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    Nursing with Low Milk Supply: Scheduling of Feedings

    February 4, 2009 by Brandy Vencel

    Whenever I mention “scheduling feedings,” there are folks who immediately visualize babies somewhere in my house, wailing and starving because I refuse to feed them until the time I have deigned it appropriate to feed them. This is a straw man fallacy, to be sure, just as it is a straw man fallacy to be the type of person to judge the merits of “demand-feeding” because it is exaggerated to the point where Mommy is assumed to be feeding Baby every fifteen minutes and any {and every} time Baby cries and Mommy and Baby are both not sleeping and not happy.

    I don’t think either of these extremes has to be true, and I think that both demand-feeding and scheduled-feeding can work and keep Mom and Baby both happy and well-rested.

    Low Milk Supply is a funny thing. Some of the assumptions that are made about milk supplies and how they work, how they are improved, and so on, simply do not apply to women with serious milk supply problems. I am going to tell you what has worked for me. However, it is the responsibility of the reader to know her own body. Having a level of self-awareness as far as how your body functions and how your supply differs with level of activity, scheduling or not scheduling, or whatever other details make up this thing called life is imperative if you are going to make Low-Supply Nursing work for you and your baby.

    An Argument for Scheduling

    I am going to run through a list of points that cover why I think scheduling has worked so well for me. This is not to be taken as an argument for scheduling all babies.

    1. Maximize Production and Output: I have been able to determine the best length of time between feedings. What I have observed is that my body makes milk only up until a certain level. No matter how long I go between feedings, I have never noticed an output of more than two ounces at one feeding. However, if I feed too closely together, my supply seems to drop. The schedules allow me to time the feedings so that Baby is getting the maximum amount of milk my body is capable of making each 24-hour period.
    2. Sleepy Babies are Easier to Feed: I use a sleep-eat-play-sleep-eat-play cycle. My schedules include waking Baby up before he is entirely done with his nap. Usually, my babies begin to stir a few minutes before they really wake. Feeding them during this sleepy, peaceful time makes for a good nursing period. Nursing a baby to sleep with low supply is extremely hard to accomplish. Only one of my four children was willing to do this, and she basically used me as a pacifier {meaning that these were non-nutritive nursing times}. Nursing a baby that is wildly awake to the fact that they are hungry doesn’t work so well with low supply because low supply is usually accompanied by a phenomena I like to call Slow Supply. It just doesn’t come out all that fast. If Baby is starving, they are going to want to circumvent nursing all together and get to that bottle ASAP. So gently waking Baby before he is awake and aware of his needs helps optimize the nursing experience.
    3. Formula is Slow to Digest, and Also Measured: One lactation consultant I had said that formula takes four whole hours to digest, while breast milk takes only two or three. On top of this, supplementation means that Baby will be eating about the same amount of milk each time, which isn’t what happens at all with natural feeding. But this is life with Low Supply. A schedule is simply a way of managing this around-the-clock balance of nursing and supplementing.

    Determining a Schedule

    Two of my four babies came home from the hospital already on schedules. Babies in NICUs are never demand-fed, and both of our boys had their feedings in their earliest days dictated by a staff of nurses. Our firstborn, however, had his nights and days completely mixed up because the night nursing staff was bored and kept him up and played with him at night, while the busy day staff appreciated his aptitude for daytime sleeping.

    Not that any of that had anything to do with making a schedule.

    Schedules are mostly, at least in the early days, going to be determined by Baby. {Is there such a thing as demand scheduling? He he…} I typically spend the first two or three weeks recording everything: what time Baby ate, how many ounces were in the supplement, and so on. Before long, a pattern begins to emerge.

    Schedules are a funny thing, though, because one must always consider the other needs of the family. Unlike nursing, where the milk is always ready, formula requires preparation and cleanup. It is very inconvenient to have to stop Circle Time to prepare a bottle, feed the baby {using both hands which are then unable to turn pages and do other school-type activities}, and then also clean the bottle afterwards. So over time a schedule can be pushed to where feedings aren’t interrupting other activities.

    The hard thing with supplementation is that it’ll be hard to get Baby to eat as close together as your body thinks feedings should be. So in the first, say, three months, there will also be the need to take care not to overfill Baby on formula. You want his stomach to be ready to accept the next nursing.

    In short, I try to keep feedings about three hours apart {from the beginning of one feeding to the beginning of another} as long as possible. Most formula-fed babies are on four-hour schedules by the end of the first month. However, most nursing moms are, by the end of the first month, still feeding about 2.5 hours apart. Pushing for that three-hour schedule will help make sure you are nursing enough each day {and night!} to keep up your supply.

    Scheduling is all about maintaining the delicate balance between the needs of your body {for the sake of continuing nursing} and the needs of the Baby for adequate nutrition.

    Of course, all of this might be a moot subject if you were able to aquire donor milk, but it is extremely expensive unless you have very nice friends. When A. was a baby, I had very nice friends. It still brings tears to my eyes to consider the two first-time moms who pumped for me religiously and brought boatloads of milk to our house. A. is my only child who went literally months without drinking any formula at all.

    Wake that Baby

    I know it is unpopular to suggest waking a baby, but just remember that, if you truly have Low Supply, you are dealing with a situation that is less than ideal. I already mentioned waking Baby a tiny bit early from a nap, just when he is beginning to stir. You also need to consider maximizing the number of feedings in a day. Look in books for nursing moms and find out how many times per day they are feeding babies that are x-months old. Then try to make sure you are keeping up. Dropping below four feedings per day is a sure way to destroy what little milk supply you have.

    One thing that has been a blessing for my supply is to wake the baby for what a friend of mine calls a Dream Feed. Every night, right before I go to bed, I wake Baby O. and give him one last feeding. This takes place between 10 and 11. Sometimes he is stirring on his own, but a lot of times I am literally waking him up. Thankfully, he’s a good sport and rises to the occasion, nursing better than any other time of day, and also drinking down a healthy supplement. I like to give him a larger supplement during this last feeding so that I can keep the ones during the day, when feedings are closer together, smaller. This just works for me. Every baby has been different.

    Current Schedule

    Right now, Baby O. is five months old. He feeds only five times per day. He has been quick about dropping feedings. Nursing with Low Milk Supply means that you have to make decisions about whether or not to spend time encouraging feedings that Baby isn’t really interested in. Baby O. simply will not be romanced into an extra feeding per day. So I’m letting it go, even though my other babies were still eating six times per day at this age.

    Baby O. eats at 7am, 10am, 1pm, 4pm and then the Dream Feed around 10pm. I say this, but usually it is more like 10:30 and then 1:45 and so on. If Baby O. isn’t quite stirring, I let him go a bit longer if it works for me, too. This will totally depend on the baby, by the way. My oldest son was a stickler for schedules. To him, eating late was 2.5 minutes after the agreed-upon time. Eating early was 2.5 minutes before the agreed-upon time. He just wasn’t {and isn’t} that flexible. Other babies will take a schedule for what they often are: a suggestion, a general pattern for the flow of daily life.

    The first three feedings of the day, O. is offered 4 oz of supplement. He often doesn’t finish his supplement at 10am. The other two feedings, he is fed 5 oz supplements. Since those last two feedings are farther apart, it is a good time to add in the extra ounces without fear of ruining the next nursing.

    Final Notes on Schedules

    This should go without saying, but if Baby is hungry, please feed him. Babies get growth spurts. They wake early and hungry and they need to be fed. A schedule is supposed to help you maximize your nursing, not starve your baby.

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