The Boob Group
Coping with Cluster Feedings

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

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ROSE DEVIGNE-JACKIEWICZ: If your baby is always nursing, it’s easy to think the problem is somehow related to your milk supply, but babies who feed constantly for long stretches of time are actually cluster feeding. Why do babies cluster feed? How does it impact your supply and what should you do when your baby wants to breastfeed non-stop?

I’m Rose deVigne-Jackiewicz an RN and international board certified lactation consultant at the Kaiser Outpatient clinic in San Diego, California. Today, we’re learning to cope with cluster feedings. This is the boob group.

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LEILANI WILDE: Welcome to The Boob Group, broadcasting from the birth education center of San Diego. The Boob Group is your weekly online, on the go support group for all things related to breastfeeding. I’m your host, Leilani Wilde, I’m also an IBCLC and owner of Leilani’s Lactation and Doula Services.

Thanks for joining today and being a loyal listener of The Boob Group. Be sure to join our special Boob Group club for extra bonus content and transcripts from our shows. You can also listen to our shows on the go by downloading our free apps available in the Android, iTunes and Windows marketplace. Now Sunny is going to tell us more about our virtual panelist program.

SUNNY GAULT: Okay, so for everyone that’s listening to today’s show, if you would like to be part of our conversation and you’re not here in our beautiful San Diego studio, you can do so online. You can follow us on Facebook and on Twitter, I’m going to be some of the same questions and topics that we are talking about here in the studio to our Facebook and Twitter pages.

We’d love for you to comment, be part of the conversation, perhaps we can even share some of your comments on the show. Follow the hashtag #BoobGroupVP, VP stands for virtual panelist, for more information. I’m actually going to kick off today with kind of introducing our panelists, because I’m going to be a panelist on the show.

To tell you a little bit more about myself, you guys know me already but I’m Sunny, I am 37 years old and I’m the owner of New Mommy Media which produces The Boob Group, Preggie Pals, Parent Savers and Twin Talks. I have four children of my own. My oldest is about to turn five, I have a three year old and I’m currently breastfeeding my 18 month old twin baby girls. I think that’s it. Okay, Courtney!

COURNEY MELVETH: Hi there! I’m Courtney [phonetic] Melveth, I am 34 years old, I’m a chiropractor and a mom. I have two sons, one just turned one year old and the other is three and a half.

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SUNNY GAULT: Okay, we’re going to talk about an app today before we get into the heart and soul of our interview regarding cluster feedings. It’s something that I found called The Nurse Log, it’s available on iTunes for your iPad, for your iPhone and this is really geared towards breastfeeding moms who want to keep track of thime.

Whether it’s time regarding how much time you’re breastfeeding on your left side, time regarding how much time you’re breastfeeding on your right side, how much time has it been since you last breastfed your baby in general, if you’re having a hard time keeping track of time in general this is an app that is focused on that. It is a free app, but it does have in-app purchases so if you want to remove those ads it’s $1.99 but you can test this app out for free to see if you like it.

It does have the ability to add notes though, so if you want to make a particular note about something that happened during a breastfeeding session you can do that. You can also print out all this information directly from your app. I just kind of wanted to see, I don’t know, Courtney do you use breastfeeding apps? Is this something you think you might use?

COURNEY MELVETH: I haven’t, I actually wasn’t aware that there are any that existed, so that’s cool. I used to just try to keep watch on the clock and do my best to go about every two hours, and then about every three when they got a little bit older.

SUNNY GAULT: I’m curious, Rose and Leilani, we hear a lot about “Don’t look at the clock”, is this a good thing or a bad thing, an app like this?

ROSE DEVIGNE-JACKIEWICZ: I found that most moms do have an app on their phone, and even though we do say “Don’t look at the clock” they still kind of want to have an idea, because those first two weeks we do like to know when they come in to see the doctors “Okay, how many times has your baby nursed? How many wet diapers?” and these apps usually will include wet diapers, poopy diapers, how long and that is really only for those first few weeks until feedings are well established and the baby is gaining weight, but moms still like it because they like to keep track and there are many, many apps.

