Sunday, January 13, 2013

So You Want to Stop Nursing

There will come a time in your baby's life when you no longer want to breastfeed, or he no longer wants to breastfeed, or you come to some kind of mutual agreement that breastfeeding needs to stop. Or, sometimes, it's out of your hands and a medical condition requires you to stop breastfeeding. What do you do?

Well, some of it depends on the age of your baby. Unless there is a medical condition that requires prompt weaning, I personally would not recommend weaning before at least three months of age. I encourage and champion mothers to continue to nurse exclusively until at least six months, as per the AAP, WHO, and other health organizations' recommendations. I also encourage and champion mothers to continue to nurse in tandem with feeding other foods from six months to one year, and I also encourage and champion mothers to continue nursing beyond a year until they are ready to stop.

Alternatives to Total Weaning:

A few points to consider before you decide to wean completely, whatever your reasons:
  • Sometimes cutting back to just a couple of sessions a day can make nursing more enjoyable. If your baby is over a year and eats well, you can introduce whole milk and try to cut back to only nursing once or twice a day. (This is partial weaning, and some tips for doing this will follow.)
  • Just because a doctor prescribes a medication and says you can't nurse while on it doesn't mean that it's true. Doctors don't always know which medications are truly compatible or safe for breastfeeding, and they tend to err on the side of caution. If you need to take a particular medication, first find out if there is a breastfeeding-friendly alternative, or double-check if that medication is truly dangerous to your child or your milk supply. You can check Dr. Hale's Medications and Mothers' Milk or go to the Infant Risk Center's website and look up the medication, or give the Infant Risk Center a call at  (806)-352-2519.
  • While in the thick of it, nursing for six months or a year may seem insurmountable, but it's really a very short time in the scheme of things. It will get easier as you go along, and while you may never enjoy nursing, it should become less of a chore. Stick with it for just a little longer and see how you feel.
  • It's normal to sometimes feel overwhelmed by nursing, especially if you have a baby who nurses frequently. Set yourself small goals, like one more week or one more month or even just one more feeding. Often after a few days, that feeling will pass and you'll again be content to continue nursing. Sometimes life gets complicated and it seems like weaning would be an answer to the complications, but once things lighten up, nursing won't seem like such a burden.
Okay, but you really do want to cut back or stop. How?

First of all, no matter the age of your baby, I recommend taking it in gradual steps (if possible), rather than stopping cold turkey. If you're going from mostly breastmilk to mostly formula, it's going to be very hard on you and your baby to stop very suddenly. You will become very engorged and risk developing plugged ducts and mastitis. Your baby's system will be shocked by the change and he may become physically uncomfortable as well as emotionally upset. After about three days to a week, both of you will feel better, but I do not recommend cold-turkey weaning if it can be avoided, especially with a young baby.

Immediate Weaning of a Young Baby:

If you do have to stop immediately, here are a few ideas to ease the transition.
  • If the baby won't take a bottle from Mom, try to have other people around who can help feed the baby while you wean: Dad, a baby-sitter, grandparent, etc. Sometimes a baby won't take a bottle when Mom is around because the baby wants to nurse.
  • Make sure you still give baby lots of cuddles, hugs, kisses, and love. Sometimes having to wean suddenly, especially if you didn't want to, can make it hard to find ways to connect to the baby, and you want to make sure you maintain your closeness even when you can't offer the breast. 
  • Remember: Even if you can't nurse, you can still co-sleep, do skin-to-skin, wear your baby, and find other ways to support your baby physically and emotionally. 
  • You don't want to bind your breasts because that could cause plugged ducts and mastitis. 
  • Chances are, you will become engorged as soon as you've missed the first feeding or two. You may express a small amount of milk to relieve any immediate discomfort, but removing milk will encourage your body to make more, so be careful.
  • Other ways to help with the engorgement and dry up your milk:
    • Cold compresses will help slow blood flow (and milk production) and ease some of the pain. You may also take a pain reliever.
    • Cold cabbage leaves in your bra. Buy a head of cabbage and keep it in the fridge. Pull off a leaf and break the veins, then put it on your breast inside your bra. When it warms up, put a new one. Repeat as needed.
    • Avoid warm water directly on your breasts, as this will stimulate blood flow.
    • Try to avoid foods that encourage milk production, such as oatmeal and the spice called fenugreek often found in Indian food.
    • Some women find that herbs such as sage and mint reduce their supply.
    • As a last resort, medications such as pseudoephedrine (Sudafed) may reduce milk supply as well.
  • This may be a difficult time for you emotionally. Be sure to continue to care for your baby in other ways. Ask your family and friends to help you watch out for signs of depression.
Milk Donation:

