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Monday, February 19, 2018

The breast milk supply over time

As a work-outside-the-home mom, Laurie Jones, MD, IBCLC, a pediatrician and lactation consultant at St. Joseph’s Hospital and Medical Center, says she’s faced plenty of her own breastfeeding challenges. “I know all the pitfalls and traps that you can fall into that prevent mothers from reaching their goals.”

Dr. Jones feeds her son, George, in the day care room at pick-up time after a workday.

But Jones, a member of the Arizona Chapter of the American Academy of Pediatrics, (AzAAP), says she’s learned to put her own milk supply, along with her baby’s health, above almost anything she might encounter in her role as pediatrician and lactation consultant.

“You wouldn’t let work come in front of your child’s health if you got called about an injury or illness, says Jones. “So why do we let work interfere with our milk supply?”

If a mother goes back to work outside the home, or back to school, she will need to learn a whole new set of skills for breastfeeding. That includes pumping technique, bottle selection and how to best maintain her milk supply over the long term.

Jones recommends that babies receive minimum of 12 months of breast milk, and that they continue to nurse after that period for as long as desired by both the mother and the baby. But to accomplish this, she says, women need to develop the skills and knowledge to maintain their supply.

Most employers have started to accommodate mothers who pump, says Jones, because of the changes to health care laws requiring unpaid time to pump during the workday. Those changes went in to effect this year.

It can be a huge challenge to make pumping time part of the workday routine. But perhaps an even greater barrier to maintaining a supply over time, says Jones, is based on the misperception that a mother should produce more milk over time.

“Studies have shown that your milk supply is pretty much the same from month one to month 12, says Jones, “which is shocking to most people who are used to seeing bottle-fed babies take higher and higher volumes over time.”

It’s a hard concept to understand, especially in light of the bottle-feeding culture we live in. First, there’s the newborn bottle. Then the baby graduates to a five-ounce bottle, then an eight-ouncer. There’s progression in terms of size involved on many levels. The bottles get bigger, the nipples get larger, and the amount of formula increases. The baby sucks, the formula disappears, and parents feel content that the baby is gaining and growing.

But that kind of visual evidence doesn’t exist for breastfed babies. That’s hard for people to reconcile, says Jones, “because the breasts simply do not grow larger with every month that a mother breastfeeds.”

Breastmilk supply totals around 24 ounces, more or less, per 24-hour period. For twins, it’s about twice as much. Family members or caregivers who don’t understand how this system works can plant the seeds of doubts in the mind of a mother who must leave pumped milk while she is away.

Jones knows this all too well from her own experience. But she’s learned to trust the process as her young son, George (who just celebrated his first birthday) has grown.

“When my daycare tells me, ‘He wants more milk – send more milk,’ I have learned to stand up for myself and tell them, ‘No. He will drink exactly what I pumped from the day before and not one drop ‘extra.’”

Jones with Caroline (3) and George at the park.

What people need to understand, says Jones, is that human milk is metabolized very efficiently. Think of breast milk as a concentrated super-food. The fat and calorie content changes from day to day and month to month to perfectly meet babies’ needs as they grow. Plus, breast-fed infants burn fewer calories per day than formula-fed infants.

By contrast, says Jones, cow’s milk formula feeding is an inefficient process that causes an infant to require more volume over time. The caloric content of formula doesn’t shift with the infant’s needs.

Jones, who has breastfed two children for just over 40 months, says that ultimately, she’s gained confidence in herself as a mom along the way. She’s learned to nurse discreetly while she’s out just living life. “You have to find a way to get comfortable breastfeeding anywhere, and everywhere you go with your kids and family, so that you are not home-bound.”

Jones takes a break to nurse on a hiking trail.

Finding clothes that work can help. “Shirts and tanks that let me cover my back-fat and stomach-jiggle while nursing made me confident enough to feed without any covers over me, she says. “Now I can go to the park and be pushing my daughter in the swing while nursing my son in one arm.  We just live our lives and when my son needs to eat, I feed him.”

Jones says she doesn’t go hide in a special room or cover herself with a drape. “I just feed him with not even one millimeter of my skin showing. I keep talking to the person I’m with.”

No matter what the occasion or the location, no one has stopped to comment or tried to stop her at any time.

“The more confidence you exude, she says, “the more relaxed other people are.”

More about breastfeeding

Local and national breastfeeding resources

More on the right to pump at work

Help for calculating how much expressed milk a baby will need

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Vicki Louk Balint

Multimedia journalist Vicki Louk Balint covers medical issues for RAISING ARIZONA KIDS magazine.

3 Responses

  1. Stacey Piccinati says:

    Go Laurie! We had a line outside the pumping room the other day! The message is coming through! Women (employees and patients) at St. Joe’s are pumping, working, and feeding their babies breast milk. I’m so happy to work with such motivated perinatologists, OB’s, LC’s, Peds, and nurses devoted to helping families. And…I love these pics of you breastfeeding wherever, whenever. To this day I can recall times when you’re at your desk hard at work…just pumping away!!!

  2. Anne Schneider says:

    Thank you for all you’ve done at Joes to make pumping at work easier!! As a mom of two who pumped after returning to work I know how important it is to have a dedicated area to sit and relax to really get the milk flowing!!

  3. […] Breastfeeding and the milk supply over time ( […]

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