A little knowledge can be a dangerous thing. This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding. The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and premature weaning.
The 2003 edition of The Breastfeeding Answer Book defines these terms this way:
“The milk the baby receives when he begins breastfeeding is called the ‘foremilk,’ which is high in volume but low in fat. As the feeding progresses, the fat content of the milk rises steadily as the volume decreases. The milk near the end of the feeding is low in volume but high in fat and is called the ‘hindmilk’” (Mohrbacher and Stock, p. 34).
It goes on to explain that by simply letting the baby “finish the first breast first”—switching breasts when the baby comes off the breast on his own rather than after a set time—the mother can be sure her baby receives the “proper balance of fluid and fat.” Since this book was published, research has expanded our understanding of foremilk and hindmilk and answered many of the common questions mothers have about these concepts.
What worries? Confusion about foremilk and hindmilk has led to all sorts of uncertainty. Are there two distinctly different types of milk? Does the baby need to breastfeed for a specific number of minutes before foremilk suddenly turns to hindmilk? Can a baby miss out on hindmilk altogether if he breastfeeds for too short a time? If this happens often, will his weight gain suffer? Sometimes healthcare providers get into the act, telling breastfeeding mothers they should watch the clock to make sure their baby breastfeeds “long enough to get the hindmilk,” with the number of minutes recommended varying by adviser What do we really need to know about foremilk and hindmilk? And is there any reason to worry?
The truth about foremilk and hindmilk. Research has found this concept is not as simple as it sounds. It is true that fat sticks to the milk ducts in the breast and the percentage of fat in the milk increases during a breastfeeding as the fat is released from the ducts during milk ejections. But the reality of this seemingly simple dynamic is not always as it seems.
There are not “two kinds of milk.” Despite this common belief, there is no “magic moment” when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.
The total milk consumed daily—not the hindmilk—determines baby’s weight gain. Whether babies breastfeed often for shorter periods or go for hours between feedings and feed longer, the total daily fat consumption does not actually vary.
Foremilk is not always low-fat. The reason for this is that at the fat content of the foremilk varies greatly, depending on the daily breastfeeding pattern. If the baby breastfeeds again soon after the last feeding, the foremilk at that feeding may be higher in fat than the hindmilk consumed at other feedings.
How does this work? Interestingly, foremilk and hindmilk are concepts that really only make sense when longer intervals such as two to three hours or more occur between feedings. The longer the time gap between feedings and the fuller a mother’s breasts become, the greater the difference in fat content between her foremilk and hindmilk. These differences in fat content can vary greatly over the course of a day even among individual mothers. For example, when a long breastfeeding gap occurs during the night, at the next feeding a mother’s foremilk will be lower in fat than during the evening when her baby breastfeeds more often.
What really matters. Research indicates that there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer. As long as a baby is breastfeeding effectively and the mother does not cut feedings short, baby will receive about the same amount of milk fat over the course of a day no matter what the breastfeeding pattern (Kent, 2007). This is because the baby who breastfeeds more often consumes foremilk higher in fat than the baby who breastfeeds less often. So in the end it all evens out.
What’s most important to a baby’s weight gain and growth is the total volume of milk consumed every 24 hours. On average, babies consume about 750 mL of milk per day (Kent et al., 2006). As far as growth is concerned, it doesn’t matter if a baby takes 30 mL every hour or 95 mL every three hours, as long as he receives enough milk overall (Mohrbacher, 2010). In fact, researchers have found that whether babies practice the frequent feedings of traditional cultures or the longer intervals common in the West, they take about the same amount of milk each day (Hartmann, 2007) and get about the same amount of milk fat. Let’s simplify breastfeeding for the mothers we help and once and for all cross foremilk and hindmilk off our “worry lists.”
Hartmann, P.E. (2007). Mammary gland: Past, present, and future. in eds. Hale, T.W. & Hartmann, P.E. Hale & Hartmann's Textbook of Human Lactation. Amarillo, TX: Hale Publishing, pp. 3-16.
Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.
Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.
Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX: Hale Publishing, 2010.
Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3rd edition. Schaumburg, IL: La Leche League International, 2003.
The following articles may be of interest to mothers and those who support them. This is just the beginning of an extensive online library which will grow over time as the organization grows. Our goal is to provide evidence-based information and support: What Does Evidence-Based Mean? Each article is well researched and contains up-to-date information. An Editorial Review Board ensures the quality of the articles. Our website and these articles are brought to you by the generous donations and memberships of others in communities across the USA. Please consider making a contribution or joining Breastfeeding USA today.
Preparing to Breastfeed
Just for Teen Mothers
Positioning and Latch
Infant Growth and Development
Caring for Your Growing Baby
Expressing Your Milk
Special Breastfeeding Circumstances
Family and Community
We extend sincere appreciation to all the authors that have donated articles to Breastfeeding USA.
In a recent blog post, I told a military mother who had returned to work at six weeks postpartum that she was making as much milk as her thriving baby would ever need. To meet her breastfeeding goal of one year, I told her, “all she had to do was maintain her milk production.” But maintaining milk production is not always easy for employed mothers, especially when they don’t know the basic dynamics affecting how much milk they make. I shared some of these with this mother, and my explanation set her mind at ease.
Breast storage capacity. This is the amount of milk in a woman’s breasts when they are at their fullest each day and this amount can vary greatly among mothers. Breast storage capacity affects how many times every 24 hours a woman’s breasts need to be drained well of milk—either by breastfeeding or expression—to maintain her milk production. When her breasts become full, this sends her body the signal to make milk slower. In other words, “drained breasts make milk faster” and “full breasts make milk slower.” The amount of milk needed to slow milk production will be much greater in a woman with a large breast storage capacity, so she can remove her milk fewer times a day without her milk production decreasing
The “magic number.” This refers to the number of times each day a mother’s breasts need to be well drained of milk to keep her milk production stable. Due to differences in breast storage capacity, some mothers’ “magic number” may be as few as 4-5 or as many as 9-10. But when a mother’s total number of breast drainings (breastfeedings plus milk expressions) dips below her “magic number,” her milk production slows.
Daily totals. Many of the employed breastfeeding mothers I help by phone are diligent about maintaining their number of milk expressions at work, but often, as the months pass, they breastfeed less and less at home. With this change in routine, they may drop below their “magic number,” which causes a dip in milk production.
Recently, as I asked one employed mother with decreasing milk production about her daily routine, she told me that her baby was sleeping in a swing all night. She discovered that in the swing he did not wake at night to feed, so she was sleeping on the couch in her living room next to the swing and waking every hour to check on him. I told her that eliminating those nighttime breastfeedings was the likely cause of her decreased milk production and I asked if she thought returning to breastfeeding at night might mean more sleep for her as well as more milk for her baby.
More Breastfeeding When Together Means Less Expressed Milk Needed. The amount of milk per day babies need between 1 and 6 months stays remarkably stable, on average between 25 and 35 oz. (750-1050 mL) per day. By thinking of the 24-hour-day as a whole, it becomes obvious that the more times each day the baby breastfeeds directly, the less expressed milk will be needed while mother and baby are apart. But many mothers don’t realize that dropping breastfeedings at home and encouraging baby to sleep more at night adds to the amount of expressed milk their baby needs during the day. Understanding these basic dynamics can go a long way in helping mothers meet their long-term breastfeeding goals.
In response to the previous post, "The 'Magic Number' and Long-Term Milk Production," a reader of this blog wrote: “I have a 6-week-old and just returned to work. I pump once every 3 hours and am pumping more than enough milk for my baby. But I am fearful of pumping less. Given my son’s eating routine is still getting established and will likely change still, how do I determine my ‘magic number?’”
