The Importance of Weaning Safely, Whether You Breastfeed or Not
Just a quick reminder this article is focused on weaning a mother’s milk supply, not a nutritional guideline on how much breast milk or breast milk substitute is needed for babies. Most pediatricians recommend breast milk or a breast milk substitute until at least 1 year.
I interviewed one of my favorite IBCLCs (International Board Certified Lactation Consultant), Catherine “Cat” Halek, to learn more about the importance of safely weaning milk supply. Regardless of your choice to initiate breastfeeding, provide expressed breast milk, or feed your baby with an alternative option right off the bat; it’s important to tamper down supply carefully. In this series we discuss some important facts and insights for weaning your supply as well as different examples on how to wean safely.
Q: First things first, what is weaning?
According to Cat, “The moment you offer anything but the breast you have started the weaning process.” This may sound abrupt, but it’s not meant to. So let’s reframe this a bit. You start breastfeeding with the intent for it to end at some point. Every step of introducing a bottle, pacifier, solid food, etc. are all small steps toward weaning. And that’s okay because in time this phase will end, but it can take weeks, months, or years. “Weaning can be systematically faster or take as long as it wants to.” Cat explained further, “With breastfeeding it’s much more of a slow and gradual process. Having that perspective as you begin breastfeeding can be very helpful. Because, in those hard moments you can be like- it’s okay I will take one more step closer or weaning. And then the next day you can be like- ehh I’ll put a pause on the whole weaning process.” It doesn’t have to be all or nothing when it comes to weaning. (Unless you have life factors that are driving the weaning schedule, in which case please keep reading and stay tuned for weaning scenarios and example plans in parts two through four.)
Q: Why does weaning carefully matter?
Weaning safely protects the health of your breasts. Cat explained, “When you wean over several months you don’t really have to worry about the impact of weaning on breast health.” However, when a mother stops cold turkey or takes drastic measures to wean they can end up with irreversible damage, not to mention extreme discomfort. For the woman planning to build supply and provide breast milk, a plan that fits her needs and unique timeline can be especially helpful (more on this later). Cat says, “Women who birth a baby and do not want to continue with breastfeeding, for any reason, still need to have a weaning plan. They may be starting to wean immediately and a little bit more aggressively, but it’s important for everyone to wean carefully to avoid pathological engorgement.” Pathological engorgement happens when “your breasts are swollen and full from birth fluids and breastmilk”. Cat shared that “if engorgement is not addressed in a timely manner and alleviated, then what you are doing is telling the glandular tissue in your body not to make milk. But you are doing it in a way that might actually damage the glandular tissue which can ruin their ability to produce milk now and in the future.” Cat encourages mothers to wean safely and take care of their breast health, even if they choose not to provide human milk. She also warns against poor advice such as tightly wrapping or constricting breasts postpartum as this can also create damage- not to mention be painful.
Q: How can a woman wean immediately or closely following birth?
For a safer approach to weaning immediately after birth here’s what Cat suggests:
“For women who don’t want to breastfeed (or provide breast milk), do not stimulate your breasts during the first 3-5 days postpartum. Just leave them alone. When you stimulate your breasts in the first 3-5 days, you are telling your body via receptor sites to boost prolactin which is the milk making hormone.” This is the first step in taking the milk making process down a notch which will make the next steps easier. “Most women will still have some level of fullness, which is engorgement of their breasts when their milk comes in usually between days 3-5. When the engorgement hits, you don’t want it to get so bad that they are rock hard and painful.” She suggests expressing only a little bit of milk, and only for comfort via hand expression, breast massage, or lymphatic drainage techniques. If you pump or breastfeed, you are asking your body to make more milk. When you are just alleviating pressure it shouldn’t tell your body to keep ramping up supply.
Cat also added, “I like hand expression as an option a lot. I think everyone, whether they are breastfeeding or not, should get comfortable with touching their boobs during pregnancy. It’s just a helpful tool and we should all be doing our monthly breast cancer screenings anyway.”
Lastly, some women benefit from anti-inflammatory measures. Ice or cool packs along with certain foods, supplements, and medications all fit within this category. Often, women are already recommended some type of postpartum anti-inflammatory measures following birth. As usual, this should be discussed with and okayed by your doctor to be on the safe side.
Example plan:
Don’t encourage the milk supply to ramp up (i.e. do not stimulate breasts)
Alleviate pressure for comfort (e.g. hand expression, gentle breast massage, lymphatic drainage)
Short period of anti-inflammatory measures as needed around day 3-5 when milk is coming in (e.g. ice, supportive nutrition, supplements, or medications which ought to be discussed with your doctor)
Q: What should we know about accelerated weaning for the woman with an established supply?
I asked Cat about women with an established breast milk supply, the ones who spent the post birth period encouraging milk. She might be weeks or months into providing breast milk, but need to wean with some level of efficiency. Is there a difference in what she would do?
