Before milk "comes in"..? - Mothering Forums

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Old 04-29-2009, 04:27 PM - Thread Starter
 
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I always hear of women supplementing "before their milk comes in". Now, I trust my body and mother nature and don't understand this. If your milk hasn't come in, isn't your baby hungry? I don't want to supplement with formula. What happens in those first few days?

I hope this makes sense, I don't want to feel like I don't have enough milk and give my baby formula, but I don't want the baby in pain over hunger either.
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Old 04-29-2009, 04:33 PM
 
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When your baby is born, you will colostrum, and that will be enough for your baby. You certainly don't need to supplement.
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Old 04-29-2009, 04:42 PM
 
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I think the only justification for supplementing until the milk comes in could be those few women whose milk takes 7-10 days to come in, rather than 2-5.

A baby can lose a LOT of weight in 10 days, and with medicalized birth, who is to say that the delay in lactogenesis II isn't pathological in some way?

Mother to R- 2/09, & C- 5/11

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Old 04-29-2009, 04:42 PM
 
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In the first few days of life, baby doesn't need much milk at all. They're born with fluid reserves that see them through, and their stomachs aren't ready for large loads of milk-- a newborn's stomach has the capacity of about a marble. What they need in those first few days is colostrum. You'll begin to produce that even before baby is born, so it'll be present in your breasts right after birth. It's produced in very small quantities-- baby may only get a spoonful during a whole feeding. But it's exactly the concentrated nutrition they need early on. It contains a wonderful cocktail of living cells like leukocytes that protect baby against infection and safely inoculate baby against disease and infection. Those life elements, which are present in less concentration in mature milk, will protect baby until baby's own immune system matures. It also helps to seal baby's gut, and has a laxative effect, encouraging baby to pass meconium.

Stomach capacity grows quickly. A few days after birth, the milk will increase in volume and slowly become mature milk-- just exactly when baby is ready to consume this mature milk.

Rest assured that the system almost always works perfectly, when it's allowed to work naturally. You will begin to produce a larger quantity of milk just exactly when baby is ready for it.

Some people will notice that the newborn baby wants to nurse constantly, in the early days, especially in that last day before the milk comes in. They will then conclude that baby is starving, and supplement, which undermines the establishment of a milk supply. That insatiable sucking is baby's way of stimulating the breasts to induce a full supply of milk to come in. There is a complex hormonal response between mother and baby when baby suckles that helps mother's body return to normal and feels very comforting to baby. Baby suckles constantly because he's supposed to. It doesn't mean he needs supplementing.

http://www.llli.org/FAQ/colostrum.html

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Old 04-29-2009, 04:45 PM
 
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My milk didnt come in until day 4. We did not need supplements. Just nurse, nurse nurse.

Me(33), Mama to a crazy DD (6), Wife to a wonderful mountain man(32) BF my babe for 2 years
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Old 04-29-2009, 04:48 PM
 
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Those women who supplement before their milk comes in are just making trouble for themselves, not very far down the line.

When the baby is born, you will have colostrum. It won't seem like much, but it's perfect for your baby, who doesn't have a whole lot of room in the stomach anyway.

The thing that brings your milk in is the hungry baby suckling at your breast. You want the baby at the breast as much as possible during those first few days (and weeks, probably) after birth. When you give the baby bottles instead of nursing, you interfere with that cycle, leading to low supply, and more supplementing. There are times when supplementing with formula is necessary and appropriate, but you should absolutely not do it just because your milk hasn't come in yet.
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Old 04-29-2009, 04:55 PM
 
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There are times when supplementing with formula is necessary and appropriate, but you should absolutely not do it just because your milk hasn't come in yet.
Unless, of course, your baby has lost 20%+ of their birth weight, its 10 days out, and you still aren't making milk. At which point you would need to be evaluated for why.

Chances are, this will not happen! PPs are correct that the baby will probably nurse constantly, which doesn't mean they are starving, just that they are helping to establish your supply.