I suggest you begin by thinking back to your maternity leave, assuming you were breastfeeding exclusively and your baby was thriving. On average, how many times every 24 hours did your baby breastfeed? As a starting point, consider this your “magic number.” For example, if the answer is 8 (which seems to be average), assume that to keep your milk production steady long-term you will need to continue to drain your breasts well at least 8 times each day. If you’re pumping 3 times each workday, this means you’ll need to breastfeed 5 times when you and your baby are together. (This will be much easier if 2 of these breastfeedings include one just before leaving your baby for work and another as soon as you and your baby are reunited again.)
Another factor that can affect milk production is the longest stretch between breast drainings (breastfeedings or pumpings). Ideally, to keep milk production stable, do not regularly allow your breasts to become uncomfortably full, as that gives your body the signal to slow milk production. If your baby sleeps for long stretches at night, I usually suggest going no longer than about 8 hours between breast drainings. Despite the social pressure for your baby to sleep through the night as young as possible, for most mothers it is easier to keep long-term milk production stable if they continue to breastfeed at night.
So don’t just focus on your pumpings at work. Also keep your eye on the number of breastfeedings outside your work hours. As I mentioned in a previous post, many of the employed breastfeeding mothers I talk to pump often enough at work, but as the months pass, the number of breastfeedings outside of work gradually decreases. It’s not just how many times you pump at work that determines your milk production. More important is the number of breast drainings every 24 hours and how this total compares to your “magic number.”
Q: Why does my breastfed baby take at most 4 ounces (120 mL) from the bottle when my neighbor’s formula-fed baby takes 7 or 8 ounces (210-240 mL)? Am I doing something wrong?
A: You are not doing anything wrong. And in this case, more is not necessarily better. Formula-fed babies typically consume much more milk at each feeding than breastfed babies, but they are also more likely to grow into overweight children and adults.1,2 One large study (16,755 babies in Belarus) compared feeding volumes in formula-fed and breastfed babies and found that the formula-fed babies consumed 49% more milk at 1 month, 57% at 3 months, and 71% at 5 months.3 Australian research found that between 1 and 6 months of age breastfed babies consistently take on average around 3 ounces (90mL) at a feeding. (Younger babies with smaller tummies take less milk.)
Breastfed babies’ milk intake doesn’t increase from months 1 to 6 because their growth rate slows.4 As growth slows, breastfed babies continue to get bigger and heavier on about the same daily milk intake, averaging about 25 ounces (750 mL) per 24 hours.
Why do formula-fed babies drink so much more milk? There are several reasons:
The bottle flows more consistently. During the first 3 to 4 months of life, after swallowing, an inborn reflex automatically triggers suckling.5 Milk flows more consistently from the bottle than the breast (which has a natural ebb and flow due to milk ejections, or let-downs), so babies tend to consume more milk from the bottle at a feeding. Before this reflexive suckling is outgrown, babies fed by bottle are at greater risk of overfeeding.
Breastfeeding gives babies more control over milk intake. Not seeing how much milk is in the breast makes a breastfeeding mother less likely to coax her baby to continue after he’s full.3,6 As the breastfed baby grows and thrives, his mother learns to trust her baby to take what he needs from both breast and bottle and also solid foods when they are introduced later. One U.K. study found that between 6 and 12 months of age breastfeeding mothers put less pressure on their babies to eat solid foods and were more sensitive to their babies’ cues.7
More milk in the bottle means more milk consumed. In the Belarus study mentioned before, babies took more formula at feedings when their mothers offered bottles containing more than 6 ounces (180 mL).3
Mother’s milk and formula are metabolized differently. Formula-fed babies use the nutrients in formula less efficiently,8 so they may need more milk to meet their nutritional needs. Formula is also missing hormones, such as leptin and adiponectin, which help babies regulate appetite and energy metabolism.9,10 Even babies’ sleep metabolism is affected, with formula-fed babies burning more calories during sleep than breastfed babies.11
Q: If my baby takes more milk from the bottle than I can express at one sitting, does that mean my milk production is low?
