There is a question that ranks right up there with childbirth method, homeschooling, and whether or not you’ll let your children watch TV. Proponents of both sides promise you a happy, healthy child if you follow their advice, and a maladjusted, sickly child if you go with the other side. There’s been a lot of rhetoric spewed back and forth, along with condemnation, hurt feelings, and accusations. What am I talking about? The mother of all parenting questions: Are you going to feed your baby on a schedule (or “flexible routine”), or are you going to feed on demand (or “cue feed”)?
I used to find the debate frustrating and bewildering. I knew what I believed in my heart, but I was disturbed by so many other Christians who just as strongly believed something else. Then a couple of years ago, I stumbled across some information that finally helped me understand how people could have such enormously different experiences with feeding their babies.
Breastfeeding is a supply and demand process, and the way the “demand” is communicated to our bodies all depends on something near and dear to the hearts of countless women: storage space.
Think of it in terms of your kitchen counter. Imagine you and a friend are working in the kitchen serving up ice cream for a church party. You’re scooping out bowls of ice cream, and your friend is carrying the bowls to the hungry people. Well, imagine if every time you filled a bowl, it was instantly passed to someone, and maybe your friend was even standing there a moment, waiting for you while you scooped. You’d probably be working as fast as you could, dishing up ice cream at lightning speed. But what if your friend started walking around with a couple of bowls, and she couldn’t find anyone who needed any? You might notice that your filled bowls were starting to accumulate on the counter. In fact, you might be running out of space to put them, and by then, you certainly wouldn’t be feeling any pressure. You might look around, stretch, chat for a minute, etc., maybe even stop entirely, and have some ice cream yourself! Your “ice cream bowl production” slows to match the speed with which the bowls are removed from the counter.
It’s just the same with your breasts. It turns out that empty breasts “hurry” and make milk at a rate of about two ounces per hour, while full breasts slow way down and only make milk at a rate of 1/3 of an ounce per hour (and it’s a good thing they slow down production because otherwise we might explode). (Learn more here.) Put another way, empty breasts make six times as much milk in an hour as full breasts do. If your breasts are full, you have to empty them before you can make very much more milk. If healthy women are emptying their breasts regularly, they can have what is for all intents and purposes an unlimited supply (giving them the ability to nurse twins or even triplets).
Now, here’s where the storage space comes in. Imagine you’re back in the kitchen at your church party. How many bowls of ice cream are you going to fill before you give up on your friend and quit? It might depend on how much space you have on your counter. If you live in a farm house with acres of counter top spreading out before you, you might fill eight or ten more bowls before you decide to give up. But what if you live in a tiny newlywed apartment with barely enough space between the dish drainer and the coffee maker to cram in more than about two bowls? Are you going to fill ten? Not likely. You’ve got no place to put them.
Breasts are just the same. All women can make plenty of milk for their babies over a 24 hour period, but the amount that the breasts can hold without feeling uncomfortably full and needing to be emptied varies greatly. There is a 300% variation in milk storage capacity (counter top space) among women (Learn more here). We’ve all got a nice freezer, a Costco bag of plastic bowls, and a perfectly functional ice cream scoop, but how many bowls can sit on our counters before we stop filling them is not the same. If we don’t get the milk emptied out of our breasts, production will grind to a halt.
Now, think about something else. Chances are, all that “emptying” is going into your baby’s little tummy. That’s his food and drink for the day. So, that 300% variation also means something else. It means that when two babies nurse and take in almost all the milk each of their mothers has at any given time, the babies are actually getting different amounts of milk. Therefore, in order to take in exactly the same number of ounces of milk per day, two babies with different mommies are going to have to nurse two different numbers of times. It’s sort of like plate sizes at an all you can eat buffet. If your friend has a turkey platter for a plate, she’ll only need to go through the line once to get enough to fill her up. But if you have a salad plate, you’ll need to go through the line several times to get enough. And babies have different metabolic rates and activity levels, not to mention different sized little bodies! All these things have an effect on how many times they need to “go through the buffet line.”
OK, enter the schedule. Let’s say you buy a book that your friend said worked great for her, and the book says your baby should nurse every three hours or so, and that he shouldn’t need any more than that. You try your best to follow the book, but pretty soon, it appears that you’re not making enough milk. What happened? Storage space strikes again. Your breasts filled up, didn’t get emptied, and slowed production. If women have a 300% variation in milk storage capacity, then one schedule is not going to work for all of them.
This accounts for the wildly varying testimonies of different families trying to follow the same “book” schedules. I remember one father of a schedule fed baby who told me that the only problem he and his wife had was dealing with the jealousy of other parents when they heard how this dad’s baby slept through the night thanks to her wonderful schedule. But I have also read the words of other parents whose babies were on the exact same schedule who had very different experiences:
The reason why my baby was sleeping so long was her blood sugar was dropping so low she couldn’t wake up. She, in fact, was going into a coma. She may have had a pre-existing condition, but following Babywise (a scheduling book) reduced my milk supply and gave me a false picture of normal, healthy feeding and sleeping patterns, making her health problem truly dangerous. We almost lost our baby. –D.P.
After being admitted to the hospital, it took several specialists nearly 2 hours to insert an IV because his veins collapsed every time they inserted the needle due to his critical state of dehydration.
We can honestly say this was the hardest moment of our lives, knowing that our son was suffering and had been suffering for nearly three weeks because he had not been fed enough due to our foolish implementation of a feeding program taught by Prep (a scheduling program). –Jeremy, Lori & Son
We went to his 4-month appointment and he weighed in at 11 pounds, 6 ounces. He had lost nearly a pound in 2 months, where he should have gained at least 3.
I was horrified….
I still didn’t want to screw up my baby’s schedule. Mr. Ezzo (an author of scheduling books) promised me I’d have a demanding brat with “metabolic confusion” if I did. So I sadly sent my husband out for formula, and started pumping my milk to try and get my supply back up.
It didn’t work. Within a week I was feeding J. 75% formula. –K.M.
You can find links to more schedule feeding testimonies here. Of course, these are rather extreme cases, but they demonstrate graphically one end of the schedule response spectrum. And because there is such a spectrum, following a one size fits all schedule, no matter how well it worked for your friend, does involve risk. You have no idea whether your breasts will be able to store enough milk to continue to produce when feedings are spaced according to the schedule. You have no idea whether your baby will be like the daughter of the schedule feeding dad I knew or like one of the babies in the tragic stories I just quoted.
So, if your baby’s nursing needs can’t be predicted by an external schedule, how do you figure out when your baby needs to eat? Well, pretty much the same way you figure out when your older children need to eat. Not when they get so hungry that they’re crying (crying is actually a late indicator of hunger, according to the American Academy of Pediatrics Policy Statement, Breastfeeding and the Use of Human Milk) but long before then, when they either wake up, or when they say politely, “I’m hungry, Mommy, may I have a snack, please?” How does a baby who can’t talk tell you politely that he’s hungry? By making nursing cues, any kind of “increased alertness or activity, mouthing, or rooting,” according to the AAP, what we call at our house a “nursey face” –smacking his lips, opening his mouth, turning towards you, sucking on a fist or your shoulder or cheek. My current baby has always tried to throw herself down into nursing position when she wanted to nurse, taking a sudden sideways dive toward “lunch.”
Let your baby’s behavior tell you when it’s time to hit the buffet line, and keep that ice cream scoop going by keeping your counter tops clear.