I have downloaded many of them to my phone just so that I can see what is out there. It’s pretty interesting how many apps I have on my phone for feedings.

SUNNY GAULT: What is the benefit? I was thinking, because you can time how much on the left and how much on the right, what are some of the benefits of knowing that besides just knowing? Usually I just felt how full I am on one side or the other. Is that the main thing?

ROSE DEVIGNE-JACKIEWICZ: Partially, type A moms just want to know everything. The one time that it might be somewhat beneficial is if you have a premature baby, you have a small baby that isn’t gaining weight and well, how long is he nursing? For her using these apps, she comes in and goes “Oh wow, he’s nursing for a whole hour” so for that reason it might be helpful, but again just in those early weeks until feedings are going. We like to encourage moms to just feed on demand, the baby will tell you and when he’s done he’s done.

COURNEY MELVETH: Exactly.

LEILANI WILDE: I agree, I think that the apps can be helpful in the very beginning, just like some of the other tools. They can use that as a comparison, but before you look at that, why don’t you check and feel how your breasts feel?

COURNEY MELVETH: Yes, I always fed on-demand for my sons, and watching the clock was really just for me to make sure that I had really drained one side so that they were getting all the hind milk and not just the foremilk and I wasn’t switching to the other boob too soon. Other than that, just like you said I would do the squeeze test.

COURNEY MELVETH: Squeeze my boobs, see which one is more full.

SUNNY GAULT: Alright, well thanks for everyone’s input. Again, this is called The Nursing Log and it is free, but $1.99 if you want to remove those ads and we’ll include some more information about it on our website.

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LEILANI WILDE: Today on The Boob Group we’re discussing how to cope with cluster feedings. Our expert, Rose in San Diego, California at the Kaiser Outpatient clinic as an RN and an IBCLC. Thank you for joining us, Rose, and welcome to the show.

ROSE DEVIGNE-JACKIEWICZ: Thank you for the opportunity to be here.

LEILANI WILDE: What concerns do you often hear moms dealing with a baby who wants to cluster feed?

ROSE DEVIGNE-JACKIEWICZ: You know what? This is probably one of the most common topics I hear from moms in the clinic and on the phones. They’re calling because they’re concerned that their baby must not be getting enough because they nurse so often and for so long. They’re convinced maybe that their milk isn’t enough or their milk is drying up. They think they need to use formula because the baby is nursing so often and mom thinks it’s maybe something she ate, her milk isn’t good and that’s why the baby is fussy. Then there are those others that are telling mom what they think is wrong and what they need to do to fix the problem.

LEILANI WILDE: Those well-meaning people.

ROSE DEVIGNE-JACKIEWICZ: Those well-meaning people, yes. Some of them are strangers at the supermarket.

LEILANI WILDE: Of course, we all know those. What do you tell them when they call or come in with their concern?

ROSE DEVIGNE-JACKIEWICZ: First of all, I need to get some basic information as far as how old the baby is and how often the baby is nursing in a 24 hour period. Is the baby gaining weight? Is the baby having lots of wet diapers and poopy diapers? Then I ask moms, when does the baby seem to want to do these cluster feeds? Most of the time they say, you know what, every evening for like a 2-3 hour period I’m stuck on this awful nursing, nursing, nursing.

Overall, how is the baby’s behavior? Is the baby always fussy, is the baby happy at times and it’s only during these cluster feed times that he just seems to be real needy? Does he spit up? Is he irritable? Has there been a change in diaper? I fully assess the mom and the baby to determine if this is normal or not. Most of the time it’s very normal cluster feeds.

LEILANI WILDE: Courtney, have you ever been confused about your baby wanting to feed constantly for hours?

