Anyone who wants to breastfeed or is even currently breastfeeding will increase their success and lower their frustration by understanding how milk is produced by the body, and how that alone dictates milk supply. With this simple piece of information, you can transform your breastfeeding relationship because you will understand milk supply even though you can’t even see it, or know how much milk baby is getting.
The Milk Flow Cycle
Milk is constantly being produced by the body and therefore your breasts are never empty. Why do you not have milk continuously flowing out of your breasts? Because milk is produced and stored in glands until triggered to be released. The release of milk is known as a let-down. Let-downs are caused by stimulation of the breast (sucking) but can also be caused by crying. If you hand express (squeeze your breast), you will see milk come out and you might also have milk leak out but both of these scenarios are different than a let-down. A let-down is when milk flows from the breast quickly.
Foremilk vs. Hindmilk
The initial fast flowing milk is called foremilk, this is composed of mainly water and its purpose is to quench baby’s thirst. After several minutes, the flow of your milk will slow down and the milk changes to hindmilk, which is very fatty. Hindmilk is baby’s food. If you watch baby nurse, you will start to recognize the fast and slow-paced flow. Baby will start to gulp milk at a fast rate and then start to slow down and then even pause between sucks for hindmilk. Eventually milk will stop flowing and this completes a cycle. Baby can either stay on and continue nursing or de-latch (come off the breast). If baby decides to stay on and continue sucking, a new cycle will start with another let-down.
MORE SUCKING EQUALS MORE MILK: The Hormone Prolactin
Before the moment your baby nurses for the very first time, your body is already producing milk in the form of colostrum. Why? Hormones. Specifically, the hormone prolactin, which starts to continually increase after the first trimester. When baby nurses, this hormone spikes telling the body to produce more milk. Every time baby stimulates the breast by sucking (nursing), prolactin spikes, and more milk is made. Or in other words, more frequent nursing causes more prolactin prdocution, which increases milk supply.
Which scenario better increases milk supply?
Nursing every hour for 10 minutes or nursing every 3 hours for 20 minutes?
Both scenarios have the same total duration but the correct answer is nursing every hour for 10 minutes because this results in a higher frequency, meaning more prolactin and an increased milk supply. The quickest way to cause problems with supply is by limiting the number of feedings, especially in those first three months when your milk supply is continually increasing to match baby’s needs. Waiting to feed a baby who is clearly showing hunger signs will hurt your supply. Giving baby a pacifier to placate them instead of nursing will hurt your supply. Not feeding baby because they can’t possibly be hungry as you just nursed them will hurt your supply.
Instead follow the rule, nurse on demand. If baby is fussy, nurse. If baby is showing any hunger cues such as hand eating, turning side to side, rooting, or crying, nurse. Another fact about breastmilk is that it digests in 60-90 minutes so that means baby will be hungry a lot and it is 100% completely normal to feel like you are nursing all day and all night. Remember, you cannot over-nurse a baby! I promise as baby gets older, it will not feel so overwhelming and it will actually be so much easier than bottles.
Follow baby’s cues
Babies instinctively know how much and when to nurse to increase your milk supply to match their needs. This is why a mother of twins can produce enough milk as both babies will nurse as much as they need to in order to get the supply they need.
An interesting fact about night time is that prolactin levels are higher, meaning that mom has more milk at night than during the day. Nursing babies during the night, especially in those early months is critical to supply. Every time you decide to skip a nursing session at night and have someone give baby a bottle, you are essentially telling your body that baby doesn’t need as much, and your body will produce less.
Note: There is a second hormone that also helps regulate milk production, the Feedback Inhibitor of Lactation (FIL). The important thing to note here is that it’s a local hormone located in the breast, and when it’s removed by nursing it tells the body to increase production. Because it is local, if baby is only nursing on one side, the other side will actually dry up or produce less because this local hormone isn’t being removed on both sides. Babies usually have a side preference. They usually like the left side more because they can hear the mother’s heartbeat while nursing, but try as much as possible to nurse evenly on both sides.
To Cause a Let-down: The hormone Oxytocin
Don’t panic about milk supply, in addition to prolactin, oxytocin also plays a role in breastfeeding. In order to have a let-down, a release in the hormone oxytocin occurs. What produces the release? Hearing your baby or any baby cry, seeing pictures of your baby, or most importantly being calm and relaxed. The worst thing to do is be stressed, frustrated and tense when you try to nurse. If you need to, take a few deep breaths before trying to latch baby. If you are trying to latch baby and it isn’t going well, have someone help you. Let them calm the baby by bouncing and shhh-ing as you prepare to try again. Maybe adjust your position, close your eyes and breath calmly. Have them hand baby back after you have a boob out so you can quickly get them latched.