Mother to R- 2/09, & C- 5/11

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Old 04-29-2009, 04:58 PM
 
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nak

i am where you are worried about being, ds is 5 days old and the ped is on me about supplementing because of jaundice.

my opinion at this juncture is if everything goes well, you get your baby on the breast early, you have an LC that actually watches you nurse, don't have to battle jaundice, (nursing under this billi blanket is about impossible) yes, boobies are all you need.

formula and bottles aren't the devil, if your priorities are to breast feed you will make things work. don't get upset if things are derailed momentairly, they will get back on track.

ds is teaching me plans mean exactly beans to him. just know your priorities and roll with it,

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Old 04-29-2009, 06:08 PM
 
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My LO had Jaundice at day 5 his bili level was 17, but we just nursed right thought it. My milk didn't come in until day 5.

he is doing great now at 18 weeks

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Old 04-29-2009, 06:59 PM
 
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nak
ds is teaching me plans mean exactly beans to him. just know your priorities and roll with it,
haha, dd taught me this lesson super quickly, too!
don't worry, colostrum is superfood. you guys will be fine- better than fine, great!

congrats

eta: most babies aren't born with much of an appetite, anyway. barring certain medical concerns, colostrum is more than enough to keep them full and healthy!

mummy to one sweet, beautiful, strong, clever, perfect
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Old 04-29-2009, 08:39 PM
 
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How in the world did the human race possibly survive in the millenia before man-made forumla? Oh, yeah, Mother Nature and biology worked all that out. We have colostrum to feed the baby before the milk comes in.

No need for most women to supplement in those early days. Mother Nature/biology provides.
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Old 04-29-2009, 08:54 PM
 
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formula and bottles aren't the devil, if your priorities are to breast feed you will make things work. don't get upset if things are derailed momentairly, they will get back on track.
:

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Old 04-29-2009, 09:00 PM
 
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Formula is destructive to the newborn gut here is an article about it: (Sorry I know this is long, but it is great info- I don't have a way to link to the article, so I am hoping it is okay to pst the entire thing? Please let me know if this isn't okay mods!)

Supplementation of the Breastfed Baby

“Just One Bottle Won’t Hurt”---or Will It?

Marsha Walker, RN, IBCLC

Background
• The gastrointestinal (GI) tract of a normal fetus is sterile

• the type of delivery has an effect on the development of the intestinal microbiota

o vaginally born infants are colonized with their mother’s bacteria

o cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer

o the primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after birth (Gronlund et al, 1999)

• babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother

o infants requiring intensive care acquire intestinal organisms slowly and the establishment of bifidobacterial flora is retarded

o a delayed bacterial colonization of the gut with a limited number of bacterial species tends to be virulent

o control and manipulation of the neonatal gut with human milk can be used as a strategy to prevent and treat intestinal diseases (Dai & Walker, 1999)

• major ecological disturbances are observed in newborn infants treated with antimicrobial agents

o one way of minimizing ecological disturbances in the NICU is to provide these babies with fresh breast milk (Zetterstrom et al, 1994)

• breastfed and formula-fed infants have different gut flora

o breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci

o flora with a diet-dependent pattern is present from the 4th day of life with breast milk-fed guts showing a 47% bifidobacterium and formula-fed guts showing 15%. Enterococci prevail in formula-fed infants (Rubaltelli et al, 1998)

o babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species

o in infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week

o when formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached

o breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants

• The neonatal GI tract undergoes rapid growth and maturational change following birth

o Infants have a functionally immature and immunonaive gut at birth

o Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens

o Intestinal permeability decreases faster in breastfed babies than in formula-fed infants (Catassi, et al, 1995)

o Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy

o sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function 2

o mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings

o the mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe

o these antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation

• infant formula should not be given to a breastfed baby before gut closure occurs

o once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs (Mackie, Sghir, Gaskins, 1999)

o relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern (Bullen, Tearle, Stewart, 1977)

o the introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci (Stark & Lee, 1982)

o with the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours (Gerstley, Howell, Nagel, 1932)

o if breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the gram positive flora (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

• in susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first three days of life (Host, Husby, Osterballe, 1988; Host, 1991)

o infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history (Chandra, 2000)

o in breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet (Zieger, 1999; AAP, 2000)

• in susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)

o human insulin content in breast milk is significantly higher than bovine insulin in cow’s milk; insulin content in infant formulas is extremely low to absent; insulin supports gut maturation

o in animal models oral administration of human insulin stimulates the intestinal immune system generating active cellular mechanisms that suppress the development of autoimmune diabetes

o the lack of human insulin in infant formulas may break the tolerance to insulin and lead to the development of type 1 diabetes (Vaarala et al, 1998)

o the avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals (AAP, 1994)

o infants who are exclusively breastfed for at least 4 months have a lower risk of seroconversion leading to beta-cell autoimmunity 3

§ short-term breastfeeding and the early introduction of cow’s milk based infant formula predispose young children who are genetically susceptible to Type 1 diabetes to progressive signs of beta-cell autoimmunity (Kimpimaki et al, 2001)

o sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM (Kostraba, et al, 1993)

§ sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure

§ sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions

§ sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization (Savilahti, et al, 1993)

References
American Academy of Pediatrics, Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feeding practices
and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994; 94:752-754
American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000;
106:346-349
Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal
babies receiving breast milk. Am J Dis Child 1922; 23:243
Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora
of infants. J Med Microbiol 1977; 10:403-413
Catassi C, et al. Intestinal permeability changes during the first month: effect of natural versus artificial feeding. J
Pediatr Gastroenterol Nutr 1995; 21:383-386
Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc 2000; 59:273-277
Dai D, Walker WA. Protective nutrients and bacterial colonization in the immature human gut. Adv Pediatr 1999;
46:353-382
Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932; 43:555
Gronlund MM, et al. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in
intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr 1999; 28:19-25
Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta
Paediatr Scand 1988; 77:663-670
Host A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991;
10:227-232
4
Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes
mellitus. N Engl J Med 1992; 327:302-307
Kimpimaki T, et al. Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type
1 diabetes to progressive beta-cell autoimmunity. Diabetologia 2001; 44:63-69
Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, et al. Early exposure to cow’s milk and solid foods in infancy,
genetic predisposition, and risk of IDDM. Diabetes 1993; 42:288-295
Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin
Nutr 1999; 69(Suppl):1035S-1045S
Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The Colorado IDDM
Registry. Diabetes 1988; 37:1625-1632
Rubaltelli FF, et al. Intestinal flora in breast and bottle-fed infants. J Perinat Med 1998; 26:186-191
Savilahti E, Tuomilehto J, Saukkonen TT, et al. Increased levels of cow’s milk and b-lactoglobulin antibodies in young
children with newly diagnosed IDDM. Diabetes Care 1993; 16:984-989
Stark PL, Lee A. The microbial ecology of the large bowel of breastfed and formula-fed infants during the first year
of life. J Med Microbiol 1982; 15:189-203
Vaarala O, et al. Cow milk feeding induces antibodies to insulin in children – a link between cow milk and insulindependent
mellitus? Scand J Immunol 1998; 47:131-135
Zetterstrom R, et al. Early infant feeding and micro-ecology of the gut. Acta Paediatr Jpn 1994; 36:562-571
Zieger R. Prevention of food allergy in infants and children. Immunology & Allergy Clinics of North America
1999; 19(3)

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Old 04-29-2009, 09:43 PM
 
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Babies tummies are so tiny, they only need the colostrum you can give them. They don't need more than that.

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Old 04-29-2009, 10:22 PM
 
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Originally Posted by jeminijad View Post
Unless, of course, your baby has lost 20%+ of their birth weight, its 10 days out, and you still aren't making milk. At which point you would need to be evaluated for why.
Hence my use of the word "just". Don't supplement *just* because your milk hasn't come in yet. If other reasons crop up (like 20% weight loss, or severe jaundice, or whatever other thing), by all means do whatever you need to do.
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Old 04-29-2009, 11:59 PM
 
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Hence my use of the word "just". Don't supplement *just* because your milk hasn't come in yet. If other reasons crop up (like 20% weight loss, or severe jaundice, or whatever other thing), by all means do whatever you need to do.
Of course. And a lot of us have been temporarily derailed by unplanned NICU stays, etc., where breastfeeding wasn't possible/allowed.

joannamf, Absent any extenuating circumstances, colostrum will sustain your baby. Congradulations on your pregnancy.

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Old 04-30-2009, 05:01 PM
 
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As others have said, just nurse nurse nurse. A baby nursing a LOT in the first few days is just establishing your milk supply. They are not starving. Lots of women get pressure from family and uneducated medical professionals to the contrary.
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Old 04-30-2009, 08:08 PM
 
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IMO, nursing a lot before your milk "comes in" is what actually makes your milk come in. You're making colostrum, and nursing constantly those first few days. The suckling is what helps your milk change over. So it doesn't make any sense to supplement during that time.

Carrie SAHM to Nora Caitlyn (5) and Finnley Dax (2) homebirthing, breastfeeding, babywearing, intactivist, doula mama!         
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Old 04-30-2009, 11:40 PM
 
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Many people don't realize that the change from colostrum to milk is somewhat gradual, and takes a few weeks to accomplish - babies sucking is part of what makes it all work. And at the beginning, baby only needs 1 tsp of colostrum per feeding, she isn't meant to get a lot, and when you give formula early it stretches the stomach. Although we don't really know, some think this is part of the reason ff babies are more likely to be obese as adults.

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