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Breastfeeding 101: Milk Supply

For whatever reason, milk supply is a huge concern for new breastfeeding moms. I tend to think it is because breastfeeding doesn't work the way formula feeding does. Breast milk is digested faster and new breast fed babies eat more often than their formula fed counterparts. Cluster feeds, babies who want to nurse frequently, mother-in-laws who never breastfed wondering why the baby can't go more than two hours without eating, and tired moms are just a few reasons that women begin to wonder...

Am I making enough? Am I even capable of doing this?

Almost certainly, yes!

I'm not trying to be dismissive of these concerns and I will get specific about how to know if there's a problem and what to do about it. I just don't want you to go into this thinking that there's likely to be a problem. I've been active on breastfeeding support for over two years now and have almost never run into women who quite simply did not make enough milk. There is usually a reason for whatever is going on – from everything is perfectly normal (The most common answer, actually....growth spurts seem to spark a lot of concern.) to early supplementation or bottle use resulting in nipple confusion. Even if there is a real supply problem, very often it can be corrected if you know what to look for or who to ask.

I often hear pregnant women say the following: “I'm going to try to breastfeed.” or “I'm going to breastfeed if I can.”

Somewhere, someone must have given women the impression that being physically incapable of breastfeeding is common or that breastfeeding is just too hard. Yeah, I've already said it can be a struggle for the first few weeks and that I don't expect you to love it from the word go. On the other hand, why not take a lesson from “The Little Engine Who Could?” “I think I can...I think I can...” You can do it! :=)

Before I had my son, when people asked me if I would breastfeed, I said, “Yes.” No ifs, ands, or buts. The same is true for this one. I will breastfeed. In fact, this time I won't even have formula in the house. It was a bit of a temptation last time.

In countries where breastfeeding is encouraged and mothers are given long maternity leave, such as Sweden and Norway, something like 99% of women breastfeed. So if someone, probably a La Leche Leage member, tells you that 99% of women can breastfeed, that's a good place to look for verification.

So as I said: Are you making enough? Are you capable of doing this?

Almost certainly, yes.

Now, let's get specific!

IS MY MILK SUPPLY LOW?

There are exactly two ways to identify that your baby is not getting enough breast milk:

1.Insufficient wet diapers. (There should be at least 5-6 a day.)

2.Poor weight gain. (This one will get its own topic in a bit. You need to use breastfeeding charts, not general baby growth charts that include formula fed babies, and you need to understand what a problem really looks like....just moving around percentile lines isn't necessarily it. A breastfeeding friendly doctor will help greatly. Of course, sometimes it's obvious. If your baby is losing weight, there's a problem.)

If one or both of these things is true then you need to get some help for your baby as soon as possible. See my “Getting Support” topic for how to know where to get help.

As I said, I've been active in breastfeeding support for over 2 years and we get lots of moms coming through, wondering if their supply is low. Here are just a few of the signs that many women mistake as signs of inadequate milk. They are NOT.

1.Frequent nursing. Breast milk is digested quickly and most breast fed babies nurse often, even going through occasional cluster feeds. There is no upper limit to the amount a baby can or should nurse. This can be frustrating (as a mom whose son averaged 15 times a day for the first couple months, I can sympathize) but it does not mean the baby isn't getting enough.

2.Infrequent or short nursing, particularly when babies previous nursed longer or more often. If you are nursing on demand, then you are nursing the right amount. Some women get concerned because other breastfed babies nurse more often or because their breast fed baby used to nurse more often and has slowed down. Take both of those things as a blessing, and in fact, most babies do slow down after the first few weeks.

3.Sudden increased frequency of length of nursing. This is probably a growth spurt. The most common times for a baby to growth spurt are 3 weeks, 6 weeks, 3 months, 6 months, and 9 months but a growth spurt can occur at ANY time.

4.More frequent/fussier nursing at a certain time of day, particularly evenings. This is normal. (http://www.kellymom.com/babyconce
rns/fussy-evening.html)


5.Fussiness. Lots of things cause fussiness. If your baby cries inconsolably for long periods of time, this may be colic and it may be something to investigate, but it does not mean your baby isn't getting enough milk unless, of course, there are insufficient diapers and/or poor weight gain. Some fussiness is perfectly normal.

6.Baby will drink readily from a bottle right after a meal. Here's a quote:

“When the bottle goes in the baby's mouth the mouth fills with milk, the baby is obligated to swallow and the action of swallowing initiates another suck. The suck again fills the mouth and the cycle repeats, giving an appearance of the baby "gulping the bottle down hungrily".”

www.mother-2-mother.com/cc-baby-B.htm#Fuss
iness


7.Not leaking or no longer leaking or leaking very little. Whether during pregnancy or after, leaking has nothing to do with your ability to produce milk. I never leaked at all.

8.You never feel let down. Once again, no relevance at all. Not all women feel this. I never did.

9.Your breasts get softer or lose that “full” feeling. This is pretty normal, especially around 3-6 months as your breasts adjust to your supply needs.

10.You pump very little milk. This is a big one, but remember that pumps are not as efficient as babies and aren't all that good at getting milk out. It is also normal for the amount you pump to go down over time. If you need to pump more milk, especially if you're a working and pumping mommy, here's a great article to help:
www.kellymom.com/bf/pumping/pumping_decrea
se.html


WHY IS MY MILK SUPPLY LOW?

