Why I don’t breastfeed on a schedule.

Whether a mom chooses to feed her baby on a schedule or not is one of those issues that I had no idea was such a hot topic that many people have a strong opinion about until I actually had a baby.  (I mean, before you have a baby, you certainly don’t sit around and think about these things!)  So, for the uneducated and childless, we’re basically talking about whether you feed your baby based-upon what time it is or upon their hunger cues.  (or a combination)  And of course, there are moms who take both sides to the extreme– some won’t feed their baby until the clock says a certain time, and some whip-out the boob any time there’s a little fussing, no matter how long it’s been since the baby last ate.  And I would guess most moms fall somewhere in between.  

I would say that currently I’m somewhere between a combination and a whip-it-out mom, although I expect that I’ll slide more toward the middle-of-the-road as Harris gets older as I did with Evelyne.  Much of the way I nurse Harris is very particular to his temperament and individual needs, and some of it is because it’s simply what works right now.  However, since I had such problems nursing both my kids in the beginning (low supply, slow weight gain, etc…) out of necessity I’ve done a lot of research and learning about how breastfeeding works.  One of my favorite resources is http://www.kellymom.com, a great evidence-based website written by a lactation consultant.  If you’ve ever wanted to know anything about nursing, this website probably has information on your particular question!  Another good one (with instructional videos that are helpful for beginners) is http://www.drjacknewman.com. 

So I’m going to hopefully write a short series on a few things I’ve learned regarding how God designed our bodies to function in a breastfeeding relationship and why scheduled feedings aren’t a part of that design:

*If you are a scheduled-feeding mom and it’s working for you (your baby is happy and gaining weight normally), then just consider this a little extra information to tuck away in case you ever need it.  I’m not trying to invalidate your experience, but depending on how much flexibility you allow in your schedule, there’s a good chance you don’t represent the experience of the majority of moms, and frankly, I think you probably just got lucky.  

Part 1: Storage Capacity

One of the beautiful things about breastfeeding is that God designed every mom and every baby differently.  There is no one-size-fits-all, and to try to fit your nursing patterns into a schedule that’s not led by your baby’s hunger patterns can really cause problems.  One big reason for this is the fact that moms have different storage capacities in their breasts.  It’s not like each and every one of us has, say, 3 oz. inside each breast and as long as the baby nurses 4 times a day, he’s guaranteed to get 24 oz., which might be plenty.  While you may have a 6 oz. storage capacity, I might have a 4 oz. capacity.  So if I try to hold my baby off and only let him nurse 4 times a day, he only gets 16 oz., which is not enough.  This is one reason why some women have no problems feeding their babies at longer intervals, their babies are naturally receiving more at each sitting.  But to those of us who might have smaller storage capacities, while we are still able to produce plenty of milk for our babies over a 24-hr. period, they need more frequent access to it in order to drink the total number of ounces they need for the day.  

I’m guessing my storage capacity is on the smaller side because Harris still nurses every 2-3 hours (usually only 3 if he’s been asleep, if he’s awake it’s 2).  And he’s hungry!!!  This doesn’t mean that there’s anything wrong with my milk supply, but it does mean that he needs more frequent meals throughout the day.  This also doesn’t mean that he’s “snacking” or not taking-in a full meal.  And doesn’t mean that he’s not accessing the fatty hind milk that comes at the end of a feeding.  As long as I allow him to fully finish one before the other, he’s getting everything he needs to get.  (And I’m still a little confused about why we know from nutritionists and doctors that humans are healthier and function better when we eat fewer small meals throughout the day, yet we seem to think that’s a bad thing when it comes to babies!  Why is it “better” to try to get them to eat more in one sitting only a few times a day?  Why is the goal for us to not have to feed our babies very often?) Because a mom with a smaller storage capacity will have breasts that become full in a sooner amount of time than if her capacity was larger, it’s necessary for her to go ahead and feed the baby then in order to keep-up her milk supply.  The longer the milk sits in the breast without removal, the slower her production and the lower her supply.  (More on that in the next post!)

Here’s what KellyMom says:  

*Storage capacity: Another factor that affects milk production and breastfeeding management is mom’s milk storage capacity. Storage capacity is the amount of milk that the breast can store between feedings. This can vary widely from mom to mom and also between breasts for the same mom. Storage capacity is not determined by breast size, although breast size can certainly limit the amount of milk that can be stored. Moms with large or small storage capacities can produce plenty of milk for baby. A mother with a larger milk storage capacity may be able to go longer between feedings without impacting milk supply and baby’s growth. A mother with a smaller storage capacity, however, will need to nurse baby more often to satisfy baby’s appetite and maintain milk supply since her breasts will become full (slowing production) more quickly.

 Think of storage capacity as a cup – you can easily drink a large amount of water throughout the day usingany size of cup – small, medium or large – but if you use a smaller cup it will be refilled more often.

