Breastmilk supply and demand: your questions answered

February 18, 2013, 5:27 pm Simone Casey | Lactation consultant Yahoo!7

Whether your breastmilk supply is a little low or your breasts are too full, Practical Parenting explores the most common problems of breastmilk production.

Breastmilk supply and demand - your questions answered
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Your breastmilk supply is a delicate operation relying on the demands of your baby, but it can be confusing trying to work out if your little one is getting exactly what she needs to help her thrive. Read on for insight on how your milk supply works and some troubleshooting plans.

Is colostrum enough?


In the first days of breastfeeding your breasts produce colostrum, a yellowish, antibody-rich milk. At this stage, if you hand express only a few drops will come out, but on the first day of life your baby’s tummy is only the size of a small marble (maybe 5ml, max!), so rest assured this is all she needs for now. Her tummy expands to 15ml by day three and your breasts will be firming up as your milk comes in.

My breasts are too full, what can I do?


If you allow your baby unlimited access to the boob from birth, this will help prevent engorgement, which is when breasts become very full and feel bruised to touch. If this happens, they key piece of advice is “don’t limit your baby’s time at the breast,” says Nicole Bridges, from the Australian Breastfeeding Association (ABA), who adds that it’s a good idea to “wake your baby for a feed if your breasts become uncomfortable, especially at night-time.” Pay careful attention to positioning and attachment to maximise the amount of milk your baby is getting. If your full breasts are still hurting, “use warmth before feeds to help trigger your let-down reflex, massage gently while you are feeding and use cold packs or chilled, washed cabbage leaves after a feed to reduce inflammation,” Nicole advises. You may even need to express for comfort after feeds or ask your medical advisor or the hospital staff about taking anti-inflammatory medication for pain relief.

What if my baby loses weight?


Don’t panic if your baby loses weight after birth, as this is expected and doesn’t mean you can’t produce enough milk. Most hospitals prefer babies to lose no more than 10 per cent of their birth weight until they start regaining it (usually after the first week), but not all babies fit into this category and it’s important to speak to an expert, such as a lactation consultant, if your baby has lost more than this. Sometimes it’s just a matter of waiting another day for your milk to fully come in under the watchful eye of a health professional, and to feed, feed, feed.

How will I know if my supply is too low?


When your milk is finally in, it’s the frequency and effectiveness of your baby’s sucking at the breast that will keep breastmilk supply up. This is known as supply and demand. “Remember, the more the baby takes, the more the breast makes!” says Nicole.

Is my baby getting enough breastmilk?


Newborns feed between eight and 12 times in 24 hours - to work out whether your baby is getting enough milk, Nicole says that she needs to meet at least two of the below criteria:
  • At least four or five heavily wet disposable nappies, or six to eight cloth nappies, in 24 hours. A very young baby will usually have two or more soft bowel movements a day for several weeks. An older baby is likely to have fewer than this.
  • Good skin colour and muscle tone.
  • Alertness, being reasonably contented and not constantly wanting to feed.
  • Some weight gain and growth in length and head circumference.
  • Your baby may still wake for night feeds – some babies sleep through the night at an early age while others wake during the night for some time.

How can I boost my breastmilk supply?

If you discover your supply is low, there are lots of natural ways to increase it rather than having to turn to formula, drugs, expressing or top-ups – although in some instances these steps are required. One of the keys to increasing supply is good attachment, says Nicole, who explains that “a baby who is well positioned is more able to empty the breast”. Nicole recommends seeking help from the ABA (www.breastfeeding.asn.au) or a lactation consultant for one-on-one assistance. ‘Switch feeding’, which involves changing sides several times during a feed, may help, coupled with breast compressions to train your baby to keep sucking when she stops. Alternatively, simply adjusting the frequency of feeds may work. “You may want to offer a breastfeed every two to three hours during the day, for a few days, or at least increase the number of feeds by offering the breast in between your baby’s usual breastfeeds,” says Nicole.

Does my breastmilk supply decline in the evenings?


Mums commonly complain of their breasts feeling empty during cluster feeding spells in the late afternoons or evenings. “Rest assured there is milk there, as breasts are never totally empty,” says Nicole, who suggests following bub’s lead and feeding according to need rather than timing feeds by the clock. “You may need to feed very frequently for a few hours but will have a settled, sleepy baby at the end of it all,” she says. When your breasts feel emptier, it also means your milk is higher in fat, which eventually will get your baby into a long sleep, as well as help her to put on weight.

What if I have too much breastmilk?


As worrying as it is to have low supply, the opposite is also distressing for mums. Life can feel out of control when you can’t go out without your breasts soaking through breast pads and causing embarrassing wet patches. Oversupply can also lead to blocked ducts and mastitis if the breasts aren’t drained often enough. Your bub may show signs of an over-abundant supply with explosive green poos, lots of possetting or spluttering and gagging at the breast.

Julie Wedd, a mum of one, realised she had an oversupply after speaking to an ABA counsellor at a local support-group meeting. Her son Marlo’s symptoms included “massive green poos and gut aches” and during feeds the let-down “was so full-on, he had to really hold on and I could hear it chugging into his poor stomach. If he pulled off it sprayed everywhere”. After discovering a technique called ‘block feeding’, Julie was able to calm her supply down. “This strategy means feeding your baby on one breast for two more feeds in a row,” explains Nicole. “You choose a time period, say, four hours, and each time during that time period you offer the same breast.” It worked for Julie, whose son is now nine months and much better at controlling her flow. Occasionally milk can still go everywhere, but luckily Julie can see the funny side. “The look of indignation as milk squirts into his face is priceless!” she says.

Other tips to cope with fast flow include ‘posture feeding’, where you lay right back so bub is feeding uphill, or positions such as lying down to feed or the football hold. “If bub is finding the initial gush of milk to be particularly distressing, you may also like to express until the first gush subsides and then attach her,” adds Nicole.

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