This is one of those topics that is so commonly asked in online mom forums, you can just begin to type the phrased question into the search bar of Google, and about a million various responses will pop up for you. So how do we sift through all that noise and give parents, and parents-to-be the actual nitty gritty, SIMPLE information on how to answer this question for themselves?
Well, we'll try our best to do that here. Without too much of a backstory, I had a difficult breastfeeding journey with all 3 of my babes. My youngest, my son, I had the toughest time, because I had to work the hardest to stay on top of my dwindling supply, he had an incredibly rough time around the 4-6 month mark, and I was at my wits end by 6 months as to how I was going to keep going. That's when I found out about the dormant tongue tie that had been there for the last 2 months, that was at the root of all the issues we were having. Once I sought the expert help, got it properly released by a healthcare professional that knew what they were doing, breastfeeding began getting exponentially easier, by the day! Suddenly we were at 17 months old and it was only then that he decided he was done. (spoiler alert...I cried for weeks afterwards lol)
But this was a question even I asked my IBCLC, when I was having my consultation with her. And she laid it out so perfectly and simply, I knew we had to publish this information for everyone to know, and SHARE! So please make sure, at the end of this blog, to share this with all your friends and family, and definitely share it in all the mommy or parenting groups you are a part of! Let's help make this journey a whole ton easier for many more breastfeeding parents out there. Without further ado, here are the tried and true, 3 ways to know whether your baby is getting enough breastmilk, and what to do about it if they aren't for some reason.
1. Wet Diapers
Babies who are getting enough breastmilk will have several wet diapers throughout any given day. Now, this is not to be confused with bowel movements. That is separate, and we'll talk about that in a second here. But back to the urine part of things. A baby who is getting enough milk supply will be having wet diapers (urinated) at least 4 to 6 times a day or more. If a baby is not wetting diapers, or there is close to 24 hours that goes by without a wet diaper, this is a problem and baby is suffering the beginnings of dehydration. This must be attended to immediately by supplementing with a READY MADE formula only (NO concentrates or powdered formula until after the age of 6 months old), and taking baby into their pediatrician, or the midwife, or family doctor, right away for assessment. You will also need to see an IBCLC (International Board Certified Lactation Consultant) asap as well, to help assess why your supply has gone down so much, and what plan of action would work best in helping to build that supply back up again as quickly as possible.
Returning to the question of stool/bowel movements. It is not uncommon or unsafe for a newborn between the ages of 0-6 months of age, to go a few days, or even a week, without making a bowel movement. If baby is comfortable and not constantly crying/in pain, then there is no need to worry about the bowel movement not being present every single day. Sometimes, also, exclusively breastfed babies make less bowel movements than formula fed babies because there isn't as much gastrointestinal waste that is being made, as in the case of a formula fed baby.
2. Weight Gain
This is another tried and true indication of whether or not baby is getting enough breastmilk. This is especially handy to know and understand in the cases where a baby has especially bad reflux and is seeming to vomit up everything they just ate. This can be a very common fear when that is occurring, because in our minds, how in the world can they be getting enough into their systems if they are vomiting everything up all the time? The reflux is a separate issue and is caused by a few possible factors which I will touch on in a moment. But when it comes to a baby's weight, we want to make sure that they are continuing to gain weight according to THEIR curve. When you take a baby to the pediatrician's or family doctor's or midwife's office, they will be weighing your baby every time and making sure their weight is increasing according to a charted curve that they will start to establish right after birth. Other than an immediate loss of up to 10% of their birth weight, right after they are born, within a few days, they should be fully back to their birth weight and from that point on, they should be gaining weight consistently. If there is a point where weight gain stops, or they begin to lose weight again, this is a clear indication that they are not getting enough breastmilk. In this circumstance, you need to get yourself in to see a skilled and properly trained IBCLC asap. We have 2 amazing IBCLC's on our team that we are more than happy to get you set up with, who are standing ready to go for any and all emergency appointments needed. We can usually have an IBCLC see you within 24 to 72 hours. This is extremely important, because they will be able to fully assess and diagnose why your supply has gone down, and what can be done to immediately increase it once again, as well as a temporary plan to supplement if it's absolutely needed, depending on the baby and their needs at that point in time.
