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July 29, 2016

Breastfeeding is often one of the first challenges after giving birth and many mums worry about having enough breast milk to satisfy their growing baby. Lactation consultant Trish Warder explains how to get off to a good start.

When baby arrives it’s a wonderful time - but it can also be a challenging, emotional, confusing and tiring time. One of the main concerns for new mothers is whether they have enough milk. Milk supply is considered low if there is not enough being produced to meet baby’s growing needs. 

The truth is that most new mothers can produce enough milk for their babies, but to achieve this all mothers need the best start to ensure their milk-making potential is achieved, as a number of factors can combine to hinder milk production. 

What’s normal?

Our breasts develop with our monthly menstrual cycle and then reach full maturity during pregnancy in preparation for breastfeeding. When our baby is born, the pregnancy hormones leave with the placenta, while the milk-making hormones surge. It’s these first days that are a vital time for stimulating the milk production and building a strong foundation for our developing milk supply. 

The milk supply grows with our baby breastfeeding early, frequently and efficiently.

Early: within that first hour after birth. Then it’s time for a big sleep.

Frequently: breastfeeding at least eight times in 24 hours or when the baby shows pre-feeding behaviour, such as licking and searching for the breast. Babies need lots of closeness, so keeping them in skin-to-skin contact with the mother helps the milk making hormones surge and generally gets the baby thinking about feeding often. 

Efficiently: this means baby is swallowing and the feed is comfortable for the mother. Swallowing is minimal in the first few days as the baby is consuming small volumes of colostrum; it sounds like an exhaled breath. However, by days five to seven, ideally the mother is hearing lots of louder swallows.

Initially the breasts are soft and the baby drinks wonderful colostrum. In fact, it’s in our breasts from 20 weeks into the pregnancy! Colostrum is  powerful stuff and is present only in small quantities. The baby starts to wake up more after a few days, as he is getting ready for larger volumes. His job is to drive the milk production, so he does this by demanding lots of feeds. So then, by about days three to five, the breasts are firm and milk is starting to flow better. More swallowing is heard and baby starts to be happier.

Many mothers have heard about this golden rule of supply and demand: the more the milk is removed from the breast, the more milk is made.

How do I know my baby is getting enough? 

Wet nappies increase from one on day one to a few on day five. By then, the black bowel motions should have gone. The expectation now is that the bowel motions will change from black to brown to green to finally the runny yellow/orange bowel motions of a breastfed baby. Lots  of the latter are a good sign! Do expect seven to 10 per cent weight loss on day three post-birth, but after this you can expect weight gain. By two weeks, if not before, it is expected that your baby will be back to their birth weight.

However, breastfeeding is affected by many factors and often more than one red flag or risk factor is present for an individual mother and baby.

Potential red flags

Poor breastfeeding management (remember the need for early, frequent and efficient feeding): some information is conflicting and unhelpful and often mothers can get the wrong advice e.g. “Let sleeping babies sleep” or “Give a dummy.” Both of these comments are likely to cause poor milk production in the first weeks.

There are also many myths associated with breastfeeding that can set us on the wrong track. The fact is that breasts don’t have to leak and a mother doesn’t have to feel the milk let-down. Also, don’t worry that the milk will look thin and blue after a number of days. This is what mature breast milk looks like; it’s not weak or inadequate, it just doesn’t look like cow’s milk! 

Mother and baby behaviour: both are learning this new job,  so many of those early feeds don’t rate a gold star. Mother may be extra tired, emotional and may struggle to take new information on board, so some prior learning during pregnancy is likely to be helpful. Baby may not wake or latch correctly or feed comfortably or may fall asleep after very few swallows. It’s important to be able to identify ‘a swallow’. These babies will need to be woken to feed at least eight times but often up to 12 times in 24 hours. Remember that the baby’s stomach is initially the size of a marble!

Inadequate expressing if feeding is poor: remember the golden rule of supply and demand to build a healthy milk production. A mother is often best advised to hand express in the first days as this is more efficient, after which time an electric double hospital-grade pump is more useful for extracting milk. This type of pump will help your milk production best. A poor quality pump and inadequate guidance on expressing are also likely to hinder milk production. 

Micromanaging the feeding: in the first weeks this is often a contributing factor to inadequate milk production. Every baby and mother have different needs. Some babies are very efficient feeders, while others require more time. Babies’ temperaments play a role too, so take care with your expectations over ‘time’ or a ‘number’ on the feeds in 24 hours. Of course, babies’ feeding needs change frequently over the first weeks, as there are growth spurts and cluster feeds. All of this is normal and to be expected as baby challenges the milk supply to continue to develop.

Poor positioning and latch: the problem can be technique, which is important for efficient milk removal i.e. swallowing.
But the issue can also be an anatomical one for mother (e.g. breast or nipple tissue), or for baby (e.g. tight frenulum - a small fold of tissue that restricts tongue movement, also known as a tongue-tie).

Newborn health: for example, being born premature or with a heart condition. 

Maternal health: high blood pressure, minimal breast growth in pregnancy, breast shape, retained placental fragments, excessive swelling in the body post-birth, minimal filling of breasts in the week after birth, breast surgery (reduction or implants), other hormonal or endocrine conditions such as polycystic ovaries, insulin-dependent diabetes, thyroid or pituitary conditions, inability to get pregnant or maintain a pregnancy, hormonal birth control, medications such as Sudafed, smoking.

Tips for a good start 

  • Before baby arrives: watch friends feed, ask questions of mothers who are successfully feeding, go to a La Leche League meeting or a Preparing to Breastfeed session. 
  • Be well informed. Be careful where you source your information.
  • Learn what’s normal and when to act. 
  • Get help early, because the best chance of a full milk production is in the first days.
  • If you are needing to express and take things like fenugreek and Domperidone (used for insufficient milk supply), please stop and ask why? These strategies will help but it’s best to find out the cause(s) and resolve this if at all possible. 
  • If your milk production was low with your first baby then I would definitely suggest a session in pregnancy with an IBCLC/International Board Certified Lactation Consultant early for a full consultation. This includes a careful assessment of the mother’s history, putting a plan in place and then following up. '

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