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Help, my milk supply is low! Or is it?

By Tanya Lieberman, IBCLC

Ever wish your breasts had little ounce markings? If so, you’re not alone. One of the more confusing things about breastfeeding is determining how much milk you’re making. You can’t see how much is going into your baby, so how can you tell if your milk supply is enough for your baby?

On this page we share the best ways to determine if your milk supply is in fact low, and describe the many things that can make you think that your supply is low when it actually isn’t.

 

Below are some normal experiences that can trick you into believing that your supply is low:

“My baby wants to eat all the time.” It’s normal for babies to eat frequently, generally in the range of 8 to 12 times in 24 hours for many months. This means many hours of feeding a day, and it may feel constant at times. It’s also normal for babies to “cluster feed” at times during the day. If your baby is feeding significantly outside of the 8-12 times range, contact a lactation consultant or other breastfeeding support person.

“My breasts feel softer than they used to.” Toward the end of the first month of breastfeeding many women notice that their breasts have decreased from the size they were when their mature milk came in. This is normal, and does not indicate anything about milk supply.

“I don’t feel that ‘let down’ sensation.” Some women have a “let down” sensation when they make milk, and some don’t. It doesn’t seem to have any bearing on the amount of milk a mother makes, so don’t worry if you don’t feel anything.

“My baby suddenly wants to eat all the time.” Babies go through growth spurts. They do this in order to increase your milk supply to meet an increased need for calories. To do this, they go on a feeding rampage for a few days – eating more often than usual and sometimes acting unsatisfied and fussy after feedings. During a growth spurt it’s common to question your supply. After a growth spurt you’ll find that you have more milk than ever!

“I can’t pump very much.” Pumping output is usually not a good measure of milk supply. Why? Because your body doesn’t always make milk for the pump (it has to be tricked into believing that the pump is your baby!) and when it does the pump doesn’t remove milk as well as your baby does. So don’t gauge your milk supply based on your pumping output. You almost always have more than you pump.

“My baby is fussy when she nurses.” There are many causes of fussiness at the breast. And while hunger is one of them, your baby may be fussy because of gas, pooping, a flow that is too fast or too slow, or a host of other reasons. If you believe that your baby is fussy because he or she isn’t getting enough milk, or if the fussiness is causing you distress, consult a lactation consultant or other breastfeeding support person.

“My baby is suddenly waking up at night a lot.” Night waking can be due to hunger, but it can also be due to teething or “reverse cycling,” (when babies eat less during the day and more at night, often due to a change in routine like a return to work, or distracted behavior during the day).

 

Here’s how to tell if your milk supply is actually low:

1) Your baby’s weight. The best measure of whether your baby is getting enough milk is his or her weight gain.

If you are concerned about your milk supply, have your baby weighed and re-weighed using a baby scale. Scales will always be a little different, so be sure to compare only weights taken on the same scale. Except in critical situations, weight checks every few days or weekly is generally sufficient.

In the first three months of life babies gain an average of 1 ounce per day. That slows to at least approximately a half an ounce per day between 4 and 6 months. 

Occasionally your health care provider may suggest a “test weight,” in which your baby is weighed on a sensitive scale before and after a feeding (with the same clothes on) to determine how much milk the baby received at that feeding. This can give you a snapshot of a feeding, but be cautious in drawing conclusions from the data. The amount of milk babies take in at different feedings can vary widely, so bear this in mind if you do a test weight of your baby.

 

2) Diaper output. You can get a sense of how much your baby is taking in by what comes out. After the first few days, babies generally have at least three poops that are bigger than a quarter in size each day. This frequency may decline after several weeks. And your baby should have five very wet diapers per day. It can be difficult to measure output in very absorbent diapers, which is why your baby’s weight is considered the ‘bottom line.’

 

3) Swallowing. You may also take comfort in how much your baby is swallowing when nursing. This is not a definitive measure of your supply and should be confirmed with information about your baby’s growth, but a period of rapid swallowing (one swallow per one or two sucks) during a feeding shows you that your baby is getting milk. To check out your baby’s swallowing, listen for a ‘cah’ sound or a squeak or gulp, and look for a longer and slower movement of the jaw, often with a brief pause at the widest point. 

 

What to do if your milk supply is indeed low:

If your milk supply is low, be sure to get help from a lactation consultant (IBCLC) or other qualified breastfeeding support person. There are many steps you can take to build your milk supply, and these support people will be able to guide you through that process. You can find a lactation consultant by going to www.ilca.org.

 

Resources:

The Breastfeeding Mother’s Guide to Making More Milk. Diana West and Lisa Marasco, McGraw Hill, 2009.

