Milking For All It’s Worth

This week’s guest columnists are Drs. Meghan Gaddis and Camtu Nguyen, Family Practice residents at the University Hospital and Clinics here in Lafayette.

Nothing’s worse than a crying, inconsolable baby.  We face them from time to time in the Pediatric Emergency Department, and this one evening mom was equally frazzled: hair in a messy bun, bloodshot, teary eyes from nights not sleeping, clothes stained with various colors and textures.  “My baby hasn’t breastfed or taken a bottle since yesterday!  I don’t know what to do!”

Baby was 6 days old, and seemed a poor breast-feeder due to trouble latching on.  This first-time mom maybe wasn’t producing much milk with the latching difficulty, and stressing out certainly wasn’t helping her supply.  To make breast milk, breasts need stimulation from baby, and a calm mom. She was also using a breast pump to stimulate supply, but this wasn’t going well either.  She was dead set on NOT giving baby formula, because of course, “breast is best.”

However, baby looked pretty darn healthy.  Sure he was fussy, but calmed down with swaddling and a pacifier.  He looked rounded-out and well fed.  He wasn’t dehydrated, with moist eyes and mouth, and acting vigorous, and making wet diapers.

Many first-time mothers aren’t aware of the timeline of milk production.  The first milk produced immediately after birth is called colostrum.  Colostrum is thicker than later breast milk, and has a higher protein content. This “liquid gold” only comes out in teaspoonfuls at a time, but that’s all baby needs.  It provides enough calories, encourages baby to practice sucking, swallowing, and breathing, before regular breast milk comes in in quantity.  And believe it or not, newborns’ stomachs are only about the size of a cherry, so a few teaspoonfuls will fill her up just fine!

In three to five days, breast milk really comes in.  Mom’s breasts begin to feel heavy and full, and baby begins gulping and swallowing with more vigor.  Urine and poop production also ramp up with this increased intake.  Poop goes from the tarry green, sticky “meconium,” to a loose yellow stool that looks like it has oatmeal flakes, or “seeds” in it.  Isn’t this an enjoyable talk with your morning coffee?

Breast-feeding has always had a bit of a stigma.  From ancient Egypt to medieval times, nobility considered itself above breast feeding.  Queens and princesses often employed wet nurses, mothers who recently weaned their own babies, to feed their little heirs.  When 20th century technology brought ordinary people things that only royalty used to have- one’s own in-house music, indoor plumbing, ready-made meals- it also brought formula.  Now, no one had to breast-feed.

Bottle feeding is easier for moms and babies, in the beginning.  As we mentioned above, latching and sucking takes some training. While bottle feeding, like many other technologies, has the front-end convenience of ease, it begats more problems than it solves.  Bottle-fed babies more easily become obese children and adults, with higher risk of diabetes.  They have more colic (nightime cramping and fussiness) in the first few months. They’re often more constipated and spit up more.  Finally, bottle-fed babies get more stomach viruses, colds, and ear infections than their breast-fed cohort.  Then these moms come to the Pediatric Emergency Department or their doctor’s offices with their vomiting, constipated, infected, squawling progeny.

Breast feeding has many advantages for moms, as well as for babies.  Making milk burns calories, and thus moms lose weight faster.  Suckling stimulates the release of oxytocin, a hormone that shrinks the uterus to pre-pregnancy size, and reduces bleeding.  Finally, breast feeding parents have less junk to haul around.  Traveling with babies has become a modern-day caravan, with car seats, portable cribs, and diaper bags bulging with spare clothes, diapers, wipes, ointments, etc.  Add to that an assortment of bottles and nipples, formula cans, and measuring cups.  And where can I get some sterile water, please?

Back to our mom from above, who was worried her newborn wasn’t getting enough breast milk and dehydrating.  How can you tell if baby is getting adequate fluids?  First, if your baby is crying, the fact that the little booger is hooping and hollering means she has enough fluids to be active.  If she’s making tears, that’s another good sign.  The best way to tell if baby is hydrated is if he’s making wet diapers.  At least one or two wet diapers per day means baby’s getting enough milk, for all it’s worth!

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