MILK SUPPLY DEMYSTIFIED

Understanding how milk supply is established and maintained is crucial information for a breastfeeding mother.

What are the factors that drive milk supply?

Breastmilk supply is driven by two primary factors:  nipple stimulation and draining the breast.  Nipple stimulation occurs when a mother places the baby to breast and the baby begins to suckle.  Put simply, a signal is sent to the brain that says "make milk."  The brain causes the milk ducts to produce milk.  Milk is then ejected from the breast by involuntary muscle contractions.  This is commonly referred to as a "let down".  The breast continues to be drained by the suckling baby.  The milk flow slows as the baby drains the breast of milk and the flow of milk eventually stops.  If the baby continues to suckle the process repeats - the drained breast along with the stimulation of the nipple tells the body "make more milk."  The process of "let downs" can occur several times during a feeding.

When either of these two mechanisms - nipple stimulation and draining the breast - is consistently reduced or eliminated the result will be a decrease in milk supply.  Nipple stimulation is reduced by the use of pacifiers, supplemental bottles or when the baby will not come to breast or stay at the breast for a full feeding.  Drainage of the breast is compromised when supplemental bottles are given in place of breastfeeding or when the baby will not feed long enough to drain the breast.  Mothers can compensate for the use of supplemental bottles by using a breast pump to fully drain their breasts whenever a supplemental bottle is given to the baby, thereby protecting her milk supply.

My baby is breastfeeding all the time.  I don't think I have any milk in my breasts and that my baby is hungry.  My family is telling me to give the baby a supplemental bottle.  What should I do?

The best way to know if your baby is getting enough is to  watch your baby.  If after coming off the breast from a feeding, the baby is content you can feel assured his/her tummy is full.  If your baby is feeding for more than 20 minutes on each side during one feeding, or if he/she cries when removed from the breast after a feeding you may need to seek the advice of a Lactation Consultant for further evaluation.

As long as your baby is gaining weight, your baby is getting enough to eat.  By day 3-4 you can take a base weight measurement of your baby.  This can be done with a scale that measures pounds and ounces which can be found at a pediatrician's office or a local post office (put the baby in the carrier and weigh both the carrier and the baby then subtract the weight of just the carrier).  Wait a day or two and then repeat the weighing process at approximately the same time of the day.  In the first few weeks, the baby should gain an average of  approximately 1 ounce per day. 

Remember, a baby's stomach is the size of the of their fist.  Baby's eat frequently because their stomachs can't hold large quantities of food.  Giving supplemental bottles is not a good idea unless medically necessary.  Frequent feedings are natures way of ensuring that the milk supply gets well established.  If your baby is hungry, feed him/her - the additional nipple stimulation and draining of the breast will automatically tell your body to "make more milk" and within a few days your supply will adjust to meet your baby's needs.

For tips on increasing your milk supply, click here.

For information about the differences between formula and breastmilk, click here.

For information about breast pumps, click here. and pumping tips click here.

To understand why a newborn eats all the time one must consider how milk "comes in" and the reasons behind mother nature's design.

Colostrum.  At the time a baby is born, the mother's breasts contain a substance called colostrum.  Colostrum is a thick yellow liquid that is rich with proteins, carbohydrates and fats that are balanced just right for the baby's nutritional needs.  Called "liquid gold," colostrum is produced in small quantities.  There are several reasons for this.  1) The baby is learning to suck, breathe and swallow all at the same time.  Large amounts of liquid could cause the baby to choke. 2) The baby's digestive system is immature and filled with meconium (a tar like substance that collects in the digestive tract while the baby is in utero).  Colostrum is designed to help move this substance out of the baby's digestive tract while maturing the tissues of the intestines.  3)  The small quantities cause frequent feedings.  This results in lots of nipple stimulation, helping establish milk supply, and frequent bowl movements (studies show that it is frequent bowl movements, not  frequent feedings, that reduces the incidence of jaundice. Colostrum is present in the breast for about 2-3 days. 

Transitional Milk.  By day 3-4, the baby has been eating every 1-3 hours around the clock and the milk is "coming in." For a few days the milk is a combination of colostrum and mature milk.  Some babies continue to feed frequently to drive the milk supply even higher. 

Mature Milk.  By day 6-7 breastmilk is fully mature.  During the next 6 weeks feedings will be gradually space themselves and become more routine.

I want to give a bottle to the baby and a pacifier to get a break once in a while.  Do bottles or pacifiers affect my milk supply?

Spaced out a few times per week, pacifiers and supplemental bottles should not affect milk supply.  However, regular use of supplemental bottles compromises the two key factors needed to maintain a well established milk supply (see above).  In addition, pacifiers can create sucking styles for the baby that are not effective at the breast and which can cause a mother to have a painful breastfeeding experience.  Most pacifiers are too short to mimic the length of the human nipple.  The result can be that the baby will have shallow latch and suck the tip of the nipple.  This can cause blisters, cracks and pain which can ultimately interfere with breastfeeding and therefore milk supply.

For bottle feeding, using a slow-flow nipple is key.  Fast-flowing nipples that are easy to get lots of fluid from make it easy for the baby to eat rapidly.  While some babies will willingly switch from bottle to breast regardless of the nipple type, others begin to prefer the bottle because it is less work than breastfeeding.  To play it safe, check the nipple to make sure the baby will have to work to eat before introducing the bottle to the baby. 

If your goal is to fully breastfeed your baby, avoid or sparingly use pacifiers and pump if your baby has to receive a supplemental bottle.

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