Pumping For Growth Spurts — And Other Stuff I Learnt Breastfeeding

Material from classes I attended.

When my long-awaited only child arrived in this world I thought I was over-prepared to breastfeed her. I had taken not one but THREE breastfeeding classes. I mean who else does that? First class was by a NICU nurse who brought us little baby dolls to practice our cross-cradle and football holds. Another was a “Lactation and Employment” seminar that was all about pumping — how to, how much, etc. And finally, a straight-on “Breastfeeding” seminar by a lactation consultant where we focused on latches and milk consistency and what poopy diapers should look like. Two of these were at Stanford Hospital. All of these provided a wealth of information I was grateful to have.

And yet breastfeeding was hard for me at first. Really, really, hard. And hard on my little one too.

Fast-forward three months. My baby and I have finally figured out breastfeeding. I feel relieved to say my baby is “EBF” as women would say on the La Leche League forums (EBF: Exclusively Breast Fed, never had formula). I have a decent milk supply, she has a good latch. She’s steadily gaining weight and all of her percentiles are trending slightly upward.

Here are the top 7 things I learned the hard way:

1) Breastfeeding will mostly likely be hard at first. Especially the first 2 to 4 days. No one tells you that and it’s better to expect that right off the bat so you’re not wondering how on earth you’ll continue this torture. Hard on your nipples, hard on baby, hard on your endurance, hard on your body.

Classes are tailored to the “best-case scenario” of a normal uncomplicated delivery and normal uncomplicated nipple/baby scenarios. And even when everything goes “right” breastfeeding is damn hard. Just look online at the amount of baby/mom forums and people venting in them. There’s a great piece by Hanna Rosin that appeared in The Atlantic “The Case Against Breastfeeding”. And Hanna Rosin had normal, uncomplicated breastfeeding experiences with not one but three children — yet she found it hard enough to write that article. Another one that appeared in the New York Times is “Overselling Breastfeeding.”

Breastfeeding is often portrayed as a wonderful, soothing, mother/child ritual. Invariably this ends up causing unrealistic expectations.

First obviously is if your milk is late to come in. Lucky folks with uncomplicated normal deliveries get their ‘milk supply’ in 24 to 46 hours from birth. For C-sections it could take four days and that is normal. I had a C-section (incidentally 1 in 3 deliveries in the US are via C-section). My milk arrived on day three. Day two was by far the roughest. Baby was wailing and hungry all the time. My boobs were sore from her gums chomping down on them. And on that horrendous second day I felt the classes had left me entirely unprepared for the ordeal. I was supposed to have colostrum for my little one whose tummy was only as big as a teaspoon they told me in class. How hard was it to produce a few drops to fill that I had figured. Well their little tummies expand daily and need filling every 2 or 3 hours and clearly there weren’t nearly enough drops coming through.

Milk delays can also happen if labor is induced or drugs given to speed up labor. Other complications include smaller babies whose mouths are not big enough to latch properly. Babies with tongue tie who find it physically hard to latch. Big babies whose mother’s don’t have enough supply to keep them from going hungry. Those first few days are crucial — you and baby have to figure out latching and baby has to drink enough to gain an ounce per day minimum to keep pediatricians from getting nervous and start talking about supplementing with formula.

2) Sheer amount of time spent will make you feel crazy. Feeding a small, delicate baby every 2 or 3 hours for months is a daunting task. A feed can last anywhere from 1/2 an hour to an hour. Babies could fall asleep every few mouthfuls, have diaper changes needed mid-feed or just be slow. Burping a baby a few minutes after a feed is often not enough and babies need to be held upright a bit to prevent spit-ups. This true in the early days when their tummies are so little. If all goes well you’re looking at 1 hour of free time while baby sleeps max if your feeding interval is 3 hours.

