Basics of Breast Milk
In my work as a postpartum doula, I hear new moms talk quite a lot about how much they want to breastfeed as long as possible. And yet, every day I hear new moms skeptically share advice they've been given by family members, friends, and sometimes even from staff at their hospital.
For this reason, I've put together a series of blog posts that offer basic information about breast milk, breastfeeding, and breastfeeding support. If you'd like to see something added to this series, please send me an email or leave me a comment, and we'll try to make sure that the information and support available to moms like you who want to breastfeed will actually help you meet your goals!
Breast milk in the first week
Okay, so no matter what your feelings and plans for breastfeeding may be, starting around half-way through your pregnancy, your breasts will start producing colostrum. You might even be able to express a few drops of it around the end of your pregnancy. It tends to be a bit thick, golden colored, and taste fairly sweet. Because colostrum contains all the nutrition a newborn needs PLUS a hearty dose of antibodies from the mother, it's often called liquid gold, and it is so beneficial for your newborn that every effort should be made to try to feed your newborn your own colostrum for the first two or three days after birth.
The production of colostrum and the more mature milk your breasts produce by the end of the first week after you give birth is entirely driven by your hormones. Your baby's placenta maintained high levels of progesterone in your body throughout your pregnancy, and once you birth the placenta, progesterone levels drop, allowing your elevated prolactin levels to finally get started on milk production in your breasts. This process happens fairly quickly after birth whether or not your baby ever feeds at your breast.
However, if you are breastfeeding your baby, you will undoubtedly be waiting for any sign that your milk has 'come in'. The most common advice I hear new moms receiving is to go ahead and supplement with donated milk or formula by the end of the second day after birth if the baby cries a lot and they don't think their milk has come in yet.
Unfortunately, while supplementation may seem to ease the crying of a hungry baby, it does not help support a mother and baby's efforts to breastfeed. In fact, after a fairly sleepy first day, quite a lot of babies seem to cry much more on the second and third day after birth, and this may have nothing at all to do with hunger. Or perhaps it is a matter of hunger! When we were in the hospital after giving birth to our son, we were coached to feed our baby every 2-3 hours, and we expected long naps in between feedings, but for babies with tiny bellies, feeding hourly or perhaps every 90 minutes is more realistic, especially in the first two weeks. In this case, better information, with more realistic expectations, can ease new parents' worries and will help more families meet their breastfeeding goals. In most cases, the amount of colostrum your baby gets from more frequent feedings in the first few days is enough. Each feeding may only consist of 1oz. of colostrum or less, but it is enough!
Breast milk in the second week
For most women, breast milk production seems to really increase by day 3 or perhaps as late as day 5. In this time, moms often worry that their baby is hungry and is hardly getting anything from the breast, but let me say again that the milk your body produces in the early days is almost definitely enough!
Then, sometime before the end of the first week after birth, you may notice a sudden fullness in your breasts between feedings which signals that your body has caught up to the hormonally driven push to produce milk. From this point on, you are likely to start leaking breast milk during and between feedings, and you may produce so much milk at first, that your breasts are quite firm and sore.
Within a few days of this feeling that your milk has come in, the production of milk becomes a matter of supply and demand, and your hormones take on a much smaller role. From this point on, milk production slows when your breasts are full and speeds up when your breasts are empty. This means if you have a sleepy baby who often falls asleep during feedings, and then naps 2-3 or even 4 hours between feedings, your breasts will often be full and receive the signal to slow down milk production. If you have an alert baby who seems to nurse every hour, your breasts will often be emptied and are therefore cued to produce more and more milk. It's a matter of demand and supply.
In these early weeks, the feeling of fullness in each breast can be reassuring - it feels like there's plenty of milk, and after a nursing session, you can really tell the difference and be reassured that your baby has gotten enough to eat. But as the weeks pass, your breasts may not feel quite as full and you may start to worry that you're not making as much milk as before. This is another common point in the journey when moms lose confidence and start to consider adding a feeding or two with formula or donor milk. The good news is that this easing of engorgement pain is normal! It means that your body has started to get used to the amount of milk required and is no longer making a surplus! The problem with supplementing a feed with something else is that this almost always lowers the 'demand' part of the equation, which is likely to slow down your supply.
Increasing or decreasing your milk supply
So, if you are very determined to breastfeed, and are worried about your milk supply, empty your breasts more frequently! Do this with your baby (hopefully he or she is an effective feeder - something to discuss in another post!), with your breast pump, or by hand-expressing, which may be more effective than the pump!
Similarly, if you are suffering (and I mean, really suffering!) from oversupply, the best fix is to keep your breasts fuller longer. If you still want to breastfeed but simply slow production, block feeding is the way to go: only feed from one side for 3 or 4 hours at a time. This way, the other side is full longer, and milk production slows. Then switch to the other side for several hours. To ease painful engorgement without stimulating the production of even more milk, pump or express only as much as it takes to ease the pain.
Should you take supplements to increase your milk supply? Well, it's up to you. The most common suggestions out there are to eat more oatmeal, drink blue gatorade, and add fenugreek to your diet (in seed, pill, or tea form). None of these things are likely to hurt you, and there is plenty of anecdotal evidence from women who felt one or the other really made a difference, but the science is mixed. If you want to keep things simple, the common sense advice is to stay well-hydrated and to rest! Hang out on the couch or your bed with your baby and a giant glass of water, frequently refilled by your partner or helpful visitors, and do nothing so your body can focus on this stage of mothering. That sounds easy enough, granted you have plenty of help, but it can be difficult to commit to spending two or three weeks in the house! And yet, this is the advice that works!
How can you tell if your baby is getting enough?
This is a very common question, and a perfectly legitimate thing to worry about! If you're only breastfeeding, it's impossible to know how much your baby is eating, but that's doesn't mean you can't tell whether or not your baby is getting enough! There are certain things we do to try to track how much your baby is drinking. We pump and count ounces, we weigh the baby before and after a feeding session, and we track feeding times and percentiles, but none of these things is very accurate, and none tell the complete story! A breast pump may never empty your breast the same way your baby can. A weighted feed this morning might yield very different results compared to tomorrow afternoon, and weight gain and target percentiles don't take your particular baby and his parentage into consideration.
The best way to tell if your baby is getting enough milk is to watch your baby. Babies who have had enough to eat tend to be drowsy and calm after a feeding. Additionally, babies who are eating enough have plenty of wet and dirty diapers every day. If you're changing at least 6 diapers per day, and your baby seems sleepy and satisfied after a nursing session, your baby is likely getting enough milk. Trust your instincts, trust the process, and watch your baby.
And if you are bottle feeding your baby expressed breast milk, please keep in mind that on average, breastfed babies drink between 3-4oz of breastmilk per feeding from about 4 or 5 weeks all the way through to 6 months! The amount of breast milk consumed doesn't really change (except perhaps for a day or two during a growth spurt). Formula-fed babies, however, tend to gradually increase the amount they eat up to about 8oz per feeding by 6 months. Before you start worrying that your baby is growing too slowly, or that you are not producing enough milk according to your breast pump, make sure you are measuring against a standard for breastfed babies since growth curves and feeding amounts often differ a significant amount from formula-fed babies.
The final word: it's up to you!
What are your breastfeeding goals? Whether you're very determined to breastfeed for at least a year, or you're hopeful to get through your 3-month maternity leave before switching to some other way, it's important to get the support you need to reach those goals. Find the helpful people in your community who will take the time to encourage and support you, and don't let the critics hang around too long. But ultimately, watch your baby and trust your instincts. And get in touch with me or another trusted postpartum expert if you're looking for a little expertise or support. You're the mom, you get to decide!