Colostrum Harvesting – Should you, or shouldn’t you?

If you’re expecting, you’ve probably heard about “colostrum harvesting,” and how you need to do this to get ready for breastfeeding. This is not true. There is nothing you need to do while pregnant in order to successfully breastfeed.

Let’s separate the fact from the fiction:


You can start pumping while pregnant and fill up your freezer with milk before the baby even arrives.

Collecting milk while pregnant will help boost your milk supply, so that you will have plenty of milk by the time the baby is born.

If you collect colostrum while pregnant, there will be no need to use formula, should your baby need a supplement.


You have colostrum from around 16 weeks of pregnancy. You may see it leaking, or may not, and both are normal.

If you hand express at any point after 16 weeks, you will probably see a few drops. However, your pregnancy hormones will not allow your supply to increase at this point, because your body is super smart and knows when to grow a baby (when the baby is inside) and when to feed a baby (when the baby is outside). Until you deliver the baby and your lactation hormones “come online,” you will probably only ever see a few drops at a time during a hand expression or pumping session.

You probably don’t need to fill up your freezer with milk, but that’s a post for another day. (Contact me if you need to talk through the freezer stash situation.)

Should your baby need a supplement, it is usually ordered in the amount of 10-20 ml per feeding, and babies eat at least eight times a day. Most parents expressing colostrum while pregnant collect around 1 ml per session. When you consider the math, you can see that unless you are spending most of your maternity leave pumping, it is unlikely that you will have enough colostrum to feed a baby who needs a supplement. The good news is that when you hand express or pump after the baby is on the outside and your lactation hormones are flowing freely – it is now possible to see higher volumes of colostrum that will increase over time.

Please note that high risk pregnancies are typically advised not to pump or hand express while pregnant, as breast stimulation may trigger contractions.

For these reasons, if you’re enjoying a healthy uncomplicated pregnancy,* I don’t recommend prenatal milk expression. There will be plenty of time for pumping later, and it will actually work to produce decent amounts of milk once the baby is out. Also, remember that if your baby is latching well, you won’t even need to pump for the first few weeks.

So let’s not make baby feeding any harder than it needs to be: Sit back, relax and enjoy your pregnancy! And if you want an individualized breastfeeding or pumping plan to stack the odds in your favor, let’s work together to create it!

*Pregnant parents with a medical conditions like gestational diabetes have more of a reason to be concerned about their baby needing a supplement. Please reach out to me if you’d like to talk through a plan to get breastfeeding off to a great start, that may include some prenatal milk expression, depending on your preferences.

Colostrum Harvesting – Should you, or shouldn’t you?

The Deconstructed Lactation Cookie…When you Want the Milk, Without the Cookies.

If you’re breastfeeding or pumping, you’ve probably heard about lactation cookies. They sound a lot like chocolate chip cookies, only lactation cookies contain a few mysterious ingredients that supposedly boost your supply. As you’re always looking for ways to make a little more milk, you think, “Heck, why not?” and give them a try. After a few days of snacking on these magical morsels, you notice your supply IS going up a bit. Problem is, the SCALE is definitely going up a bit, too. 

And so now you’re wondering if you can somehow harness the benefits of the lactation cookie without including the parts that aren’t working for you. 

So let’s hack the lactation cookie by breaking it down into its main ingredients:

  • Sugar not helpful in milk making
  • White flour not helpful in milk making
  • Chocolate Chips delicious…but not helpful in milk making
  • Eggs – A great source of protein…but you don’t need to eat them in cookie form.
  • Butter/Coconut Oil – Fats are a necessary part of a healthy diet…but you’re probably getting plenty outside of cookie eating.
  • Brewer’s yeast High in protein, minerals and vitamin B and therefore...helpful in milk making!
  • Flaxseeds Contain essential fatty acids and phytoestrogens and therefore...helpful in milk making!
  • Oatmeal High in iron, magnesium and zinc and therefore...helpful in milk making!

And so we’ve identified brewers yeast, flaxseed and oatmeal as the lactation cookie ingredients that are actually working to give your supply a slight boost. 

Cool! So how can you incorporate these ingredients into your diet in non-cookie form?