Everyone tells you “sleep when baby sleeps”. My response to that is I wish I could have. If you’re super lucky you’re left with a total of maybe 10 hours free time in short increments. That time is spent on personal care, eating, making sure baby supplies are in order (diapers/wipes/burp-cloths) and her endless laundry is done etc. You’re barely functioning let alone getting anywhere close to 8 hours of sleep.

At about two to three months baby will start sleeping in the night (hopefully) a good 5 hour stretch and you can breathe a huge sigh of relief.

3) Sheer quantity of breast-milk needed for baby will surprise you. One tiny baby will drink an average of 25 ounces (750 mL) of milk every day. To put that in perspective — that’s how much liquid a standard wine bottle contains.

4) Your food intake is way over the 500 calorie recommendation. Most health-websites and hospitals will tell you all you need to do is consume 500 extra calories per day — this is the same as the third trimester of pregnancy. I am pretty sure this is wrong. I was WAY more hungry than pregnancy and ate like maniac while breastfeeding. I did not gain any weight. In fact I lost 25lb of my pregnancy weight during the first two months of breastfeeding. I only have 10lb more of pregnancy weight to lose but will not even try to lose that. Most days if I skip any snacks or meals I feel weak and non-functional. I never had cravings for strange food items during my pregnancy and I never had a sweet tooth. But breastfeeding made me crave sugar like it was drugs and I was an addict.

Another factor is raging thirst — like I’d been hiking each time I breastfed. Keep a jug of water by your bedside. Water is your friend when your baby is wailing at night and you have no time to fetch a glass from the kitchen. Think back to #3 you’re producing a bottle-of-wine-equivalent liquid per day packed with glucose, nutrients, and fat to grow a human being. And unlike pregnancy when nutrients were efficiently transferred via blood — now you have to produce liquid food for digestion instead. Some of that is spent as energy when the baby flails her arms legs and cries. Some of it comes out as a poopy diaper. That’s a LOT of calories.

5) Constipation. No one told me about this one. Hormones wracking havoc in your body to produce breast milk will also constipate you. I ate a bunch of fruit and a couple prunes at night to keep me regular. The constipation eased up for me — finally — around 3 months of breastfeeding.

6) The breast-pump is not that bad despite the bad press. Insurance will pay the cost of this or part of the cost — so get a good one. I had a nurse tell me in hospital the first time I pumped that it has to be cranked up as high as you can endure it — in her words “uncomfortable but not painful.” Perhaps this is what works for most people. For me this was bad advice, I had a miserable and demoralizing first pumping session that yielded no colostrum. I figured out later at home how to make the pump work for me. I use mine on the lowest setting possible. You have to stop watching those milk bottles and drops of milk and just space-out, do something else, look at pictures of baby or think of baby. The more stressed you are the less milk you produce. The more pain your nipples are in the less you produce. Milk-production is not a mechanical process I’ve realized — the human body is a sensitive, emotional, apparatus.

Getting somewhat tangential — the breast-pump is long overdue for innovation. It’s original male inventors based it on the machines used by the dairy industry on cattle (I kid you not see article). Why can’t it be a comfortable bra-like-thing that you can purchase in your size and without a lots of little removable parts that have to be sterilized? I have high hopes that the women behind Moxxly or some other start-up will make a better pump. I do know you can purchase some Freemie cups that go in your bra but it’s not a pump — you still need to purchase a pump to go with the freemie cups.

Moving on to random pump-advice. Only pump early morning when your supply is high and the body’s prolactin levels are high. I started using my pump on and off if baby slept later for a morning feed and I wanted to keep my supply up. Maybe an ounce here or there. I only had a couple 2 ounce vials in the freezer till my baby was about 2 months. It’s important not to stress your body or baby by going crazy with the pump in the early days when the body is still trying to adjust to producing a decent supply for your newborn.

For me at 2 months — baby slept a whopping 5 hour stretch (yahoo!). Of course I woke up engorged about 4 hours into her sleep and so I pumped off a couple ounces. I continued this early-morning pumping routine daily to keep milk supply high. I don’t keep an alarm to wake up — I just pump if I happen to wake up and if I don’t wake up I just pump extras after baby is done feeding. I used it to build up a freezer stash for myself when I go back to work.