COURNEY MELVETH: I definitely was with my first son. I had the exact concern that Rose was talking about, I thought I must not be producing enough milk, I must be the one woman in 100 or however many that has a problem. I definitely did seek support not only from Facebook groups but also lactation consultants and they assured me that it was completely normal and that the baby was really filling up either for the evening or just because he was really filling up on hind milk. I also found that the cluster feeds happened in the evenings.

Everything I was hearing was this is very normal, this is very typical, this is sort of the pattern that lots of babies follow. People also just talked about the fact that it was normal as a new mom to feel like there was always a baby on your boob. In some cultures they’ll put the baby on the boob 50 times a day, if the baby cries that’s just how they sooth them, especially in cultures where they carry the baby with them everywhere they go.

I felt assured that that was what was supposed to be happening, and they do eventually grow out of it. I found that once my children got to be a little bit older it just didn’t happen as much, unless it was a time where they were feeling a little unwell or they just needed extra comfort.

LEILANI WILDE: Did you find yourself sitting on the couch and preparing for that ahead of time?

COURNEY MELVETH: Yes, a little bit. Get some water ready, get some snacks ready, just get in the mode of relaxing and maybe watching a show on TV or getting a book so that I could just relax and do what my son needed. My first son, and now my second.

LEILANI WILDE: Sunny, have you ever been confused about your baby wanting to feed constantly for hours, or in your case maybe babies?

SUNNY GAULT: Oh my goodness, I feel like I’m always confused on what they want. My babies are a little bit different than what I’m hearing here in the studio, because I believe they cluster feed but they typically do it in the morning before their naps. It is already crazy in my house at night time, getting everyone ready for bed, so maybe I’m just not as in tune with their needs at night.

I would say I’m typically confused about their needs, but whenever I don’t know what to do with them, whenever they cry or whenever I feel like they need me I always offer the breast. That is my go-to thing for everything. Sometimes I don’t even remember which baby is on me. I mean they’re identical and I dress them alike, so a lot of the times I’m in a mode of just trying to handle the situation and care for other children at the same time.

Sometimes it’s hard to keep track of who’s feeding all the time, because they’re not necessarily doing it. If they’re cluster feeding, it’s not that both kids are necessarily doing it at the same time. One can be going through that and the other one not, and sometimes it’s hard for me to keep track of who’s doing what.

LEILANI WILDE: I suppose if you just are listening to what they’re saying to you, then you’ll probably figure it out. It’s kind of like the whole which breast is fuller.

SUNNY GAULT: Somehow it works out throughout the day, I don’t know.

LEILANI WILDE: Maybe you should squeeze their bellies.

SUNNY GAULT: Who did I just feed?

ROSE DEVIGNE-JACKIEWICZ: Sunny, you mentioned the morning, and while I mentioned that most often it seems to be night time there are many babies that will have another time during the day that is just their awake fussy time. It could be morning, it could be middle of the day, it could be afternoon. It’s not uncommon for many babies to have a couple fussy times during the day. Absolutely.

LEILANI WILDE: In your case, with you having older children they may understand that you don’t have that time in the evening, so they’re grabbing you when you are available.

SUNNY GAULT: Yeah, grab me when you can, right?

LEILANI WILDE: They’re adapting quite well. Why do babies cluster feed, Rose?

ROSE DEVIGNE-JACKIEWICZ: It kind of depends on who you talk to. There are a lot of experts when it comes to breastfeeding and babies, a lot of books out there but the exact reasons really aren’t know. We just suspect what many of the reasons are, and some feel like it’s the baby’s way, especially during that evening time, and that is the most common time when babies do cluster feed because it’s their awake time.

Many times when moms come in I’ll ask them, how is the baby feeding and does he have a tendency to want to eat, eat, eat in the early evenings? She looks at me like “How did you know that?” Being able to identify it before she even brings it up helps her to realize, oh, maybe it is normal.

Some feel like they nurse more to kind of boost mom’s milk supply, to kick start her milk supply. They nurse more during those few hours to kind of prepare for a long sleep. During fussy times they like to just be held and nursed, some want just extra sucking. Babies are just more awake during these cluster feeds and while it’s most common in the evening time, it can be at another time.