Here’s what another lactation consultant said: 

Dr. Hartmann is a researcher in Perth, Australia, specializing in human milk production. In his laboratories, Dr. Hartmann has studied mothers before and after nursing sessions by making topographical-type maps of lactating breasts using video cameras and computer equipment in order to analyze changes. Their accuracy has been assessed at +/- 5%, an excellent percentage for this type of work. Dr. Hartmann has discovered, through this work, that the breast does not make all of the milk at nursing time, but rather is making milk around the clock. The rate of milk production between feedings varies according to the degree of fullness of the breast; the fuller the breast, the slower the milk production rate, and conversely the emptier the breast, the faster the rate of production for replacement.

Even more fascinating, Dr. Hartmann has also quantified differences in the maximum storage capacity of women’s breasts, identifying at least a 300% difference between the most one woman could store versus the most another could store in his study. Further, Dr. Hartmann noted that the women who had larger storage capacities often nursed at longer intervals, whereas women with smaller storage capacities nursed naturally at more frequent intervals [Comment: breast size appearance is not always a good predictor of production or storage capacity]. Most importantly, it was noted that all of these women had the ability to produce plenty of milk over 24 hours; what varied was the maximum amount that they could deliver at one sitting.

The implication for scheduled feeding is quite evident, as noted in one of Daly and Hartmann’s papers:

“At an historical level the typical four hourly breastfeeding schedule that
was once widely favoured in the western world [citations removed] may
not have caused problems for women with larger storage capacities but might
have had disastrous consequences for women with smaller storage capacities.
Such women, who needed to breastfeed more frequently, would have been
aware that their provision of milk was inadequate on a four hourly breast-
feeding schedule. However, rather than dispensing with the schedule, it is
clear that such mothers more often doubted their ability to provide milk for
their infants and instead introduced artificial milks.”

 

Aside from the actual physiology of how human milk is made and how that relates to the demand of the baby (more on that in the next post), storage capacity is one basic reason why breastfeeding according to the time on the clock and not the hunger of your baby is not a great idea.  It also gives reason to why some women generally don’t have any problem with it, their storage capacity is naturally larger.  But for the woman who has a smaller storage capacity and yet tries to nurse on a schedule with longer intervals (and yes, every 3 hours is too long for some babies, including mine!), it could be dangerous to the infant’s growth and spell the end of the nursing relationship as the mom’s supply plummets.  (as stated in the above quote, what really makes me sad is when the mom thinks that there is something inherently wrong with her body rather than the schedule she was putting her body under)

I plan to write another post detailing some more information about how milk is made and stored.  My intention is just that this will be an educational series of posts, whether you’re currently a nursing mom or not.  There are lots of opinions out there about how to feed your baby, and I’m not trying to add my voice to the many who are militant about any one particular way.  But I do think great consideration should be given to the way God designed our bodies to function and how we can best work with it instead of against it in order to feed our babies.  The human race has thrived for thousands of years as mothers nursed their babies with no idea of the time but simply paid attention to the baby’s hunger cues, and I’m guessing that everything will be ok if we ignore the time on our modern clocks and do the same.

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10 responses to “Why I don’t breastfeed on a schedule.

  1. Very interesting, Emily. And, you do know that I consider you quite the expert = ). Seriously.

    I will say this about breastfeeding~it is, to me, THE best example of selflessness in taking care of your little one. Truly. And, looking back, I think I needed to be much more selfless in order to take breastfeeding more seriously and keep it up longer than the 6 months (for S) and 5 months (for A) that I chose to do so. I think also that I lacked the knowledge to really understand how good breastfeeding is for baby and mom. And while I’m telling all of my weaknesses on breastfeeding, I’ll tell you this too: I was more by the clock and, looking back, I think that was a poor decision b/c it hurt my supply and that is why I gave it up when I did.
    Whew. So much confession. I look forward to reading more a/b what you have to say…

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  2. Thanks for your honesty, Laurin!!! Five and six months is a huge milestone because its those first months that are the hardest!!!! You definitely had plenty of experience to know what you’re talking about.
    Breastfeeding is definitely a very awesome thing (and a very very hard thing!!!!!! let’s NOT forget that!), and every mom has to make the best decision for her family’s overall well-being. But like I’ve told you before, what makes me sad is when moms are ill-informed, through no fault of their own, (usually just because they happened across bad information that they didn’t know was wrong, and bad advice from well-meaning friends and family) and when problems arise the mom assumes it’s her body’s fault. I’m definitely “pro-choice” about breastfeeding, it’s every mom’s choice to make, but I just wish every mom had the opportunity to make an educated one, ya know? Unfortunately I run into too many women who don’t really know how it works, just what they’ve heard from nurses in the hospital or the experience of friends. Sometimes it turns-out ok, sometimes not. Oh well, that’s why I’m writing this! =)

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  3. katharinesavage

    This was a great post!!! I am gearing up to breastfeed again and though I hung in there for over a year last time, I don’t think I really understood the ins and outs in so much detail. . .

