Categories
Breastfeeding and Supplementing Breastfeeding In the hospital Breastfeeding Problems Milk Supply

Am I producing breastmilk yet?

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Your breasts aren’t heavy and full yet…

Your baby is either insatiable or won’t wake up. You’re worried that you’re not even producing breastmilk yet. So what will your baby even eat? Mama, you’re not alone! Nearly every new mother has these concerns. Below I’ve written a little sample convo between myself and a new mama about this problem. I outline exactly the recommendations I make to moms in this situation and offer tips and tricks to overcome it.

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The Story:

1 day old baby.

First time mom.

Has been breastfeeding,

but is concerned she’s not producing milk yet.

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Mom: My baby is getting nothing, should I give formula?

Lactitioner: What makes you think your baby is getting nothing?

Mom: My breasts don’t feel full, I’m not leaking, when I squeeze nothing comes out.

Lactitioner: On days 1-3 you are making colostrum. You’ve been making since you were about 20 weeks pregnant. Your breasts don’t feel full yet and you’re not leaking yet because the amount of colostrum is small, but it’s super concentrated. It’s all the baby needs for his tiny tummy in the first few days of life. As for not seeing anything when you squeeze, most moms just try to squeeze the nipple like a tube of toothpaste and expect colostrum to come out. That’s not how it works. You have to do massage and compression further back on the breast and sort of milk it forward. Just squeezing the nipple closes off the milk ducts so nothing will come out. (Read here about hand expression to learn more about this.)

Mom: What can I do to make my milk come in? Should I be pumping or drinking more water?

Lactitioner: There is nothing you can do to make your milk come in any faster. It is a hormonal process that has to take place and in a first time mom, the milk generally doesn’t come before 72 hours after delivery. If the baby is breastfeeding every 2-3 hours, there is no reason you need to pump. As long as you are stimulating, your body will deliver your milk. Pumping would just add to your exhaustion because it’s one more thing to do in between breastfeeding every 2-3 hours. As for drinking water, you should be drinking to keep yourself hydrated. However, drinking lots of water will not bring in your milk any faster nor will it increase your milk supply. (Read here to learn more about milk supply.)

Mom: How do I know if my baby is getting anything?

Lactitioner: Baby should be breastfeeding every 2-3 hours around the clock. Baby may skip a feeding or two in the first 24-hours during recovery sleep, or sometimes after the circumcision, though.

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The Truth About Milk Supply

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If baby is doing these things, he’s getting your colostrum:

  • Sucking actively at the breast during the feeding with some pauses
  • Making long jaw movements that wiggle the ear which indicate swallowing (or you hear it!)
  • Baby is content between feedings
  • Baby is having appropriate diaper output (1 wet, 1 stool on day 1; 2 wet, 2 stool on day 2; 3 wet, 3 stool on day 3; etc.)

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If those things are not happening, you may need to work closely with the lactation consultant to improve positioning and/or latch, confirm the presence of swallowing, begin hand expressing or pumping, or supplement if needed.

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Suppementing Your Breastfed Baby

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The Moral of the Story

Nearly every new mama wonders if they’re making breastmilk when their baby is born. Obviously if you are not feeling fullness or seeing milk, you may wonder what the heck is happening. I share these common concerns so that you are educated, prepared, and don’t feel silly for not knowing how it all works.

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Categories
Milk Supply Pumping The Basics of Breastfeeding

The Truth About Milk Supply

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Your sister had a low milk supply. Your BFF had a low milk supply. Your neighbor’s cousin’s sister-in-law had a low milk supply. So, naturally, you will, too, right? WRONG. Girl, listen… If I had to name the number one thing that new breastfeeding mothers worry about, it’s definitely about milk supply and how to make more milk! The truth is that the number of women who actually cannot make enough milk for their babies is very low. But the incidence of PERCEIVED low milk supply is very high. (Meaning that most women believe they have a low milk supply when they actually don’t.) Why suffer all of that anxiety about milk supply when you can just know the facts, Mama?! Here I lay out how milk supply works and answer some frequently asked questions so that you will be a ultra-confident breastfeeding superhero! (I totes believe making humans and making milk makes us superheroes!) 

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The basics:

Your body starts making colostrum at around 20 weeks into your pregnancy. You’ll make colostrum until about 10 days after delivery. Your breastmilk will “come in” somewhere between days 3-5. This means that your breastmilk will be mixed with your colostrum and will appear thicker and more yellow until about day 10 after delivery. The volume of colostrum that you’re making in the early days is small, which coincides with the small size of the baby’s stomach. However, the colostrum is very concentrated. Once the milk comes in, the volume increases significantly.

Recap:

  • Colostrum from about 20 weeks pregnant until about 10 days after delivery
  • Mature milk comes in somewhere around days 3-5 after delivery
  • Colostrum and mature milk mixed until day 10, appearing thicker and more yellow than milk alone
  • Volume of colostrum is very small, but highly concentrated
  • Volume of mature milk much greater

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Milk Supply:

Your milk supply is largely based on demand. In the first three days after delivery, before your milk comes in, frequent breastfeeding sends the message to your body that it should prepare to make lots of breastmilk. Think of it this way: You’re putting in the order now so that when the milk comes in, you’re making plenty.

 Once the milk comes in, it’s the frequent stimulation and milk removal that keeps the supply going. This is achieved by the baby breastfeeding often and emptying (or mostly emptying) the breast at each feeding.