First Cat recommends, “Take a beat and check in with what you are currently doing to get a basic baseline.” Some moms already have every intake and output tracked and recorded, and other moms don’t really know how long or frequently their baby is feeding. “You know really, neither of those are the correct or better way. There's detailed tracking, not tracking, and everywhere in between, right? So when you're ready to wean, if you're not one of those people that have everything recorded of every breastfeed, it's helpful to know ‘what are you currently doing?’.” If this is the case, she recommends logging the schedule for a day or two:
7am- pumped ___ minutes
10am- breastfed for ____ minutes
12pm- breastfed for ____ minutes
Etc. for a 24 hour period
Once you have a baseline you know where you are starting from you can make small incremental changes. Cat says it can be easier to control weaning off pumping since you already have the minutes and measured output to go off of.
One question that Cat encourages mothers who are time pressed to wean to consider, is why they are weaning. “Is there a problem to be solved, or what is the pain point? If possible, fix the problem and go slow on weaning. No problem to be solved, or circumstances that really do require weaning now? Then it’s time to make a plan.” Cat gives examples of breastfeeding mothers who have had a horrible time dealing with recurring mastitis or constantly having multiple plugged ducts who were just done. “For these circumstances, then I think it’s easier to switch to pumping.” Be sure to transition the baby to their new feeding plan (make sure they accept the bottle and tolerate the new nutrition plan). Then start the step down process of weaning supply on the pump. She said to aim for “two or three days between steps and then when you have any pain or push back from your boobs from the weaning process, you increase that to maybe two extra days.” There’s no need to return to the previous step, just stay at the current step for longer. In her practice, Cat writes a very specific plan from start to finish to fit a mother’s situation. A mom will typically reach out a couple of times throughout the process to check in and ask any questions based on how it’s going. Here is an example of what to do below. Keep in mind, this plan may change depending on your personal baseline.
Example Plan for Weaning with a Pump:
1. Transition baby to new feeding method as gradually as needed to keep baby thriving.
2. Stop breastfeeding and start pumping.
3. Pump every 3 hours working toward a 6 hour stretch at night.
4. Step down every 3 (or more) days by either the length of the pumping session OR the frequency of the pumping session (e.g. steps: pumping 8x/day for 15 minutes, 7x/day for 15 minutes, 6x/day for 15 minutes, 6x/day for 10 minutes, 5x/day for 10 minutes, 4x/day for 10 minutes, 4x/day for 5 minutes, etc.).
5. Keep an eye out for signs of pain, mastitis, plugged ducts, or push back from your breasts which is indication to slow down and stay on your current routine for an extra couple of days before continuing.
For many women, accelerated weaning is not necessary. If you are ready for partial weaning or strategies for modifying an exhausting schedule, stay tuned for part three. Then in part four we ask Cat for help on how to wean our older babies and toddlers.
Q: How can we cater our overall weaning plan to fit our needs, wean we have a little time?
Let’s jump right in. Cat always recommends starting by looking at the whole picture and asking, “What is the root problem or the part that is stressing you out the most?”. Is it sleep deprivation, needing more time alone, or the stress of doing all the feeds? (Is it all of the above?). You can also simply ask which is the most stressful feeding session. Cat always asks a mother to share about what is going on so she can help provide the most catered and supportive plan for that family. Cat pointed out that oftentimes when a mother calls for a weaning consult, breastfeeding isn’t the actual problem. “Breastfeeding gets blamed for everything,” Cat laughed. “Sometimes there’s something else that’s the problem that’s related to breastfeeding, and once that’s managed better breastfeeding the rest of the time is great.” She says the most common answer she gets is that the nighttime feeding or pumping sessions are the hardest. Many moms are just so tired of waking multiple times a night to breastfeed at this point, are often back to work, and needing more sleep to function. “I find that if there is a partner or other caregiver in the home that can take on some of the nighttime responsibilities it makes a big difference for the breastfeeding mother.” She goes on to say, “What that can look like is, maybe instead of breastfeeding at 10:00 p.m.; right before putting the baby down for the longest stretch the other parent comes in and gives the baby a bottle and puts the baby completely and totally to sleep without the mom”. This can be helpful because there is a natural sleep association with breasts and breastfeeding. She adds, “there’s nothing wrong with a baby falling asleep at the breast, but when you get to the point where you are ready not to have them wake so frequently during the night then it’s helpful to slowly disassociate sleep from the breast”. Sleep is a whole other topic for another day, but the point of this last suggestion is to take some stress off the breastfeeding mother and make small steps toward weaning. This nighttime example is a small step specifically toward night weaning. One important thing Cat specified here is that the majority of infants will still nurse or feed at least once per night. “It is not appropriate to fully night wean before a year old. Unless they are doing it on their own and completely sleeping through the night.” She says it is totally normal and developmentally appropriate to still have some night waking for a while. Getting a plan where all the sleep deprivation is not solely on the breastfeeding mother’s shoulders and the baby is supported to sleep their longest stretch can make a considerable difference. Just remember, that if the goal is to continue the breast milk diet then you will have to pump to provide for that feed.
