Breastmilk supply

I find myself constantly writing these comments over and over again, so I think I’ll write a post I can reference.

Breastfeeding is really really difficult at first.  It doesn’t really come naturally either for mom or for the baby.  (Some folks suggest it comes easier if the baby is allowed to nurse immediately after birth, which may be true, but there’s still a lot of learning involved.)  Reading up on it is helpful, and having the number for a good lactation consultant or LLL can work wonders.

Breastmilk is demand-induced supply.  The way the baby tells your breasts to make more milk is by sucking as much as ze can, even after the breast is empty (the breast never gets completely empty, but it definitely will go down in amount stored with each feeding).  Unfortunately, there’s a delayed response between the baby saying, “I want more” and the body actually making more.  The breasts will have more storage capacity and more milk in them later, so long as the baby keeps sucking.  A common mistake encouraged by the formula companies is to feed a bottle of formula at this point, but when you do that, the breast doesn’t get the message to make more milk and so the baby still doesn’t have enough to drink the next time, so there’s more formula supplementation, and eventually the mother loses her supply and stops nursing.  A recommendation is no formula for the first two weeks (assuming the right number of wet diapers) until the milk supply is set in.  Another trick you can do that cuts down on the painful (to mom) crying is to pump so that you get a small oversupply, so that your breasts are ahead of the curve on supply.

Your baby starts out with a tummy that’s about the size of a dime.  That means lots and lots of nursing while you and the baby learn how to nurse.  As the baby grows, the tummy grows, and it wants more milk but can go longer between feedings.  It is normal for a baby to eat frequently, especially during growth spurts.

Later on, you may think you have a lower supply. Read these links on kelly-mom:

http://www.kellymom.com/bf/supply/
and
http://www.kellymom.com/bf/supply/low-supply.html

Remember too that babies will lose some weight after being born, and that’s normal.  Additionally breast-fed babies have a different growth-curve than formula-fed babies and don’t poo as much.  An older breast-fed baby can go a LONG time without a poo and that is also normal.  (The resulting poo is generally ginormous though.)

A few more things to point out if you suspect a low supply later:

1. You may be about to have your period. Your supply will go back up after it is over.
2. You may be anemic. You need to eat more iron: pills, red meat, oatmeal etc.
3.  At some point in nursing your breasts become less milk storage devices and more milk creation devices. This is normal. Just because they’re squishy doesn’t mean they’re not making enough milk.
4. The one major thing missing from kellymom is discussions about pumping problems.  If you’re just going by pump output, you may need to clean out your pump. Is there cat hair on the motor membrane? The medela PISA seems to be designed for the rubber membrane to rupture every 9 months (at least the versions I and my similar baby aged colleagues had… the earlier ones were more hardy and the later ones may be as well). Do you need to replace the little white flappy things on the horn?

How to insure a good supply:

Mom needs to do NOTHING for the first two weeks (longer if c-section) except sleep, eat, drink water, nurse, and relax.  She needs to be waited on hand and foot.  She is not to be allowed to clean or cook or anything.  She needs to conserve her energy and her sleep for learning how to nurse and making food for the baby.  The #1 determinant of ability to nurse long-term is support.  (Obviously there are cases in which breast-feeding is impossible, like after some kinds of breast reduction surgery, or because of genetic problems, and thank God we have formula, but for most people it is lack of support that is the problem.)  Kellymom now has a forum in addition to being an awesome resource otherwise.

I could talk a lot more about breast-feeding, but I think I’ll just stick to the issues of supply.  Do you have any questions, comments, concerns, stories?

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23 Responses to “Breastmilk supply”

  1. Cloud Says:

    I actually have oversupply and a fast let down- and I STILL had a hard time getting breastfeeding going with my first kid. It really can be hard. I don’t know why I persevered, but I just believed that my body COULD do this so I stubbornly held on until it DID. I did have good support, too, which I agree is key.

    It was sooooo much easier the second time around. And that kid was born via C-section, and I spent my first day post-partum throwing up a lot. Experience matters.

    FWIW, I nursed the first kid until she was 23 months old, quitting because I was pregnant with kiddo #2. I’m still nursing her, at 18 months. People are often amazed that I nurse so long, and think I am making some sort of huge sacrifice. I laugh, because now is the easy part. I’m not pumping anymore, and we both know what we’re doing. The hard part was early on!

    • nicoleandmaggie Says:

      Yeah, it isn’t biologically automatic… I think it’s something the body relied on culture to take care of. But when that link of support is broken there’s a much steeper learning curve.

      DC weaned entirely sometime before age 3. It was so very good for my health because it kept all of my endocrine problems at bay. Not quite enough to make me want another kid again, but I sure wish I had someone else’s to nurse. Milk sharing isn’t so big in this part of the country though because most folks find germs scarier than chemicals.

  2. julier Says:

    Wow, you make it sound so easy.

    I wish I could have breastfed my twins, but the circumstances surrounding their premature delivery and events occurring in the month after that made it so difficult I decided it was no longer worth the effort and that my time and energy were better spent caring for them in other ways. I was relieved when our pediatrician told me I could stop, but I still felt guilty about it. More details may appear on my blog later today.

  3. Perpetua Says:

    @Cloud – I had the same experience – so much easier with #2! I just popped hir on and viola! I didn’t worry about it at all. I also have oversupply and a fast let down, which #1 couldn’t handle at all. Ze would choke and pull off, screaming with rage. #2 is a sweet little overeater who would be choking, refuse to delatch and keep on going. (Ze gained 3 pounds in hir first three weeks of life.)

    But I was surprised all over again with #2 how much of a juggling act it can be to latch on a newborn with a rubbery neck. (I feel sometimes like I need about three more hands. Right – you have to grab the breast, line up the nipple with the nose, tickle the mouth open wide, bring the baby to the breast. Gah!) As soon as they have neck control, it gets so. much. easier.

