?  I've put together a list below that covers using your pump effectively, managing your nursing sessions, and dietary, herbal and pharmacological supplements.

Effective Pumping Techniques: (assumes use of an electric pump but may be adapted for a manual)
  • Allow the stimulatory phase (shallow, quick cycles of suction) to run completely.  This increases release of oxytocin (the nursing hormone) and stimulates maximum milk ejection reflex (MER - also known as 'let down')
  • Use the strongest suction that you can comfortably tolerate.  Don't cause yourself injury, but generally the stronger the suction, the more milk will be removed per cycle.
  • Ensure you have the proper sized horns.  Nearly all brands of pumps have horns available with larger diameter outlet for women with larger nipples.  You want all of the nipple and some of the areola to fit into the shaft of the horn.
  • Replace your membranes (if appropriate to your pump) frequently - about every 2-3 months.  If they are bent or torn at all, your suction will be noticeably reduced.
Managing Your Pumping Sessions:
  • Pumping more frequently through the day is more effective than pumping for a longer time per session.  For example - if you have 60 minutes to pump during a day, 3-20 minute sessions will be better for your supply than 2-30min sessions.  If you can swing it, 4-15 minute sessions would be even better.
  • When your first let down slows, switch your pump back to the stimulatory phase.  It is often possible to achieve 2 or 3 let downs in a single 15 minute pumping session.  Each let down results in a release of milk and stimulates the breast to further increase production.
  • Pump for approximately 5 minutes after your milk stops flowing.  This signals the breast that more milk needs to be made and will eventually help to increase your rate of production.
  • Use breast compression.  There are specific methods (Manualex is one), but essentially you are manually squeezing and massaging the breast to force more out while pumping at the same time.
  • If you are really falling short on your total output, consider pumping in the evenings before bed, or even once in the middle of the night (this is most reasonable if your baby is sleeping mostly through the night).
Supplements - dietary, herbal and pharmacological
  • Oatmeal - many women find eating a bowl of oatmeal helps to increase their supply.  These lactation cookies also get rave reviews from many moms.
  • Water - while you don't want to overdo it and make yourself sick, do make sure you are getting plenty of fluids throughout the day.
  • Fenugreek - A common and very safe herb (used in a number of foods), available at most health food stores.  See the link for excellent information. 
  • Blessed Thistle - Commonly mentioned in breastfeeding forums, this herb has less hard evidence supporting its use in lactation and some concerns about safety.  I do not recommend its use.
  • Domperidone - a pharmaceutical widely prescribed around the world (except in the US) and known to significantly increase milk production.  It is not currently approved by the Food and Drug Administration (FDA), but based on all available evidence, it appears safe and effective.  I would use it if needed - the difficulty comes in that it generally must be ordered from Canada or another international pharmacy.  It is recommended highly by Dr. Hale, the world's foremost expert on medications and breastfeeding.
  • Reglan - another pharmaceutical proven to stimulate milk production, and it is FDA approved.  However, Reglan is associated with potentially serious side effects (serious depression, tardive dyskinesia) and is generally considered less desirable than Domperidone for lactating mothers.
There are other herbs that some women use, as well as tricks and tips - leave a comment and share what worked for you!

A final note: Many working and pumping moms feel that they aren't pumping enough for their babies, when it's actually the case that well-meaning daycare providers are overfeeding their babies.  Look for a post coming soon that will address how to bottle feed an exclusively breastfed baby!

    Monday, July 5, 2010

    Managing Your Milk Bank

    There are lots and lots of ways that you could potentially organize your frozen milk bank.  The two types of collection containers for freezing and storing milk are either plastic cups (like this or this), or plastic bags.  Unless you've got a deep freezer with lots and lots of space, I personally recommend using plastic bags - they take up less room and cost far less money.  I like Gerber brand, but the Medela and the Lansinoh are great too.  Here's a list for an easy way to store and organize your stash while and maximizing freezer space.

    Checklist: Storing Milk
    1. Label the bag with a permanent marker - include the date and amount of milk to be stored.
    2. Pour milk into freezer-safe breastmilk bags and squeeze out any extra air.  I suggest you only pour about 2-3oz total in each bag, so that you can choose to thaw a small amount.  You can always thaw more milk, but it can't be thawed and refrozen.
    3. Lay the milk down on a flat surface somewhere in your freezer (on top of the ice cream works well!).
    4. Once frozen, the bag will be a nice thin, flat rectangle.  Designate a bin of some type (an empty ice bin works well) for storage.
    5. As you accumulate milk, stand the frozen bags up, Rolodex style, in your bin.  Always add newer milk to the back, and use milk from the front.  That way you use up the oldest milk first, rotate your stash automatically, and never worry about some of your liquid gold becoming expired!  If you have a very large stash, you may need to have several containers for storage - some periodic rotation of your stash from bin to bin will be required.
    There are several products on the market that promise to help you keep everything neat and orderly.  If you really want one of these, go for it.  However, my experience is that these systems are cumbersome to use and don't hold nearly as much as a decent sized Tupperware container.

