What are good strategies to support extended breastfeeding?

Question

We are new parents who would like to go for extended breastfeeding, in our case for 2 years. One threat we see to this is the reduction of breastmilk. I have heard from many mothers that their milk supply reduced towards the end of the year. Some of them lost it too in the first year itsef. How to counter this and what are some other problems and solutions that would help us smoothly follow extended breastfeeding?

Answer 1

Anyone who has nursed a baby for two years can continue longer without worrying about "losing the milk" or the like. The reasons for stopping nursing after two years are usually:

• she is pregnant again and nursing is painful, or she believes she will get more sleep if she weans the toddler, or she wants the toddler to switch out of baby mode before the new baby arrives
• she doesn't like some aspect of nursing (either actually doing it, or diet restrictions it requires, or clothing choices, or how other people think about her) and feels that the baby has now got enough benefit from it so enough is enough
• someone else is pressuring her to stop with the same "the baby has enough" argument.

For example I knew of a grandparent who believed milk was manufactured during pregnancy and therefore at 2 or 3 weeks an infant was drinking old spoiled milk. The older that baby got the more desperate that grandparent was for weaning. I know many women who felt they were not sexual beings while they were nursing, and wanted to wean to be sexy again. And I know some fathers who want to be more involved and want there to be nothing that only mommy can do for the baby any more. These things don't apply to everyone, but they are very real considerations for some.

After age two, the toddler is likely to be getting primary nutrition from solid food, and nursing is providing extra protein and fat (important in the developing world, likely plenty of it in the solid diet for first world children) along with a little bit of calm one-on-one time each day and perhaps some immunity boost. If you want to keep going, keep going. If you're getting some of that pressure from someone else to wean, you have several choices:

• blind them with science and convince them you're right
• thank them for their input and do whatever you want
• don't discuss it and don't do it in front of them and they'll assume you've stopped

Most families I know will nurse a newborn in front of anyone, but a toddler not so much. That's partly because it's something done at nap time and toddlers are super distractible. But it's also because slipping away to "get you ready for bed" and returning with a calm, pajamed, bathed little one is a standard end of day thing whether that toddler nurses during the bedtime routine or not. One side effect of that is that people who think you shouldn't be nursing will assume you're not. I'm not saying be closeted, just don't open the whole thing up for a community vote. Do what's right for your family.

Answer 2

For establishing a healthy milk supply, the first two weeks are critical. During that time allow your baby to suck regularly. Infant sucking increases the number of prolactin receptors which is critical to future milk supply. Begin this as early as possible in the hospital, according to a guide from LLLI. During the first two weeks do not use a pump in addition to your baby's sucking unless you are pumping to cover expressed milk or formula that your baby is drinking. Early pumping may lead to a significant oversupply which can lead to stressful feedings and discomfort in both the mother and the baby. Oversupply can be corrected, but is best avoided.

If your child loses a concerning amount of weight, usually 10% of their birth weight, in the early days and your doctor or hospital recommends formula, don't worry. In a randomized trial early, limited formula supplementation was shown to actually help breastfeeding. However make sure to continue stimulating milk production when formula is given.

News reports are also covering a recent study that describes the critical role insulin plays in establishing a healthy milk supply. Insulin disregulation can upset the milk supply. Also make sure to eat plenty of food - nursing mothers need 500 extra calories daily - and drink 1 large glass of water per nursing session, as well as drinking to thirst. Adequate rest, if you can get it, also helps your milk supply.

During the first six weeks breastfeeding is a major challenge for the mother and the small, tired baby. It may be natural, but that doesn't make it a smooth thing. Being determined to breastfeed for six weeks unless your child is showing detrimental effects or you have a medical condition that prevents you such as breast hypoplasia may help you get over these challenges.

Once your milk supply is established the next challenge usually arrives in the form of a mother's return to work. If you anticipate that you will returning to work, around 3 weeks post-partum you should begin pumping and also begin offering your baby a bottle 1-2 times weekly. This age is a crucial one for preventing bottle refusal later, and continuing to provide a bottle is also crucial. If you bottle feed in a manner appropriate to breastfed babies, it will help prevent fussiness when your baby transitions back to nursing after a bottle feeding. Use the lowest flow bottle nipple, feed at the same time you would breastfeed, and make sure to pump around the same time to let your body know that your child needed that amount of milk. During the time between when you begin pumping and your return to work you will need an extra daily pumping session that allows you to build up enough milk in your freezer to cover at least the first day of work, plus an emergency stash should one day's pumped milk be spoiled for some reason.

After your return to work there is a major rule to follow to ensure that you maintain adequate supply: only send to daycare or give to your child's caregiver as much expressed milk as you pumped the day before. Many mothers send frozen milk on Monday (freezing Friday's milk), then use the day before's refrigerated milk for the other days of the week making this process very simple. To continue building a freezer stash as needed you may want an additional before-work or after-work pumping session.

A challenge to breastfeeding here is ensuring a supportive workplace. Your workplace will need to provide a place for you to pump in private, a place where you can keep your milk safely in the refrigerator, and adequate breaks for you to pump. Ideally you will pump every time your child has a bottle, though some mothers find they can pump on a more spaced out schedule without issue. Many workplaces, unfortunately, are not supportive of pumping mothers.

The next challenge to breastfeeding comes around the time of the establishment of solid food eating and increased mobility. Children may become uninterested in breastfeeding. Some mothers even report that their child chooses to wean at this point. As your child is his or her own person, there is nothing you can do about this. When breastfeeding no longer works for one half of a breastfeeding pair, it no longer works - full stop. Some older infants simply conduct nursing strikes, however, and you can continue to pump and lure your child back to the breast eventually. During this time make sure not to dip into your stash of frozen milk to feed your child unless you wish to begin weaning. If your child wants more breastmilk he or she will nurse more and trigger your body to make more. If you feed frozen expressed milk during this time you teach your child to get those calories from milk without telling your body to make that milk.

Some find during the 6-12 month phase when nursing interest decreases and supply decreases that some formula supplementation actually reduces stress and allows a mother to continue some breastfeeding alongside formula. However since no two women are the same some may be able to continue just a few feedings in this timeframe while others will lose their milk supply with this tactic. You may not know in advance of trying it which will happen to you.

The final challenge to breastfeeding from a supply standpoint comes from mothers weaning themselves from the pump during the work day. While some mothers can continue to breastfeed when with the baby while not pumping at work, others can't. Within a few weeks those mothers lose their milk supply completely. However anecdotes I've heard indicate that pumping full-time at work until a year makes it more likely that you will be able to continue morning and night nursing with your child for longer after you do wean from the pump.

Throughout your breastfeeding journey with your child surrounding yourself with supportive people is valuable. This means during the newborn stage it is helpful to have people who understand the rhythms of a breastfed baby around you - long, frequent feedings - and aren't pushing you to let them give the baby a bottle. It means that if you chose to breastfed beyond when some consider it socially acceptable, you handle those people in the manner Chrys suggested.

If you do end up weaning before 2 years, LLLI has an excellent reminder in the book "The Womanly Art of Breastfeeding" that any breastmilk you have given your child is excellent. So no matter how long you make it on the nursing journey - way to go!