How to Enhance Total Milk/Hindmilk Intake

Strategies to Enhance Total Milk/Hindmilk Intake
In order to produce multiple daily bowel movements and optimal infant weight gain, maximize the infant's opportunities and willingness to suck by:

• Keeping mother and baby together for bonding, kangaroo care, and free access to the breast.
• Initiating the first latch-on and uninterrupted sucking within 30-60 minutes of birth, if possible.
• Encouraging active and sustained nursing episodes 10 to 12 times each 24-hour period.

Allowing nearly constant suckling in the first hours/days after birth gives the newborn ample oral exercise and practice on the softer breasts before managing fuller, heavier breasts when the milk supply increases. This also allows for the greatest intake of colostrum, stimulates rapid evacuation of meconium and promotes an early and full increase of the mother's milk supply. During the first weeks after birth:

• Continue encouraging active, sustained sucking totalling 10-12 feedings in each 24-hour period.
• Attend to the details of latch-on and positioning to achieve high effectiveness of sucking efforts.
• Listen for the sounds and patterns of infant swallowing.
• Enhance multiple let-downs each feeding by nursing in a relaxing atmosphere and taking a refreshing drink or snack.
• If baby tends to doze off at the breast, try gently encouraging a return to active sucking by talking to, lightly jiggling or stroking baby.
• If moving baby to the opposite breast is the most successful way to stimulate active sucking, then moving baby three, four or more times each feeding (super-switching) may best improve baby's hindmilk intake.

Hindrances to Total Milk/Hindmilk Intake
These possible hindrances to adequate total milk/hindmilk intake may contribute to infrequent newborn stooling, elevated bilirubin levels and/or reduced newborn weight gain:

• First breastfeeding occurring more than 30-60 minutes after birth.
• Separation of mother and baby resulting in reduced opportunity for frequent, leisurely feedings.
• Scheduled or haphazard feedings resulting in fewer than 10-12 feedings in 24 hours.
• Timed or shortened feedings resulting in reduced sucking time and less hindmilk intake.
• Giving newborn anything to swallow other than colostrum/human milk.
• Giving newborn artificial nipples, teats, pacifiers, soothers or dummies.
• Positioning which hinders effective latch-on and comfortable sucking.
• Removing baby from the breast while baby is still actively sucking and swallowing (even to offer the opposite breast).
• Unusually stressful nursing environment that prevents mother or baby from enjoying uninterrupted, leisurely feedings.
• Parenting practices designed to soothe baby which may postpone or delay feedings: baby swings, walking, rocking, rides in cars, buggies, strollers, sucking other than at the breast, supplements, letting baby cry to sleep.
• Allowing/encouraging more than 4-6 hours between any two feedings.
• Assuming a feeding is completed when the newborn has taken milk from each breast.
  

If a fully breastfed newborn younger than 6-8 weeks old is not producing several yellow, seedy bowel movements each day, the Leader may encourage the mother to:

• Have the infant's weight gain and well-being checked by a health care provider.
• Practice effective positioning and latch-on techniques so baby holds nipple behind the milk sinuses.
• Use breastfeeding strategies that allow the infant to take in more of the higher calorie hindmilk.
• Possibly work to increase her milk supply, the length of feedings and the total number of feedings per day.
• Infants with inadequate urination (wetting fewer than 6-8 cloth or 5-6 disposable diapers/nappies in 24 hours) require immediate medical referral.