Colostrum to Milk: The Start of Your Milk Supply
During the first day with you newborn, you can expect to produce around a 1 tsp of colostrum at each feeding to fill baby’s tummy, which at this point is about the size of a cherry. With such a tiny tummy, you should expect to nurse as often as possible. The first mistake that new mothers make in establishing a milk supply is that they don’t breastfeed frequently enough in those first few days. Newborns are very sleepy and might sleep through feedings. Don’t let this happen, if you are approaching 2 hours since the beginning of your last feeding, take your sleeping newborn into a nursing position and gently stir them until they begin rooting and latch. At night, just nurse every time baby wakes. During day 2-3, continue nursing as often as possible. Baby’s tummy is growing to a walnut size and you are producing around 2-3 tsp of colostrum at each feeding. You will most likely be heading home soon so remember to utilize the staff at the hospital for breastfeeding help, especially if they have a lactation consultant. Also, don’t leave until you ask about how you can acquire a pump from insurance, which is mandatory for all insurance companies to cover.
Sometime between day 3-5, your milk should come in. If you have any concerns that your milk isn’t coming in or baby is always crying, see your pediatrician immediately as baby might not be getting proper nutrients or hydration. When your milk comes in, your breasts will feel fuller and hard. The milk will change from yellow (colostrum) to white over the course of the next two weeks. Over these days, the quantity of milk per feeding should increase to about 2.5 oz as baby’s tummy grows to the size of an apricot.
After day 5, your breasts should have returned to being soft, which is not a sign of low supply. Your milk supply will continue to increase based on how often you nurse baby. It is very common during these first few weeks to have a clogged duct. For understanding what a clogged duct is, how it can turn into mastitis and tips on clearing it, read Alli’s article on clogged ducts.
A few tips as you start your breastfeeding journey
Try to remember the phrase, quality not quantity in those early days. As baby’s belly is so tiny, frequency is key here to have your milk come in and to have a happy baby. In addition to ramping up your milk supply, there is another way to utilize these frequent feedings which is to gain a lot of practice. Use all these feeding to get the latch right, understand baby’s hunger cues, and as a time to bond with baby, so put down the phone and look at your beautiful baby while you nurse.
Sometimes baby will only root (search for a boob by turning head side to side and opening mouth) on you. So, during these happy first few days home with all of those visitors, remember to check in with baby often by just taking baby back and seeing if they are ready to nurse. It isn’t impolite to frequently nurse even if you have visitors. They will understand. Not nursing frequently enough will not only be detrimental to your supply, but will also result in a baby who will need even more than usual feedings during the night due to not getting enough feedings during the day.
If you are already nursing and having milk supply issues
If you are currently dealing with a low milk supply, first I want to ensure you there is no shame and you should have not guilt in supplementing. Fed is always best and any breastmilk you are giving your child is truly a gift. No matter where you are in the nursing process, the same rules discussed above hold true. Increasing the frequency of nursing will increase supply. One of the best ways to add in more feedings is to dream feed baby. Dream feed is feeding a baby who is sleeping. Sleeping babies are the easiest to latch so if you are having any nursing issues, dream feeding might also help you. Essentially, nurse baby when they go to sleep, when they stir during their naps, and when they wake.
During the night, a dream feed means you nurse baby right before you go to sleep to get an extra nursing session in and to also get some zzzs before baby wakes. If you are supplementing, your first step is to pump every time baby supplements. I highly recommend you power pump as this mimics cluster feeding, which is high frequency for an hour. Power pumping goes as follows: Pump for 20 minutes or until milk stops flowing, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes, pump for 10 minutes.
The other two biggest culprits to having a low milk supply?
As discussed earlier in this post, the most important factor to having good milk production is frequent nursing. The other two common reasons for not producing enough breastmilk is dehydration and not taking in enough calories. At your nursing station always ensure there is a water bottle and a healthy snack such as trail mix. When you nurse, you will most likely feel hungry and very thirsty. Listen to your body! I know you might be worried about losing baby weight as I was, but I promise, if you eat healthy and nurse, the weight will fall off.
It is very common to hit a plateau in weight loss after the initial drop but slowly if you continue nursing and fueling your body, the weight will fall off. Something that really helped me eat healthy was freezer meal prep as you have very little time to get things done around the house with a baby. Evening is a very popular time for all babies to want to nurse for hours on end to increase supply, and to stock up before night. If you also want to get dinner on the table, this can be really problematic. To save yourself a lot of time and guarantee eating healthy, I recommend checking out Alli’s freezer meal prepping guide.
Want more resources?
I hope by the end of this post you feel more confident in understanding how your supply changes based on how milk is produced. Remember above all else, frequency is key in succeeding at breastfeeding. Whether you are expecting and want to breastfeed or are already a breastfeeding mama, we want to help you reach your breastfeeding goals. We have designed a FREE breastfeeding email course that helps you develop tools and support no matter where you are in your breastfeeding journey. We have also taken all the knowledge we have learned from lactation consultants, breastfeeding support groups, and academic journals and compiled it into a quick easy to reference handbook along with trackers to help you gain insight on your own breastfeeding relationship.
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Dr. Trina Fitzpatrick is a wife, mom, blogger, and a breastfeeding advocate. She is the co-author of the Week-by-Week Bump Smart Course, the Nesting Planner and the Breastfeeding Handbook. She attributes her success at breastfeeding her own children into toddlerhood with working with lactation consultants in the hospital in the early stages and on a weekly basis afterwards. By writing at MomSmartNotHard, she educates mamas-to-be on all things pregnancy, birth and breastfeeding. Read more about Trina.