  • An easy way to get all of these ingredients into the same place is to make a smoothie. Put all of these things into your blender:
    • 2 cups of the milk of your choice
    • 1 banana
    • A handful of berries 
    • 1 TB of nut butter or a half an avocado (for healthy fat)
    • 1 tsp ground flax seeds
    • ¼ cup oats (raw, toasted or cooked)
    • ½ tsp of brewers yeast
    •  ½ tsp of vanilla 
    • 1 TB of honey if desired
  • Make homemade granola that includes the three magic ingredients. Stir together:
    • 2 cups rolled oats
    • 3/4 cups chopped nut pieces of your choice
    • 1/2 cup unsweetened shredded coconut
    • 1.5 TB ground flaxseed
    • 1 TB brewer’s yeast
    • 1/2 tsp salt
    • 1/4 cup honey or maple syrup
    • 1 TB molasses
    • 1/4 cup + 1 TB melted coconut oil
    • 1 cup chopped dried fruit
    • 2 tsp vanilla or almond extract
    • Once combined, spread the mixture on a baking sheet, and bake at 325F for about 30 minutes. Stir it a few times while it’s baking, and watch carefully after 20 minutes to make sure it doesn’t burn!
    • (Mix this granola with yogurt and some fresh berries for an out-of-this-world snack!)

  • Eat a bowl of oatmeal every day, adding a ½ tsp of brewers yeast and/or ground flaxseed to it.
  • Sprinkle ½ tsp of ground flaxseed and/or brewers yeast over soup, salad, yogurt, or hummus. 
  • If you don’t like the taste of brewers yeast, you can take it in tablet form. Talk to your doctor about the right dosage for you.
  • Note on amounts: Most moms do fine with adding up to about one tablespoon of brewer’s yeast daily. Any more than that and you or your baby might have some GI issues. If you have any concerns about adding brewers yeast to your diet, talk to your doctor. Flaxseed is super healthy when consumed in moderation, so feel good about adding one to two tablespoons to your daily diet.

And there you have it! A few easy ways to get some milk making foods into your diet, without packing on the pounds. Happy eating!

Please note: There is no hard scientific evidence that lactation cookies or the milk making ingredients they contain increase milk supply. However, many moms over many years have said these things have been helpful for them, and so it doesn’t hurt to give it a try! If you are having issues making enough milk for your baby, please call a lactation specialist to get some professional help.

Breastfeeding 101: Prepare for the Suck

This is my new book. I wrote it, my sister illustrated it, and my brother designed the layout. It’s a pretty fun and informative book, if I do say so myself. I’m super proud of all the work we put in, and the finished product exceeded my expectations. Go check it out on Amazon today.

Here’s a description:

Funny breastfeeding books are hard to come by these days.

But in this quirky book, breastfeeding education is transformed from a serious, dull and overwhelming experience into a light-hearted, humorous and relaxing one.

In easy-to-understand language chock full of baby and boob jokes, you’ll learn the basics of breastfeeding a newborn including:

  • How to prepare for breastfeeding
  • How to make enough milk
  • How to get a comfortable latch and
  • How to feel confident your baby is getting enough

Beth McKeown, the author’s sister and an accomplished artist, supplies playful and unique illustrations that will make you laugh out loud. So whether you’re planning on breastfeeding but not sure what to expect, nursing a baby but have breastfeeding questions, or looking for a unique baby shower gift, this book is a great choice.

How Can Partners Help With Breastfeeding?

If your partner has decided to breastfeed, you might be wondering how or even IF you’ll be able to contribute on the baby feeding front.

You’ve probably heard a few people say you can be a big help by…

wait for it…

changing the baby’s diapers. 

And while you definitely should be pitching in on diaper duty, this wasn’t really what you had in mind. And there’s nothing like being elbow deep in baby poop to make you feel just a tad jealous of the dads who get to snuggle up with their babies and give a bottle.

But never fear! 

