Milk Supply and Intake:
The first two weeks
by Denise Altman
"I don"t think that my baby is getting enough milk."
When I am answering phone calls from new mothers, this is the statement that I most often hear. There seems to be something that kicks in with the postpartum hormones that leads mothers to doubt themselves and their abilities whenever parenting - and especially breastfeeding - becomes uncertain. The reality with this statement is actually rare, particularly once breastfeeding is well established. There are lots of ways a mother can verify for herself that her baby is getting enough milk.
Days 1 Through 3
Once the baby is born, a lot of learning takes place for both of you. Breastfeeding may be natural, but it doesn"t always seem to come naturally! In the first four hours after delivery, your baby may initially be very alert but then very sleepy. This can last for the next 24 to 48 hours, possibly even longer depending on the delivery and the individual. Sometimes it may be difficult to wake your baby for a feeding. Your nurse will encourage you to feed your baby every two to three hours; if the baby is sleepy, this can be a challenge. Ask for help whenever you need it.
Key points to remember:
- Latch Look at how the baby is latched on. Are his cheeks rounded and full?
- Can you or a partner see a pink lip line on the top and bottom? (You may have to gently compress the breast long enough to check). Can you see long jaw movement that is visible even at her temples or may cause her ears to wiggle? These are signs of a good latch.
- Sensation Does it hurt? If so, don"t try to tough it out. Pain is not normal; it's a sign of improper latch and the milk may not transfer effectively from you to him. What will happen is you will develop nipple trauma, which takes time to heal. Get help from the lactation consultant or nurse if you can"t obtain a pain-free latch.
- Between feedings How does the baby look? The nurse can help you with this; ask her to teach you how to check for symptoms. The baby should not be jittery or lethargic due to low blood sugar, and any jaundice (yellowish skin color) should be mild.
- Weight All babies will lose weight after delivery, regardless of feeding methods. They are born with extra fluid on board and will release it over the next few days. However, if a baby loses 10% of her birth weight, feedings definitely need to be fully assessed by an expert.
- Length of feedings vary widely in the first few days. On average, feedings may take 20 to 45 minutes of active sucking (not including burping and related activity). Some babies feed on one breast, others on both. Let your baby go as long as he wants until he falls asleep or release the latch. Then burp him and offer the other side. If he takes it, great! If not, that"s fine too. Eventually, most babies nurse on both breasts for a feeding, but they all find their own way to this.
- It may be difficult to hear your baby swallowing or to burp your baby in these early days. That is because the milk volume is fairly small, depending on the individual. However, colostrum is far more nutritionally dense than any other food source, so your baby doesn"t need much. Your milk usually comes in on day three to five. It is transitional at the time and will gradually change to fully mature milk. As your baby's appetite increases, so does your milk production.
- If at all possible, ask that at least one feeding be fully observed by a lactation consultant or breastfeeding expert before discharge. This can head off potential problems and also give you the positive reinforcement you may need.
Days 4 Through 7
By this point, you should be experiencing some breast fullness or even engorgement. You will be able to hand express some milk fairly easily. It should also be easier to hear the baby swallow and to see milk in or on her mouth. You may also be feeling tired and hormonal from the birth (and visitors). Fatigue often leads to anxieties about your newborn.
Key points to remember:
- Four in Four (4-4-24) - This is not a reference to April 4th, but the number four! By day 4, your baby should be making about four bowel movements that are at least the size of a quarter in a 24-hour period. This means your diaper count should include both the day and the night. Your baby may have more bowel movements than this, but there shouldn't be less. Wet diapers are good, but poopie diapers are better. If it's coming out, it must be going in!
- By day 5, unless your baby is jaundiced, his bowel movements will look loose and seedy or curdy and bright yellow, like French's mustard. There is very little odor.
- Your baby is nursing a total of 8 to 12 times in a 24-hour period. This is typically about every two to three hours. Less than eight feedings is probably not enough for good growth.
- Your breast tissue itself should be softer after a feeding. The nipple should be round and pink. If it is creased or reddened, the potential for trauma is greatly increased.
If you don"t observe these signs, seek help from a board-certified lactation consultant or other qualified individual. Sometimes the milk is there but it is not transferring. Other times, the baby is nursing well but the supply is not present. An expert will have a highly sensitive scale (two-gram accuracy) and can do pre- and post-feed weights to measure how much the baby is actually taking in. She can also do a complete feeding assessment and identify problems that aren't visible to the average person. By getting help early with problems early on, you can better establish your supply and save yourself a lot of energy.
Week Two
By this point, your milk is in and the baby should be gaining weight. The general goal is a weight gain of at least half an ounce per day, with the birth weight regained by two weeks of age. You will probably be a little more comfortable with latch and positioning, especially after practicing for this many days.
However, you will probably still be feeling a little anxious about caring for your baby in general. This is very normal. You have a whole new role to adjust to and that takes time - certainly more than a couple of weeks.
Babies at this age are not built to sleep through the night yet, so this may still be an adjustment for you as well. This is not a milk supply issue but a developmental one. A tremendous amount of growth occurs in these early months, and they seem to keep waking up for it! Some babies will sleep for one four-hour period during the day or night. At two weeks, the best thing that you can do during this time is to sleep as well, whenever your baby does. Your body has not healed yet, even if you are feeling good. You have heard this before and it is very true - nap when the baby naps.
What not to look for
There are a lot of myths out there that undermine a new mother's confidence in her ability to breastfeed. Listen to your own instincts and ask lots of questions, remembering to sort out opinion and personal experience from fact.
What to look for
Engorgement As milk production becomes well established, the breast tissue itself softens up, even to the point where you don't feel full before a feeding. This can occur after two or more weeks. Your body has adjusted to your baby's needs and is responding accordingly.
Crying A baby cries for a lot of reasons, not always hunger. He may have a burp, need changing, be tired or even overstimulated, something that can happen very easily. Crying is the only way your baby has to communicate. In time, it will be easier for both of you to understand the communication.
Length of feedings This varies as much as babies themselves, and there is no rule or magic number. Babies have a very strong sucking need and may also nurse for comfort; this is normal.
Wet diapers only Babies who nurse for short periods of time may be "snacking and snoozing." This means that they are taking in only enough to satisfy their initial hunger but not enough to sustain proper growth.
Pumping The amount of milk that can be obtained by pumping varies widely and depends on the type of pump, age of equipment, pump settings and duration. However, even if you are using a hospital grade pump in the most efficient manner possible, you still can't express what your baby is nursing, if he is latching well.
Bottle feeding Many times a baby will take a bottle after nursing, even if they are full. When a bottle is upended, the milk flows out and the baby will automatically swallow. And babies are often like puppies - if it's there, they will eat it!
Finally, try to remember that you are both learning. That takes time - maybe longer than you are used to. The one thing that is absolutely true about breastfeeding and any baby is that it does get easier ... at least until the teen years!
Denise Altman RN, IBCLC, LCCE is a private practice lactation consultant and nurse educator in Columbia, SC. The name of her business, All The Best reflects the skills, service and products she strives to offer expectant and new families. She is also the mother to twin girls and a son; they are her most joyful experience to date. Denise can be found at www.feedyourbaby.com.