Thursday, August 12, 2010

What is normal, anyway?

In my experience, a lot of moms give up pumping (and breastfeeding in general) because of what they perceive to be problems with their baby or their nursing relationship.  Too often I hear things like "baby wanted to eat every 2 hours" or " she seemed starving every night", with the unspoken implication being "I wasn't making enough milk, so I had to switch to formula".  Every time I hear a woman say something like this, usually with sadness or shame, I get angry.  Really angry.  Angry, not at the mother who has only done what she believes is best for her baby, but angry that our society is so formula-centered that we generally have no idea of what is normal behavior for a breastfed baby (aka. a human baby), and no understanding of what to expect in a baby who is fed mom's expressed milk while she's away. Angry, because it's too late for that nursing pair.  And angry, because there is one more woman who has internalized the message that it's not possible to exclusively breastfeed while working outside of the home.

To this end, I've started compiling a list of normal, even expected behaviors for breastfed babies of working mothers.  Please note, some of these are common to all breastfed babies, whether mom SAH or WOH.

Breastfed babies will:
  • Want to eat at least every two hours while they are awake, usually until past their first birthday.
    Breastmilk digests quickly and easily - usually in about 90 minutes.  Empty tummies = hungry babies.  This is not an indication that he isn't getting enough - it's an indication that his system is functioning properly!  Frequent nursing also helps maintain and stimulate mom's milk supply - it's a symbiotic relationship.
  • Often want to feed constantly in the evenings, especially on weekdays (workdays).
    This is a phenomenon known as cluster-feeding, and is thought to be a result of two factors.  Psycologically, baby has been separated from mom all day long, is tired, and wants nothing more than to be comforted in his mother's arms.  Physiologically, breasts have their slowest production in the late afternoon/evening hours - but - the milk that is produced tends to be higher in fat.  Frequent feeding during this time allows baby to get as much of this higher fat milk as possible before bedtime - which may help baby to sleep for a longer initial stretch each night. 
  • Not sleep through the night consistently, for at least the first year.
    It's hard to be a working mom with an infant who still wakes frequently - believe me, I know!  However, fast digesting milk can leave a baby hungry well before morning.  It is unreasonable to expect a breastfed baby to sleep through the night much before their first birthday.  To maximize your rest, consider potential options such as co-sleeping (full or part time) or having baby sleep in your room in a bassinet, side-car style crib or other safe place.  After their first birthday, if night waking is still very frequent, consider some gentle nightweaning techniques.
  • Be able to drink several ounces of formula (or other liquid), after nursing.
    Drinking from a bottle is much easier than nursing from the breast, and it's very easy to over-feed a baby via bottle.  Think about it - is it possible for you to eat more after a satisfying meal?  Sure, that's pretty much the definition of Thanksgiving, right?  That doesn't mean you're not getting enough at your regular meals - and the same runs true for infants.  The point is to satisfy their needs, not to fill them up as much as possible!
  • Grow quickly their first 2 months, and then often more slowly then their formula fed peers from months 2-12.
    Breastmilk is relatively higher in fats and lower in protein relative to cow's milk (the basis for most formulas).  All that fat makes it great at growing babies with big brains but slower at growing big bodies.  Baby cows, in contrast, need big bodies fast and small heads, which is why cow's milk has lots of protein and less fat. So, which are you growing, a human or a cow?
  • Want to be held by mom more often.
    Don't we all? Everything about mom is love - really, why shouldn't baby want to be held often?  The difference is that it is easier for formula fed babies to be fed by others, or feed themselves, or have their bottles propped up for them, and that's how many learn to comfort themselves.  Personally, I'd rather have my baby want to be comforted by a person than an object, wouldn't you?

If I'm missed anything obvious, please let me know and I'll add it.  Also, a final note. Many parents (and especially grandparents) will see this list as a reason that formula feeding is more convenient or even better for baby.  This is a hangover from the Victorian perspective that saw babies and children as an inconvenience - not small people with their own needs.  In the millions of years of human evolution, babies have always been breastfed frequently, slept next to their parents, and been held much of the time by loving family or friends.  It's how we ensured the safety and survival of our very helpless infants in a dangerous world. While these things might not fit well into your busy life of 2010, 150 years of artificial feeding and modern parenting techniques cannot erase eons of biological heritage.  In short, babies are not meant to be convenient!



    re: Are these charts appropriate for exclusively breast-fed babies?

  2. Thanks! The gold standard for growth charts is actually the updated version put out by the World Health Organization, which included only healthy, exclusively breast-fed infants. The charts can be found here: ( and here's a study comparing the CDC charts vs. WHO charts: (

  3. I have a question re: pumping. I just recently purchased a Medela breast pump in hopes to allow other family members enjoy the experience of feeding the baby. In the past and w/ my other 2 children, i wasn't able to breastfeed for long about 5-6 wks. I don't think that I really gave 100% in trying to breastfeed longer than that so i know frustration was a part of it. So I am hoping this time around I can really put in an effort.

    Anyways, my question is... during the first few weeks i know its important to breastfeed exclusively so i don't plan on pumping. Besides its mainly collostrum at that point. But when my milk does come in.... how do i even get started on pumping. For example... when a feeding is due, do i breastfeed and then when he is done, try the pump to see if any more comes out? Or do i breastfeed and allow him to finish and then maybe an hour later try pumping?? What will happen at the next feeding... will there be enough?? I am just really confused and this was part of my frustration w/ the first 2.

    Thank you so much for your input.

  4. That's a really great question. While there's not just one way to do it, I'll give you two options, plus a comment or two.

    Option 1: Many babies only breastfeed from one breast per feeding, or feed very little from the second breast. If this is the case, you can pump immediately after a feeding from the lesser used side (some women even manage to pump the other side while nursing!).

    Option 2: If baby feeds from both sides pretty equally, try pumping about 45min to an hour after that feed (about mid-way between two feedings). You'll have the best results if you do this in the morning, as that's when your production will be highest. Even if baby wants to eat again immediately after pumping, there will still be milk available - baby can always get more milk out than you can pump. Also, you are constantly making milk, so you're never completely 'empty'.

    Comment 1:If you are nursing exclusively, it may take you 2 or 3 pumping sessions to get a 'full' bottle. It's normal to only be able to pump 0.5-2 ounces after baby has just nursed.

    Comment 2: In the early days after your milk comes in and you're really feeling full/engorged, it's absolutely fine for you to pump once a day and save that milk for future use. Frozen milk is good for about 6 months in a regular home freezer. Most moms make a lot of extra milk in the first 2 weeks, so there will always be plenty available - use that oversupply to your advantage and start your freezer stash early.


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