There are many (fun and non-stinky) ways you can help your breastfeeding partner:

  • Know your baby’s hunger cues. When your baby is hungry he will:
    • Open and close his mouth (like a little baby bird).
    • Turn his head from side to side (he’s looking for a nipple).
    • Put his hands in his mouth and maybe suck on them (until he gets a boob, his hands will do).
  • Keep your baby happy while mom gets ready for the feed. You can rock him, sing to him, and give him a clean finger or pacifier to suck on.
  • Once your baby is latched, make sure mom is comfortable. Adjust her pillows and place a rolled up receiving blanket under her hand that’s supporting the baby.
  • Have a look at your baby on the breast, and get familiar with what’s going on there. Does the latch look nice and deep? Is he showing you wide rhythmic sucking? Do you hear any swallows? Tell mom what you’re observing, as sometimes she can’t see much from her perspective.
  • Newborns often start to doze off while they’re eating. You can help keep your baby awake by tickling his feet, stroking his head, and massaging his hands and arms. 
  • Talk to your baby while he’s eating. He knows and loves your voice.  
  • When your baby is done the first breast, pick him up and burp him while mom gets ready to feed on the other side. Sit him up and talk to him to wake him up a bit.  
  • When your baby is done on the second breast, take him from mom and give her a break. If your baby is asleep, hold him until he’s deeply sleeping, and then put him down in his safe sleep space. And if he’s awake? This is a great opportunity for some dad and baby bonding. 

And so you see, while of course you can’t actually physically breastfeed your baby, there are many other ways to be involved in the feeding. Many breastfeeding moms decide to pump their milk and offer a bottle once breastfeeding is going is well, and so it will probably only be a few weeks until you’re able to feed the baby. In the meantime, tell mom what an amazing job she’s doing…and when you’re helping out by following the advice above, know that you’re doing a great job, too.

Bottle Feeding Help in Austin, TX

Hi Y’all!

Are you struggling to get your breastfed baby to take a bottle?  Never fear! My method called “Baby Steps to Bottle Feeding,” has successfully gotten many babies happily onto their bottles, and I’m sure I can help, you too!  I’ll come to your home, do an assessment of the current situation and set you up with a plan for success. My fee is $50/hr, and you may only need to see me once! Call or text today to set up your bottle feeding consult.


Michelle Poole MS, RN, IBCLC




2018: A New Year’s Resolution

I read this sentence recently (forget where) and it’s stuck with me this week, playing over and over in my head:

“In life, we don’t get what we want, we get what we think we deserve.”

Wow. It’s so heavy when you really stop to think about what it means. What I want, vs. what I think I deserve. This brings into question how hard we are on ourselves, how negative we can be and how we deny ourselves things that we DO want, and DO deserve…but that on some level, we think that we don’t.


“I want a clean and tidy house, but I am just not motivated enough to make it happen (and so I deserve this mess).”

“I want a child who is well behaved and good mannered; but I am not a very good mother (and so deserve a child who is difficult to control).”

“I want to spend more quality time with my kids, but there are just too many other things to get done (and so I haven’t *earrned* it and  don’t deserve it).”

” I want to take a break from pumping, cut back a bit or stop altogether but this is selfish and not what the *best* moms do (and so I must continue around the clock).”

“I want to be able to take a break from parenting and have some “me time,” but (again) this is selfish and not what the *best* moms do (and so I don’t deserve it).”

I want a partner who loves me unconditionally; but I am flawed in many ways (and so deserve the judgement and unfaithfulness).”


Do you see how we can defeat ourselves and in doing so, not have, and maybe NEVER have, the life that we want?

In this New Year of 2018, we need to start changing our thinking. We need to think about what we want and how we’re going to get it, and not come up with reasons or excuses why it can’t be that way. We need to give ourselves permission to make these change, and move forward and achieve our goals.

Only you can give yourself this permission.

So what do you want…in regards to baby feeding, motherhood, and for your life in general? Take a minute and really think about this. Write a few things down. And then give yourself permission to get what you want.


Here are a few self permissions that could probably help us all:

1. I give myself permission to take breaks and rest.

2. I give myself permission to make mistakes, learn from them, and move on.

3. I give myself permission to step out of my comfort zone.

4. I give myself permission to fulfill my lifelong dreams.

5. I give myself permission to not feel responsible for other peoples’ happiness.

6. I give myself permission to listen to my gut when it tries to tell me that something isn’t right.

7. I give myself permission to create—paint, play an instrument, compose songs, knit, and so on.

8. I give myself permission to release the past.

9. I give myself permission to be OK (and maybe eventually happy) with where I am now.

10. I give myself permission to get what I want out of this life.

What permissions do you need to give yourself this year?

