Basics

Making milk

Posted in Breastfeeding Information

Breasts make more milk when milk is removed effectively and more often.  This is the basic principle behind making plenty of milk for your baby.  In most cases a mother’s breasts will continue to make plenty of milk when feeds are comfortable by feeding according to their baby’s cues and their baby does big suck swallows at the breast.

There are however, situations where this may not happen and mothers require care from a health professional, such as an IBCLC to determine the cause and provide a plan of care to address the issue.  See reasons for low supply.

Knowing my baby is getting plenty of milk

Posted in Breastfeeding Information

Many mothers say one of the challenges of breastfeeding is knowing how much milk their baby is getting each feed.  When we, as a culture, have been exposed to bottle feeding, mothers find it difficult to trust other ways of recognising their baby is doing well.  There are several ways mothers can be confident they are providing plenty of milk for their baby.

  • Baby has at least five heavy pale wet nappies in 24 hours
  • Baby passes soft, runny yellow, mustard poos at least 3 times a day in the first 6-8 weeks
  • Baby can be seen to do deep rhythmic suck/swallows while feeding
  • Baby is bright and alert when awake
  • Baby has good skin elasticity, not loose and saggy
  • Baby is back to birth weight by 2 weeks of age and gains at least 150-200 grams (often more) per week from 2 weeks to 3 months.

Reasons for low supply

Posted in Breastfeeding Information

Studies have shown that not making enough milk is one of the most common reasons mothers stop breastfeeding before they would have liked.  These mums are either not making enough milk to meet their baby’s needs or perceive they aren’t.  These are two very different scenarios.

There are many possible reasons for mothers who have an identified low supply. They can be divided into two broad categories.

Mother related causes

  • Inadequate stimulation and removal of colostrum/milk by;
    •  not feeding the baby according to his cues
    • ‘stretching the baby out’ by following a rigid feeding schedule
    • using formula or dummies inappropriately
  • If unable to feed baby directly at the breast, not expressing regularly or effectively
  • Breast surgery (augmentation or reduction), where there may be interference to the ductal system, removal of milk making tissue or disruption of nerve supply in the breast
  • Medical conditions that affect the production or release of hormones such as;
    • thyroid or pituitary disorders
    • diabetes
    • polycystic ovary syndrome
    • retained fragments of placenta or membranes following birth
    • post-partum haemorrhage
  • Inadequate amount of mammary tissue known as hypoplasia.  This is difficult to determine as the size of the breast is largely due to the amount of adipose (fat) tissue

Baby related causes

  • Baby is unable to latch and or remove milk effectively as a result of;
    • positioned at the breast in a way that inhibits/interferes with baby’s own reflexes and behaviours that enable the baby to latch and feed effectively
    • prematurity
    • ankyloglossia (tongue-tie)
    • recovering from assisted birth (forceps or vacuum delivery)
    • severe jaundice causing sleepiness
    • cleft lip +/- palate
    • low muscle tone eg. Trisomy 21
    • neurological impairment

Perceived low milk supply

Posted in Breastfeeding Information

Many parents are unaware of what ‘normal or typical’ newborn feeding and sleep patterns are and when their baby wants to feed more frequently than 3 or 4 hourly they come to the conclusion that the baby isn’t getting enough milk or the mother isn’t producing enough milk.  Human babies are meant to wake and feed often because:

  • Breast milk is species specific and is easily digested
  • A newborn’s stomach is small
  • Sleep cycles are about half as long as an adult and they have more REM (rapid eye movement) sleep enabling them to rouse easily to feed and be tended to by their parent
  • Every mother and baby dyad are unique and don’t comply with the ‘routines’ described by most books written by ‘sleep and parenting’ experts
  • Mothers have different storage capacities ie. each breast is able to hold a maximum volume of milk at any one time.  For mothers that have smaller storage capacities (not visible breast size), their babies may need to feed frequently around the clock

Outside sources can impact on the mother’s perception;

  • Non supportive comments from well meaning friends or family such as “are you still feeding that baby?”, “he can’t possibly be hungry” or “he’s just using you as a dummy” undermine a mother’s confidence and lead her to question whether she is making enough milk for her baby

Health care professionals can also give inaccurate and non-evidenced based advice such as “you need to stretch him out so he’ll feed better” or “don’t let him snack feed”. This can lead mothers to think their babies aren’t getting enough milk or feeding practices that will lead to a decrease in the mother’s milk supply.

Making more milk (increasing supply)

Posted in Breastfeeding Information

If a mother has identified a low milk supply and that her baby is not receiving enough milk to meet their needs (refer to knowing my baby is getting plenty of milk), there are a number of strategies she can use to improve the situation.  Referring to reasons for low supply may help to identify the cause of low milk production.

If you are uncertain your baby is receiving plenty of your milk, contact me to arrange a consultation where we can look at your individual situation and develop a plan of care to meet you and your baby’s needs.

Sore nipples

Posted in Breastfeeding Information

Research shows that sore or damaged nipples is a common reason why mothers stop breastfeeding sooner than they would have liked.  Though it is true on one hand that ‘breastfeeding shouldn’t hurt’, it would be unrealistic to say that women experience no discomfort during the early days or weeks of feeding their baby.

Sensitivity of the nipples increases during pregnancy and following birth. The baby sucking or expressing stimulates the nerve endings in the nipple which send messages to the brain to release two important hormones.

  1. Prolactin tells milk making cells in the breast to make more milk and
  2. Oxytocin causes contraction of tiny muscles around the milk making cells, releasing milk down the ducts and out the nipple for the baby to drink.

‘Nipple stretch pain’ can be uncomfortable when the baby draws the nipple and breast tissue well into their mouth,  it usually settles once baby starts doing big suck swallows.  Feeds may continue to be uncomfortable with initial latch until the connective tissue becomes more supple and stretchy.

If a mother continues to experience discomfort or pain throughout the feed, this is a sign that something isn’t right.  The most likely reason for pain is that the baby doesn’t have a deep latch (a big enough mouthful of breast) and the nipple is being compressed by the tongue against the hard palate, the tip of the nipple is being rubbed by the tongue or the nipple is being bent in the wrong direction.

Every mother-baby pair are unique.  If you are concerned about how your baby is latching, contact me to arrange a consultation to receive the help and support you need.