Breast and bottle feeding with ebm

[~ Vik ~]

Many moms want the convenience of bottle feeding, but want to ensure that their lo is exclusively breastfed.  If this is the case for you, then read on!

Pumping

It is important to note that pumping is NOT an indicator of supply - when moms begin pumping, some are surprised by the small amount that they pump and begin to get concerned about supply.  There are hormonal things that happen between mom and baby when breastfeeding that don't happen between mom and pump.  Babies are also much more efficient than pumps, and can extract milk much more quickly than a pump - a baby may take a full feed in as little as 5 or 10 minutes, but pumping for that length of time may only yield an ounce or less.  When a mom is nursing full time, any pumping output is *above and beyond* baby's demand so it could take 2-3 pumping sessions to get enough milk for one feeding.

For more information on pumping, and what to do if you're not pumping enough milk, please see the http://babywhispererforums.com/index.php?topic=63603.0 FAQ.

Best times to pump

Our milk supply is naturally higher in the mornings and lower in the evenings - when pumping, you will likely find that you get a higher yield in the morning.  You can pump immediately after feeding, or up to one hour after feeding.  (It is best not to pump more than an hour after feeding lest it interfere with your milk supply for the next feed.)  

If you are only pumping for an occasional bottle (for an evening out, special events, etc.) you have a lot of flexibility.  You can pump after every single feed if you are eager to build a stash, or you can pump after only specific feeds, or simply when it's most convenient for you.  Remember not to worry if you only get a small amount per pumping session - that's perfectly normal

If you are pumping to replace one or more specific feeds, there are several ways to go about it.  Ideally, you will want to pump at the normal feed time.  So, for example, if you have returned to work and your lo will be receiving a bottle of ebm at 11am, you will want to pump at 11am for a couple of reasons:
- your own comfort, as you will likely get slightly engorged at that time since your body is expecting to feed
- so your body *knows* that it is still producing milk for that feed, even though you are not feeding your lo directly
For various reasons, you may not be able to pump at the normal feed time.  For example, if your partner is doing an ebm dream feed, it's not much of a break for you if you have to pump at that time anyway!  In that case, you should try to pump as close to the feed time as possible.  For example, if you are pumping for your partner to do an 11pm dream feed, you may choose to pump at 930pm right before you go to bed.
In either of these cases, you will likely need to do additional pumping sessions above and beyond the *missed* feed - because it often takes 2-3 pumping sessions to obtain enough milk for one feed, even one additional pumping session in the morning will be helpful.

If you must skip a feed completely (i.e., you cannot pump at or near feed time) there are things you can do to help.  First, pump right before your *event* (right before you leave, for example).  You will also want to pump as soon as you can afterward - but how much you pump will depend on how close you are to your next feed time.  If your next feed is 2 or more hours away you can likely do a full pumping session (especially with the knowledge that you can top up with ebm if your baby seems hungry after the feed).  If your feed is less than 2 hours away you likely won't want to do a full pump (though judge for yourself, again you can always top up with ebm) but you may want to do a short pumping session to relieve any engorgement, making yourself more comfortable and making it easier for your lo to latch for the next feed.
If you must miss a feed it's not a disaster - your supply will not suffer for missing one feed on occasion.  Missing feeds consistently will impact supply, however, due to the supply and demand nature of milk production.  If you miss a feed it's important to get back on track with feeding and/or pumping over the next few days.  

Breastmilk storage and handling

Here is a link to a printable pdf with milk storage and usage guidelines for healthy, full term babies.  If you are pumping for a premature or ill baby make sure you consult your doctor for specific instructions.
http://www.kellymom.com/store/freehandouts/milkstorage01.pdf

Here is more information from the BW FAQ:  http://babywhispererforums.com/index.php?topic=88953.0

How much milk does my baby need?

Breastfeeding moms often wonder how much milk they should put in the bottle - you want to ensure that your baby has a full feed, but you certainly don't want to waste any precious ebm!

In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months (though it likely increases short term during growth spurts). Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months. After six months, breastmilk intake will continue at this same level until sometime after six months, depending on solid food intake, baby's milk intake begins to decrease gradually.

The research tells us that exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. Different babies take in different amounts of milk; a typical range of milk intakes is 19-30 oz per day (570-900 mL per day). We can use this information to estimate the average amount of milk baby will need at a feeding:
- Estimate the number of times that baby nurses per day (24 hours).
- Then divide 25 oz by the number of nursings.
- This gives you a "ballpark" figure for the amount of expressed milk your exclusively breastfed baby will need at one feeding.
Visit http://www.kellymom.com/bf/pumping/milkcalc.html#calculator for an automatic milk calculator to do the math for you