    Saturday, July 3, 2010

    Pumping vs. Formula: A Cost Analysis

    If you're considering buying a pump for your return to work, you may experience a bit of sticker shock the first time you go shopping. In our home, the conversations went something like this: 'Two hundred and fifty dollars?!? How can we possibly afford this with all of the other things we still need to buy for the baby? Is it really worth it to spend so much money?'

    I knew I wanted to continue breastfeeding, but I thought I could go cheap and get away with a less expensive manual pump. It was a great pump, but the amount of time I was spending trying to fill up a bottle and the stress I was experiencing resulted in a trip to the baby superstore the very next weekend for a bigger and better dual electric.

    You may have read it before, but I'll say it again - the cost of even the nicest consumer-grade breast pumps is far, far less than you'll spend on baby formula. You'll read this on many pro-breastfeeding websites, but I'm going to break it down for you so you can really compare the difference, and I'll put in all of my assumptions so you understand where this is all coming from.

    Amount of formula, by month.
    Let's say you choose to formula feed from the time you return to work until baby's first birthday (a standard time for switching to cow's milk). How much formula will you need to buy? Based on the feeding guidelines I found on Enfamil's website, an average baby's intake will look something like this:

    Age in Months              Oz. Per Bottle             Daily          Weekly        Monthly
    2mo 4.0 24 168 722


    So that gives us a rough estimate of 10,000 ounces for the first year of life.  Now lets look at the cost of several formula options.  To be fair, I'll compare an inexpensive, generic-brand powder (Makers Mark,, a name brand powder (Enfamil Premium,, a ready-to-feed liquid (Similac,, and a hypo-allergenic version (Similac Alimentum, for babies with cow's milk protein intolerance.  All babies react differently to formula, so it's impossible to say in advance whether you could use the bargain brand or might need the expensive stuff.  The next table lists the amount of prepared formula a can of each brand will make, the cost per can or bottle, how many containers you would need to buy in a year, and the total price. 

    Cost of feeding infant formulas for 10 months:

    Brand Ounces/Can  Cost/Can Total Cans Final Cost
    Generic, Powder 255 $18 44 $713
    Brand-name, Powder 170 $24 66 $1,411
    Ready-to-Serve, Liquid 192 $35 59 $1,823
    Hypoallergenic, Powder 114 $30 98 $2,632
    *prices found online on 7/3/2010

    Keep in mind that this only covers the cost for 10 months - starting with an estimated return to work after 8 weeks of maternity leave, up through baby's first birthday.  Additionally, if you were to breastfeed while home with baby but skip pumping at work in favor of formula feeding, your costs would be reduced.

    Now lets consider the costs associated with buying a high quality double electric pump and some useful accessories.
    Cost of pumping equipment

    Equipment Price
    Double electric pump $250
    Hands free pumping bra $25
    Extra freezer pack $5
    Milk storage bags, 120ct $18

    Total Cost $298

    Quite a difference, wouldn't you say?  Outfitting yourself with a top of the line pump and some helpful accessories saves you at least $415, but could end up saving you thousands of dollars.  Of course, none of this considers the fact that breastfed babies are sick significantly less often - leading to fewer missed days of work and fewer medical bills.  Consider, too, whether you plan to have more than one child.  Most women find that a quality pump will last quite a long time - long enough to be used through the infancy of two children.  I'm on my third child and only my second pump - and I only bought a new one for baby #2 because I was looking for some of the (then) extra features on a newer pump.

    So, what will you do with an extra $400 - $2000?  Bills, baby gear, clothes, evenings out, the college fund?  Or do you want to spend it on over-processed, nutritionally inferior, artificial baby formula?

    I thought so.

    Friday, July 2, 2010

    Hands Free Pumping

    If you haven't figured it out already, being a working mom means perfecting the art of multi-tasking.  If you're working full time, you may find yourself spending up to an hour a day strapped to your pump - a huge amount of time when you've got things to do (like some work, perhaps?). Thankfully, when it comes to pumping, there is a solution:

    Choose to go hands free.

    There are a number of options for hands free pumping, but what it ultimately comes down to is the ability to use your hands for typing, holding a book, writing notes, making phone calls, or in my case, driving my car.  Yes, really - it's less distracting than using a cell phone in the car, I promise.

    There are several options for pumping hands free - I've listed a few, but I'd love to hear about what has worked for you!

    Pumping bras and bands:  These can be worn in lieu of or over top your normal nursing bra.  They hold the horns securely against the breast while supporting the collection bottle.  Several brands are listed below with links to  Search around for the best deals if you're planning to buy. 

      The Elastic Band Method: If you want to save money, it is possible to use 4 elastic bands to hook your pumping horns directly to your nursing bra.  Here is a great set of visuals that illustrate how to make this work.  I've tried this and it works in a pinch, but doesn't offer the security and stability that a quality pumping bra will provide.

