Despite breastfeeding being a “natural” way to feed, it can also be a source of anxiety and uncertainty. There is a culture heavily reliant on concrete, numerical affirmation, both from the family and the medical community, that with the slightest concern, occasionally equates to leading the mother to supplement and even stopping completely. Understanding “supply”, the most common word used in regard to breastfeeding, how its established and what is adequate would relieve many of these anxieties, as well as aid in mothers’ self-efficacy.
What to Know About Breastmilk Supply?
How Is Milk Made?
The pregnancy hormone, progesterone, begins the milk-making process in the 2nd trimester of pregnancy. It’s sourced from the placenta. This first milk, colostrum, is produced in small, concentrated amounts to prepare for the birth of a baby at any given time from that point on.At birth, the placenta leaves the body, triggering a transitional change in the milk. This change takes 3 to 5 days after the birth of the baby. What will determine the efficiency of this transition will be how quickly the baby was introduced to the breast to try to breastfeed, how often baby is allowed to try to nurse, and any interventions during the labor/delivery.Once milk is mature, it is now reliant upon demand. In other words the body will regulate how much milk to make based on how much milk is removed from the baby or pump. It will also be determined on how frequently this is done- a delicate balance between the hormones oxytocin and prolactin along with a special protein, FIL, that monitors use or stagnation of milk.
Important Factors of Milk Supply
Since milk production is so hormonally-charged, there will be factors that will positively and negatively affect the mother's ability to produce and sustain milk production.
Feeding within first hour of birth
Keeping baby close
Room sharing for the first 4 months
Feeding on demand
Comfort at breast
Proper breastfeeding support
Delayed feeding due to separation after birth
Block / scheduled feedings
Poor / shallow latching
Prematurity <36 weeks (if mother is not supported with milk removal)
Interventions during labor
- Pitocin is artificial oxytocin and can block receptors to it
- Epidural numbness can travel where unintended
- Drugs may cause infant drowsiness
Hemorrhaging and / or low iron
Certain medications and birth control can lessen supply
As a lactation consultant, there have been numerous myths and anxieties surrounding milk supply that have had to be weeded through. Despite educating and providing resources, there is still an abundant amount of bad information circulating that feeds this doubt. It’s easy to explore through search engines about milk supply, and lets not forget the well-meaning momma groups on social media that at times perpetuate the ideals behind how to increase supply. What a lot of the sources have failed to do is encourage mom to determine whether or not supply is even an issue to begin with, and educate them on how to tell that supply is fine.Self doubt is much more common than supply issues, and the supply problems that do exist are usually a secondary/resulting issue from a different problem, not just an inherent issue because a mother's body isn’t working right.
Myths That Need Busting
Breast size matters
Augmentation prevents ability to breastfeed
Frequent feeding means baby is not getting enough
Pumping used as a gauge for supply
Wait for breasts to feel full before feeding
Eating certain foods will increase supply (without the application of improving the breastfeeding output / efficiency on baby’s end)
And many more!
Breast size / cup size will not be a determinant on the mother’s ability to breast-feed. It is merely how much fat tissue is in the breast that determines cup size. The alveoli and other mechanics of the breast can be present in even the smallest of breast tissues. Breast capacity will determine sometimes how often the baby needs to be fed, but it’s rarely a measurable difference. Mothers who have had a breast removed due to breast cancer can still feed exclusively from the remaining breast! Breast enlargement /augmentation is seemingly harmless on breastfeeding and breast supply capabilities, so long as nerves around the nipple were not damaged and can be stimulated. On the flipside, breast reduction can be problematic if too much tissue was removed, removing the ally and milk ducts. It’s important to discuss long-term goals with your surgeon before performing such surgeries.
A common concern among parents who are not sure about infant behaviors in terms of breastfeeding is how frequently they eat and if that equates to mom not having enough milk to get them to the next feeding properly. The truth is, breastfeeding equates to a better metabolism because it is designed to feed baby and small and frequent meals. This is why infants who breastfeed are more likely to have a healthier weight in childhood and adulthood. Breastmilk is also very easy to digest, and does not linger long in the digestive system, contrary to formula. They will also go through growth and development spurts, which will equate to feeding in clusters throughout the day. They may go from feeding on average of every 2 to 3 hours to every 1 to 1.5 hours during this time, and it’s all very normal.
Pump output should never be a professional gauge for breastmilk supply. Many mothers have a hard time responding to a pump, and pumping is also a learned technique. If baby is growing well feeding directly from the breast, but mom is only pumping out an ounce, that does not reflect the other. Pumping support should be treated differently from breastmilk supply support.
Full breasts are at times the standard for determining adequate supply for many mothers, how many will even wait to feel full before offering to feed. This is not recommended, as the proteins that controls levels of milk based on stagnation / how long has milk been sitting in there for, will tell the brain to make less milk. In other words: Emptied breasts make more milk faster! It’s important to not wait to feel full before offering to feed. Feed on demand, and the body will respond accordingly.
In terms of food and breastmilk supply, this can be a very dangerous situation to put a mom in if she is told to eat a lactation cookie or a certain meal in order to fix a supply issue, especially if her baby is not gaining weight well. The proper advice would be to give her support in the form of professional lactation care. The body is responsive to two types of stimuli: physical and emotional. Just like with making tears, if mascara get in the eyes, eyes tear up. If someone gets their feelings hurt, they tear up and cry. You do not need a special cookie to make enough tears, nor will it fix breast milk supply.
What Does Adequate Supply Look Like?
What goes in, must come out! A way to tell that breastfeeding is going well is look at growth and diapers. Infants should be growing .4 to 1 ounce a day. After day four of life, infants should be having four and more wet diapers a day, and pooping fairly frequently as colostrum and transitional milk are like laxatives. If poop is still black with meconium by day three, the mother needs breastfeeding support to assess baby’s efficiency at removing milk.
Infant body language can tell us a nice story as well. Balled fists indicate hunger in many infants, along with tension in the rest of the body. They should relax after a full feeding.
Active feeding for 45 minutes or more can indicate difficulty feeding at the breast, efficiency and removing milk. Feeding for 15 to 20 minutes and then again an hour and a half later is very appropriate for a baby going through a cluster stage, and this is very normal. If questioning supply, make note of how long baby is actively feeding for, not counting pacifying at the breast.
Keep in mind, it may not be a supply issue, but if a concern is not addressed, it may develop into one. When in doubt, seek assistance from a trained lactation professional.