A: See the previous answer. Babies commonly take more milk from the bottle than they do from the breast. The fast, consistent milk flow of the bottle makes overfeeding more likely. So if your baby takes more milk from the bottle than you express, by itself this is not an indicator of low milk production.
To reduce the amount of expressed milk needed and to decrease the risk of overfeeding, take steps to slow milk flow during bottle-feeding:
- Use the slowest flow nipple/teat the baby will accept.
- Suggest the feeder try holding the baby in a more upright position with the bottle horizontal to slow flow and help the baby feel full on less milk.
- Short breaks during bottle-feeding can also help baby “realize” he’s full before he takes more milk than needed.
1 Arenz, S., Ruckerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity--a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28(10), 1247-1256.
2Dewey, K. G. (2009). Infant feeding and growth. In G. Goldberg, A. Prentice, P. A., S. Filteau & K. Simondon (Eds.), Breast-Feeding: Early influences on later health (pp. 57-66). New York, NY: Springer.
3Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. (2004). Feeding effects on growth during infancy. Journal of Pediatrics, 145(5), 600-605.
4Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.
5Wolf, L. S., & Glass, R. P. (1992). Feeding and Swallowing Disorders in Infancy. Tucson, AZ: Therapy Skill Builders.
6Taveras, E. M., et al. (2004). Association of breastfeeding with maternal control of infant feeding at age 1 year. Pediatrics, 114(5), e577-583.
7Farrow, C., & Blissett, J. (2006). Breast-feeding, maternal feeding practices and mealtime negativity at one year. Appetite, 46(1), 49-56.
8Motil, K. J., Sheng, H. P., Montandon, C. M., & Wong, W. W. (1997). Human milk protein does not limit growth of breast-fed infants. Journal of Pediatric Gastroenterology and Nutrition, 24(1), 10-17.
9Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2008). Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants' risk for excess weight at late infancy. Pediatrics, 122 Suppl 2, S77-84.
10Doneray, H., Orbak, Z., & Yildiz, L. (2009). The relationship between breast milk leptin and neonatal weight gain. Acta Paediatrica, 98(4), 643-647.
11Butte, N. F., et al. (2000). Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. American Journal of Clinical Nutrition, 72(6), 1558-1569.
Today I spoke by phone with an employed breastfeeding mother in the military who had recently returned to work. She told me she was worried she would not be able to keep up her milk production over the long term. I shared with her some facts that could smooth the way for any employed breastfeeding mother but are not widely known.
From 1 to 6 months of age the breastfed baby’s daily milk intake stays relatively stable. This mother assumed—like most—that as her baby grew bigger and heavier, he would need more milk. In fact, that’s not what the research shows. Because babies’ rate of growth slows between 1 and 6 months, daily milk intake remains remarkably consistent during this time.1 I told this mother that since her baby had been thriving on exclusive breastfeeding for his first six weeks that she was golden. She was already producing as much milk as her baby would ever need. All she needed to do was maintain it. (Note: This is not the case for the formula-fed baby, as explained in my article Breast Versus Bottle: How Much Milk Should Baby Take? which leads to many mistaken assumptions.)
After solid foods are started, the breastfed baby needs less milk. This mother also expressed concern about meeting her one-year breastfeeding goal because her husband was scheduled to deploy in January, when her baby would be 7 months old. She was worried that as an employed mother alone with a 7-month-old baby and a 2-year-old toddler, she would not be able to keep up with her baby’s need for milk. I told her that once her baby started on solids, which is recommended at six months, the baby would actually need less and less milk, as he ate more and more solids.2,3
She told me that this information was a huge morale booster and that it made meeting her breastfeeding goals seem much more feasible. This is information every employed breastfeeding mother needs to know.
1. Kent, J. C., et al. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.
2. Islam, M. M., et al. (2006). Effects of varied energy density of complementary foods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children. American Journal of Clinical Nutrition, 83(4), 851-858.