May 2018 be the year of self forgiveness, self love, forward momentum, appreciation and joy. Happy New Year!

When do I switch sides?

“How do I know when it’s time to switch?”
This is a question that has plagued moms for years. 
Many well meaning friends and even some healthcare professionals will give you a time frame, with “15 minutes on one side and 15 minutes on the other” being the one I hear most often. However, breastfeeding is never as easy as a simple matter of timing. In fact, if you ONLY consider the timing of your baby’s feed, you are likely to run into trouble. 
Consider the following three babies:
Baby A:  This baby latches to mom’s right breast.  He sucks vigorously and mom can hear swallows. As the feeding progresses, the swallows become more and more spaced out.  At the 15 minute mark, mom switches baby, and he gives a similar performance on the left side. At the 30 minute mark, mom detaches him and the feeding is over.
Baby B: Baby B latches to the right breast, sucks a few times, and then falls asleep. Mom rubs her back and feet, and when she does, baby perks up and starts sucking again for a few seconds..then falls asleep again.  The feeding continues on like this for 30 minutes, mom dutifully switching breasts at the 15 minute mark.
Baby C: This kid latches to the right breast and begins to loudly gulp milk, coughing and sputtering at certain points. At the 7 minute mark, he comes off on his own and will not relatch. Mom becomes upset because her baby did not even reach the 15 minute mark on one side.
Which baby do you think got the most milk?  Did Baby A and B get the same amount of milk because they fed for the same amount of time? (Probably not.) Did Baby C get less because he fed for only a few minutes? (Probably not.)
Do you see how a timed feeding can cause confusion about understanding your baby’s intake?  There is no way to know how much any of these babies got, (unless they were weighed before and after eating), but I’d put money on Baby C as getting the most milk, and Baby B not getting much at all. Baby A probably took an average amount of milk, but perhaps would have gotten more if he hadn’t been arbitrarily stopped.
Because of the trouble that timed feedings can cause with understanding your baby’s intake, a different strategy is required. Instead of watching the clock, you need to tune in to what’s happening on the boob.  What you want to see is a baby who is actively sucking and swallowing, and as long as your baby is doing this, he shouldn’t be switched, no matter what the clock says.  Most babies start out strong, and then gradually take longer and longer pauses while the swallows become fewer and fewer. Eventually, most babies will fall asleep on the boob, or take themselves off of the ’empty” breast, and this tends to happen between the 10-20 minute mark of the feed.  And in most cases, switching at this point in the feed would probably be fine for baby’s overall intake. 
But wouldn’t it be great to know for sure that your baby had really and truly emptied your breast before switching him? To feel confident that he took as much milk as possible?
 And of course, there is a way: use breast compressions!  And a breast compression is exactly what it sounds like – you squeeze your boob.
Here’s how to do a breast compression: when baby starts to slow down on his sucking, squeeze your breast and watch his response. If he starts swallowing again, hold the squeeze until he has stopped. If he doesn’t respond, or once he has finished swallowing, move your hand to a new spot on your breast, wait for him to start sucking again, and repeat the squeeze. Once baby no longer responds to compressions (or takes himself off), it’s time to switch sides. And you should always offer the second side. Baby may or may not take it, but always offer!
You should also try breast compressions if:
  • You have a very sleepy eater. The faster flow of milk can help to keep baby awake and interested.
  • You have a low supply/poor gainer. The breast compressions will allow your breast to be most fully drained, which will give your baby more milk and should help to boost your production over time.
  • You have a slow initial letdown. Some babies are impatient and aren’t happy to wait for the fast flow of a letdown. Squeezing out what you have might help your baby to stop fussing and perhaps even encourage your letdown to occutr more quickly.
  • Your baby is a slow eater. If your baby regularly takes 45 minutes or longer to eat, try some breast compressions to see if you can make feedings more efficient. (And call an IBCLC while you’re at it as there might be something else up with the lengthy feeds.)
So the next time your baby eats, put your eyes on your baby, and give your breasts a squeeze!

photo credit: Yachichurova август60 via photopin (license)
photo credit: UNICEF Ethiopia World Breastfeeding Week 2016 via photopin (license)
photo credit: Chris Alban Hansen Breastfeeding on the Museum Island, Berlin via photopin (license)

Supplementing Solutions – How much??