    Nicoleandmaggie are right on about the supply and demand factor. I nursed both mine every time they made a peep of any kind. No schedule, no “ze can’t be hungry!” I just put them on. They take themselves off if they don’t want to nurse. And even if they aren’t eating, it’s great practice.

    • nicoleandmaggie Says:

      A secret: I told people that we didn’t use a pacifier because ze sucked on hir thumb and you don’t lose thumbs… but in reality I just stuck a breast in hir mouth when most parents would be rooting around for a paci. Then I felt slightly superior when they complained about kids not wanting to give up the paci. (Lots of lots of paci pressure around here, with advice on how to get a kid who doesn’t want one to take one, and then how to wean them off a couple years later when they don’t want to let go.) Ze did sometimes chew on the bottle nipple when I was at work, and figured out pretty soon how to suck on it without actually getting milk like a paci.

      Sometimes I wonder if this is related to hir complete and total ability to stop eating super yummy food whenever ze gets full. I’m not sure ze has ever felt hunger or unpleasantly overfull. But who knows… ze certainly didn’t get that trait from either of us! (Nor would I still have most of my Easter candy left at hir age…)

  4. Everyday Tips Says:

    I volunteered for years with the hospital to help new mothers, and breastfeeding can be a huge challenge for many. Latch issues, supply, pain, and a million other situations can make it very frustrating. Add hormones to the mix, and mom can be very upset.

    You are so right about giving the mom a break. However, many dads are nervous about taking care of a newborn too so rest may not come easily.

    My advice regarding nursing is this: Do the best you can but do not exhaust yourself. I have no problem with supplementing with a bottle in the middle of the night (dad gives the bottle) so mom can get some rest. Don’t worry about being perfect, just do the best you can. Stay hydrated, try to rest and relax, and hopefully it will all fall in to place.

    I know I could not keep up with my oldest son when he was in a growth spurt. I may have had the milk, but he wanted to eat constantly. I would have gone insane had I not supplemented a little. I beat myself up over it at the time, but with each successive child, I realized that there is no perfect. Doing what you can and loving the baby is what matters.

    • nicoleandmaggie Says:

      That’s a great way to volunteer!

      And yes, new moms often need more support than just dad.

      I don’t want to take a stand on formula supplementation other than to say that I have seen it to both help and to harm new mothers. I tend to agree that not doing it during the first two weeks is generally a good idea so long as the baby is peeing enough, and if it is done during that time period to use a device that does not involve an artificial nipple. Nipple confusion is rare but it is horrible when it does happen. Not insurmountable, but can cause a huge amount of avoidable stress and guilt.

      • Comrade PhysioProf Says:

        What’s “nipple confusion”?

      • nicoleandmaggie Says:

        It’s really really awful.

        It happens sometimes when a baby gets introduced to the bottle too early. The nipple on a bottle flows much faster than the nipple on a breast, so the baby may reject the breast when offered, preferring the fast flow of the nipple and the plastic of the bottle. It can be avoided by waiting until after 3-4 weeks to introduce a plastic nipple such as a bottle. I know a couple of people that this happened to (including one of my colleagues) and it is really hard to get the baby back on the breast. It is rare, but heartbreaking when it happens.

      • Comrade PhysioProf Says:

        Wow, that really sucks.

  5. Dr. O Says:

    I started writing a comment, but it turned into 6 paragraphs of jabber, so I wrote a blog post instead. I agree with everything you said, but I had a lot to add about the difficulties of nursing early on.

    The post will queue up tomorrow (Friday) morning!

  6. Medela Representative Says:

    Hi – I am an official representative from Medela. I just wanted to say that it is so nice to see such wonderful breastfeeding support. If you have questions about your pump, please reach out to Customer Service for troubleshooting: http://bit.ly/cs_medelaus

  7. Sandy H Says:

    This is a really good post. I think new mothers don’t realize how hard it is to start breastfeeding and you are so right it isn’t really a natural thing for mom or for baby- it is a learning process.

    Also, new moms get so frustrated when babies tend to ‘eat’ ALL the time, and they start supplementing. My sister is there right now, and I keep telling her my niece is just trying to get her supply ready- but I know she is ready to call it done (after only 3 months.)

    Great post and great reference!

    • nicoleandmaggie Says:

      It’s so sad. Moms need so much more support than they get. You’re guilted whether you supplement with formula or not, and early on it’s hard to feel secure that you’re making the right decisions.

  8. Molly On Money Says:

    When I was born in 1968 my mother and I sat in a hospital bed and nursed for two weeks while the nurses waited on her every need. They help when she had problems breastfeeding me and wouldn’t let her leave until they were sure she was confident in her new feeding skills. She was lucky and I was lucky to have her around when I had my baby.
    Another thing that is not recognized is that when a breast feed baby is about 3 months old your milk will change. I was so lucky that I had the proper support or I would have given up breast feeding at that point. I would breast feed as my baby would fuss at the lack of milk coming out. I’d do this for about 10 min. My boss (my baby came to work with me) would than take the baby and feed her either some of my pumped milk or formula from a bottle. I was never in the room when my baby was bottled fed. This went on for about an very tiring week. After that it went back to normal. And on a last note, breast feeding was always painful for me. Typically I had to do something else while I fed her (like shop, have a cup of tea). Because of this I breast fed in public all over my city and only once did someone suggest I go somewhere more private to breastfeed. Ironically it was at a baby store!

  9. Tips for nursing and working « Grumpy rumblings of the untenured Says:

    […] earlier post on nursing addressed issues of supply.  Check it out for what could go wrong with your […]


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