Feed Your Baby—When Supplementing Saves Breastfeeding and Lives

Jody Segrave-Daly, RN, MS, IBCLC

Mothers are taught that it’s rare to not produce enough milk to exclusively breastfeed in nearly every breastfeeding book, mommy group and hospital breastfeeding class. The truth is, we have limited studies that provide an accurate percentage of the number of mothers who can produce enough milk for their baby for the recommended 6 months. Although actual rates of adequate milk production are unknown, there are estimates that range from 12-15 percent or more.  

  • Dr. Marianne Neifert, Clinical Professor of Pediatrics at the University of Colorado Denver School of Medicine, who co-authored a 1990 study of 319 breastfeeding women found 15 percent of the women were unable to produce sufficient milk by three weeks after delivery.
  • Data from the Infant Feeding Practices Study (IFPS) II, a study of U.S. women, showed that one in eight women experienced early, undesired weaning from disrupted lactation due to physiologic reasons. According to the study, pain, difficulty with latch and insufficient breast milk supply were the most common reasons for early weaning.
  • Dr. Shannon Kelleher talks about these staggering numbers in her publication,  “Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology,” where she says the prevalence of lactation insufficiency may be much higher, as 40–50% of women in the US and 60–90% of women internationally cite “not producing enough milk” or that their baby was “not satisfied with breast milk” as the primary reasons for weaning prior to 6 months.
  • We are learning that mothers in western societies are experiencing delayed lactogenesis II (onset of full milk production) for complex and unknown reasons. This study suggests that the prevalence of DOL has reached epidemic proportions.

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The ‘Second Night Syndrome’ is Abnormal and This is Why

Written by Jody Segrave-Daly, RN, MS, IBCLC

As a NICU/nursery nurse and IBCLC who has worked with newborn babies her entire nursing career, I was mystified when I first heard the phrase “second night syndrome.” When I began to research where the phrase came from, it became clear that this phrase is not based on any scientific research, but rather based on a theory that describes behavior of exclusively breastfed newborns on their second day of life. I think it is a frightening phrase for new parents to hear, as the word “syndrome” is defined as a group of signs and symptoms that occur together and characterize a particular abnormality or condition. 

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The truth is, the “second night syndrome” is a theory that describes abnormal newborn behavior.

Babies can go into a very deep, recovery sleep period after the first 2 hours from birth. This period can range from 8-12 hours after birth and is often a time that babies may not wake up on their own to feed every 2-3 hours. Babies often need gentle encouragement from their parents to wake them up for feeding sessions. Some babies will nurse for 5 minutes or suckle on a bottle for 5 minutes or less and fall back asleep. It’s well known that babies are fasting during this time and if they have enough caloric reserves, they may tolerate this fasting period without complications. Nursery nurses are quite skilled with performing clinical assessments of babies to ensure they are stable. They are looking for signs of hypoglycemia or low blood sugar levels, jaundice and other abnormal clinical markers.  Ten percent of healthy, full-term exclusively breastfed newborns develop hypoglycemia in the first days of life and may require specialized care until they are stable.  All babies are transitioning from intrauterine to extra-uterine life and need skilled observation from the nurse while they are bonding with their parents in their room.

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Risk factors for delayed onset of full breast milk production

After babies begin to ‘wake-up’ from their deep recovery sleep period on their second day of life, they will begin to exhibit stronger hunger cues to nurse or bottle feed, every 2-3 hours and they become much more alert. This is a new opportunity for parents to bond because their babies become alert again, opening their eyes while gazing at their parent’s adoring faces. Some babies are a bit demanding during this time because they are very hungry. Newborn babies are very easy to console after their feeding by being held and snuggled. Every nursery nurse will tell you if a baby is not content after feeding, something is wrong. I suspect this is where the word “syndrome” came from, which describes abnormal infant behavior. Continue reading

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What Is “Cluster-Feeding”And Is It Normal?