If the baby is sucking but not removing any milk, or is too sleepy to even suck and therefore no stimulation is happening, your milk supply will be negatively affected.

Whatever milk is removed from your breasts will be replaced. However, any milk left behind will send the message to your body that the milk is excess and that milk will be reduced. This is a good thing in the early weeks of breastfeeding, after your milk comes in.

You don’t want to be very full all of the time. Your goal should be that your breasts to fill up when it’s time for the baby to eat, and are softer by the end of the feeding.

Recap:

  • Supply is based on demand
  • Early supply is determined by frequent stimulation on days 1-3
  • Supply is maintained by frequent stimulation and milk removal
  • Whatever milk is removed will be replaced
  • Whatever milk is not removed will send the message to reduce the supply some

*All of the above is assuming you do not suffer from hormonal problems, untreated thyroid, infertility, have any sort of breast surgery that could impact your supply, or have underdeveloped breasts. While all of these could be a red flag, they do not necessarily guarantee you’ll have supply problems. This is just a heads up that you should work closely with a lactation consultant. Don’t assume anything. Find a lactation consultant and make a plan.

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Do I need to start pumping right away to help my milk come in?

No. The milk “coming in” is a hormonal process and you can’t speed it up. The process starts when the placenta is   delivered, but generally takes 3-5 days before the milk comes in for a first time mom. You body has to get rid of all of the excess progesterone from the placenta before the prolactin can take over. The process is usually quicker with subsequent babies. Pumping right away will ensure that your body is getting the message that you want lots of milk, but isn’t necessary if the baby is breastfeeding well. Take advantage of the down time between feedings and rest. Don’t add to your exhaustion by doing something that isn’t necessary.

When should I pump to ensure that I’m making enough milk?

When your milk first comes in, you are making much more than you need. The goal in the first few weeks is to actually reduce the supply to what the baby needs. It may make you feel like you have superpowers when your breasts are bursting with milk or if you pump or express some milk and have a full bottle to show for it, but this will quickly become uncomfortable or miserable. You only want to make what your baby needs. You want your breasts to fill up when baby needs to feed and be softer at the end of the feeding. Remember this rule: whatever you take out your body will replace. If you are breastfeeding every three hours then pumping after every feeding (essentially removing enough milk for twins), your body will think you’re feeding twins and it’ll keep giving you what you asked for. However, when you’re feeling back to your old self and want a day of shopping or a girl’s night out, you will either be lugging your pump around, pumping every 3 hours after feeding baby, or will be miserably full and uncomfortable. Moral of the story: let your baby determine the supply and leave the pump for when you need to be away or are going back to work. If you’re separated from your baby or baby is not feeding well, read here to learn about pumping.

How do I know if I’m making enough or have a low supply?

You cannot measure how much your baby takes at each feeding from the breast very easily or accurately. However, you can gauge his general milk intake by paying attention to a few things: diapers, mood, and weight. Once your milk comes in (days 3-5), your baby should have 5-6 wet diapers and 3-4 poop diapers in a 24-hour period. If he falls below this, have your breastfeeding evaluated by a lactation consultant. The baby should feed every 2-3 hours around the clock and be relatively content between feedings (might fuss to be held, but isn’t hungry). If baby never seems satisfied (looks like a little piranha when anything comes near his mouth), then have the feedings evaluated by a lactation consultant. Babies lose weight after delivery and don’t start gaining until the milk comes in. After that, they typically gain 1/2-1 oz  per day. They should be back to birth weight by 2 weeks of age. If baby’s weight gain is slow or he is not back to birth weight by two weeks, have your feeding evaluated by a lactation consultant.

Do I need to drink Mother’s Milk Tea to have a good milk supply?

Mother’s Milk Tea is a tea consisting of herbs that anecdotally work to increase milk supply. There is no scientific literature verifying this. However, many mothers swear by it. Whether you choose to drink the tea, eat lactation cookies, or make a lactation smoothie, the most important thing to remember is that no supplement will increase milk supply without frequent stimulation and milk removal. That means, if you are not breastfeeding and/or pumping as often as your baby should be eating and/or are not effectively removing the milk from the breasts, no supplement in the world will increase your supply. The teas, cookies and smoothies are nutritional. They won’t hurt, but they won’t help without stimulation and milk removal.

What should I eat/ drink to increase my milk supply?

There are many foods and drinks that people swear by for milk supply. These anecdotally work to increase milk supply. There is no scientific literature verifying this. However, many mothers swear by it. Whether you choose to drink the tea, eat lactation cookies, or make a lactation smoothie, the most important thing to remember is that no supplement will increase milk supply without frequent stimulation and milk removal. That means, if you are not breastfeeding and/or pumping as often as your baby should be eating and/or are not effectively removing the milk from the breasts, no supplement in the world will increase your supply. The teas, cookies and smoothies are nutritional. They won’t hurt, but they won’t help without stimulation and milk removal.

How much water should I drink to have a good milk supply?

You should drink if you’re thirsty. There is no set amount you need to drink for  normal, everyday functioning and there is no set amount for producing milk, either. Remember, there is water in other beverages and the foods we eat, as well. Increasing your water intake has no impact on your milk supply unless you are drinking massive amounts of water, in which case it can decrease your supply. If you are drinking more water than your body can handle you may experience some edema. The edema that results in your breasts can reduce your supply. The moral: drink if you’re thirsty. Breastfeeding tends to make you thirsty!

 

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