3. Cohen, R. J., et al. (1994). Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet, 344(8918), 288-293.
These laid-back positions not only make breastfeeding less work for mothers, they also make it easier for babies to take the breast deeply, especially during the early weeks. That’s because in these positions gravity helps rather than hinders babies’ inborn feeding reflexes, which can make a huge difference when babies are at their most uncoordinated. After decades of teaching mothers to breastfeed sitting upright or lying on their sides, many have difficulty visualizing this new approach. One common question I am often asked is whether these positions are practical after a cesarean birth. The answer is most definitely yes.
A number of adjustments can be made to help a mother customize laid-back breastfeeding (also known as “Biological Nurturing”) to her body type and situation. As you can see from these line drawings, one adjustment is changing the direction of the baby’s “lie” on her body. In all laid-back positions, baby lies tummy down on mother, but this can be accomplished in many ways. The baby can lie vertically below mother’s breast (as on this website’s banner), diagonally below the breasts, across her breasts, at her side, even over her shoulder. As Suzanne Colson explains in her DVD, “Biological Nurturing: Laid-Back Breastfeeding,” the breast is a circle, and the baby can approach it from any of its 360 degrees, except for positions in which the baby’s body covers mother’s face. So after a cesarean birth a mother can use many laid-back positions without baby resting on her incision.
Another possible adjustment is the mother’s angle of recline, or how far the mother leans back. In laid-back positions, the mother leans back far enough so that her baby rests comfortably on her body without needing to support her baby with her arms but is upright enough so she and her baby can easily maintain eye contact. Because most hospital beds are adjustable, finding their best angle of recline is especially easy during the hospital stay. At home, I suggest mothers imagine the positions they use to watch their favorite television show. Most of us lean back on a sofa, chair, or bed, using cushions or pillows so we can relax our shoulders, head, and arms. Colson says the best laid-back breastfeeding positions are those that mothers can easily and comfortably maintain for up to an hour.
When using laid-back breastfeeding, ideally each mother finds her own best variations by trial and error. In light of these insights, I think the time has come for us to stop naming and teaching specific breastfeeding “holds.” (After all, no one teaches bottle-feeding mothers how to hold their babies during feedings!) That way, mothers will no longer waste their time trying to duplicate feeding positions taught in classes or pictured in books that may not be right for them or--even worse--may even make early breastfeeding more difficult. Instead, each mother’s focus will stay exactly where it belongs: on her and her baby.
1 Colson, S. D., Meek, J. H., & Hawdon, J. M. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development 2008; 84(7):441-449.
Have you seen all the ads for nursing clothes? They can make you think that you will have to spend a lot of money on special clothes, but this is not true. Here are some tips to help you decide what you REALLY need. Let's start with lingerie and work our way out.
Here is a big secret: nobody really needs to wear a bra unless they want to! Nothing terrible is going to happen to your breasts if you prefer to go bra-less. However, bras are very convenient for holding nursing pads if you tend to leak.
If you do feel more comfortable wearing a bra, wait until the last couple of weeks in your pregnancy before buying them, as your breasts will change a lot during pregnancy..
Mothers who wear bras usually need them in at least two sizes. When your baby is born you will produce small amounts of concentrated milk called colostrum. During the next 10 to 14 days, your colostrum will gradually change to larger amounts of mature milk. Mother nature often assumes you will be nursing twins, if not triplets! Most mothers find their breasts expand one or two cup sizes, sometimes more.
Your baby will will regulate your milk production, because you only make more milk when milk is removed. Soon you will only be making the exact amount of milk your baby needs. By the time their babies are about three months old, many mothers have gone down a cup size and are thinking about new bras.
Do try on a variety of nursing bras to get a good fit. Soft cotton cups are usually the most comfortable. If you really want underwire bras, make sure the wires are not pressing on the sides of your breasts, as that can cause plugged ducts.
Many mothers just buy regular bras in stretchy fabrics, like cotton knits. To nurse, pull down a strap just over your shoulder and then pull down the cup. This avoids fiddling with nursing bra closures and saves a lot of money.