Written by: Jody Segrave-Daly, RN, MS, IBCLC

Cluster feeding is a phrase that is used to describe infant feeding behavior. Generally, it’s breastfeeding or bottle feeding that is in a different pattern from your baby’s typical feeding pattern. It is described as breastfeeding sessions or bottle-feeding sessions that are much shorter and more frequent, for 3-4 hours of the day. It often happens during a baby’s fussy period of the day. 

Cluster feeding is a phrase that sometimes is also called “comfort-feeding.”  As parents, we react to infant cries and feeding cues, so naturally we will assume a baby is hungry and when we feed them, they will be satisfied. But some babies will snack and will not take a full feeding during their cluster-feeding time; this is normal. Some babies simply want to suckle on a pacifier after nursing or bottle feeding. This is because their bellies are full, but they want to suckle for soothing and not for a feeding of milk.  Some breastfeeding babies will suckle, using non-nutritive sucking patterns for soothing only. Some babies will also want to be held and snuggled or may want to be carried or want movement, while suckling too!   

Cluster feeding can happen during growth spurts as well, but babies generally take in more milk during this time. It can also happen during times when a baby is not feeling well, teething or is tired or cranky.  And it’s true—some babies don’t cluster feed at all. My exclusively breastfed babies never did and preferred sucking on a pacifier, after nursing for comfort. 

When is cluster feeding considered normal?

  • It happens after a mother’s full milk supply is in, after birth.
  • It is during a limited time period of 3-4 hours in 24 hours.
  • The breastfeeding mother has adequate milk supply.
  • Baby is having plenty of dirty and wet diapers.
  • The baby is gaining enough weight.

If you are concerned that you are not making enough breast milk, or your baby isn’t transferring enough milk, you can do a simple check to see if you are.

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I Shared My Story a Year Ago And I Was Told To Go Kill Myself – How I Am Healing

By Mandy Dukovan, MS, MFT, Marriage and Family Therapist, Fed is Best Foundation Senior Advisor

It’s incredibly hard to put into words all the things that The Fed Is Best Foundation has done for me the past year.  I happened to stumble upon the Foundation when I noticed a friend of mine “liked” one of their blog posts. I was a first-time mom who was struggling with many different feelings, and wasn’t sure who or where to turn to. My son was 2 months at the time, and was just beginning to thrive after I had begun to supplement him with formula. While I was so happy to see my baby finally gaining weight and thriving, I had haunting memories and raw emotions that I was struggling to sort out. I had immense guilt that I didn’t see the signs that my baby was hungry, which tortured me non-stop. I was embarrassed that I could look at his 1-month picture and now see that he was obviously malnourished, but how on earth did I miss this at the time?

MandyBrock

1 Month Old

I was angry that I didn’t follow my own instincts that something was wrong with him and was angry that I believed all the terrible things I was told from lactivists that would happen to him,  if I gave him a drop of formula. I worried that we would not have the kind of bond that babies who were exclusively breastfed (EBF) experienced with their mothers. I now know that our bond is so much stronger because we bottle-fed him and no longer experienced the immense stress that came each time I tried to breastfeed my baby. I got to a point where I dreaded even trying to breastfeed him, but I was told that was the best thing I could do for my baby, so I kept going, at the expense of my baby’s health and my well-being. I honestly believed I was the only mother who had experienced what we went through because I only heard the stories about how amazing and natural breastfeeding was and every mother could breastfeed if only she tried hard enough.

Since I am a therapist, I knew I needed to share my story. I found courage in my strong desire for other babies and mothers not to struggle. I also found courage in the fact that I needed a reason for all of the suffering—I needed to know that Brock’s struggle was not in vain. I kept telling myself, “If I reach even one mother and prevent even one baby from suffering like Brock, then I have to do this.”  

Then I shared my story… Continue reading

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Clinicians’ Guide to Supporting Parents with Guilt About Breastfeeding Challenges

Written by Dr. Ruth Ann Harpur, Clinical Psychologist

A systematic review of the scientific literature indicates that women who intend to breastfeed but who later feed their babies formula consistently report feelings of guilt, anger, worry, uncertainty, and a sense of failure despite the relief that introducing formula after experiencing difficulties with breastfeeding may bring (Lakshman, Ogilvie, & Ong, 2009). Recent research also indicates that this group of new mothers are at particular risk for postnatal depression (Borra et al., 2015).