Babies are very individualized. Some of the other possible causes, which again, talking to your breastfeeding-friendly health professional, could it be during a grow spurt, which happens at certain times? Sometimes babies with reflux, GERD as it’s called, acid reflux, they eat more often because it makes them feel better. Potentially if moms do have a decreased milk supply, and there are lots of reason for that.

Colicky babies, your high need babies like to nurse more often and possibly maybe something mom ate made the baby a little more gassy and they like to nurse a little more. But those are not your common reasons, most of the time it’s just very normal for newborns in the first few weeks, four to six weeks at least to just need more one-on-one with mom.

LEILANI WILDE: When should we be concerned?

ROSE DEVIGNE-JACKIEWICZ: We should be concerned when, again, asking some of the key questions about how old is the baby, what is the general feeding pattern. Iif mom says “You know what, the baby eats all the time” not just in the evening time, not just for an hour or two in the morning but constantly cluster feeding, every hour. They’re never satisfied, maybe they’re not gaining weight well or they’re losing weight. They don’t sleep. If they sleep, it’s only 20-30 minutes at a time and they’re up fussing.

When moms are concerned, as health professionals we need to listen to her, not just kind of go “Oh you’re a new mom, you’re nervous about everything”. I’m always teaching moms to listen to their mommy voice, whether you talk to them on the phone or bring them in and assess the situation, most of the time it is going to be normal, but there are going to be those times where we may need to do a further assessment to identify why this baby is doing this.

Most of the time it is just reassuring mom just by showing her how the baby is gaining weight. Maybe doing a pre-imposed weight to reassure her milk supply is good, and going over what I call self-care measures. I do think we need to listen to mom, not just chalk it up as “Oh you’re a new mom and everything is fine I’m sure”.

LEILANI WILDE: When we come back, we will discuss with Rose what methods can be used to get through the hours or several days in some cases when dealing with the breastfeeding demands of our babies. We will be right back.

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LEILANI WILDE: Welcome back to the show, we are here with Rose, RN and IBCLC. Rose, what advice do you give to the parents who are struggling with normal cluster feed issues that occur in the evening hours?

ROSE DEVIGNE-JACKIEWICZ: One, I want to make sure moms understand that this is very normal, that it’s just the way babies are and to encourage them to take some extra rest periods throughout the day so they’re not so exhausted. One of the questions I ask moms every time I see them is “What are you supposed to do during the day when the baby is sleeping?” and they now know the answer: I’m supposed to be resting. To give moms that permission to give herself time, to take the extra time to sit and nurse.

Cut back on what you need to, on what doesn’t need to be done around the house during the day or in the evening to avoid you getting over exhausted. Wear babies. Baby wearing is I think one of the greatest things ever for moms to do, because babies want to be close and your hands are free. If you want to go for a little walk, if you just have to feed your toddler a snack, you’re carrying the baby and you’re multitasking, which is what moms learn to do very quickly. Change of pace: Give the baby to dad for some baby time. Grandma.

The baby just wants some skin to skin and cuddling, so have somebody else help. Go outside, go for a walk. Baby massage is also helpful. Try nursing lying down, it’s a great way to get some extra rest and avoid scheduling. It’s like “Well it’s not time for you to nurse because you fed”. Cluster feeds are totally separate, it’s their “I need you more, mommy” time, it’s what they need.

LEILANI WILDE: What about the grow spurts that last two to three days?

ROSE DEVIGNE-JACKIEWICZ: Grow spurts again are something that I like to educate moms about. It’s normal for babies to go through periods of time where they just want to eat, eat, eat. Usually right around two weeks, right around six weeks and three months. I reassure moms that most babies can’t read at that age, so it could be at ten days, it could be at three weeks, but right around that two week time frame babies suddenly want to eat, eat, eat. It’s like cluster feeding all day long for a couple of days. Normal. What they’re doing is they’re growing, they’re stimulating the breast to make more milk. Typically they only last a few days.