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  4. fascinating information, em. i am always amazed at how well you can explain complicated things in your posts! this also reaffirms my approach to breastfeeding – certainly less schedule driven. i fed charlotte that way out of necessity – the girl just wanted to eat! and i’m finding with lucy that she has her own rhythm of hunger that most likely mimics the times when my supply is higher or lower (eating less frequently in the morning and mid-day and much more frequently in the late afternoon/evening. i’m okay with that. i’ve found that it actually tunes me into my child and teaches me things about her. not to mention, it changes my whole approach to breastfeeding – it’s not just about food. that’s pretty much my mantra. anyway, you know i love the breastfeeding. it is freaking hard. i forgot how demanding it is, actually. but, the rewards are immense! i still cherish and even miss the days i spent nursing charlotte! i know i’ll feel the same way about lucy…maybe more when i get a little more sleep! can’t wait to read your future posts!

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  5. As a doula and an apprentice midwife, and also the mother of two breastfed boys who were “challenging” cases, thank you for this readable and well informed post. Neither of my boys ended up being scheduled because of their reflux and weight gain issues (for #2), and what I now know was my limited storage capacity. I’m so thankful that I instinctively let go of the scheduling idea and followed my babies’ cues instead. I think some mothers want to schedule because they think it’s best for their babies (or so they’re told). Unfortunately I think that many others want to schedule because they believe that it will be easiest for them, it’s predictable and they can get more done in between feedings if they aren’t “constantly” having to sit down to feed again. Parenting and breastfeeding require a selflessness that our society does not encourage or support. I have friends who think I’m crazy for feeding my baby whenever he needed, sleeping with my 2nd baby (which was so much easier and more restful than getting up multiple times each night and trekking across the house like I did with my first), not leaving my baby to scream in the church nursery, or being in physical contact much of the time by wearing my baby. I’ve certainly given up a lot to do these things, but it’s for a short time in the grand scheme of things. It’s also important to note that mothers who breastfeed on cue (whether it’s an average of every hour or every four hours) are much more likely to be breastfeeding at six months and beyond. Thanks again for explaining so clearly how God made it to work and why it works.

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  6. keep ’em coming em! I’d also be interested to know if anything you read has tips on what to do if you’re breastfeeding and working. I only pump once at work (I’m only at the office MWF mornings) and try to keep a little stocked in the fridge or freezer (this is tough – it’s not like I have tons extra to stock up!) in case she’s hungry after robert gives her what I pumped the workday before. I know some women supplement w/ formula but I really don’t want to do that if I don’t have to…

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  7. Kim, if you want to make sure that you keep making enough so that you don’t have to supplement and you don’t have a ton extra, then I’d add another pumping session if you have the chance. Part of what I’m going to talk about in the next post is how frequency of nursing is what determines how much milk you make. The more often you empty your breasts, the quicker they will be refilled. So if you were able to pump twice, or just one other time during the day, then that would signal your body to make even more milk. If she’s not already, when she starts going to bed a few hours before you do, that’s a great time to add an extra pumping session before you go to bed if you know she won’t be awake for another couple of hours. Just divide-up that longest period of non-nursing in your day with a pumping session. When I was nursing/pumping with Evelyne, that was the easiest time for me to do it since it was part of my nightly routine and I could just sit there and watch tv. =) Here’s KellyMom’s page on pumping with TONS of info: http://www.kellymom.com/bf/pumping/index.html

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  8. My 1st child we only went 2 or 3 months so with my 2nd i made sure to go past 1 yr (15 months) and if and when we have any more, im hoping to make it to 18 months, depending on the child. i do think a lot of it has to do with just not knowing. 2nd time around was so much easier for me and i was so much more confident, and i had tons and tons extra in the fridge that we used in his food for months after we stopped.
    great post and thanks for putting great info out there.
    -h

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  9. nicely written. thanks for putting out this kind of information (where were you when i had bethany!?!) i was told (even by my NICU doctors and nurses) seven years ago to time my feedings for bethany. both how long she nursed, and how long between feeding. i didn’t make it long nursing, and that is the reason. with sarah jane and sam- i fed them when they were hungry. i nursed sarah until i got pregnant with sam, and nursed sam 18 months. listening to your body and to what the Lord calls you to do- helped me to not worry about how much/long the second and third baby was fed. and since my first- the NICU has been better staffed with lactation consulants that helped me realize that they’ll let you know when they’re hungry.

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  10. Thanks so much for this post. I am a friend of Laurin’s and pop in on your blog now and then. My baby just turned one and I still don’t feel like we’re ready to wean. This road has been a good one and I have really been thankful for it. But it does seem like a lonely road sometimes and I often feel like an oddball for breast feeding so long and for being less than structured about it. It is good to hear validating thoughts on this matter and to know that there is a lot of support out there.

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