Clinicians are uniquely placed to provide compassionate care at a vulnerable time for this group of parents. Their attitude and words can invoke a sense of shame, judgment, and failure, or they can inspire compassion, reassurance, and emotional healing.

Lacking any widely published evidence based guide on to how to best attain the most emotionally supportive clinical environment, the Fed Is Best Foundation has developed these suggestions in collaboration with parents in our support group and a clinical psychologist with expertise in mental health.

Florence Leung, 32, vanished on October 25, 2016 after driving away from her New Westminster home. She was suffering from post-partum depression and her body was eventually discovered in the waters near B.C.’s Bowen Island. Her husband subsequently posted the following on Facebook, “You are Not alone. You are Not a bad mother. Do not EVER feel bad or guilty about not being able to ‘exclusively breastfeed’, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes. Apparently the hospitals are designated ‘baby-friendly’ only if they promote exclusive-breastfeeding. I still remember reading a handout upon Flo’s discharge from hospital with the line ‘Breast Milk Should Be the Exclusive Food For the Baby for the First Six Months,’ I also remember posters on the maternity unit ‘Breast is Best.’ While agreeing to the benefits of breast milk, there NEED [sic] to be an understanding that it is OK to supplement with formula, and that formula is a completely viable option.”

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I Contacted Every Patient Safety Organization After My IBCLC Withheld Clinical Information From Me Causing My Newborn To Starve.

When I struggled to breastfeed my son, I believed I was failing, not just at breastfeeding, but at motherhood. What was supposed to be the “best” way to feed my new baby was painful, anxiety-inducing, and landed my son back in the hospital for dehydration, eleven percent weight loss, and inability to take a bottle.

My hospital’s solution included many appointments with their lactation consultants, fenugreek from their new mother boutique, and a nurse-bottle-pump (triple-feeding) routine that drove me to the brink of despair and did nothing to increase my milk supply.

At no point in my son’s first two months did any of the lactation consultants, nurses, doctors, or any other medical staff offer a concrete explanation for my low milk  supply or my son’s vice-clamp latch. Because no one seemed to know why we couldn’t get the hang of it, I felt I was not trying hard enough.

Sometime after my son’s first birthday (my original “breastfeeding goal”), I came across several online articles that explained insufficient glandular tissue, also called breast hypoplasia. I knew my breasts were an odd shape, but I was taught by the hospital lactation “experts” that breast shape and size didn’t determine breastfeeding ability. Looking at pictures of similar widely-spaced, tube-shaped breasts that produced little or no milk left me feeling a strange cocktail of emotions—validation, disbelief, anger.

I wondered why staff at my hospital, a long-time Baby Friendly Hospital Initiative (BFHI) accredited facility, hadn’t told me that I was at risk of insufficient milk production. 

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My Baby Scream-Cried The Entire Second Night In The Hospital

My name is Amber and I am the mother of a charming, beautiful, and vivacious baby boy. I want to share with you a story: the story of my son’s birth and his first few months earthside. It is a multidimensional story full of love and heartbreak, but I think it’s important that other new mothers hear it. My hope is that if their experiences of early motherhood are not what they always dreamed of, they will know they are not alone.

I found out I was pregnant with my son in September of 2016. I was working in an emergency room as a nurse at that time and heading into my second-to-last semester of school to become a nurse practitioner. My husband and I had only been trying to conceive for a month. Because I have polycystic ovary syndrome (PCOS) and irregular periods, I figured getting pregnant would take longer, but there I was on September 1 with a positive test. We were ecstatic. Being a planner, I spent the majority of the next nine months thinking about and planning everything about my son’s birth. I consider myself a well-educated woman and medical professional, so it was no surprise that the heart of my plans included breastfeeding my son. I spent months researching the best pumps for when I had to go back to work, deciding on a storage-and-feeding set, and learning about ways to strengthen the breastfeeding bond. Formula never crossed my mind. After all, I was always told breast was best. Sure, I had some friends who gave some formula here or there, but I just knew I would be one of the ones who would exclusively breastfeed and pump for my son. Continue reading