I think there's a baby in the sheet??
I think there’s a baby in the sheet??


It’s day four of your baby’s life, and the pediatrician just told you that he’s at 14% weight loss, and that you will need to start supplementing.  It’s obvious that he needs more milk, but why?  Do you have a low supply? Did your milk come in late?  Or at all?  Or do you have plenty of milk but your baby just isn’t getting it out? What happens when you pump? Can you supplement with your own milk or do you need to use formula?  Most likely,the only one who can answer all of those questions is a lactation consultant (IBCLC), and whenever unplanned supplementing is on the menu, seeking out an IBCLC’s help should be as well. So please make an appointment to meet with a lactation consultant.

However, in the meantime, you need to feed your baby.  So, how much?

Studies have shown that breastfed babies eat about this much per feeding, at least 8 times a day:

Day One of life – 2-10 ml per feeding

Day Two of life  – 5-15 ml per feeding

Day Three of life – 1/2 oz – 1 oz (15-30 ml) per feeding

Day Four of life – 1-2 ounces (30-60ml) per feeding

Day 5 – Day 7: between 2-3 ounces (60-90ml) per feeding

Week 1- Week 2: baby will be working up to 3-4 ounces per feeding by the end of week 2. Baby will take roughly 3-4 ounces per feeding for the first 6 months of life, and then may drink a little less milk when solids are introduced.

“Well,” you say. “That’s answers the question of “how much” for the moms who are only using a bottle for a feeding. But I’m putting my baby to the breast before I give the supplement. So I would need to adjust the above numbers to what my baby needs after a breastfeed –  only, I don’t know how much he eats…which kind of puts me back to square one.”

And you’re right.  We don’t know how much your baby is taking in while on the boob. He definitely needs a supplement, but probably not the full amounts listed above (due to him probably getting some milk at the breast.) So the question of “how much to put in the bottle” is not settled yet.

At least you don't need to supplement THIS guy!
At least you don’t need to supplement THIS guy!


But I’ve got some good news.

If you use a paced bottle feeding method to supplement your baby, you don’t need to obsess over the measurements! 

A paced bottle feed allows your baby to regulate his intake, which means that he can tell you when he’s had enough.  (It also helps to protect your breastfeeding relationship by avoiding nipple confusion/flow preference so is a “win” all around.)

Here is how you pace a bottle feed.

  • Hold your baby upright, and brush his lips with the slow flow bottle nipple until he opens his mouth.
  • Holding the bottle horizontally so that milk just fills the nipple tip, slide the bottle into his mouth until he is latched deeply and his lips are flanged at the base of the nipple. (You might need to manually pull the baby’s lips out).
  • Allow the baby to take about 3-10 “gulps” of milk.
  • Twist the bottle nipple down and out of the baby’s mouth, and allow it to rest on his cheek. Don’t take it away or he will get mad!  Feeling the nipple resting on his cheek will let him know it’s there when he is ready.
  • Your baby will take a break to catch his breath, and if he is hungry, he will start to root for the nipple again.
  • Slide the nipple back in and continue this cycle, allowing for frequent burping breaks (every few minutes).
  • If baby is drinking the milk very quickly, you can use a pacifier a few times during the feed to help him slow down his intake. A pacifier also teaches him that he will still need to do some “work” for his food, just like when he breastfeeds.
  • When the baby stops opening his mouth and rooting for the bottle, or turns his head away, he is finished eating.  It takes about 15-20 minutes for baby’s brain to realize that his belly is full, so the bottle feeding should take about that long.
  • If the baby drinks all of the milk and still looks hungry, but less than 15 minutes have gone by, let the baby suck on a pacifier for a few minutes.  If he still looks hungry after the 15 minute mark, offer him some more milk using the same technique.

