Milk Supply Facts
“Knowledge is gained
by learning, trust by doubt, skill by practice, and love by love” Thomas S Sasz
When I read this
quote, I found it particularly true for my breastfeeding parents. Something
that causes a lot of the complications around breastfeeding is lack of
understanding or respect for how breastmilk is produced and maintained. If this
knowledge is not known or adhered to, we lose trust in our body’s’ ability to
continue to feed our baby once it has been born.
How will my body know to start producing milk and will mine do it?
The transition from
pregnancy to lactation is called lactogenesis. During the second half of the
pregnancy, alveoli become distended by accumulating colostrum. After 16 weeks
of pregnancy, lactation will occur even if the pregnancy is lost. From mid pregnancy
to day 2 postpartum is called lactogenesis I. Alveoli cells change into
secretory cells and prolactin stimulates mammary secretory epithelial cells to
produce milk. So during pregnancy and in the first few days after baby born,
milk supply is hormonally driven – endocrine control.
Despite mothers
knowing the many benefits of colostrum, when they hear that it is measured in
teaspoons and not tens of mls, they often think that can’t be enough for my
baby, surely I must top up.
A newborn with a stomach capacity of around 10
- 20ml translates into a feeding interval of around 1 hour. This is in line
with gastric emptying of human milk and neonatal sleep cycles. Larger feeding
volumes at longer intervals may therefore be stressful and the cause of
spitting up, reflux and hypoglycaemia. So when you feel that all that your baby
is doing is feeding, especially on day 2 of life, if you understand that this
is the physiological norm, you are less likely to doubt yourself and your milk
and can avoid the formula top ups that are offered.
Colostrum is low in fat, and high in carbohydrates, proteins and antibodies.
Nature’s first vaccine. It is easily digestible, and has a laxative effect on
baby helping to pass early stools, which aids in the excretion of excess bilirubin
and helps prevent jaundice. Colostrum has an important role to play in baby’s
gastrointestinal tract. Newborns intestines are very permeable. Colostrum seals
or paints the GI tract mostly preventing foreign objects from penetrating.
Small frequent feeds are all your baby needs, and your breasts will begin to
produce mature milk increasing in volume as your baby grows. It is often not
that our baby is feeding too often and not getting enough in these early days,
but more that our expectations of how often baby needs to be fed are
misdirected.
During pregnancy the
placenta is feeding your baby, at birth the delivery of the placenta results in
a rapid drop in progesterone (and possibly oestrogen) in the presence of high
prolactin levels. This is what causes the onset of copious amounts of milk, or
the unfortunate term of the milk coming in. We are really trying to move away
from that terminology as it implies that there was no milk before this, which
is untrue. This is where there is switching occuring from endocrine control to autocrine
control.
Day 3 to day 8 of
lactation is called lactogenesis II. The breasts may become engorged.
Initial engorgement or physiological engorgement usually begins around the time
of increased milk production. The breasts may become swollen, painful and
tender, with redness and shiny skin. The symptoms usually occur bilaterally and
are generalised. A slight increase in temperature may be present. Frequent
(8-12 times/day) and effective breastfeeding is important to prevent
engorgement becoming problematic. (Engorgement later in breastfeeding
journey can be manged differently)
After the first week,
there is a move towards autocrine control and this stage is called Lactogenesis
III or the maintenance phase. Milk removal is the primary control mechanism
for supply. SUPPLY = DEMAND. Hormonal levels do play a role but to a
lesser extent. Under normal circumstances the breasts will continue to make
milk indefinitely as long as milk is being removed. Similarly if the milk is
not removed then the body will slow and eventually stop the production. Every
time that you give your baby milk that you have not removed from the breasts
you are telling them that they do not need to produce milk and that decreases
the production.
How this works is
from a peptide in breastmilk called feedback inhibitor of lactation or FIL. If
milk is not removed, the inhibitor collects and stops the cells from secreting
any more, helping to protect the breast from the harmful effects of being too
full. If breast milk is removed the inhibitor is also removed, and secretion
resumes. If the baby cannot suckle, then milk must be removed by expression.
FIL enables the
amount of milk produced to be determined by how much the baby takes, and
therefore by how much the baby needs. This mechanism is particularly important
for ongoing close regulation after lactation is established. At this stage,
prolactin is needed to enable milk secretion to take place, but it does not
control the amount of milk produced.
The other factor that
can effect milk production is storage capacity. This is the amount of milk that
the breast can store between feeds. Storage capacity is not determined by
breast size. Storage capacity can also be different between breasts. A mother
with a small storage capacity will need to feed the baby more frequently to
satisfy the baby appetite and maintain milk supply, as the breasts will become
fuller quicker slowing the production.
If you feel that you
have a low supply or oversupply, please contact your lactation consultant.
Breastfeeding isn’t
easy, it takes practice and dedication. BUT nothing that is good for us is easy
unfortunately. It would be easier to lie on the couch watching Netflix and
ordering Ubereats, BUT we know that it is better to go to the gym, cook a
healthy meal and probably read a book. When it comes to breastfeeding, it can
be difficult to trust that our bodies are good enough to meet the feeding
demands of our baby, especially when we are bombarded with messages that we
need formula, schedules, gadgets and apps to bring up our babies. You need to
question everything except your instincts. You and your baby are the experts.
Spend time with your baby cuddling and feeding on demand, and block out all the
outside noise. If you are unsure when your baby needs to nurse, offer your
breast. If baby is hungry he will eat. Allow your baby to guide you and all
their needs will be met. Ask yourself if your baby is having wet and pooh
nappies, chat to your health care provider about how many baby should have in
24hrs, if meeting that then you are golden.
Most babies go
through several growth spurts or frequency days in the first year of life.
During a growth spurt the baby may feed more frequently, often hourly, and
behave fussier than usual. The reason for this that there is physical growth as
well has developmental milestones. There is an increase in energy output,
therefore need for increase in energy input. Growth spurts commonly occur during the first few
days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6
months and 9 months (more or less). Babies are individuals and these may vary.
Growth spurts usually last 2-3 days, but sometimes last a week or so. Remember
that a normal baby can feed between 6 – 18 times in 24hrs.
The best way to cope
with the growth spurt is to follow your baby’s lead. Baby will automatically
get more milk by nursing more frequently, and your milk supply will increase
due to the increased feeding. It is not necessary (or advised) to supplement
your baby with formula or expressed milk during a growth spurt. Supplementing
(and/or scheduling feeds) interferes with the natural supply and demand of milk
production and will prevent your body from getting the message to make more
milk during the growth spurt.
ü
Contact a certified lactation consultant in your area, if you require
assistance then you have a resource.
ü
Understand how milk production works, this goes a long way to trusting
that your body can feed your baby.
ü
Pain is not breastfeeding, don’t power through.
ü
Set your breastfeeding goals and surround yourself with cheerleaders
that will support you.
ü Your instincts are
there and will guide you, trust them.
You Got
This!
