CM CLUB - advice about breast-fed baby starting and how to help mum........

[looneytune]

I have baby starting on Monday who will be 8 weeks old by then. The baby is currently breast fed on demand with formula feed(s) at night from a bottle. The baby is used to bottles for both breast milk and formula.

Now the mum is going to carry on breastfeeding and hopes to be able to express for when baby is with me (nearly 5 hours, 2 days a week). I explained that of course when breastfeeding, we never know how much baby is having and also on demand meaning no routine in place (I wouldn't expect there to be!). So, I suggested that she brings several sterilised empty bottles, plus the milk in something sterilised so that I can pour little bits of milk into bottles as and when needed until we work out roughly how much baby is wanting each time.

Is there anything else anyone can advise? Anything I can suggest to mum to help? She said she wakes up very full in the morning (I remember that!) so suggested she maybe try and express then, maybe after feeding baby first? I said whenever she does it, it's best to be relaxed and not feeling rushed to produce the milk as the stress can cause problems with expressing. I also suggested that maybe she express some the evening before if she's formula feeding baby then - thought maybe help with the supply?

I'm just wondering if there is anything else I should think of? I've just had a thought that what if baby gets hungry and the expressed milk runs out? I would never normally suggest this but if mum is doing formula at night, should I suggest maybe bringing some formula powder/cartons of milk to use in EMERGENCY????

That's it really, just want to make everything runs as smoothly as possible whilst we are unsure of what baby needs.

TIA

Looney - I had a similar situation last year. The mother left about 5or6 bags of EBM in my freezer, and a couple of cartons of ready made formula. I found that the baby took a while to settle into a routine with me, and it did disrupt our routine a bit, as he was used to being fed on demand. We soon got it worked out and he sort of got himself into a routine. The first couple of weeks were frantic though. His mum used to express during teh day and in the evenings on her day off.

frannikin, it wouldn't be the first time that midwifery tutors taught the wrong thing to students....

Lets look at this question, even so.

Milk quality being better in the mornings because of the rest?

In what way? Cortisol - the stress hormone - is indeed found in breastmilk. But I can't find any evidence that this matters at all.

There have been some studies that attempt to see if higher stress levels interfere with the amount of antibody production - a reasonable hypothesis, as stress in humans does seem to lower immune resistance - but nothing very sensible has been discovered, as far as I can tell. This study which uses a very small number found that stressed mothers seemed to make more antibodies, not fewer, and conversely, the stress mothers made more.

Even if several studies had found the opposite, and discovered that stressed mothers routinely make milk lower in antibodies, it would be a huge leap to say that 'rested' mothers make 'better' milk, unless the tutors can point to some studies that show this...'rested' does not mean 'unstressed' and going to bed at night doesn't mean 'having rested'. Come to that, 'lower in antibodies' doesn't mean 'worse milk' - could well be that there are enough antibodies and that in any case, the levels even out over the day

Do mothers make more milk at night? Well...it seems that production of prolactin in lactating mothers is higher at night than the day, and as prolactin is the milk making hormone, this might well be a factor in production. This might be one of the reasons why mothers find it handy to express in the morning, as they have enough to feed the baby and have a generous amount for the pump.

Interesting, though - frannikin, what do you say?

and conversely, the stress mothers made more = and conversely, the unstressed mothers made fewer.

Agree with kiskidee, though - all this microanalysing of milk and quality and timing is just not helpful (as well a being based on not-very-much at all)....mothers breastfeed through extraordinary circumstances and their milk is just fine.

Thanks, Tiktok

My DS (fully bf) started nursery at 17 weeks, so a little older than your new mindee.
Theres a calculator on Kellymomthat lets you work out about how much milk a bf baby will need per feed. I used to leave 3 bottles a day of 4oz, but at first I left an extra bottle on the Monday and then they cycled through them. I also left milk in their freezer.

He was fed on demand until he gave up daytime milk, but never did have a routine with it.

I expressed at work, which really worked well, and never had a problem with supply. A double electric pump is a real necessity.