La Leche League, International: www.llli.org

Kellymom: www.kellymom.com

Find a lactation consultant: www.ilca.org

 

Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms in hospital and pediatric settings.  She writes and produces podcasts for several breastfeeding websites, including MotherwearMotherlove Herbal Company, and the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-speaking moms.  Prior to becoming a lactation consultant she was senior education policy staff to the California legislature and Governor, and served as a UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

This resource page was made possible by Motherlove Herbal Company.

 

Baby Explains- Normal Newborn Behavior

By Diana Cassar-Uhl, IBCLC 

 

Dear Mommy,

Thank you so much for breastfeeding me!  You probably already know that your milk is designed especially for me, and is better than anything else you could feed me.

I know that right now, you feel like your friends who aren’t breastfeeding their babies seem to have an easier time of things.  Those other babies sleep soundly and longer between feedings, they drink so much, and they don’t fuss to eat all the time like I do!  I can tell you’re getting a little bit frustrated, and I hear all the advice you’re getting … my grandma says you weren’t breastfed and you turned out just fine, my daddy says he feels like he can’t do anything to soothe me, and that lady with the cold hands that you call “doctor” gave you a can of something that she says will help me grow faster.  You’re tired and frustrated because taking care of me just seems too hard, but please mommy, before you give up this yummy breastfeeding thing, let me explain some of my behavior to you.  It might help you feel better.

First, if you and I were separated after I was born, for any reason (maybe it was hospital protocol that I be left under a warmer, maybe you were recovering from surgery), I’ve got some catching up to do, because I probably lost more weight than my friends who got to stay close to their mommies.  It’s OK … I’m really good at letting you know when I need some more calories, but it’s important that you let me breastfeed lots and lots, even if my grandma says “he just ate!!”  In my first few days, the nurses at the hospital might tell you I’m hungry and your body can’t make enough milk for me … but mommy, that colostrum from your breasts is some awesome stuff!  It’s packed with protein, which binds to any bilirubin in my body (elevated bilirubin causes jaundice in more than half of newborns) so I can poop it on out.  It’s also a great laxative, which makes it easy for me to get all that black, tarry meconium out of me and we can move on to the seedy, yellow-brown poops that are much easier to clean off my sweet tushie.  Now, the colostrum is really thick and sticky, and I’m so small and still figuring out how to move my tongue, and we’re both still trying to get comfortable together, so it might take me 20 minutes or longer to suck out just ONE TEASPOON (5-7 mL) of that liquid gold.

But it’s OK, mommy!  You know, there is really nowhere I’d rather be than in your arms, hearing your sweet voice and smelling you  — even though you haven’t had a shower since before I was born, you’re just delicious to me.  And something else you should know about me … even though I have a really cute “Buddha belly” that looks all chubby, the capacity of my stomach on the day I’m born is just 5-7 milliliters – that’s the size of a small marble!  You’re the smartest woman in my whole world, so I know you see the connection here!  The amount of colostrum in your breast is exactly the capacity of my tummy!  My stomach walls on my first day of life are very rigid and won’t stretch; this is why, if anyone tries to feed me with a bottle, I’m going to spit most of it back up again, even though I eagerly suck at it.  See, mommy, I only have two ways to send and receive information from my brand-new world – I can cry, and I can suck.  I can’t see much, and all these sounds are so much louder than when I was inside you, and I can use my hands to help me orient myself on your breast, but crying and sucking are pretty much how I make sense of everything.

From the Heart Photography – Tiffany Hileman

I know it seems really confusing, mommy, that I would want to suck and suck and suck even though my tummy is full.  When I suck, lots of great things happen for both of us.  I keep my own digestion moving by triggering the involuntary digestive muscles in peristalsis – moving the contents of my stomach along because I’m still moving my mouth and tongue, which are the beginning of my digestive tract.  When you let me do all this suckling at your breast, I can very easily regulate how I suck, depending on why I’m sucking at any given moment.  You can probably feel when I’m suckling nutritively and swallowing lots of milk, and when I’m kind of relaxed about it, feeding sort of like I’m savoring a bowl of ice cream … you know how sometimes, you scrape just a tiny bit onto your spoon, because you want it to last a long time?  To me, you’re better than ice cream!  But on a bottle, it’s impossible for me to suck and not get whatever’s in there, and that’s confusing to me, so I might keep sucking because that’s what my instinct is telling me to do, or I might realize my tummy hurts (because even on day 10, my stomach capacity is only a ping pong ball) and I’ll cry and cry because all I really know is crying and sucking!

