http://www.kellymom.com/newman/04enough_milk.html
Handout
#4. Is My Baby Getting Enough Milk? Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
Breastfeeding mothers frequently ask how to know
their babies are getting enough milk. The breast is not the bottle, and it is
not possible to hold the breast up to the light to see how many ounces or
millilitres of milk the baby drank. Our number obsessed society makes it
difficult for some mothers to accept not seeing exactly how much milk the baby
receives. However, there are ways of knowing that the baby is getting enough.
In the long run, weight gain is the best indication whether the baby is getting
enough, but rules about weight gain appropriate for bottle fed babies may not be appropriate
for breastfed babies.
Ways
of Knowing
1. Baby's nursing is
characteristic. A baby who is obtaining good amounts of
milk at the breast sucks in a very characteristic way. When a baby is getting
milk (he is not
getting milk just because he has the breast in his mouth and is making sucking
movements), you will see a pause at the point of his chin after he opens to the
maximum and before he closes his mouth, so that one suck is (open mouth
wide-->pause-->close
mouth). If you wish to demonstrate this to yourself, put your index or other
finger in your mouth and suck as if you were sucking on a straw. As you draw
in, your chin drops and stays down as long as you are drawing in. When you stop
drawing in, your chin comes back up. This same pause that is visible at the
baby's chin represents a mouthful of milk when the baby does it at the breast.
The longer
the pause, the more
the baby got. Once you know about the pause you can cut through so much of the
nonsense breastfeeding mothers are being told—like feed the baby twenty minutes on
each side. A baby who does this type of sucking (with the pauses) for twenty
minutes straight might not even take the second side. A baby who nibbles
(doesn't drink) for 20 hours will come off the breast hungry.
The website www.thebirthden.com/Newman.html
has videos that show this pause in the baby’s chin.
2. Baby's bowel movements. For the
first few days after delivery, the baby passes meconium, a dark green, almost
black, substance. Meconium accumulates in the baby's gut during pregnancy. It
is passed during the first few days, and by the third day, the bowel movements
start becoming lighter, as more breastmilk is taken. Usually by the fifth day,
the bowel movements have taken on the appearance of the normal breastmilk
stool. The normal breastmilk stool is pasty to watery, mustard coloured, and
usually has little odour. However, bowel movements may vary considerably from
this description. They may be green or orange, may contain curds or mucus, or
may resemble shaving cream in consistency (from air bubbles). The variations in
colour do not mean something is wrong. A baby who is breastfeeding only, and is
starting to have bowel movements that are becoming lighter by day 3 of life, is
doing well.
Without becoming obsessive about it, monitoring
the frequency and quantity of bowel motions is one of the best ways, next to
observing the baby’s drinking, (see above, and videos at www.thebirthden.com/Newman.html)
of knowing if the baby is getting enough milk. After the first three to four
days, the baby should have increasing bowel movements so that by the end of the
first week he should be passing at least two to three substantial yellow stools each
day. In addition, many infants have a stained diaper with almost each feeding. A baby who is still passing meconium
on the fourth or fifth day of life, should be seen
at the clinic the same day. A baby who is passing only brown bowel movements is
probably not getting enough, but this is not very reliable.
Some breastfed babies, after the first three to
four weeks of life, may suddenly change their stool pattern from many each day,
to one every three days or even less. Some babies have gone as long as 15 days or more
without a bowel movement. As long as the baby is otherwise well, and the stool
is the usual pasty or soft, yellow movement, this is not constipation and is of
no concern. No treatment is necessary or desirable,
because no treatment is necessary or desirable for something that is normal.
Any baby between five and 21 days of age who
does not pass at least one substantial bowel movement within a 24 hour period
should be seen at the breastfeeding clinic the same day. Generally, small,
infrequent bowel movements during this time period mean insufficient intake.
There are definitely some exceptions and everything may be fine, but it is
better to check.
3. Urination. With six soaking wet
(not just wet) diapers in a 24 hours hour period, after about 4-5 days of life,
you can be reasonably sure that the baby is getting a lot of milk (if he is
breastfeeding only).
Unfortunately, the new super dry "disposable" diapers often do indeed
feel dry even when full of urine, but when soaked with urine they are heavy. It
should be obvious that this indication of milk intake does not apply if you are
giving the baby extra water (which, in any case, is unnecessary for breastfed
babies, and if given by bottle, may interfere with breastfeeding). The baby's
urine should be almost colourless after the first few days, though occasional
darker urine is not of concern.
During the first two to three days of life, some
babies pass pink or red urine. This is not a reason to panic and does not mean
the baby is dehydrated. No one knows what it means, or even if it is abnormal.
It is undoubtedly associated with the lesser intake of the breastfed baby
compared with the bottle fed baby during this time, but the bottle feeding baby
is not the standard on which to judge
breastfeeding. However, the appearance of this colour urine should result in
attention to getting the baby well latched on and making sure the baby is drinking at the
breast. During the first few days of life, only if the baby is well latched on
can he get his mother's milk. Giving water by bottle
or cup or finger feeding at this point does not fix the problem. It only gets
the baby out of hospital with urine that is not red. Fixing the latch and using
compression will usually fix the problem (See Handout B: Protocol to Increase Breastmilk Intake by the Baby).
If relatching and breast compression do not result in better intake, there are
ways of giving extra fluid without giving a bottle directly (handout #5 Using
a Lactation Aid). Limiting the duration or frequency
of feedings can also contribute to decreased intake of milk.
Mary Murphy wrote:
Hi all. An enquiry from a mother of a 3 week
old baby re the colour of baby’s poo. Baby has never had yellow
“breast milk “ poos. He has always had greeny brown poo, a
good one every day, the same consistency of newborn yellow poo, but just never
yellow. He breast feeds frequently, seems content after feeds, has
lots of wet nappies. Any suggestions? Thanks, Mary M
Mary, Will's poos were the same. He probably had
the 'normal' yellow poo once a day, and that was for about 2 months - until my
milk supply settled down. I know that green poo is from 'oversupply' -
more food than needed, so more bile gets excreted to get rid of it fast (this
was explained to me by an LC). I also heard that green poo could be from
more foremilk than hindmilk. To combat this I used to use one breast per
feed until it was 'floppy' (!) to ensure it wasn't just foremilk he got.
Also, due to my initial forceful letdown, a lot of the initial foremilk was absorbed
by a bunny rug when he pulled off and cried because there was just too
much. This poo I remember being like it had seaweed in it...
Hope this helps!
Love Jo
