The dreaded question—you feel guilty even asking it. You’ve planned to breastfeed. You’ve read the books, you’ve watched the videos and you’ve delivered the baby. You latch him on. It hurts a bit, but you’re getting the hang of it. Then that second night in the hospital hits. Your baby is awake, nursing every 20 minutes. You find you “can’t put him down,” and that every time you do, he wakes within a few minutes. That slight pain you were feeling fine about yesterday is getting worse, and you are starting to panic about the books and the videos and the lack of information about this specific situation you find yourself in.
You feel alone. Morning comes, you are exhausted, your baby is still persistently feeding, and the nurse offers you a glimmer of relief: how about we feed him an ounce of formula? You guiltily “give in,” feeling even more panicked: didn’t the books say that formula was “the beginning of the end” of breastfeeding? To make matters worse, after the formula your baby is now asleep. Deeply. You find yourself repeating this same pattern for several feeds over the next day, and you are left feeling exhausted and conflicted, in equal measure.
So what just happened? Here is a little background, to put things in perspective: Your body begins making colostrum (a sort of “pre milk,” which the baby will drink for the first few days of life) during your third trimester of pregnancy. Once he is born and your placenta is expelled, you have a dramatic drop in certain hormones, which then signals your body to begin making milk on the “supply and demand” model that you’ve read about. Your mature milk “comes in” around day 3-4 postpartum. Up until then, the baby is drinking colostrum first, then “transitional milk” (which is sort of a cross between colostrum and mature milk), and eventually mature milk. Colostrum is high in protein and a little can go a long way in terms of satiety.
Your Baby’s Breastfeeding Expectations
Meanwhile, at the baby’s end, he is going through his own journey in terms of adjusting to this new thing called feeding. The first week of life, he is in a tremendous state of flux: he may only need a few swallows of colostrum on Day 1 of life, but by the end of Day 7, he may need 2-3 ounces of milk, every 2-3 hours around the clock. This is where things get confusing for the modern mom.
We have a very romanticized notion of breastfeeding in our culture; we often read about how the baby makes a demand for milk and how the mom’s breasts magically “read” this demand and produce exactly enough for her unique infant. And this is generally true, but not exactly true. Mother Nature isn’t so perfect. Your baby’s demand for milk volume over the first week of life may dovetail perfectly with what is happening at your end in terms of milk production. That is to say, his need for, say, a couple ounces of milk on Day 4 post-partum may be in perfect lockstep with your rate of milk production or the status of your mature milk coming in. But often times (very often times), that is not the case.
Here’s Why Formula is OK
Some women may have a baby who hits the ground running in terms of appetite. And while we don’t like to make huge generalizations such as “he’s a big baby and therefore needs a lot of milk early on,” or, “he was born past his due date and may be hungrier sooner,” the truth is that a 9-pound baby IS often hungrier and more vocal about it than, say, a baby born at 37 weeks. Or a baby who is jaundiced. Or a baby who had a difficult birth.
And sometimes at your end, mature milk production is taking longer than the typical 3-4 days. What are we to do with a robust, hungry baby and a mom whose milk is taking a bit longer to get going? 1,000 years ago, this wouldn’t have been an issue. You would have handed your baby off to your sister, who currently was nursing a 5-month-old (or a 5-year-old, but that’s a different article!), and she would have served as a stop-gap until your milk was fully in. Which would no doubt have been expedited by that 5-month-old “helping” you out. If you didn’t have a sister, another mother would have stepped in. In fact, back in the day, the village “over-producer” was the most popular woman in the group! And this collaborative feeding is one of the reasons why women have evolved to be socially close; because lives were at stake and the truth is that we needed each other in very profound ways. But we don’t live in that world anymore. So we often need to use pumps, and bottles, and… formula.
There is so much more to say on this topic. But suffice it to say that formula use is not “the beginning of the end,” AS LONG AS you are protecting your milk supply in other ways. Seek help from a lactation consultant right away if you are finding that most of the feedings are requiring a formula supplement once your mature milk comes in.
And lastly, the best advice for that famous “second day in the hospital,” is to allow your baby to feed frequently and often, to help speed the advent of your mature milk. But if you are reaching your limit in terms of being able to manage this persistent feeding pattern, let this advice here serve as an explanation for why your baby may need more volume sooner than your breasts can provide it. It is a common scenario, and knowledge always equals power.
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Heather Kelly, CLC, IBCLC is a board certified lactation consultant in New York City. She is the mother of four children and does lactation home visits in NYC. You can find her at www.NYClactationhelp.com.