A word about these instincts I feel … I really can’t help it, mommy, that I want to suckle so much.  It’s just how I came out, and there doesn’t seem to be much that I can do about it.  Please believe me, I’m not trying to trick you!  In a few weeks, this need lets up a tiny bit, but for now, suckling is my M.O.  But, do you want to know something really cool?  I’m not the only one who benefits!  When I suckle at your breast in these early days, your body actually activates prolactin receptors!  Isn’t that amazing?  In my first two weeks, the higher I make your prolactin levels go (my suckling triggers a prolactin surge in your body), the more of these receptors get activated in your breasts, and the higher your potential milk production will be for as long as you choose to breastfeed me.  That’s one reason your lactation consultant tells you to wait on introducing that bottle or that binky– this prolactin receptor thing only happens for the first 10-14 days.  After that, the prolatcin surges when I breastfeed are much smaller, so the more receptors there are to gobble up what prolactin is there, the more easily you’ll make all the milk I need.

Besides prolactin, there’s oxytocin, another hormone I activate when I am at your breast.  Oxytocin is part of what makes you so addicted to me!  It’s “the love hormone” and it helps you feel relaxed and content when we’re breastfeeding.  Go ahead, mommy, exhale and relax!  It’s OK!  Oxytocin release is triggered by nipple stimulation, not necessarily milk removal (though when things are going well, my stimulation of your nipples usually means I’m removing milk!).  Now, I know this might sound a little awkward coming from your baby, but I need you to know something about oxytocin.  There are only three events in your life that trigger oxytocin release: nipple stimulation (like when I’m breastfeeding), labor (the oxytocin released during childbirth stimulates uterine contractions, which is why nipple stimulation might be suggested when labor stalls, and also explains why sometimes, after you breastfeed me, you feel an increased expulsion of lochia and maybe some cramping), and … orgasm!!  Isn’t neat that the same hormone plays a part in making me, birthing me, and feeding me, and it’s a hormone that makes you feel GOOD to do all three?

Mommy, I know you are trying your very best for me and you’ve been worried about whether your body can satisfy my appetite.  I know you’re used to being able to measure everything, and your breasts don’t have markers on them to tell you how much milk I got.  Maybe you used a breast pump, and that confirmed your worries that there isn’t much milk there – but mommy, please understand that a good pump can mimic me, but your body wasn’t designed to have all these wonderful hormone surges for a cold piece of plastic with a noisy vacuum motor.  You know that feeling you get when you hold my warmth and weight, smell how delicious I am, and nom nom nom on my fat cheeks?  That feeling helps you make milk!  That feeling is part of the whole system that was designed to make you need to be close to me, just as much as I need to be close to you.  And mommy, I know you’re very busy, and important, and there’s so much you used to do before I came, and I know right now, it feels like you’ll never do those things again, and our house is getting messy, and maybe that scares you.  But please know, every moment you spend holding me, every time you gaze lovingly at me, and every hour you spend breastfeeding me in these early days is so important to me, because you’re all I know.  I love daddy and grandma and all of our friends, but I’m designed to be happiest and least stressed when I’m with you.  Can you wear me in a sling or soft carrier after I’m milk-drunk?  I really like listening to your heart beating while I sleep, and you are warm and soft and smell so good.  That space between your breasts is perfectly sized for my head, and there’s nothing I like better than the feel of your skin against mine.  Well, maybe there is something I like better … I love it when you sleep next to me after we’ve been breastfeeding.  Oh, mommy, when you nurse me while lying down, you relax and your milk flows so nicely, and I feel like you’re so happy to be with me, and I’m very special to you because you don’t have to run off and do something else as soon as I’ve let your breast go.

And mommy, I have a promise to make to you.  I can’t say for sure when it will happen, but there will come a day when I need you a little bit less intensely.  My feedings will get more organized, my weight gain will stabilize, and sometimes, I’ll even like when my daddy or grandma or other loving person holds me.  But today, I need you.  You’ll always be my number one, even after we’re done breastfeeding, but I will learn, like you did, to defer my needs and to trust others to meet them once you and I get a good thing going.  Thank you so much for all you’ve done for me so far. Until you start giving me an allowance, I hope my good health, sweet smiles, coos, and giggles will sustain you!

Love,

Baby


 

Many thanks to the hundreds of readers that shared so many beautiful photos of their newborn babies.  There is just a small sampling here but you all have incredible photographs of your beautiful babies.  Thank you for being willing to share and to all the photographers of these precious images!

 

Diana Cassar-Uhl, IBCLC and La Leche League Leader, has written articles for the La Leche League publications Leaven and Breastfeeding Today, and is the author of the La Leche League tear-off sheet Vitamin D, Your Baby, and You. She is a frequent presenter at breastfeeding education events. Excited about her work toward a Master of Public Health, Diana hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition. Diana, mother to three breastfed children, has served as a clarinetist on active Army duty in the West Point Band since 1995. Diana enjoys running, writing, skiing, and cross-stitching when she finds herself with spare time.  She also writes at Normal, like breathing