My five week old baby is completely breast fed and she seems to be growing well (she's gained two pounds since she was born). But she seems hungry all of the time and I often feel as though I don't have enough milk for her. What else can I do? I don't want to give her formula but I'm exhausted from all of the work of feeding her and taking care of her.
If a breast fed baby has nursed and gained well for a month already, you can be very certain that she and you are a good nursing "team" and that you are capable of making as much milk as she needs to continue to grow. It's possible that your baby is in fact getting enough milk but needs more time at the breast to meet her sucking needs. One way to tell if she needs to suck rather than to nurse for milk if by offering a pacifier after she has nursed for five to ten minutes on each breast and see if that satisfies her. If it does, then you can increase the time between feedings so that she’ll nurse longer and take in more at each feeding. There’s no rule about how often to feed—every baby is different—but you will soon figure out what is right for her.
If your baby rejects the pacifier and continues to act hungry, you may be right that your milk supply is not always enough to satisfy her, even though she seems to be growing fine. Sometimes that’s because your baby is beginning a growth spurt. When a baby is getting ready to grow—and these times are only somewhat predictable—she’ll nurse a lot for two or three days to boost your milk supply, but will then resume a more reasonable feeding pattern. Those two to three days can seem like an eternity, but usually by the time you think you are ready to give up, your baby starts to seem satisfied again and you will feel fine.
Another reason for a new mom to feel that she doesn’t have enough milk is that her supply is not increasing as much as it should because of fatigue. Any new mother has trouble getting enough rest, even with lots of help from others. But some moms try to get by on way too little sleep and don't rest or nap during the day. Their lives are busier than ever, they're waking up two or three times every night, and eventually their bodies react to the overwhelming demands. An exhausted new mom may find that her milk supply decreases, she gets sick, or she gets depressed. Does that sound like what may be happening to you?
In some cultures and communities, a new mother is nurtured and cared for by family and friends so that she will have more strength to care for her new baby. In the United States, especially in the Bay Area, a new mother may have to care for herself, the new baby, a partner and her household without extra help. Even if she's lucky enough to have a partner or family available to take care of her for a few weeks after the baby is born, often by the time the baby is a month old she may be left on her own again. The work load may be too much, or her own expectations may be unrealistic. Sometimes the first casualty of the increased stress is a reduction in milk supply and difficulty with nursing.
If you're enjoying breastfeeding and the special closeness you have with your baby, look at all the work you are doing and try to cut back for a while. Get in bed with your baby with your baby, rest as much as possible, and let everything else go. Ask friends for help with your other children or with meals. Ask your partner to help care for you—don’t assume that anyone else realizes that you're as tired as you are.
If you are hitting the bottom with fatigue and you can't rest during the day, there’s nothing the matter with giving your baby a small amount of formula for a few nights so that you can catch up on your sleep. It’s not cheating on perfectionism to do this—it’s being realistic. After your last evening feeding you can "top off" your baby with a few ounces of formula and then go to sleep right away. Your baby will probably sleep a little longer, because formula isn't digested as quickly as breast milk. You could also try going to bed early yourself and having your partner take over the next feeding and give the baby formula then. Although giving the baby formula may temporarily interfere with your building up your milk supply, it's equally important to get enough sleep. Many women find that after a few nights of extra rest they can go back to total breastfeeding with new energy. Others find that continuing a single supplemental feeding gives them a welcome break. Either way is fine. If you want to keep offering formula, keep the total amount consistent and offer it at about the same time of day so that your own milk supply continues to increase as your baby grows.
Remember that there is a lot more to being a good mom than breastfeeding. A mom who is resting well and taking care of herself will be more responsive to her baby’s needs in every way, and enjoying your baby is the best way to build a wonderful relationship with him