Many moms struggle with low milk supply. Many factors can contribute to this issue. This newsletter focuses on what can be done from the time the baby is born through the initial first two weeks after delivery to get good breast milk supply.
The most important thing to remember – skin to skin as soon as the baby is born. You may have heard this called the Sacred Hour which describes the first hour after birth where baby is immediately put on mom’s chest skin to skin. Any interventions that need to be done such as checking baby’s heart rate or temperature are done on mom’s chest. Mom and baby are not separated for any reason for at least the first hour after birth. During this time, baby is observed for feeding cues and may even self attach and begin the first breastfeeding session with minimal assistance. This is the best way to get breastfeeding and mom’s milk supply off to a good start.
While in the hospital, baby should room in with mom and nurse on demand, at least every three hours or more often. The more baby nurses, the more the breasts are told to empty and make more. This helps mom to get her mature milk in faster than if baby only nurses a few times in the hospital. Visitors need to be kept to a minimum to help establish breastfeeding or dad can ask visitors to leave as soon as feeding cues are noticed. These include rooting, putting hands to mouth, smacking, tongue movement or just getting more restless or fidgety.
The more often baby nurses in the hospital, the more practice they get before the mature milk comes in and the breasts get engorged. Frequent nursing will help to prevent severe engorgement. After mom and baby are home, baby needs to nurse at least every three hours or more often, around the clock. If it’s been three hours since the beginning of the last feeding and baby is asleep, they need to be unwrapped, have the diaper check then woken up.
If baby is not able to wake up and nurse well at least every three hours, mom should be pumping. Jaundiced babies or babies born before their due date are often sleepy and not able to nurse well every three hours. In order for mom to protect her breastmilk supply, she needs to be pumping if baby isn’t nursing well on their own.
Mom’s breasts are most receptive to making more milk within the first two weeks after delivery. If they stay full often, they are told to make less milk. Mothers who have had surgery on their breasts or those who have had a history of low milk supply should be proactive and pump even more frequently. Breasts can always be encouraged to make more milk but the further away from delivery a mom is, the harder she is going to have to work and the more interventions she will have to use to get the breasts to make more milk.
This calibration process that the breasts go through was explained well in an article by Denise Howel and Helen Ball in the Journal of Human Lactation, Volume 29, Number 4, November 2013, pages 579 to 585 in the “Association between Length of Exclusive Breastfeeding and Subsequent Breastfeeding Continuation”.
Physiological mechanisms may explain the observed association between early cessation of exclusive breastfeeding and shorter duration of any further breastfeeding. In early lactation, milk supply is hormonally regulated by the hypothalamo-pituitary axis but switches after the first few weeks, once milk production is fully established, to involve greater autocrine control with the gland itself regulating milk production. Infrequent feeding and early supplementation interfere with the calibration process. During growth spurts and other periods of increased demand, the mammary gland is less able to respond, encouraging further supplementation and dwindling milk supply. If exclusive breastfeeding continues at least until milk supply is well established, then supplementation is less likely to disrupt the maintenance of milk supply, facilitating a longer duration to cessation of any breastfeeding. This has implications for the timing of interventions to support the continuation of exclusive breastfeeding and the provision of advice to women regarding the consequences of supplementation during the early weeks of breastfeeding.
Still have questions? Don’t hesitate to call or email me anytime with your concerns. I am here to assist you in any way I can.