Example Plan:
Changing the routine to include someone else giving a bottle at the least convenient feed, such as the last feed before bedtime
Drop feeds based on the baby's ability to sleep through without waking (a caveat here is if there is a medical reason to wake your baby to feed them, then please follow those specified recommendations)
For many women, a tailored approach can be helpful when providing breast milk feels burdensome. Considering how to create a balance that works for you and your baby can help avoid the all or nothing mentality when it comes to breastfeeding. My opinion is that a modern lactation consultant should be able to support your breastfeeding journey, and sometimes that includes partial weaning.
If you have been in the breastfeeding game for a while and are ready to wean, check back next week for part four. This is where we cover weaning the older baby (who is now likely at least a toddler). This age group comes with its own challenges when it comes to weaning and Cat offers multiple strategies to provide weaning support to this group.
Q: Can you give us some ideas for how to wean an older baby, toddler, or child?
There are a few scenarios and styles of breastfeeding for the older baby, or rather toddler or child at this point. This is for the child with whom breastfeeding is well established and they are old enough to be “asking” to breastfeed with clear communication strategies. Not cueing, but asking (or in some cases demanding). Examples include pulling at your shirt to nurse, signing for milk, using words to request nursing, etc. There is a wide range of breastfeeding routines for those still nursing at this age. Here we broke down a couple examples one by one.
For those nursing on demand, Cat says you can try the “don't offer, don't refuse” method. She clarified, “So this is for older kids. When you do, don’t offer-don’t refuse, you are trying to minimize the comfort feeds. But you have to figure out other ways to soothe your child in place of breastfeeding.” She provided examples such as offering a drink, something to eat, or hugs. “Because what is breastfeeding? It’s for when they are hungry, thirsty, or they want comfort. Breastfeeding is all of that in one package. So if you can help them figure out, ‘Am I thirsty, is that why I wanted to breastfeed? Or am I hungry? Or do I just need affection?’ you are helping to meet their needs rather than just removing breastfeeding.” If they are still persistent about nursing, you don’t refuse or withhold. You can also try setting some boundaries on where you nurse. For example, only nursing at home on the sofa or in the car. When it comes to this strategy Cat says, “be sure to keep gently explaining these new rules if you didn’t have these boundaries in place from the beginning.” As they begin to understand the new routine and boundaries around breastfeeding, many toddlers will prefer to stay at the park or with the action over leaving to nurse. As time goes on, breastfeeding slowly reduces and disappears as does your milk supply.
Alternatively, there are moms of older babies or toddlers who still breastfeed a limited number of times a day on a fairly predictable schedule. Cat gives the example, “I totally have worked with moms that are like, okay, between 12 and 1 we nurse. And then there's a breastfeeding session between 3 and 4. And they don't really breastfeed outside of that. And for those moms, when they're ready to wean, I usually ask them. ‘What is the most annoying feed for you?’. Like which part of the breastfeeding experience, or pumping experience, is the most obnoxious?”. That is the feed she suggests to start with. For these day time feeds, you can try offering an alternative drink, snack, hugs, attention, play, etc. Remember the don’t offer-don’t refuse strategy when you find yourself in routine mode and about to offer even though your baby is totally focused on something else… slowly, without drawing attention to yourself, remove your hand from your shirt and do not initiate breastfeeding.
With either scenario, a mom may gradually reduce the amount of time at the breast. Again, it’s important to know what your general nursing baseline is here. You are just shaving off a little of the time at breast. (My favorite strategy is to have Dad walk into the room toward the end to provide a natural happy distraction- so exciting that the nursing session is over). Cat says, eventually “you can literally count to ten and switch sides and then they are all done.” This time cap option helps by not encouraging supply while still meeting the child’s needs. “And what’s really cute is the older kids who are starting to talk- they’ll count with you.”
The biggest mistake often made is thinking that you can wean by leaving for a weekend and just ripping the Bandaid off. “It might work for some toddlers, but for others they become a stage 4 clinger and want to nurse even more. And then, whoa, better not let mom out of sight because she might disappear again!” said Cat.
It’s important to note that these strategies are meant to be gentle and gradual, but not a perfect straight line of success. Cat says, “It’s okay to nurse if you’ve tried all of the things and your baby still wants to nurse. Giving in is part of the gradual weaning process.”
Example Plan:
Try don’t offer-don’t refuse
Take small steps to set boundaries on where you nurse, but be sure to keep gently explaining these new rules
Offer substitutes to meet the need(s) they are seeking in another way such as a drink, food, and/or a hug
Decrease the time at the breast
Remember, it’s okay to breastfeed your baby if you’ve tried all of these and they still want to nurse
If you have a unique situation, history of breast issues, or just want additional support, then creating a tailored plan with a lactation counselor is a great option. Weaning plans can even be created via virtual appointments.
Thank you so much Cat, for sharing your time and expertise on this important matter and for having our “breast” interest at heart!
Catherine “Cat” Halek is an IBCLC and Infant Feeding Specialist who provided the quality information for this article is an active provider via phone, virtual, and in person support. If you would like to reach out to her specifically, here is a link to her website: CatHalekIBCLC.com
Written By: Barbara Nelson, M.A. CCC-SLP, CLC, CBS