Coming back to the topic of reflux, now. Reflux can be caused by a lack of maturity of the small muscle that is at the bottom of the esophagus, that acts as sort of a "lid" to the stomach, however for those first 6 to 12 months, that little muscle is still building its strength up, and sometimes the lack of strength of this muscle can cause a baby to have more severe reflux symptoms. But again, if baby is continuing to gain weight, regardless of the presence of reflux or not, you can rest assured that they are getting enough breastmilk. However, the reflux is still something that should be monitored by a pediatrician, family doctor or midwife, to make sure it is not causing the baby unnecessary distress. Reflux can also be caused by a tongue, lip or buccal tie in baby's mouth. This can only be properly assessed by an adequately skilled pediatrician (who specifically has received dedicated training in how to properly diagnose these issues), or an adequately skilled IBCLC (who understands what ALL types of ties look like, and the varying degrees of ties that there can be).
3. Satisfying Feeds
An adult's version of hunger versus a newborn baby's version of hunger are quite different, and here's what I mean by that. For an average adult, unless we are absolutely STARVING, the alarm bells in our stomach and body don't really get set off. The term "hangry" was invented to describe this very thing. An adult can find themselves fasting for up to 16 hours at a time, sometimes, and not be feeling that "hangry" feeling. But when we're absolutely starving, we all know how that feels, and it feels AWFUL.
Babies work slightly opposite to adults. In other words, they might be feeding for about 20 minutes to an hour on your breast, but seem to not be very satisfied after feeding is over, by way of fussing, crying, seeming to just want to be attached to your breast forever. In other words, a baby's internal "hangry" alarm bells go off when they aren't completely full. So they may be feeding and getting about 80-90% of the milk they want, but aren't getting that last 10-20% for some reason. Because their little bodies are wired to know when their full feed has not been delivered, they show baby versions of our adult "hangry" symptoms. Now, while cluster feeding for 12 to 24 hours is quite normal, if it continues for more than 24 hours, this is almost always a breastmilk supply symptom. So the key to this is that continue to feed them on demand for 24 hours from when this behavior begins. Once that 24 hour mark passes, if baby is still exemplifying these behaviors, it's important to get them in to see an IBCLC asap. Because this is the final sign that baby is not getting enough breastmilk for some reason, and a skilled IBCLC will be able to properly and expertly assess and diagnose why baby isn't getting this milk, and have a few ways for you to be able to combat that, and be able to get the baby the supply they need!
A baby that is getting enough breastmilk will be able to either fall asleep after fully feeding, on the breast, or will be able to be put down after burping, without showing any immediate signs of rooting or discomfort.
That's it!! REALLY! What does this mean? Well, it means a lot, as you can tell. It means you now have a clear road map to follow to know how and where to seek help, if even one of those above symptoms start manifesting in your little one. All three things need to be in place in order to make sure that baby is getting enough breastmilk. If even one of those above points are not in place, this can cause worse supply issues, and long term problems for both you and baby. What this ALSO means is that if all three things are in place, there is absolutely no need to wake a sleeping baby just because they have slept for more than 4 or 6 hours at a time. A baby who is gaining weight properly, satisfied after feeds, and who is wetting diapers throughout the day with urine, and having bowel movements at least once a week or more, is doing very well. If your little one is sleeping in long stretches, take it as a welcome blessing to get some extra zzz's in yourself at the same time!
Let us know if this blog post helped you out, or if there is a question you had for us or our IBCLC's! Comment below, we would love to hear from you.
Heather Dolimont is a birth and postpartum doula in Toronto, Ontario, Canada, who also founded Mums & Tums Canada, a one-stop location online and in person where every support or healthcare need for fertility, pregnancy, birth and postpartum can be met. For more information on Mums & Tums Canada, and the services they can offer you, or to get in touch with one of their healthcare, feeding or birth professionals, check us out at www.mumsandtumscanada.com or email us at email@example.com