Breastfeeding consultant advice: what to do if you don't have enough milk

10.05.2016 12:00:00

If you find that you have, read this article. Lactation consultant Emma Pickett gives advice to breastfeeding moms on what to do if they don't have enough milk.

Forgive me for this question, but... Are you really low on milk?

I would like to start with this very important question. Please be patient. My question is not related to doubts about your situation, and I would not like to appear in your eyes as a woman, a lactation consultant, annoying with her arrogance. However, I consider it critical to note the fact that most women who have recently become mothers suspect that they have a lack of milk. Often this is not the case.

Most women who start because of their doubts about whether the baby is getting enough milk or not, do not really have this problem.

Every day, mothers give in to unreasonable panic and stop breastfeeding or start supplementing with formula, when in fact everything is fine with their lactation. In most cases, the unjustified introduction of supplementary foods, without adequate support, leads to the fact that the volume of milk produced actually decreases.

Not enough milk: when it only seems to you

1. If your baby cannot stand the X-hour intervals between feedings, this does not mean that you have little milk.

Although the book on your coffee table says it "should" be, or so your mother-in-law says, or your friend's baby is X-hours between feedings, this is not a sign of a lack of milk.

A happy healthy baby of a beautiful mother with full lactation can get hungry again 1 hour after the previous feeding or 1.5 hours, or maybe 45 minutes or 2 hours later. Babies can breastfeed very often (cluster feedings. - approx. per.) And even for a very long time do not let the breast out of the mouth at all. During growth spurts, babies can breastfeed every hour during the day.

2. The cessation of milk leakage is not a sign of its insufficient production.

Some mothers leak less than others. Most breastfeeding women find that milk leakage decreases week after week. The tiny muscles of the sphincter of the nipple that open/close the duct outlets become more and more trained.

3. Feeling soft breasts, empty, not filled as before, is not a sign of lack of milk.

Excessive fullness of the breast, which a nursing mother feels at the initial stage of breastfeeding, is associated with vascular edema (blood and lymph) and storage of excess milk between feedings, which is unusual for the body.

Gradually, the mammary glands adapt to storage (do not forget that milk is produced constantly, including during feeding), over time, as the development of glandular tissue slows down, a smaller volume of blood and lymph is required to produce breast milk.

At the initial stage of breastfeeding, it is usually fairly easy to determine which breast to offer for the next feeding. This feeling passes. And many mothers mistakenly attribute this to a decrease in milk production. Not all women continue to feel heaviness and fullness throughout the entire period of breastfeeding. Waiting "until the chest is full" is fundamentally wrong. This means a misunderstanding of the physiology of lactation, which varies with the length of the lactation period.

The more full the breast, the slower the milk is produced; in the emptied breast, milk is produced faster. "Empty" soft breasts can produce significantly more milk per day than full, heavy breasts.

4. Brief feedings are not a sign that you are not getting enough milk.

Many babies get everything they need in less than 10 minutes at the breast. Perhaps not in 5 minutes, although some feedings can be so short. Many babies use their uvula and maxillofacial muscles very effectively in the process of sucking the breast, they swallow-swallow-swallow, gradually the rate of sucking slows down, the milk becomes fatter and denser, and in the end they themselves let go of the breast with satisfaction. Feeding can last 9 minutes or 19.

The baby can spend up to 30 minutes emptying the breast (the breast is never completely empty, by "empty" we mean that the baby has sucked out the amount of milk he needs in this particular feeding). As they grow older, the duration of feedings can be significantly reduced. And this does not mean at all that there is less milk.

The short, sluggish, inefficient sucking and rapid falling asleep at the breast of a newborn with jaundice is another problem.

Long feedings, however, are not always a sign of successful breastfeeding.

5. Small breasts are not a sign of lack of milk.

Large breasts, in addition to glandular, are filled with adipose tissue. It is a mistake to judge milk production by breast size alone.

The question of the "unusual" type of breasts that worries a nursing woman, we will consider a little later.

6. Frequent awakenings of the baby are not a sign that you are not getting enough milk.

Many babies in the first months of life are breastfed quite often, at regular intervals day and night. Many grown-up babies continue to wake up for feedings every 2-3 hours.

7. A baby who does not fall asleep after feeding does not mean that he does not have enough milk.

So, mom feeds the baby, he falls asleep on his chest, she shifts him to the crib, and he immediately wakes up, as if he was put on a prickly hedgehog. He wakes up, starts looking for the chest again. This happens because being in the mother's arms, feeling her warmth, smell, contacting her skin, the baby relaxes, warms up and feels very comfortable. Cradle, bed do not have all these properties, they are not a mother.

The most likely reason for awakening when shifting is the activation of the Moro reflex (fright, throwing up). 15-30 minutes after feeding, the level of the hormone cholecystokinin in the blood decreases, therefore, when shifting from hands, babies are more sensitive to external stimuli. A small infant, like all mammalian primates, needs the availability and proximity of the mother's breast, this is the best place for him. Breast sucking has a relaxing effect on babies. They love to suck in their sleep. This does not mean that milk is not enough.

8. Your baby's willingness to continue bottle feeding after breastfeeding does not mean you are low on milk.

The position of the nipple at a certain point in the baby's upper palate stimulates his sucking reflex. Babies continue to bottle feed even when they are full for this very reason. The consequence of such unjustified supplementary feeding can be overweight and obesity.