Again, during grow spurt times I tell moms absolutely not to plan any spring cleaning, don’t do anything that’s going to frustrate you when you know you’re going to be spending more time nursing. Make sure they’re drinking lots of fluids during this time as well. And yes, when moms go “You know, I feel like I’m nursing non-stop”, yes you are, but it’s short term and they’ll go back to their nursing routine. I hate the world schedule, but they’ll go back to their normal nursing routine within a few days.

LEILANI WILDE: Excellent. Courtney, what have you done when you experienced the evening cluster feeds?

COURNEY MELVETH: I just submit to it. I just know it’s coming, especially with my second son I just kind of expected it. it wasn’t so much of a big deal. I even had times when I’d be at like a party or something and people would be like “Wow, he’s constantly eating, you’re constantly feeding him.” and I’d be like oh, well, he’s cluster feeding. That’s what he does this time of day.

I think it stressed me a little bit more with my first son, because I just couldn’t understand what was happening. With my second I felt like yep, it’s this again. I just get ready for it, and just like all the things that Rose said, I just go “Okay, we’re going to be sitting for two or three hours for the most part” so we don’t need to worry about whatever other household chores didn’t get done. Messy house, happy kids.

LEILANI WILDE: How about you, Sunny?

SUNNY GAULT: I don’t have to worry about the nighttime thing so much, but in general I’m pretty much housebound. Fortunately I can do a lot of my work from the house, so that’s good. I pretty much have given up on bras, because I feel like they’re always nursing. I’ll wear a nursing tank with some built in support, and that’s usually easier than messing with my bras.

Other than that, I agree with Courtney. I kind of just submit to it and I actually welcome it a little bit. Maybe it’s a thing with breastfeeding multiple babies, but I was always concerned about having low milk supply with them. I never did, but I was always just like “Well how is my body going to feed tow babies? This is crazy, this just can’t happen!” I find that with cluster feedings, my supply goes up a little bit. Supply and demand, right?

My babies need more, so my body is giving more. I welcome that as an opportunity, I’ve donated some breast milk in the past to other moms and stuff, so I don’t think anything bad can come out of having more breast milk, whether it’s for my babies or to pump for somebody else. That’s the upside to it.

I truly feel like my babies are always on my breast, and maybe I am a little bit more private than I would normally be, because it’s just easier to be at home to take care of that. I even turned down some playdates and stuff with moms who I know aren’t breastfeeding, because I’m like “My boobs are just always going to be out.” Maybe that’s a downside, but I kind of welcome it. It’s just one of those things that, like you guys said, is not going to be there forever. These are my last babies, so every breastfeeding moment I have with them I just cherish. As long as they want to do this, for as much as they want to do this I’m just trying to relish in that moment.

ROSE DEVIGNE-JACKIEWICZ: Courtney said something that makes so much sense, and that’s “I anticipated it, I just knew it was going to happen.” With my first one, I had gone out to dinner with my husband because we thought, well, let’s go out on our first date. Of course, we had the baby with us.

We walk into the restaurant just as he starts his little “e-e-e” and it’s like oh my gosh, what was I thinking? I looked at my husband and said “You order it to go, I’ll go wait for you in the car.” Anticipating and just knowing that this is what we’re going to need to do. You’re going to get well-meaning friends that say “Well this is what you should do.” I’m always telling moms, moms that are type A have got to have things just so, and they’re afraid to kind of let their hair down and just do it.

I say you know what, just go home and say “Well my lactation consultant said I need to do this.” It’s giving moms permission to sit there for 2-3 hours and do what their baby needs.

LEILANI WILDE: Exactly. Did either one of you have well-meaning family or friends tell you just to give your baby a bottle?