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Infant Feeding Considerations for Emergency Situations

By Jody Segrave-Daly, RN, IBCLC, Co-Founder of the Fed is Best Foundation

During an emergency the sudden disruption of electrical power, clean water, and social relief services can impact the safe acquisition and storage of formula or human milk, as well as the ability to heat water for optimal cleaning practices. Consider the options below to help you prepare for and cope with a disaster:

Preparing Safe Food Items

PUMPED/EXPRESSED BREAST MILK

Pumped breastmilk can be stored in sterile (disposable) bags in a portable cooler with pre-frozen water bottles or ice packs for up to 24 hours. Thawing breastmilk may be refrozen if ice crystals are still evident once power returns. Pump dependent mothers should have 1-2 hand pumps in case all other options fail. External batteries or a vehicle charger/power supply for pumping in the car if its safe is helpful for a short period of time. Use the correct technique to maximize hand expression output.

FORMULA

Consider buying 4-7 days worth of pre-mixed, “ready to feed” bottles of formula, as well as a corresponding amount of clean bottles and nipples. Single use bottles of pre-mixed“nursettes” with disposable nipples or bottles with disposable liners may be especially useful for ease of storage and cleaning.

READY-TO-FEED BABY/TODDLER FOOD

To prepare, buy 4-7 days worth of pre-made baby/toddler meals, disposable utensils, cups, and plates. Opened food may be kept up to 24 hours in a portable cooler.

CLEAN WATER

Having an ample supply of clean water is a top priority in any emergency. A normally active person needs at least two quarts (half a gallon) of water each day. People in hot environments, children, nursing mothers, and ill people will require even more. Store at least one gallon per person, per day. You will also need water for food preparation and hygiene. Consider storing at least a two-week supply of water for each member of your family. If you are unable to store this quantity, store as much as you can.

Preparing Safe Feeding Supplies

HOW TO CLEAN FEEDING SUPPLIES (PUMP, BOTTLE, PACIFIER etc.)

In the absence of power or hot water you can still take steps to make sure your feeding supplies are sufficiently clean:

You will need:
  • High quality paper towels
  • liquid dish soap
  • antiseptic wipes
  • disposable gloves
  • hand sanitizer
  • 1 large plastic bowls for washing
  • 1 plastic bowl for rinsing
  • 1 large container with lid for storage of clean feeding supplies.
Steps:
  • Clean prep surface with antiseptic wipes and wash hands
  • Place parts in a clean wash basin (large plastic bowl) used only for washing infant feeding equipment.
  • Fill wash basin with CLEAN water and soap.
  • Wash and scrub using clean paper towels.
  • Rinse using CLEAN water
  • Pat dry with clean paper towel / let air dry completely
  • Store in clean and closed plastic bin.
REFRIDGERATOR / FREEZER

Consider filling the freezer by stacking one gallon zip-lock bags partially filled with water. This will help keep the freezer cold if power goes out, and will also give you extra water in case of emergency. Freeze individual water bottles to place in portable coolers and to drink when thawed.

BOILING WATER

Boiling is the safest method of treating water to kill microorganisms. In a large pot or kettle, bring water to a rolling boil for 1 full minute. Let the water cool before drinking. The taste of boiled, stored water will improve if you put oxygen back into it by pouring the water back and forth between two clean containers.

CHLORINATING WATER

When no other options are available, you can use household liquid bleach to kill microorganisms. Use only regular household liquid bleach that contains 5.25 to 6.0 percent sodium hypochlorite. Do not use scented bleaches, color safe bleaches, or bleaches with added cleaners. Use bleach from a newly opened or unopened bottle as the potency of bleach diminishes over time. It is not recommended to use chlorinated water for mixing infant formula, however it is still safer than preparing formula with untreated, contaminated water.

