Sam born premie by C-section, is he getting enough milk?

QUESTION: Hello. My son was born at 37 weeks gestation by c-section. He is my fourth child, all by c-section. The other three girls were all born at 41 weeks to the day. With Sam, my water broke. Sam was declared borderline preemie; he had a heart murmur, two episodes of apnea and has a cleft of the soft palate. He spent 7 days in NICU. When he came home he weighed 6lbs. 1/2oz. At 8 weeks of age, he had surgery for double hernias and hydrocyles. He can't breastfeed, but I pump so he is getting breastmilk. My question is this; he spits up a lot and I only get about 2 oz a pumping. How much should he be getting at 13 weeks? How do I know? Thank you.

Dear Liz,

Little Sam has certainly had a hard time! You should give yourself a pat on the back for persevering with the pumping for him. By the way, stress (and you've certainly had it) can adversely affect the milk supply. Consequently, anything you can do to alleviate stress is helpful. As you know, that's not always an easy thing to do!

You say you are getting about 2 oz per pumping, but you did not say how often you are pumping or what type pump you are using. If you are pumping every 3 hours (averaging 8 times per day) then that would be a total of 16 ounces of milk per day. Your baby (7 lbs, 4 oz) needs approximately 19 ounces of milk per day.

In answer to your question about how much a baby needs at 13 weeks, it is not age but weight that determines how much is needed. Take the baby's weight in pounds (rounded). Multiply by 2.67. This will give you the average number of ounces required daily for that weight. For example, a 5 pound baby needs 5 X 2.67 or 13.4 oz per day, a 10 pounds baby needs 10 X 2.67 or 26.7 oz per day. A 16 pound baby needs 16 X 2.67 or 42.7 oz per day. Remember that these are averages. Some babies may need more, some less. As your baby grows, he, of course, needs more milk.

I hope you are using a hospital grade electric breast pump. If not, then I recommend that you get one. Nothing else will allow you to continue to keep up the supply you have or to build up your supply. You should also be double pumping. Studies have shown that double pumping helps to get the hormones flowing better. It is hormones that control lactation. If you are already double pumping with a good pump, then you may need to increase your frequency of pumping.

For any woman wanting to build up her milk supply, I recommend getting on a two-hour pumping schedule while you are awake (pumping 10-15 minutes per session.) At night, you need to pump at least once or twice. Going for long periods without pumping will cause your hormone levels to fall. As far as the spitting up goes, try to keep your baby in a semi-sitting position for about 20-30 minutes after a feeding. That usually is helpful. Most cases of spitting up in a breastfed baby mean nothing more than a laundry problem. If it seems like a great deal of milk, or there is projectile vomiting occurring, then you certainly want to tell your pediatrician.

Hope this is helpful. If you need more information, just let me know.

Cher Sealy, RN, BSN, IBCLC, LLLL

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