COURNEY MELVETH: I did, in fact it was my mom who breastfed both of us. She, just being my parent who loves me, wanted to give me a break. I know that her heart was in the right place and the best intentions, but sometimes you just have to persevere and do what instinctually seems like the right thing to you. For me, that wasn’t it. Giving a bottle wasn’t it, I knew that what I was supposed to do was keep breastfeeding him until he was satisfied and also until my supply was totally normal, exactly what it should be for that baby. I didn’t listen to my mother.

SUNNY GAULT: I think your mother was talking to my mother, because I had some similar experiences with that. Fortunately, my twins never really liked bottles so she couldn’t really say give them a bottle, but now it has become more of a “When are you going to wean them?” kind of thing, which I know is a whole other story.

I think part of it too is… And this is in general, my husband and mom are just kind of in awe about how the whole process works and how all I have to do is lift up my shirt and two babies just come charging at me. It’s a very National Geographic kind of moment. It is very cool, so I give my babies a lot of props. I’m getting some pressure about weaning, but cluster feeds, no, it is what it is. You just kind of deal with it.

LEILANI WILDE: Right. Rose? Should they offer their baby a bottle? If not, why?

ROSE DEVIGNE-JACKIEWICZ: If it is truly cluster feed and the babies are doing great as far as weight gain, then no, babies don’t need a bottle. Yes, there are a lot of well-meaning family and friends that go “Give a bottle and give yourself a break.” We don’t general recommend giving a bottle, because it prevents the baby from doing that extra nursing to help boost the milk supply. It’s not formula that the baby needs anyway, or even breast milk in a bottle. Introducing a bottle too early can potentially interfere with the baby fully establishing breastfeeding.That’s not to say if a mom says “I’m at my wit’s end,” but babies during cluster feeds really don’t need that bottle in the evening time.

LEILANI WILDE: Thank you so much Rose, Courtney and Sunny for sharing this important information about how to cope with our babies while they’re cluster feeding. For our Boob Group club members, our conversation will continue after the end of this show, as Rose will discuss other soothing strategies for dealing with a fussy baby during these times. For more information about our Boob Group club, please visit our website at www.newmommymedia.com

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COURNEY MELVETH: Here’s a question from one of our listeners. This is from Rachel, and this is what she wrote:

“I have heard that the amount of milk you produce plateaus when your baby is around six months. Does that mean that I am now producing the most milk I can? Now that my baby is six months old, is it worth to try to up my supply by adding more feedings or pumping sessions?”

VERONICA TINGZON: Hi, this is Veronica Tingzon, I’m an international board certified lactation consultant working at Tri-City Medical Center and also in private practice here in San Diego County. Rachel, I want to go ahead and address your concern with regards to milk plateauing when the baby is six months old.

Yes, it’s worth pumping and seeing more increase in milk. You have to remember that there are different factors that not only make your milk supply plateau, but there are legitimate causes as to why your supply might decrease or vane a little bit. You’re getting close to getting your period back around that time, which can decrease your milk supply. Some moms go on birth control, even if it’s a mini pill, some moms are so sensitive hormonally,even with just a Progesterone that it can decline the milk supply as well. There’s also the fact that your baby is probably a very distracted feeder at this time and not really feeding as long or as often.

More solids are being introduced and teething might also be a factor. All of those things will kind of help to decrease the milk supply. Once you’ve established the milk supply, then you’ve pretty much got what your milk base is going to be, but you can always increase it marginally, You can try pumping a little bit more often, you can try feeding more often, you can try herbal galactogogue, especially ones like Goat’s Rue that contain some type of a balancing effect on your hormones.

That’s my suggestion, maybe add some herbal galactagogues, do a little bit of pumping, a little bit more feeding and concentrate on those times during the night when your maybe is maybe less distracted and does better feeding to really have your baby do some better breast time. I hope this helps Rachel, take care.

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LEILANI WILDE: That wraps up our show for today. We appreciate you listening to The Boob Group.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Parent Savers for moms and dads with newborns, infants and toddlers
• Twin Talks, for our show with parents of multiples.

Thanks for listening to The Boob Group: “Your judgment-free breastfeeding resource.”

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com

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