If baby shows you any signs of distress below, stop, give him a break, and allow less “gulps” before stopping him the next time.

  • Furrowed eyebrows and/or eyes opening wider and wider
  • Splayed fingers (giving you the “STOP” sign) or stiffening arms and legs
  • Milk spilling from his mouth
  • Coughing, choking, gagging, or gasping
  • Grimacing
  • Flaring nostrils which are a sign that baby is struggling to catch his breath

Here are two videos that I really like, illustrating the paced feed.

So let’s wrap it all up and get on with feeding your baby.

Your Supplementing Plan:

After a breastfeed, offer your baby one ounce of expressed breastmilk/formula.  Practice a paced feeding technique with your baby.  If he takes the ounce and still wants more, offer him another ounce. If he wants more after two ounces, offer him more.  Or, if he takes half an ounce and says he is done, the next time you supplement start with only 1/2 an ounce in the bottle.  Trust that your baby’s body is working and that he can communicate his hunger/satisfaction to you!*  Follow up as soon as possible with your pediatrician and/or lactation consultant to make sure your baby’s weight gain gets back on track. And know that for most moms, supplementing is a temporary measure. A good lactation consultant should be able to figure out why your baby isn’t getting enough and come up with a plan to get back to exclusive breastfeeding.

As a closing thought, I know that it can be hard to supplement when that wasn’t in your original plan. Many moms feel defeated and as though they are failing in some way when “straight from the tap” isn’t good enough anymore. However, it’s important to remember that sometimes being the “best” simply means meeting your baby’s needs, however you are able.  A baby who feels your love and has a full belly is living in a perfect little world, so take credit for that and feel good about yourself as a mom!

*Please note that if you have a pre-term baby, a small baby (under 6 pounds), or even a very sleepy baby you should be working closely with your pediatrician and an IBCLC to determine the correct amount of supplement. These babies sometimes are not trustworthy when it comes to communicating their hunger/satisfaction, and they need a focused feeding intervention.


Your fed, loved, and well cared for baby says, “Thanks, mom!”


photo credit: History of Medicine a014808 via photopin (license)photo credit: Thailand-KohSamui-TigerZoo via photopin (license)
photo credit: over the shoulder – day sixteen via photopin (license)

Safe Sex Ed Pacifier Use

pacifier1photo credit: Une tétine. / A pacifier. via photopin (license)

Have you ever heard the pitch from a sex education abstinence program? The leaders of this type of program encourage high school students to not become sexually active. “Just don’t do it -wait until you’re older/married” is the message that teens take in. And if you’re like me (the mom of a future high school student), this probably sounds like the best advice you’ve ever heard. The only problem is, this kind of teaching doesn’t work to stop kids from having sex. For many high school students, it’s just not realistic that they will choose to abstain altogether. After all, there is a monsoon of hormones swishing around, intense situations, and the urge to find some relief from pent up frustrations. Because of these factors, some teenagers will become sexually active, no matter how much we don’t want them to. And if they are having sex without being safe about it, some negative consequences might occur.  In this case, we are mainly worried about pregnancy and STDs. So if we know this to be the reality, why not teach them how to lower their risks for problems if they choose to become sexually active? And in fact, this country is starting to move away from abstinence teaching and towards contraception teaching as the national standard.  We hope to see the rate of unintended pregnancies and STDs drop as a result.

I find that pacifier teaching bears a strong resemblance to abstinence teaching.  A similar message of “just don’t do it – wait until the baby is at least one month old” is preached to new moms. And just like with abstinence education, telling a mom to avoid the pacifier initially sounds like great advice. If we can get a baby to suck only at the breast, especially during the first few days/weeks of life, we can expect an adequate milk supply and healthy weight gain.  So holding off on the binky for a few weeks is a worthy goal, with solid reasoning behind it. However, avoiding the pacifier altogether doesn’t always mesh well with the reality of living with a newborn.  And just like the teens who thought they might be able to abstain from sexual activity but got involved anyhow, many moms end up using a pacifier even if it wasn’t their original intention. (After all, there is a monsoon of hormones swishing around, intense situations, and the urge to find some relief from the pent up frustrations.) I’ve had many moms say something to the effect of, “I know it’s bad to use the binky, but it’s been helping us all to cope!” And so these moms give their babies pacifiers without any knowledge of “safe pacifier use”…. and some negative consequences might occur. In this case, the main concern is how pacifier use might interfere with establishing a milk supply.