      Tips and Recommendations:  I pump hands free twice a day and love it.  It takes an extra minute to get set up, but the pay off is worth it.  Currently I use the Simple Wishes Bustier (size XS-M) and would recommend it.  It's endlessly adjustable and has seen me from  my post-partum 44 inch, DDD cup size all the way down to my my current 36 inch, C/D cup and still has plenty of room to adjust smaller.  I suggest you buy just one pumping bra and wear it over top of your regular nursing bra just when you're pumping (you can unhook and pull the flaps of your regular nursing bra down and out of the way).  That way it doesn't need to be washed as frequently, and you can just fold it up and store it in your pumping bag between uses.

      A final warning - it is easy to lose focus on the the fact that you are actually pumping.  I once was careless enough that one of my collections bottles was tilted at enough of an angle that allowed for a large amount of milk to get backed up and sucked up into the tubing of my pump.  A HUGE mess ensued, with milk spraying out of the pump face plate - yuck!  I ended up needing to buy brand new tubing - a costly mistake for a momentary lapse in attention.  So, pay attention to your posture and be sure to check that you haven't filled up your bottle to the brim!

      Getting Into a Routine

      One of the hardest parts about starting back to work is getting yourself into a new workable routine.  During my maternity leave with my second child, I nearly had panic attacks when I tried to figure out how I'd get a 2 year old, a baby and myself out the door in time (hubby left for work very early back then), but now I manage it with 3 kids in under an hour!

      When it comes to pumping, storing milk, washing up and preparing the next day, I recommend figuring out a routine that works for you before your first day, work out any kinks, and then stick with it.  That way you'll be ready to go in the morning and less likely to find yourself at puming time missing something critical - like your bottle caps, or those darn little membranes that seem to disappear when you're not looking!

      Here's what my schedule looks like - I've left out all of the herding of small children, schlepping of heavy bags, etc., that's also a part of my daily routine...

      Arriving home after work:
      1. Immediately place my pump and other bags on the end of the kitchen counter in a row, so I don't forget one the next day.
      2. Remove milk from the pump's cooler bag and place in the fridge.
      3. Place pump freezer pack  and cold pack from baby's diaper bag into the freezer.
      4. Take apart and dump all of the baby's bottle parts into a tub of soapy water in the sink to soak.
      5. Play with the kids and nurse the baby.
      Time - 3 minutes
      After kiddie bedtime:

      1. Measure out milk into clean bottles for the next day.  Label with a sharpie and masking tape (per daycare regulations).  I have enough bottles for 2 days, but this isn't a necessity.
      2. Wash all bottles and pump parts in hot, soapy water and allow to air dry overnight.
      Time - 15 minutes
      In the morning:
      1. Pack up baby's bottles and a freezer pack into her diaper bag.
      2. Assemble pump parts and place into pump bag.
      3. Grab freezer pack from the freezer and put it into the pump bag.
      4. Do a quick double check to make sure nothing was left behind on the counter!
      5. Out the door to daycare drop off!
        Time - 2-3 minutes


      Thursday, July 1, 2010

      Getting Started - Preparing to Return to Work

      Whether you're still pregnant or nearing the end of your maternity leave, the thought of returning to work can fill even the most dedicated career woman with feelings of dread and anxiety. How will the baby adjust to daycare? Will my boss and coworkers still value me? Will I ever fit into my professional wardrobe? It can all be so overwhelming!

      If you're worried about whether you will be able to continue breastfeeding your baby after your leave ends, the answer is Yes! Absolutely! The list below gives you a step by step guide you can follow to maximize your chances for success. As this site develops, look for articles devoted to each of these topics and much more!

      Checklist: Preparing for Pumping

      1. Learn as much as possible about breastfeeding your baby. See here and here for my top 2 favorite sources for research-based information.
      2. Know the law. Certain federal and state laws protect the rights of breastfeeding mothers in the workplace.
      3. Choose a pump. Consider your needs, budget, and product reviews.
      4. Figure out where and when you will pump. Discuss your plans with your supervisor and/or human resources department.
      5. Buy your accessories. Do you want to pump hands-free? Need an alternate power supply?
      6. Set up your milk storage system - how will your milk bank work?
      7. Practice setting up and using your pump.
      8. Sterilize your collection bottles, horns, valves and baby bottles a few weeks before your due date.
      9. Establish a solid breastfeeding relationship before you return to work! Whether you and baby are a match made in nursing heaven or need a bit of help from a good lactation consultant, this is the most important thing you can do to ensure you'll make your breastfeeding goals.
      10. Review the guidelines for freezing, storing and thawing human milk. It's not nearly as fragile as you may think!
      11. Start building your milk stockpile. Take advantage of that early over-supply to learn how to pump and begin building your frozen milk stash for a rainy day. However, be careful not to pump yourself into over-supply!
      12. Introduce baby to the bottle. Most experts recommend waiting until breastfeeding is well established, and at least 2-3 weeks, to introduce baby to expressed milk.
      13. Learn about the typical feeding patterns of exclusively breastfed babies receiving expressed milk by bottle. The average baby only needs about an ounce per hour while she's away from mom.
      14. Review your feeding plan with your baby's care provider. Make sure they understand that your milk needs to be treated differently than formula and that it's not a biohazard!
      15. Develop routines for the cleaning and prep of bottles and your pump.
      16. Take a deep breath and head back out into the real world!
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