Two piece outfits are easiest. Although there are lots of lovely nursing tops in the stores, you don't need one to nurse discreetly. Just lift the hem of your top and tuck in your baby! Knit tops work especially well because they drape so nicely.
Here is another easy idea to save you money – the two-layered look.
- First put on a knit shirt - any camisole or tee shirt, or even a man's undershirt will work!
- With two pins - or a marker - mark two spots on the shirt, one about three inches above your left nipple, and one about three inches below your left nipple.
- Repeat on the right side.
- Take off the shirt, and cut two slits, lengthwise, between the pins. There is no sewing as knit fabric does not unravel.
You can wear this shirt under any other top. To nurse, lift the top layer so that you can nurse through the slits in the under shirt. Have fun making these in colors to mix and match with your top layers!
Dresses, jumpers, nightgowns and PJs
If you have a choice, then two-piece dresses (or Pjs) are the way to go.
Look for sleeveless dresses, jumpers and nightgowns which have openings under the arms or deep armholes, through which you can nurse. Some of the currently fashionable dresses and nightgowns have cross-over or stretchy necklines which can be pulled down to nurse.
Jackets, cardigans and shawls
If you are still a bit nervous about breastfeeding outside your home, then jackets, cardigans and shawls are good for shielding the side view.
When you think about it, there are very few clothes you MUST buy to nurse a baby. Pass on these tips to other nursing mothers!
Did you know that nursing pillows were originally designed to prop up babies who are not quite ready to sit on their own? They became popular when women started using them to help them nurse.
Nowadays these curved pillows are on many "must have" check lists. They can sometimes be quite useful. For example, mothers who are nursing twins may find it helps to use the extra-wide pillows. Being able to lie the twins on each side of the pillow is almost like having an extra arm.
Unfortunately, nursing pillows are not always as helpful as people think they will be.
Emily and her friend Lauren were both upset because breastfeeding was not going well. Like many new mothers, they thought breastfeeding would just come naturally. They had not taken any classes or read anything about breastfeeding before their babies were born. Now they were wondering why they were having difficulties.
You may be surprised at the reason for both Emily and Lauren's problems – nursing pillows!
Lauren took her new nursing pillow to the hospital and began using it as soon as her baby was born. However, she quickly noticed that Baby Ethan was not nursing well and not gaining enough weight. Added to that, her nipples were getting sore. Lauren tried holding her baby in different positions, but nothing seemed to help. Even her back seemed to hurt.
Emily had been so happy that nursing had gone so well in the hospital. Her problems started when she got home and found that a nursing pillow had arrived as a gift.
“Lily had just loved to nurse, but when I started to use the pillow, everything changed,” she said, crying softly. “Lily tried so hard to latch on. We both became very frustrated and my nipples became sore. It was awful.”
So what was it about the nursing pillows that made it difficult for Lauren's and Emily's babies to nurse?
They can actually create problems where none existed before. Babies need to be very close to their mothers' bodies to get a good latch, and nursing pillows often get in the way. Most mothers do not need nursing pillows. In fact, it is much easier to get a good latch without one!
The instructions on how to use the pillows are not always clear or accurate.
- Laying your baby on the pillow can make it difficult for him to latch. This makes it more likely you will get sore nipples. Your baby needs to be turned toward your body to get a good latch. AFTER he has started nursing well, you can rest your arm on the pillow.
- Many mothers get backaches from leaning over a baby placed on a nursing pillow.
- One size does NOT fit all, and there are no standard sizing charts. This makes it difficult to know which brand or design will work best for you. Your height, the length of your arms and the size of your waist can all make a difference.
- Nursing pillows are bulky. It can be a nuisance to take one with you every time you go out!
Luckily, both Emily and Lauren were able to get the help they needed. As soon as they learned how to position their babies so they could get a good latch, nursing became much easier.
Nursing a baby is supposed to feel comfortable. If it hurts to nurse, it means there is something wrong. The good news is that most breastfeeding concerns can be easily fixed, so do get help right away.