Considering what’s at stake (a happy and healthy breastfeeding relationship) and the reality of the situation (many moms choosing to use a pacifier) I want to pose the question – is it possible to use a pacifier in the early days and limit or avoid negative outcomes?

What would happen if, like with sex ed, we shifted from a “just don’t do it” message to more of a “if you decide to use a pacifier, here is how you can help to protect breastfeeding” message? I would hope to see fewer negative consequences resulting from pacifier use. I don’t see the down side of a more forthcoming manner of teaching, as we know that many moms are using the pacifier despite the prevalent “just don’t do it” message.


pacifier 3photo credit: Sagan – Binky Obsession via photopin (license)

The American Academy of Pediatrics says:

“For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.”

And I would like to add that if you decide to use one anyway, please keep in mind:

Rule #1. Limit the pacifier during the first few days of life. Making milk is a simple case of supply and demand, and it is your baby’s job to tell your body to make milk. Your body is in an especially sensitive period in the hours and days after you deliver. The more you allow your baby to suck on the breast, the greater a supply of milk you will make. The less that your baby is sucking on the breast, the less milk you will make. Some babies take their job very seriously, and want to be on the boob for what feels to mom like a 24/7 shift. Moms with a baby like this may feel overwhelmed and tired of having their baby not be content unless he has a boob in his mouth. They want a break, they need a shower, they need two hands to eat their cheeseburger, and they need to put the baby down to sleep so that everyone can sleep safely. And after using the pacifier to get a little breathing room and perhaps take a nap, I would hope that a mom like this feels refreshed enough to give her baby his boob back.

So as long as your baby is feeding well 8-12 times in a day and putting out the correct amount of diapers, limited pacifier use shouldn’t be a milk-making deal breaker. You can always choose to hand express/pump a little, too, if you feel as though your body has been missing out on “make milk” signals.

Once your milk increases in volume (usually around day 3), continue to ensure 8-12 good feedings at the breast, watch for signs that baby is getting enough, and use the pacifier as desired when you really need a break but baby wants to suck.  Another good time to consider the pacifier is when you know baby wants to eat but he will have to wait a few minutes and you want to keep him calm in the meantime. For example, you’re in the shower and the baby is trying to latch on to dad, or, the baby is screaming in the carseat and your boobs just aren’t that flexible.

Rule #2. Get help if you are using a pacifier due to very sore nipples. Some moms start using the pacifier because their toes curl in pain at the mere thought of breastfeeding. A mom like this puts her baby on the breast for only as long as she can stand it and then he gets cut off. But he immediately starts crying and tries to go back on. Instead of her own nipple, the mom gives her baby his binky, which settles him and he falls asleep. Mom breathes a deep sigh of relief, but she has actually just made things worse for herself in the long run. Because the baby is sucking on the pacifier instead of her breast, her body decides to downgrade the milk supply. With less milk available, the baby will be hungry more often and will want to spend more time nursing, which is a terrible fate for a mom with sore nips.

If you are having intense nipple pain, there is something going on with the latch, baby’s suck, or both. And an IBCLC is probably the best person to help you. So, if you are using the pacifier to give your nipples a vacation, continue to use the pacifier, but definitely start pumping (and bottle feeding) to replace your baby’s demand, and get some help!