My freezer stash, a work in progress.

I don’t have a monster stash — a couple days worth of breast milk basically so total of around 50 oz — enough for emergencies. I use these reusable 2.7 ounce and tiny 1 ounce containers that way I can pump the odd ounce here and there without baby getting shortchanged for milk. (I started using these containers because the first time I pumped these were what I had for free in my hospital bag already sterilized.) They screw onto standard pumps (I use the Medela PISA). If I am freezing, I freeze the same day I pump it. Added bonus is that frozen vials can be safely popped right into a bottle warmer for a quick snack or feed for baby.

I also dip into the freezer stash when I leave baby with her Dad and spend a little time outside the house. Baby enjoys a bottle of “aged breast-milk” as her Dad puts it. Dad enjoys 1–1 baby-time and I enjoy a much-needed break. When I come back home I invariably pump and save that feed — being careful never to mess with the supply/demand phenomenon. This actually works out great to rotate the freezer stash — I defrost an old vial and pop a new vial back in.

7) You can use pumped breast milk to survive those awful growth spurts. Growth spurts are when contented, sleepy, baby turns into a 24/7 hungry, angry, baby who wants to chow down on you constantly although you just fed her an hour ago. It is apparently nature’s way of increasing your milk supply (mother nature can be truly mean). Lactation consultants will tell you — let your baby nurse as often as she wants. Well I do let my baby feed till my breasts are truly and completely empty to the point that baby will come off the breast and look annoyed and hungry do more feeding cues (smacking lips, sucking on her hand, whining at me etc). At this point I feel my body has pretty much got the message — but your body takes 2 to 3 days to adjust to this message and produce more milk. What’s the little baby to do in the meantime? No one tells you that.

My baby girl with her bottle, looking suspicious.

I wasn’t going to watch my hungry baby stay hungry. So at that point — I break out a 2 oz vial of frozen breast milk and feed her that in a Comotomo bottle. Incidentally I really like those boob-shaped soft and squishy bottles and so does my baby. She will go from bottle to boob and back again in the same feed completely unfazed. Baby feels more content, baby goes to sleep. The next night I might need to repeat the frozen vial approach, maybe just a 1 oz this time, but by the third day for my milk supply has fully kicked in and I don’t need the frozen ounce to tide me over. So my advice is to dip into the freezer stash and feed your poor baby through those growth spurts so everyone can get the precious little sleep there is to get in this newborn planet you’re inhabiting where baby rules supreme.

Those are my hard-learned 7 tips. For the record I am not one of those women with tons of natural milk over-supply either. I take care to maintain what I have and constantly keep an eye on whether baby gets enough. I drink a cup of Mother’s Milk tea daily — granted it’s not the tastiest cup of tea — but I close my eyes and just chug a luke-warm cup down instead of sipping it hot. Sometimes I eat oatmeal for breakfast or a snack. And I eat plenty of healthy food. Protein, fats, leafy greens are high on my priorities. I try to sleep when I can. I am originally from Sri Lanka so a lot of our curries contain fenugreek — which is convenient — I just throw in extra fresh fenugreek seeds into curries I make now that I know it’s a galactagogue. Not sure which of those things works for me — but I do them all.

For me breastfeeding is especially important since I am a formula-fed child. I remember a childhood where I was often sick with colds. I suffered with childhood asthma. I still have patches of eczema on my skin from time to time. I have a food allergy. I don’t attribute all of these to being formula-fed — I’m sure some of it could be genetic. But if I can increase the chances of my baby girl having a healthier childhood — it’s worth the hassle. I realize there’s controversy about whether the benefits of breastfeeding are over-rated. But here’s the study that really sold me — the baby’s thymus is twice the size in an exclusively breast-fed infant compared to an exclusively formula-fed infant. You really can’t argue with blatant physical evidence like that.