Remember when it felt like you had two boulders full of milk on your chest? And if the baby let go while nursing, you'd laugh as the milk sprayed everywhere? But now things have changed. No more leaking, your breasts don't feel “full” anymore, and your baby's behaviour is changing too. Have you lost your milk?
It's a common worry. “I would say that the majority of breastfeeding women will have concerns about their milk production at some point,” says lactation consultant Karyn-grace Clarke, president of the British Columbia Lactation Consultants Association. There are certain times when this is more likely: in the first couple of days after birth, before the mature milk comes in; when the baby is around three or four weeks old and starts nursing frequently; and between three and six months.
Changes in baby's behaviour are often behind these concerns, Clarke says. “Mothers tend to think they've lost their milk if suddenly the baby is fussier, feeding more often or crying more than usual. Sometimes the baby begins to wake more frequently at night or starts taking shorter naps in the day, and the mother may think this means the baby is hungry because she has less milk.”
What could be happening? Clarke lists some of the common — and normal — changes that can sometimes be interpreted as a decrease in milk:
- Mothers often feel that once their breasts are not engorged, or when they stop leaking milk between feedings, their milk supply has gone down. “In truth, what these things mean is that their milk supply has been regulated,” says Clarke. “It’s common for a mother to overproduce milk in the beginning before her body finally understands how much it really needs to make on a daily basis.”
- As babies grow, it’s normal for them to take less time to feed. Your newborn might have needed 30 or 40 minutes to fill his tummy; by three months, he may be satisfied after just five or 10 minutes.
- Between four and six months, most babies become easily distracted, even at feeding times. They latch on, nurse for a few seconds, pull off to look at the TV, then go back on for a few more seconds, let go again because a fire truck just went by, and so on. “Many mothers think this means they don't have enough milk to keep the baby interested in feeding,” says Clarke.
- A baby who had been sleeping for fairly long stretches at night may begin waking again, and mothers often think this means the baby is hungry due to a drop in milk production. However, there can be many reasons for increased night waking, including teething, nursing less often during the day, a cold or a virus.
Signs your milk production has dropped
How can you know if your milk production really has dropped, or if you're experiencing one of those normal changes? “If baby continues to have a regular pattern of wet and poopy diapers, it's very likely that everything is fine,” says Clarke. “One thing to note is that around the six-week mark, many breastfed babies start having fewer poopy diapers.”
If your baby’s output pattern has changed, it would be a good idea to check his weight gain; if that has slowed down significantly, then milk production may be a concern that needs attention.
Should you supplement if you see signs of an actual decrease in milk? Clarke recommends you first consult with a breastfeeding expert who can help you figure out the cause. “I would need to consider many different things that could be in play: the mother's health history or current health situation, any changes in breastfeeding or sleeping patterns, any medications that the mother is taking, possible stresses, separation between mother and baby, adding other foods or liquids to baby's diet, and so on.”
Depending on the cause, you might be able to increase milk production by adjusting your breastfeeding technique or the frequency of feedings, changing medications, or taking herbal supplements or medication to increase the amount of milk you make.
At times, supplementation is needed, but it's less likely to lead to unintended weaning if done with a plan to increase milk production and gradually decrease the supplementation — the kind of plan a lactation consultant or other breastfeeding expert can help you work out. If continued supplementation is needed, that doesn't have to mean the end of breastfeeding, either: There are approaches (such as “paced” bottlefeeding and giving the supplement first, then finishing at the breast) that help to keep the baby interested in nursing
The hormonal shift
Lactation consultant Karyn-grace Clarke points out that when the baby is about three months old, milk production stops being controlled by the mother's postpartum hormones, and starts being controlled by the information that the body has gathered during the previous weeks of breastfeeding. If the baby nursed infrequently in those early weeks, the milk production may decrease at this point because there were not enough “milk-making factories” created to match the baby’s needs.
Copyright Teresa Pitman. Used with permission. Originally published in Today's Parent.
What if babies were born knowing how to breastfeed? While that’s a new idea to most of us, it does make sense. Other newborn mammals know how to find and attach to their mother’s nipples, following inborn instincts in response to physical cues they receive from contact with the mother’s body.
Paediatrician Christina Smillie has found that human babies do, in fact, have quite remarkable abilities when it comes to breastfeeding.
"Baby’s instincts to look for and latch on to the breast involve a sequence of behaviours, where one behaviour leads to the next." She says that sometimes our attempts to help babies latch can actually interfere, by jumping the queue as it were. “"When we start with the baby's mouth at the nipple, we are skipping a lot of the early part of the sequence, which sets the stage and helps the baby organize his behaviour," she explains. Of course, many babies do latch when put to the breast, and once a baby has latched several times, there is no need to follow the whole sequence. But for many babies who are learning to latch, Smillie says, "it is helpful to engage the full sequence."
We asked Dr. Smillie to take us through this amazing process, step by step:
- Aim for a calm beginning
"The mom should hold her baby, skin to skin — baby in a diaper only, mom with no shirt or bra — and just enjoy the baby. She should hold the baby upright, midline between her breasts, just cuddling the baby with no thought about breastfeeding. There's no hurry; we’re on baby time here." If the baby is not interested in nursing — perhaps he's not hungry, or he’s more sleepy than hungry — Smillie says he'll usually stay curled up on his mother's chest so that his chest and tummy don’t touch hers. "It seems to be the feeling of the baby's chest against the mother's chest, skin to skin, that starts the nursing sequence."
- Follow baby's lead
If he's hungry and ready to eat, the baby will start squirming around, bobbing his head against you, perhaps looking up at your face and making eye contact. He'll then start twisting to one side or even moving quite vigorously, almost throwing himself sideways. "At this point," Smillie says, "the mother's job is just to keep the baby relaxed and comfortable so he can follow through on his instincts. Support his neck and shoulders with one hand and his hips with the other, and just follow him as he moves. Avoid the temptation to try to make him latch on or even to try to line up his mouth with the nipple."
- Support the baby as he is latching
As the baby moves down, Smillie continues, "his lower cheek might brush the nipple or the breast and that makes him turn towards it — the rooting reflex. When baby's chin hits the breast, the firm pressure of the breast against his chin makes him open his mouth wide and reach up and over the nipple. As the baby approaches the nipple, it is his nose, not his mouth, that will first be positioned over the nipple." As he presses his chin into the breast and opens his mouth, he'll get a large mouthful of breast and a deep latch.
Baby-led latching is ideal for babies learning to breastfeed, but can also be helpful for those who've already had some negative experiences at the breast. "Babies can begin to associate the breast with a lot of pressure and hassle," Smillie says. "They often need a break." If this is the case, Smillie suggests the mother stop trying to latch the baby for a few days (giving the baby her pumped milk instead), and provide lots of relaxed skin-to-skin time on her chest after each feeding.
Eventually (remember, "we're on baby time") the baby will naturally begin the process of seeking the breast. "We help the baby stay calm and relaxed to allow him to follow his own instincts. There's no rush, no pressure."
What if that latch isn't quite perfect and the mother's nipples are hurting? "Pain is a guide," says Smillie. "Mothers shouldn't put up with it. Often, if the pain is mild, she can fix things by adjusting the baby's position without unlatching — usually by pulling the baby's rump in more snugly, which moves the baby's whole body and the baby's head will tip back a little bit more, allowing his jaw to open wider. This way the baby gets a bigger mouthful of breast.
"It can also help to roll the baby's whole body outward. Most women's nipples point at least slightly downwards, so most babies need to be positioned to look up at their mothers, chin deep into the breast and mouth under the breast."
As one mother said, after her baby daughter followed these steps and latched on beautifully, "I had no idea babies were so smart! She really does know what to do. That takes a lot of pressure off me — I can just relax and let her lead the way."
Copyright Teresa Pitman. Used with permission. Originally published in Today's Parent.