I like it when TT validates my response.

wow, loads of posts!!! will have a catch up a bit later as there are so many just finished so need to tidy/clean/hoover, bath ds/put to bed etc. then i'll come and have a proper read.

thanks all

I leave ebm for my childminder although DD much older (9mo) and on solids too (well she would be if she would actually eat anything).

I leave 2x4oz which she has from a cup. I made sure to leave too much to start off with until we found out that this is how much she usually takes. Hadn't thought of leaving some in the freezer but might nick that idea!

I don't express at work just days off and evenings but I do wonder if this will work from 8 weeks especially if not feeding at night. She might find either her supply goes down or she's leaking at work. I 2nd cmot's vote for a double electric pump- it's the only way I can get a decent amount.

Thanks everyone. I was rushing earlier so didn't go into the formula bit too much, I basically wondered about this because she didn't seem to be getting on great with the expressing from how our conversation went yesterday. Of course I can ask for frozen milk but it's whether or not she can get enough, hopefully she can though I did recommend an electric pump as she said her pump hurt her hand/wrist plus I know electric are supposed to be good, she didn't seem very keen but I can't remember why so will mention again when I see her on Friday.

crace - can't do settling in sessions as starts on Monday and I'm full before then

Thanks again for all the tips, will see what I can mention but am not going to start going into when she should and why etc. unless she seems to want to know. She only gave birth 7 weeks ago and not everyone wants to be told what to do like this, especially by a childminder they have only just met! Will just see how much help/advice she wants first but thanks anyway as I've learnt a lot from this thread and with my own baby due in June, it's handy to know

looney - maybe the mum can borrow an electric pump from the local surestart?
i'm a breast-feeding peer supporter with my local surestart and we have pumps/slings/reading material about b/f available on loan - it's worth a try

Another point for the uni tutors- Cortisol levels rise and fall during the day - (diurnal variation), and are at their highest peak at 8am, then fall throughout the day, despite any running around! Not that this matters at all in terms of milk production.

Hope frannikin comes back and comments after she's had a word with her tutors....

Hello tiktok!

So I had a word yesterday and basically I'm sorry to say my tutor are sticking to her opinion that milk is best in the morning and refuses to believe the "opinions of a bunch of women from the internet". Tiktok - aren't you a midwife?

Rested mummies produce better milk, apparently. And women are all more stressed at the end of the day than they are at the beginning, despite me pointing out that they've been up all night BFing if the midwives have done their job in encouraging them properly. She did mention higher levels of prolactin at night too!

Possibly I'm inclined to agree with the rested bit but from everything I've heard on here and the reading I've gone and done which (suprise suprise) wasn't on the list, the difference seems to be very very minimal. So minimal it's really not worth bothering about. And I can completely see how stressing about expressing in the morning is going to make life worse. So given that my tutor is evidently rubbish at her job (wonder if there's a reason she's teaching rather than practising ) can anyone give me some good reading so I have a chance of being half decent if I qualify?

I'm still writing what she wants to hear on the exam by the way.

It would be very good of you to point your lecturer in the direction of MN, frannikin!

Let a bunch of women on t'internet put her through her paces. who knows, she may even learn something. evil[girn]

Btw, Tiktok is a bf counsellor for the NCT not a midwife, but there are a few v. knowledgeable midwives here too.

I like the book by Dr Jack Newman called the ultimate book of breastfeeding answers. I love his plain speaking no nonsense writing style.

his website is www.drjacknewman.com it is a fantastic website with videos too. you will also see wwww.kellymom.com linked to a lot here on Mumsnet. it is excellent. if you can't afford books at the moment, these links are deffo the next best thing.

I have seen the book Bestfeeding recommended on here by a few knowledgeable mums but i don't know it.

frannikin, it would be better if your tutor could give you a reference for what she says - I have given you references for what I have said, and I could give you more, too.

Higher prolactin at night may have an impact on quantity of milk - no one has argued against that - but it won't be better milk.

I'm bowing out of this - sympathies to you, frannikin. A student who asks questions and wants to know more and challenges is a student who should be encouraged and supported, and any tutor who has a student like this should ask herself 'hmm.....I wonder if my references are up to date?' and go and check!