If you as the mother are the one with the medical condition requiring weaning, there are ways to continue to provide breastmilk to your child if you want. There are several mother-to-mother milk donation sites that match up willing donors with mothers in need. These include Eats on Feets, Milkshare, and Human Milk 4 Human Babies. Typically, the agreement is that one or more women will pump for the baby and supply you with their milk, and you will cover the costs of any shipping (if the donor is not local) and for storage bags. This can be a great alternative to formula, or you can feed your baby a combination of donated milk and formula.

If your baby has a medical condition that requires you to wean from breastmilk but you are not certain you want to dry up your milk, you can continue to pump and save your milk to donate via one of the sites mentioned above, or you may be able to donate to a Human Milk Banking Association of North America milk bank (HMBANA), a nonprofit organization which provides donated breastmilk to preemies and other babies in need. Helping other babies via your breastmilk may help you come to terms with the emotional loss of having to stop nursing your own baby.

Gradual Weaning of a Younger Baby:

If you do not need to wean immediately for a medical reason, weaning can be a much more gradual process.

To gradually wean a very young baby (under three months), you may just have to offer a bottle of formula instead of nursing when your baby shows signs of hunger. Slowly give more bottles and nurse less often until you've found the balance you want. Keep in mind that you may not be able to maintain a partial supply if you wean before three months postpartum. Again, I do not recommend weaning such a young baby from the breast, as those first three months are vitally important to his development, the population of his gut flora, his brain and eye growth, his immune system, and his bond with you. However, if your health or your baby's health depend on your weaning from the breast, then it may not be difficult. Some babies will reject a bottle, and it may be a matter of basically forcing the issue (a baby won't let himself starve) or finding an alternative feeding method until he is ready to take a sippy cup instead. Also, sometimes a baby will prefer one bottle over another, so it may be worth trying a few different brands.

Gradual Weaning of an Infant:

For an infant, the ease of weaning will really depend on whether your baby is willing to take a bottle, and if he tolerates the flavor of formula. As above, it may be as straightforward as replacing a breastmilk feeding with a formula feeding. Remember that until six months of age, the only thing your baby should be eating is breastmilk or formula. If he takes a bottle but doesn't like the flavor of formula, you can try mixing expressed breastmilk with formula and gradually increasing the ratio of formula to breastmilk until he's completely on formula. You may also need to experiment with the temperature of the bottle. Some babies prefer a cold bottle, while others will only take it warm. Some don't have a preference. If he doesn't take a bottle, it may be difficult to introduce one. For a baby over six months, you may try to increase his solids intake or try mixing formula with his cereals or vegetables so he gets the nutrients he needs. You can also try offering formula in a sippy cup or straw cup, as some kids won't mind drinking from a vessel completely different from the breast even if they don't like the bottle. From six months to one year, gradually increasing solids and decreasing feedings from the breast may be all you need to do, and taking several months to completely wean will make it a very gradual and comfortable process.

Remember that until one year of age, breastmilk and/or formula should still make up the majority of your baby's diet, not solid foods. Also, do not introduce whole milk until one year of age.

If your baby relies on nursing to fall asleep or stay asleep, you'll have to take that into account when you decide to wean. You may need to have someone else put the baby to bed for a few nights so that you can break the association of nursing and sleep. I'm not saying it's going to be an easy process, but after three nights to a week, your baby should be used to falling asleep without nursing. It may take a few tries to find what new technique works best, but some ideas to try are rocking, shushing, singing, using a pacifier, putting white noise in the room, swaddling (for younger babies), and patting.

Weaning a Toddler:

For toddlers, weaning may be both more difficult and more simple. Since toddlers can get all the nutrition they need from solid foods and cow's (or other whole) milk, you won't need to worry about introducing a bottle or giving formula. However, toddlers also know how to ask for (demand) what they want, and they've learned to associate nursing with comfort, care, and closeness and may ask for it even when not hungry. However, toddlers also start to understand language, so it can help to talk to them about the weaning process (in an age-appropriate way). You can use phrases like, "No nursing right now. Do you want a snack?" or "You can nurse after ____ (we get home, you eat some peas, we read this book, whatever)," for example.