If you determine that your supply is low, the next question you should be asking is why? This will directly impact what you do about it. Here are some common reasons that milk supply is low:

1.Supplements. Nursing works on supply and demand. If you aren't demanding it, your breasts will stop supplying it. Every bottle of formula you give impacts supply a little bit and because supplementing decreases your ability to nurse, it can be a slippery slope. Here is an article that I have linked to before that talks about when it's a good idea to supplement, when it's not, how to supplement if you do, and how to WEAN from supplements if you believe this is the problem with your supply.
www.mother-2-mother.com/supplement.h
tm


2.Nipple Confusion. It's not just about outright refusal of the breast. Sometimes nipple confusion is subtle and insidious. This is why I can't stress enough how dangerous bottles are for the first few weeks of life. Bottles are easier and faster sources of milk for a baby and this can cause a preference, or it can cause babies to get lazy at the breast. It can also cause a bad latch. If you think this is a problem, the best thing to do is to stop bottle use immediately. This doesn't mean to stop supplementing since this can worsen weight problems, but supplements should be given in a different way. Here is Dr. Sears' on nipple confusion...towards the bottom he has tome info on un-confusing the baby. Those of you who are reading this pre-pregnancy, the best thing is prevention!

www.askdrsears.com/html/2/T022400.as
p


3.Pacifiers can cause nipple confusion as well and they can also cause your baby to spend less time nursing, which might be a problem in the wrong baby.

4.Nipple shields are known to effect supply for a variety of reasons. If your supply is low and you are using nipple shields, it may be time to wean off of them. Think carefully before you use them in the first place. They have their uses, but also their dangers. Here's a repost of the whole scoop on nipple shields
www.kellymom.com/bf/concerns/baby/we
an
-shield.html


5.Scheduling feedings is not a good idea. Sometimes, the problems in supply from scheduling don't even show up for a while. Babies should be fed when they are hungry or the natural cycle of demand and supply is thrown off. If you're considering schedule, I implore you to look carefully at the other side. Here are some references: www.kellymom.com/babyconcerns/bf-links-con
cerns.html#schedule


6.Sleepy Baby. I had this problem and it can be very frustrating for the first few weeks for some women. If your baby is sleeping too much, then the problem is not with you but with getting the baby awake and engaged enough to eat. The best thing to do is to try to wake your baby to feed more often. Here are lots of articles with some tips and suggestions: www.kellymom.com/babyconcerns/bf-lin
ks
-concerns.html#sleepy


7.Cutting feeding time short. If you've heard that you should feed for 20 minutes on each side, or 10, or 15, or 24.8, it's all a load of bologna. Watch your baby, not the clock. Stopping a feeding before a baby is done eating can impact supply.

8.Only offering one breast per feeding. There are times when this is ok and even a good idea, but not when you are struggling with increasing your supply. By default, it's best to offer both breasts.

9.Health problems on the part of the baby can keep them from getting enough milk out. If your baby is sick or premature, you need to work closely with a doctor and lactation consultant.

10.Tongue tie. This one will come up again under latch problems. Some babies are born with a condition in which their frenulum is too short and tight, causing restricted movement of the tongue. It's not all that uncommon, but it can be hard to find a health professional who is willing and able to diagnose it. Here's some info:
www.breastfeeding-basics.com/html/to
ng
uetie.shtml


11.Latch problems can cause supply issues. I'll get into detail there when I talk about latch problems.

12.Sick mommy. This is usually temporary and it is best to nurse through sickness except under very rare circumstances. When you're better, your supply will get back to normal, although your baby may nurse more frequently for a while. www.kellymom.com/health/illness/mom-
il
lness.htm


13. Poor Diet. Women who try to diet too soon or who go on a restrictive (1200-1500 calorie) diet at any point are risking their milk supply. Make sure you are eating and drinking enough.

14. For me, I know if I don't eat or drink enough while dieting and working out, it hurts my supply. Make sure you are eating and drinking enough!

At the bottom of this article, which I've been using heavily for the above information, you'll find some general tips on increasing milk supply:
www.kellymom.com/bf/supply/low-suppl
y.
html#supply


You may have noticed – I sure did – that the list didn't include the possibility that there's just something wrong with your ability to produce milk. It's rare, but there's always the other 1%, isn't there? It is difficult to find information about what to do if you're in that situation. I've looked and have found very little information. Most breastfeeding supporters don't want to talk about this possibility. Some don't even want to acknowledge it.

I'm not that type of breastfeeding supporter. (Hopefully you can tell from my topics so far!) I first stress that it's rare, then tell you how to know if there's a problem, then tell you what may be causing that problem, but if all that is in place and you still aren't producing enough milk then the only thing I can suggest is going to a lactation consultant to see if you can nurse part time and supplement with formula. I will go into this more in my topic on supplementing. Unfortunately, as I mentioned above, supplements can be a slippery slope to an even lower supply, but there's never harm in trying to make it work. In the end, you'll know you did the best you could and that the breast milk you were able to give your baby was a great start for life!

OVERSUPPLY

Many women make too much milk, especially at first. In fact, as little as we hear about it, this is far more common than the other way around. For many women, this isn't a real problem. Eventually, your supply will regulate downward and that's fine.

Some women, though, do have problems because of too much milk or too forceful of a letdown. It can cause your baby to gag, choke, gulp, gasp, or cough. It can cause them to pull off the breast, chomp down, spit up often, be very gassy, refuse to nurse, and dislike comfort nursing. If oversupply or overactive letdown are causing you problems, here's some advice for you:


www.kellymom.com/bf/supply/fast-letd
ow
n.html


REFERENCES


www.kellymom.com/bf/supply/low-suppl
y.
html#supply


www.kellymom.com/babyconcerns/fussy-
ev
ening.html


www.mother-2-mother.com/cc-baby-B.ht
m#
Fussiness


I would like to give a sweet mama from babyfit a special thank you for giving me permission to use her info. Thank you Christine Amsden!! Also, I want to invite you all to look at her new website! www.christineamsden.com

Edited by: ROAD2HEALTHY at: 1/5/2009 (16:19)
~Lisa~ Pagan mama of three boys! road2healthy-simplelife.blogspot.com
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