Rule #3. Don’t use the pacifier because you think your baby is eating too often. Moms in this camp look at their baby giving clear hunger cues and say “You just ate an hour ago so you’re not due to eat for at least another hour.” In goes the binky, and then maybe mom latches the baby in an hour or two. Or maybe the baby falls asleep and sleeps for 2-3 hours. Either way, this mom’s body just received a very clear signal to “make a little less” when baby would have been happy to spread the “make a little more” message. It is not possible to overfeed your baby in the first few days. Your baby has a tiny tummy and you are making small amounts of colostrum (newborn milk) which baby has to work very hard to extract. If your baby is giving clear hunger cues, put him back onto the breast, irregardless of when you fed him last. Watch your baby and not the clock. If this starts to get overwhelming, refer back to Rule#1 for some guidance and seek help from an IBCLC.

pacifier2photo credit: Baby Ben with Uncle Ben via photopin (license)

I hope that you now have a better understanding of why the “just don’t do it” message exists, and how holding off on the pacifier for a few days is typically a good move if you want to meet your breastfeeding goals.  But if you must, please practice “safe pacifier use”….and spread the word!

How much to supplement?


Well, it’s happening. The doctor just told you to start supplementing. It’s day five of your baby’s life, and he’s at 14% weight loss.  It’s obvious that he needs more milk, but why?  Do you have a low supply? Did your milk come in late?  Or at all?  Or do you have plenty of milk but your baby just isn’t getting it out? What happens when you pump? Can you supplement with your own milk or do you need to use formula?  Most likely,the only one who can answer all of those questions is a lactation consultant (IBCLC), and whenever unplanned supplementing is on the menu, seeking out an IBCLC’s help should be as well.

However, while you are waiting for your lactation appointment, you need to know how much you should be putting into your baby’s bottle, be it breastmilk or formula.
So there’s good news and bad news and then some REALLY good news regarding solving the “how much” question….
The good news is that we know how much your baby’s stomach should be holding for each day of life.  Baby should be eating about this much per feeding, at least 8 times a day*:

Day One -2-10 ml

Day Two – 5-15 ml

Day Three – 15-30 ml

Day Four – 1-2 ounces (30-60ml)

Day 5 – Day 7: between 2-3 ounces (60-90ml)

Week 1- Week 2: Your baby will be working up to 3-4 ounces by the end of week 2. She will take roughly 3-4 ounces per feeding for the first 6 months of life, and then may drink a little less milk when solids are introduced.

The above numbers work well when baby is not going to the breast at all, i.e. you are replacing a breastfeeding with a bottle feeding.

But what if you are breastfeeding before offering a supplement?
The bad news is that we don’t know whats coming out of your boob.  We just know that it’s not enough right now for whatever reason. You know that something is coming out if you see your baby taking big long pulls, hear swallows, and feel as though your breasts are softer after a feeding. But after 45 minutes of nursing on both sides, your baby is still showing signs of hunger.  And so you bring out the bottle, but you’re kind of clueless about how much should go in it at this point.
The REALLY good news is that your baby can tell you when he’s full, and so you don’t actually need to worry about how much is the right amount!  If you use a paced bottle feeding method, (and here) your baby will be able to give you clear cues when he has had enough.  When he shows you satisfaction cues, you know that you fed him the right amount, whatever that happened to be.
So here’s a temporary plan: Start with an ounce in your supplemental bottle. Practice paced feeding with your baby. Make sure that you are spending about 10-15 minutes on the bottle feed as that’s how long it takes your baby’s brain to know that his stomach is full. If he takes the ounce and still wants more, give him another ounce. Or, if he takes half an ounce and says he is done (mouth closed/turning head away), start with a half of an ounce the next time you supplement.  If he wants more after two ounces, give him more.  Trust that your baby’s body is working, so that if he can tell you when he is hungry, he can also tell you when he is full.**
Continue to monitor all of the signs that your baby is getting enough to eat , and talk to your pediatrician if you have any concerns.
Working on breastfeeding can be a challenge, but now you can always feel good about the fact that your baby is being well fed while you figure things out!
*Volumes taken from the Academy of Breastfeeding Medicine’s supplementation protocol.
**If you have a pre-term baby, a baby under 7 pounds, a jaundiced baby or a sleepy baby you should be working very closely with your pediatrician and an IBCLC to determine the correct amount of supplement. These babies are not as trustworthy as healthy full term babies at telling us their needs, and may not eat as much as they need to before tiring out or falling asleep.

photo credit: Chronic drinker via photopin (license)
photo credit: Baby & Bottle via photopin (license)
photo credit: bottle V via photopin (license)