Many websites will suggest that, to wean, you eliminate one session per day and offer food or water instead. This is not so simple if you're nursing "on demand" still or do not have a predictable nursing schedule. Here are a few other suggestions I can offer for weaning a toddler. I suggest choosing one of the following techniques and sticking with it for a few days, rather than trying several at once or switching from one to another randomly. As with anything else with a toddler, consistency is key.
  1. Have a designated nursing area in your house. Only nurse there. It could be a special chair, the living room couch, your bed, his bed, etc, but be consistent. "You want to nurse? Okay, let's go to the nursing chair (or Mommy's bed, or whatever)." Sometimes a toddler will be too busy to actually want to go somewhere else and nurse. This can also discourage nursing when out and about (if you want to do that) because the "nursing place" won't be available.
  2. Make a rule about when you nurse that your toddler can understand. Only nurse at night or when the sun is up. Only nurse for sleeping. Only nurse after a meal. Only nurse when we get home from X. Whatever works for your routine.
  3. Rather than cutting back on the number of sessions, cut back on the duration. Start counting, or sing the ABC's or other song, or something that your toddler will understand the "end" of. Say that when you get to the end, or when you get to X number, that he has to stop nursing, and then make him stop. You can start out by not beginning the countdown until he's been nursing for a solid amount of time, and then gradually start the countdown earlier in the sessions once he's used to stopping at the end of it. 
  4. As a last resort, you can try purposely drying up your milk. This may not eliminate the comfort-nursing, at least not at first, but if there's no milk, nursing won't be as satisfying. Again, this would be a last resort. There are herbs (such as sage and mint) that can cause your milk supply to drop, as well as medications that may have a similar effect. This information may be more useful to dry up your milk after you've weaned.
Remember that as you wean, you'll need to replace nursing with something else. Nursing isn't just about food, it's also about comfort, closeness, love, reconnecting, and snuggles. You'll need to make sure he's getting his nutrition from other sources, but you'll also need to meet his emotional needs by allowing lots of cuddles, hugs and kisses, telling him that you love him, and reassurance. 

I want to reiterate that I'm not saying weaning will be easy. Indeed, weaning can be very difficult. Yes, some kids wean themselves. Some begin to prefer the bottle over the breast and simply don't want to nurse anymore. Some mothers find that their milk supply dwindles on its own (such as during pregnancy), which discourages their babies from nursing. Some toddlers are just too busy to stop and nurse. 

If your baby isn't one of those, then weaning will be a challenge. If you decide to say no, you have to stick with it. Your toddler may scream and cry. He may throw a tantrum (he's a toddler, after all). He may hit and kick and claw at you. This depends on your kid, of course, and how he handles being told no (and how attached to nursing he is). You may need to physically separate yourself until he calms down. You will need to find ways to handle the tantrums safely. You can treat nursing and weaning just like anything else you want your child to learn: manners, how to treat friends, sharing, picking up toys, not throwing food on the floor, cooperating during diaper changes. Be consistent and firm.

You may also find that once you have gained some control of the situation, nursing will become more tolerable or even enjoyable. When you're nursing on your terms instead of your toddler's, and you don't feel that your toddler is taking advantage of you, you may find that you don't need or want to wean completely. In this case, you may also want to try the "don't offer/don't refuse" method, whereby you don't ask your toddler if he wants to nurse, but if he asks, you consent. Over time, the child may simply ask less often as he becomes busier and more interested in the world. This is called "child-led weaning," as opposed to "mother-led weaning," and it is a method that works well for some women who are not in a hurry to wean but don't mind cutting back. It also depends on how attached your toddler is to nursing.

If you have weaned or partially weaned your baby or toddler and would like to share how it went for you, please comment with your story. If you have questions for those who have been through the weaning process, please post them in the comments as well. Weaning can be a touchy subject, but at some point, all kids stop nursing, so weaning is relevant and important to discuss.

Read my story about nursing and eventually weaning my middle son, S, here. I haven't started weaning G yet, but I have been known to tell him no or put him off for a bit, either by distracting him or by offering food. He's also used to mostly only nursing in bed, so that has helped keep him from asking to nurse 20 times a day.

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