Add 16 drops (1/8 teaspoon) of bleach per gallon of water, stir, and let stand for 30 minutes. The water should have a slight bleach odor. If it doesn’t, then repeat the dosage and let stand another 15 minutes. If it still does not smell of bleach, discard it and find another source of water. Other chemicals, such as iodine or water treatment products (sold in camping or surplus stores) that do not contain 5.25 to 6.0 percent sodium hypochlorite as the only active ingredient are not recommended and should not be used.

Additional Resources:

https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
https://www.cdc.gov/healthywater/pdf/hygiene/breast-pump-fact-sheet.pdf
https://www.fema.gov/pdf/library/f&web.pdf?fref=gc&dti=217577232092793
https://www.qld.gov.au/emergency/dealing-disasters/formula-emergency
http://www.fearlessformulafeeder.com/2011/11/formula-feeding-in-disaster-situations-is-there-a-dose-of-reality-in-your-emegency-kit/

Click below for a printable version of this article
Infant Feeding Guide in Emergency Situations
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Donor Breast Milk – Is It Worth It?

Written by Hillary Kuzdeba, MPH

Many women in developed countries like the U.S. find that despite their best efforts, they are unable to exclusively breastfeed due to supply problems or other circumstances. They may feel pressured into finding some other way of ensuring their babies are exclusively breastfed, even though they cannot produce enough for baby. Adoptive parents may also feel pressure to provide breast milk. A lot of this pressure to provide breast milk comes from the over-exaggeration or misinterpretation of the benefits of breast milk on long term health outcomes, or from unfounded fears about infant formula.

Currently there are two types of donor breast milk available to moms in the US, but only one type that is supported and recommended by major medical bodies like the American Academy of Pediatrics (AAP)(1, 2) and by the Fed is Best Foundation. Donor milk obtained from a milk bank or hospital is a safe and healthy alternative to mom’s own milk.(2) Milk banks thoroughly screen their donor moms to ensure the safety of the milk and pasteurize it following strict food safety protocols to destroy bacteria that can make infants very ill. Milk banks are similar to blood banks. These organizations are designed to make sure human body fluids, whether breast milk or blood products, are screened and safe before they are used by vulnerable people like newborns and sick patients. This is because human body fluids, including breast milk, can pass transmissible infections like HIV from person to person.(3-5) For more information on the milk bank process, please visit https://www.hmbana.org/. Continue reading

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The Newborn Stomach Size Myth: It’s not 5-7 mL

Written by Jody Segrave-Daly, RN, IBCLC

As a veteran NICU, nursery nurse and lactation consultant, I have taken care of and fed thousands of babies over the years. When working in the special care nursery, babies were always fed according to their weight and cumulative losses, to determine their caloric requirements for intake amounts and optimal nourishment. For example, term babies who are admitted to the NICU from complications of not receiving enough colostrum are immediately fed based on their weight, usually about 60-80 ml/kg/day (typically 15-30 ml) every 2-3 hours. When allowed to feed on demand, newborns will typically take  increased volumes eagerly and demonstrate feeding satisfaction and comfort.  Why do some babies tolerate fasting before the onset of copious milk production and other babies do not? 

 

This is contrary to a lot of non-clinical discussion you’ll read out there on the internet in a plethora of mommy groups about an infant’s intake needs, which suggest it’s mostly based on stomach size. So what’s fact and what’s fiction?

 

Calories and Feeding Amounts for Breast Milk, Formula, and Colostrum

What science tells us is that mature breast milk averages around 20 calories per ounce (~30 mL) and formula contains approximately 20 calories per ounce as well. Thus their per-milliliter (mL) calorie count is on average the same. Colostrum, a key substance that imparts passive maternal immunity to a newborn in the first few days of life if a mother breastfeeds, is lower in fat and carbohydrates than those two, and comes in around 17 calories per ounce (~30ml) (Guthrie 1989).

#2 Why Fed is Best- CaloriesColostrum(1)

With that knowledge in mind, current hospital feeding protocols for formula-fed newborns range from feeding 10-30 ml for newborns less than 6 pounds’ every 2-3 hours and feeding newborns over 6 pounds 10-30 ml every 3 hours on the first day of life. Continue reading

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