I am an IBCLC (International Board Certified Lactation Consultant) in private practice in Northern Ireland as well as volunteering as a breastfeeding counsellor with my local voluntary organisation.
The (Un)necessary Breast Milk stash?
Some of the concerns I hear most frequently from breastfeeding mums are around windy, gassy babies with green frothy poo. Often when we discuss how feeding is going she mentions she is expressing each day. When I ask why she is expressing, by far the most common answer I hear is "I just want to have a wee stash in the freezer, just in case". Do you recognise this? If you do, do you know what it is in case of? Do you know how much you need? Do you know when you need it? Do you actually need it at all?
Regular expression for a freezer stash in the early weeks can lead to a problem of oversupply. If your 3 week old baby is drinking 20oz a day, for example, and you are expressing 5 Oz a day for your stash, you are removing 125% of what your baby needs each day. That gives your body the message that your baby is drinking that extra amount and so the body continues to make more milk than is needed by your baby. The extra milk in your Breasts is under higher pressure and this causes letdown to be faster. This can have a few effects. If can mean that your baby struggles to keep up with flow and swallows air. It can mean that your baby gets more milk delivered to his stomach than he wants or needs, leading to him being overfull and to vomit. When your supply matches your baby and you are feeding on cue, your baby is able to regulate his intake of sugar/fat content in the milk (discussed more here). If you are expressing this may upset your baby's regulation of intake and he may get more lactose rich milk. This can lead to extra fermentation in the gut causing gas. It also passes through the stomach quickly and when it hits the intestine the lactose pulls in water causing watery and sometimes green frothy stools. Add it all together and you get wind, gas, watery stools and an upset baby which, frequently, is mis-diagnosed as reflux.
Daily expressing doesn't cause an problem for every dyad, but it does for many, particularly if expressing starts in the first few weeks when milk supply is being calibrated to your baby's needs. For some mums and babies even expressing small amounts in the early weeks can make a difference.
Pregnancy websites, magazines and shops make us feel like a Breast pump is an essential piece of breastfeeding equipment, and expressing is something that is necessary, but not everyone needs to express their milk. For most people their baby will be with them during much of the duration of their breastfeeding, and for most of those who do leave their baby it is for short periods. Maybe for an appointment or a few hours with friends. Those mums don't need a huge freezer stash. A few ounces is probably all that is needed. This is very different to the unpurposeful, ever building stash - the one which comes from daily expressing and freezing for days and weeks just to have in the freezer.
Is a stash with no real purpose partly about lack of confidence in breastfeeding? When we constantly hear comments about how often our baby is feeding and hear others querying if our baby is getting enough, it can be reassuring to see the milk flowing, to see bottles or bags stocked, to see the abundance that your body can produce. The ounces of milky liquid goodness. The oxytocin boost can be intoxicating, but ultimately is it created by anxious thinking in a society dominated by bottles and measurements?
If you have a hoard of milk in the freezer, how do you feel about using it? Are you happy to give it to your baby when an outing does arise and let it dwindle down or are you attached to the idea of the stash? If someone suggested donating to the milk bank, for example, would you feel anxious about losing the milk? For many the stash becomes the goal in itself and then, all too soon, the milk reaches it's expiry date (6 months in the freezer) and must be dumped. It seems like such a travesty to dump this amazing nutritious milk full of antibodies and stem cells and growth factors and cancer fighting properties. It's a bit like saving for a rainy day and the bank going bankrupt before you ever had a chance to enjoy your money.
If you find yourself not wanting to use the milk in the freezer, maybe ask yourself what you are saving it for? If you find yourself worried about not having enough in the freezer perhaps open the door and look at it again. Realise all that milk came from you. You. Just you. Milk doesn't come from the freezer. It comes from you. You are everything your baby needs. There is no scarcity. You don't need to worry about Jon Snow appearing to tell you, "Winter is coming" (Sorry, I couldn't resist :-) ). You are abundant. Your milk is plentiful. You are enough.
The targeted stash
So how much is reasonable for a freezer stash? That very much depends on what the "just in case" is and how long the separation will be. If your "in case" scenario is for something like an afternoon or an evening away, you can estimate how much your baby might need for that kind of a timeframe and plan your stash around that. On average, a baby between the ages of 5 weeks and around 6 months (or whenever he starts eating solids) drinks around 25-30 of milk a day (range of 22-41 Oz). Before 5 weeks it will be less and after he starts eating solids the milk needed will gradually reduce as calories from solids increase. Let's take a 6 hr afternoon or evening separation as an example for easy mathematics. You can estimate the milk you need by looking at the day as a whole. So if your baby takes 28 Oz over 24 hrs then in a quater of that time (6hrs) he will need around 7 Oz. This is a simple example and obviously will need tinkering from dyad to dyad. If your baby sleeps a long stretch at night and takes most of his milk during the day you may need to leave a little more.
You can also estimate how much to leave by your baby's normal feeding rhythm during the time you will be away. If your baby normally feeds twice during that time frame, and you know that on average breastfed babies take 2-4 Oz in a feeding, then you may want to be able to grab 4oz x 2feeds = 8 Oz from your freezer. This is just is few ounces, not a freezer full of milk. Obviously your baby may take more or less depending on how your caregiver feeds your baby (read here about how to protect breastfeeding while offering bottles) and most mums want to leave a few ounces more than what they think their baby will drink, again "just in case". That's completely understandable, and sensible. Just be careful that you limit it to a few ounces and don't start building a 'just in case' stash for your 'just in case stash'!