9. Not feeling hot doesn't mean you're low on milk.

Some breastfeeding mothers feel a tingling sensation in their breasts during a rush of milk, others do not. Most experience such sensations in the first few weeks, and gradually this effect disappears, which provokes anxiety in lactating women. In fact, this should not be taken as an indicator of the presence of problems with lactation. Feelings are normal.

10. Small amounts of milk obtained from pumping are not a sign of a lack of milk.

The processes of pumping and breastfeeding have significant differences. The baby gets milk from the breast in a completely different way. Many women with normal full lactation cannot express large amounts of milk because the milk ejection reflex (flushing) does not work fully in response to pumping. The breast pump is not suitable for everyone, and the parts wear out.

These are the only signs that you are low on milk

1. Problems with weight gain. The baby is born and then loses weight. Within two weeks after birth, he regains the weight he was born with. Further increases average 150-200 g per week. After about 4 months, the intensity of weight gain usually decreases. If weight loss exceeds 10% of birth weight in the first days after birth, this is cause for close attention, but other factors, such as how the birth was, should be considered.

• Were there intravenous infusions during labor that filled mom and baby with extra fluid?
• Does the newborn look edematous, similar to the Marshmallow Man in the photographs of the first days of life?

This fluid increases birth weight and leaves the body in the first few days, so we can see a lot of weight loss. But this is not necessarily due to a lack of nutrition or milk production. However, after day 5, the weight loss should stop and not recur. Some babies take 3 weeks to regain their birth weight.

Look at the weight gain chart provided in your red book (Individual Child Health Chart in the UK, it features WHO weight gain charts). Note that there is a line on the graph corresponding to birth weight, then the curves break and resume in the second week.

If a baby's birth weight is in the 75th percentile, don't expect him to follow that target exactly after a two-week period. That is why the lines do not continue and there is a missing space. Resumption occurs after two weeks, and the baby's weight may be closer to the 50th percentile, then ideally weight gain should be in line with this guideline. But in reality, weight gain fluctuates around the benchmark, or it can drop and approach the 25th percentile and then bounce back up.

Therefore, most children gain weight on their own schedule, not exactly following the line of a certain percentile. These graphs are a guide, average data, but not a mathematical pattern.

2. Diapers. In the first 4 weeks, we focus on the number of bowel movements and urination. After the arrival of milk for 2-5 days after childbirth, it should be normal to have at least 6 wet diapers and stools 3 times a day, each the size of half a tablespoon or more. After 4 weeks, some babies may experience a decrease in stool frequency, which is normal. Sometimes the stool may be absent for several days, and supplementary feeding is not required.

Weight gain and diapers. It is these and only these indicators that can be used to reliably assess milk production. You've probably heard the opinion that "the baby should calm down after feeding", but some babies need to pass gases, poop or burp, others wake up and require a second portion. Therefore, it is better not to focus on this opinion, but to monitor weight gain and diapers.

So let's recap, are you really low on milk? I sincerely regret if this is true. If your baby only gained 60g in the last week and 90g or less or nothing at all in the previous week and the gain curve on the chart is going down. I'm sorry, because I understand how frightening this feeling is, there is nothing more important. Then here's what you can do.

Not enough milk: what to do

1. Find Helpers

Find people with experience in breastfeeding. The help of a person advising you to use the mixture in this situation will hardly be useful to you. If his help is limited to this suggestion, most likely he does not understand much about breastfeeding, you need to find a knowledgeable assistant who understands the laws of lactation. Experienced people can also recommend the use of formula (or donor milk), but only in small quantities and in special cases, and at the same time they will give actionable recommendations that will help maintain and increase milk production.

You need the help of loved ones. If you plan to follow the recommendations below, you will need the support of loving people who will take care of you - prepare food, sometimes fill the bath for you ... and send a message before your next weigh-in next week at the clinic about how what they think of you.

2. Effective organization of breastfeeding

The Lactation Consultant or IBCLC (Lactation Consultant) should assess attachment, latch on. Something in the process of suckling may not be perfect, even though there are no injuries and deformation of the nipples after feeding. Attachment check:

• Is your baby's chin deep enough against your chest?
• Is the baby firmly pressed against your body with his tummy?
• Are the ear, shoulder and hip in line (axis)?

In addition to attachment, the consultant will also evaluate the organization of the breastfeeding process. How often do you feed? Maybe your baby doesn't show signs of suckling very clearly, or did someone tell you that you have to wait for him to show them, and therefore there are sometimes breaks of 4 hours between feedings? Maybe you should breastfeed more often?

The specialist may also need to take a closer look at your baby. Is there any reason that prevents him from efficiently extracting milk? The consultant will evaluate the frenulum of the tongue (is it not short, does it belong to the posterior (submucosal, ingrown) type), the anatomy of the jaw, palate. If certain structural features are found, the consultant will offer to master and work out deeper attachment and various postures for feeding, or recommend contacting a specialist who deals with these problems (for example, cutting the bridle).

How do you rotate breasts? Too often? (And the baby is not getting enough fat). OR did someone advise you to “glue” the baby to one breast forever so that he gets to the “hind” milk, and the baby doesn’t really eat anything in 45 minutes? Perhaps, on the contrary, you need to alternate breasts every 20-30 minutes and then the baby will receive more milk from both breasts in general, including milk rich in fats. Both too frequent and too infrequent breast rotation can be the cause of problems with weight gain. Find a specialist who will teach you to recognize the moments when the baby swallows, to understand in what situation it is necessary to offer the breast and to understand when full feeding can be considered complete.