Too Much Milk

"Third time's the charm" is certainly the case with my third baby. This little hunk is already in size 6-9m clothes despite being only just 4m old. He was 9lbs at birth but is already 17lbs - my firstborn didn't weigh that much til nearly 1yr old. 

Breastfeeding the third time around is a lot smoother too. I expected to have zero hiccups, since I had successfully breastfed my previous two in the last two years, despite the first time suffering the steep learning curve and the second time having a newborn in NICU. Yet, I still had a curve, albeit more like relearning how to ride a bike first thing in the summer - a lot faster and a lot of 'oh that's right, this is how that works.'

I am beginning to feel like an 'old salt' mom. I've been encouraging younger first-time moms, despite the fact that I was in their shoes less than 4 years ago. The breastfeeding issue is a sensitive one. Nearly all moms I meet express a desire to do it, surprise with the unexpected difficulties, and a constant pressure to give it up. Whether for their sanity, their babies' weight-gain, or to avoid the public confrontation there is always a good reason available for a discouraged mom who is just done with the effort. I feel for them, it's not easy to choose one thing when you'd prefer another. 

After my experiences though, I really wanted to offer some of my story hoping it could be useful, since I haven't heard it from anyone else. (not that I've looked terribly hard)

The chief fear of mine as a new mom was 'is my baby getting enough to eat?' Doctors measure it in minutes spent nursing, weight-gain, wet diapers. Relaxed grandmothers measure it in swallowing-noises, good latch, baby's contentment. My lactation consultant literally measured it in ounces of milk swallowed. Everyone wants to have a fat-but-not-too-fat, happy, well-sleeping baby. 

So when baby isn't happy, instead is fussy, gassy, doesn't latch well, doesn't nurse long before fussing, doesn't sleep for long, wakes up ravenous and panicky; when mom is exhausted, has painfully tight breasts and painful or unnoticeable let-down, cannot pump much milk, - the conclusion is: baby isn't getting enough. The assumption is: mommy doesn't have enough.

What I didn't know is that TOO MUCH MILK can look like that as well. Here's what happened in my case:

My boobs were full, very VERY full. My babies' mouths are somewhat short, my nipples are somewhat small. (I know, TMI, but it's pertinent) So in order to get a good latch, they had to take in the nipple very far into their mouth. When the milk came in strong they gagged. (Picture trying to suck from a water bottle that has a stream the size of a hose) 

Bc I had so much milk, when let-down happened it would stream out, like a fire-hose for a newborn, but I couldn't see it when they pulled off. Now in order to try to close off the flow so they could swallow, they would shorten the latch so they could pinch the nipple with their tongue. That meant MUCH more painful nursing, and it also chafed the skin raw so that I could hardly stand to nurse them. 

Also, a newborn has to learn how to breath and swallow separately without choking, this means when they gulp milk they usually gulp air. This means that when they get a good latch and my abundant supply pours in, they gulp down air trying to keep up with the milk flow. This causes huge bubble discomfort that makes them not want to nurse until it's taken care of, but it can be so deep that they spit up when it's finally burped, making me think they've had enough. 

The effort can be so exhausting that once their initial hunger is sated, they are content to rest. Since nursing was painful I was only too happy to comply and let my boobs recover. I waited too long and they were once again ravenous and the whole thing went round again. 

Here is what helped me:

Nurse often. The first time, I used a 2 1/2 - 3 hour schedule. The second time I used a 3 hour routine. The third kid I used a 3 hour routine in the beginning to help get the daytime hours set, then nursed him whenever.  Specifically, for the third (that I count as having been the smoothest) I nursed him whenever he 1. woke up 2. fussed 3. seemed sleepy. To set his hours I woke him at 7am to nurse, again at 10am, again at 1pm, again at 4pm again at 7pm, again at 10pm and then let him wake up for the night feeding usually about 4am. 

Use a rocking chair or recline on the couch or bed and lean back. Hold your arms apart from your chest (the natural tendency for me was to clench them in a bit) a bit and in general try to remove all extra pressure on the breast except what baby makes. That gives them more control over the pace of the flow. 

Get fitted for a nipple shield. They aren't expensive, but you need a consultant or doctor to help you choose the right size, as it is dependent on both your nipple size and the baby's mouth size. The advantages are worth the trouble in my opinion: It creates a gap between nipple and mouth which relieves the excess milk pressure allowing baby to take breaks for rest and breath without breaking latch. It teaches baby to latch properly because it only pulls milk from the breast if latched correctly. It helps mama's stress and let down by relieving some of the intensity and helping heal and prevent chafing by both protecting the skin from the tongue and also allowing the nipple to be bathed in the excess milk.

Pump to relieve fullness. Once my milk came in, one boob had plenty of milk for one newborn nursing. That meant the other one would be bursting by the next feeding and too stiff for a good latch and too full for a well-paced flow. So I would pump off the extra until it didn't come so fast and then allow baby to nurse. This was only for the first two weeks or so until he could take the flow and my supply stabilized. 

Go dairy-free. I don't know all the exact details but the gist that I got from my pediatrician is that cow's milk proteins are long and stringy and not easily digested by small baby guts. If you think about how big a calf is (like the size of an elementary school kid) compared to a human baby it makes sense that their milk molecules would also be too big. Regardless of why, my experience was a lot of colicky baby and projectile vomiting baby until I cut dairy from my diet. For my second and third I didn't even bother with a trial, I cut it from the beginning, and never had those issues. But digestive discomfort would immediately follow any time I tried to sneak a piece of cheese or bit of yogurt. Butter and cream seemed okay. For their relief and comfort it was worth it, and being able to know that baby is hungry and not gassy is also very helpful.

Let them de-latch. If you have a slow or painful nurser, or one that likes to trickle off, the temptation is to call 'done' for them. If you have a lot of milk, chances are they will get what they need nursing one boob at a feeding. Also, the first bit of milk (called the 'fore milk') is higher in protein and vitamins, the second bit (called the 'hind milk') is higher in fat content. A hungry baby needs the second bit of milk to be sated for longer. Once they de-latch from one breast, burp them and offer the second. If they need more milk than you have they will trickle nurse at the end getting every last drop and that stimulates your milk supply to grow. 

Give them rest. For the first 3-4 months a baby experiences REM cycle sleep first, instead of the usual light drowsiness the way older children and adults do. That means a sleeping baby can nurse, may have their eyes open, even looking around a bit, wiggle or jerk their body and already be totally asleep. For me I watch for a more regular breath and a 'glassed over' look in their eyes. The key thing in my experience is to do the same repetitive thing, such as nursing, rocking, swinging or singing for about 5-20 min until they seem settled and then put them down to sleep. If they are uncomfortable they will let you know, but if you constantly change up what you're doing or try to over-stimulate them to sleep you're actually more likely to rewake them. An over-stimulated, over-tired baby actually sleeps worse and eats worse than a well-rested baby. 

Best of luck to you, breast-feeding mom. :)