Have you been building your stash with the idea of returning to work in the back of your mind? When your baby is small and feeding intensely, the thought of returning to work and having to leave enough milk for your baby is overwhelming. It's no wonder we feel like we need to have milk built up. It seems rational until you consider the practicalities. We're lucky here in Northern Ireland. We have 39 weeks of statutory maternity leave and many women manage to take this entire time. What hard to visualise now is that your tiny baby will be a 9 month old infant by then, a 9 month old who will likely be well established on solids and his breastfeeding pattern will look entirely different to what it does now. He may not actually need any expressed milk during your workday. He may breastfeed when you drop him off and at pick up and drink water during your work time (depending on how long you are away of course). If he does have mik, it is likely to be nothing like the amount he is drinking right now,
Even if you are returning at 6 months the pattern will look very different.
Have you thought about how milk changes as your baby grows? The milk you produce for your 9 month old or even your 6 or 4 month old is different from the milk you produce for your 1 month old. Your milk is perfect right now for the stage your baby is at right now. When you reach the stage of returning to work the milk you will be producing then will be perfect for your baby then. You don't need to build up a store of milk now. Often mums work a day ahead. So, when you return to work on Monday you leave 1 days milk with childcare. This is the only milk you needed in your stash - again only a few ounces. On Monday you express at work when you would normally be feeding your baby. You store that milk and give it to your childcare provider on Tues. On Tues you express for Wed. No stash required, and your baby gets fresh mik full of antibodies for the viruses and bugs which he is exposed to now.
Expressing at work might seem awkward and impossible at first glance, but employers have obligations obliged to breastfeeding mothers for this to happen (see further reading section below). If you want to to talk about whether you need to express at work and how this could work for your circumstances, talk to a breasfeeding counsellor or IBCLC (International Board Certified Lactation Consultant).
A small amount of milk in the freezer can be useful. Maybe even enough for day or two, but anymore than that can cause more problems than it solves. If you are expressing for a freezer stash I would urge you to think about what your stash is for and how much you need. Consider if you need to do it now, or if it can wait till breastfeeding is easy and well established for both of you. Consider waiting till past the 5 weeks and think about how the amount may affect your baby. Think about how whether it would suit you and your baby better to express small amounts over a longer period, or to have a few one off expression sessions. If you are having concerns about your baby and fussiness/gas/ green stools, consider whether your expressing could be related and chat to a breastfeeding counsellor or IBCLC to discuss the impact.
You don't need a freezer full of milk. The milk you are making right now, is perfect for your baby right now. Stashing milk is only feeding your electricity bill. Feed your baby instead. Enjoy your abundance together. You are the real just in case stash.
The suggestion of top-ups undermines mothers. It quietly instills in the mother an almost hypnotic suggestion that she cannot meet the needs of her baby. The mother who is already tired, worried about her baby's weight or unsettled behaviour and seeking reassurance and help. Once the top-up has been given, the mother's supply starts dropping and now she really feels she needs the topup and often a cycle of ever decreasing breastfeeding ensues. The woman grieves her lost breastfeeding experience.
Let me clarify a few very important things. Breastmilk is perfectly designed for your baby. Your milk is exactly what your baby needs. There is no need for a modified cows milk product in order to add "something" to help our babies develop or settle. If your baby isn't settling, or wants to feed frequently consider whether what you are experiencing is actually normal. If you are worrying about having enough milk remember that it is biologically normal to produce enough milk for our babies. It is not normal to have insufficient milk or for our milk to not meet the needs of our baby. When you hear your parents/grandparents talk about how they didn't have enough milk, remember that they were never given a real chance to breastfeed. They had their babies when they perhaps a "feed" was considered a few minutes (maybe even 3-4 minutes in the first few days). The basics of demand and supply were never considered. Remember that these were the days that women were advised to "toughen up" their nipples prior to birth, and the basics of latching were poorly understood.
Women's bodies are designed to grow, birth and feed their babies. We grow entire human beings from one cell, and then birth that baby human. Contemplate the creative processes involved in that, and what exactly happens in our bodies. It doesn't make any sense that our body would be able to do that, but not be able to feed that child. Pregnancy, birth and breastfeeding are all one event evolutionarily speaking. They are about producing an offspring. Most of us probably played mothering with our dolls as young children, just as we watch our children do now. I suspect that many of us just expected that one day we would grow up and have a baby. When you played, how did you feed that baby? Did you use your chest or a bottle? It is a cultural issue that we doubt that we will be able to feed that baby, not a biological one. The human race wouldn't have got this far if women could create the baby, birth him but not be able to feed and grow him.
If you are having top-ups suggested and you want to breastfeed - ask your HCP if there is an breastfeedkng alternative solution. If you aren't happy with the answer search out a lactation consultant (IBCLC) or breastfeeding counsellor who believes in breasfeeding. One who is confident in breastfeeding, in breastmilk and knows that you can feed your baby. Break the cycle and find someone who will help you meet your breastfeeding goals. Resolving the issue through a breastfeeding solution increases your own confidence in yourself and your mothering, and not only that, confidence is contagious. As more HCPs see breastfeeding resolutions, their confidence grows as well, and little by little our culture changes.
Top ups aren't the answer to normal early day breastfeeding difficulties. Breastfeeding Problems have Breastfeeding Solutions. You and your baby deserve a breastfeeding solution.
If you have any questions about a consultation or would like to arrange to meet, please get in touch.
Expressing & Storage Guidelines - https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BFNExpressing_and_Storing.pdf
PHA leaflet on Breastfeeding and Returning To Work - http://www.publichealth.hscni.net/sites/default/files/Breastfeeding_Return_To_Work_02_15_1.pdf
PHA guide for employers of Breastfeeding mothers - http://www.publichealth.hscni.net/sites/default/files/Promoting_Breastfeeding_Returning_To_Work_02_15.pdf
All material on this website is provided for educational purposes only. Online information cannot replace an in-person consultation with a qualified, independent International Board Certified Lactation Consultant (IBCLC) or your health care provider. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation.