36: From Day One- The Basics of Milk Supply
In today’s episode we are going to review some important factors to establish, build, and support breastmilk production. One take-away from this episode that is really important, is that most of the time low supply is caused by failing to or being unable to meet the basics needed to establish and maintain your supply. So these basics are really important and you’ll want to be aware of these from the start.
Your breastmilk supply does not magically build or maintain itself without the right actions that send the right message to your body that, yes it should make more milk and/or maintain its supply.
A few days after giving birth, usually between days 3 and 5, a woman’s body initiates a new phase of lactogenesis, and even though things have been happening in your breast glands for some time and you already have colostrum available for your baby- everyone refers to this next phase as the one where your “milk comes in”.
Perhaps it’s because it’s more obvious that there’s milk in there when you are fuller and the volume is higher. But even if your milk comes in as expected on day three, the routine you’ve kept since day one, along with other underlying factors, have already been playing a role in your future milk supply. These include: a good latch (or pump fit) and frequent milk removal. Let’s break these down now first for breastfeeding and then for pumping.
Firstly, it is so important to be breastfeeding with an adequate latch. Poor or painful latches are the enemy of pro-milk making hormones, milk transfer, and fully fed babies. (For more on latching check out Episode 24: Causes of a difficult latch.)
Next, and ideally, you will nurse within an hour or so after birth and then frequently thereafter at LEAST 8 times per 24 hours (10-12 times is actually more typical when following an infant's feeding cues).
One of these feedings should be between 1 and 5 am when prolactin (the milk making hormone) is high. A healthy full term newborn baby will typically cue sometime during this window.
Lets recap what we’ve learned so far: a good latch, high frequency breastfeeding schedule, and nursing during the high prolactin window supports your milk supply. This sounds so simple but gets missed more often than you think, especially when babies are supplemented with donor milk or formula by bottle because frankly it’s a lot to keep up with when you are feeding a baby, and pumping, and trying to problem-solve a breastfeeding issue around the clock.
We can apply the same three rules for moms who are exclusively pumping or pumping until they can get breastfeeding off the ground. Pumping is meant to mimic breastfeeding. So, pumping with the wrong flange fit, discomfort with pumping, or simply not meeting the pumping frequency needed (again at least 8 times per 24 hrs) literally tells your body to make less milk.
I prefer establishing breastfeeding and supply first, then once everyone is comfortable and you get through the first month or so you can gradually plug in substitute pumping/bottle feeds. However if you are, for some reason, both nursing and pumping early on then the same three rules apply to support supply. Your breasts will need stimulation and milk removal (aka nursing or pumping comfortably and effectively) at that high frequency. And once during the wee hours when prolactin is high. If this is you, and you are both nursing and pumping with a baby less than a month old, please get some help so you can get to the easiest schedule as fast as possible.
One commonly misunderstood factor is that high frequency is not the same as the total time. See, some women think that if they nurse or pump for a longer duration or more minutes, they can then nurse or pump less frequently and the results are the same. Like, “Oh I’ll pump for 30 minutes once instead of 15 minutes twice.” This is simply and inconveniently not true. There may be situations where power pumping or other strategies are used for supply intervention, but just like you can’t workout once a week for a long session and make up for skipping workouts all week, you can’t pump for one long session and it makes up for missing the others.
Let’s review. For a stable and full supply, start with the basics. Is the latch (or pump) comfortable and effective, are you breastfeeding (or pumping) frequently enough, and once during that high prolactin time? If you aren’t feeling confident or run into a problem with any of these basics, I recommend getting support. And I’ll include a link to my resource guide on Finding a Lactation Consultant.
There are, of course, other factors unrelated to your behavior and routine, that also seriously impact milk supply. And we will cover those next week’s episode: Causes of Low Milk Supply. And with that I’ll see you next week!
Links mentioned in the show:
Link for: Episode 24: Causes of a difficult latch