Running out of milk

[Barb Glare]

Hi,

Some very interesting points and observations.
Milk "drying up' is basically a myth. Breastfeeding is actually a very sturdy system. It's based on a very simple principle of supply and demand. When you feed the baby you make more milk.
Unfortunately we live in a society with a very low level of knowledge about how breastfeeding works. And a society with a very low level of knowledge of normal baby behaviour. Basically, we live in a bottle feeding culture. This leads women to doubt their body's ability to make milk. This is reinforced by friends, family, and health professionals who urge a mother to "top her baby up with formula"
Most women tend to have an abundance of milk in the early day, usually enough for a couple of babies. Over time, her body "down'regulates" so that it very exactly matches the needs of her baby. When the initial fullness and engorgement abates, mothers sometimes feel that they don't have enough milk.
Baby's behaviour changes. Often, especially when babies are born with the use of drugs and instruments babies are very sleepy in the first couple of weeks. The family support network often percieve this as "good" behaviour (it's probably more abnormal behaviour) When the baby "wakes up" and becomes quite demanding after a couple of weeks, often the mother's milk supply is called in to question. Actually, it is the demanding baby who is the "good" baby - it will be ensuring it gets enough to eat.
Breastfed babies grow more quickly in the first 3 months, but then their weightgain plateus out at about 3 months. Our current infant growth charts do not acurately reflect this, so this is also a time when mothers may feel their milk supply is not keeping up.
Often mothers will "test" themselves by pumping to see how much milk they have. This will tell you very little in fact. It sets up a stressful situation. Think about the last time you went to the doctor and they handed you a specimen jar and asked for a urine sample. Anyone have "Let down" problems? Luckily, the dr did not reach the conclusion that you didn't make enough urine - just that you were stressed. Some women find it difficult to let down for a pump, and stress will often inhibit milk letdown.
When baby is really not getting enough (as ascertained by low weight gain after ruling out any medical possiblities) I find that very often strict routines and sleep settling scenarios are implicated. Babies need to fee a lot - 8-12 times in 24 hrs is normal. Babies who are fed according to their needs fare much better.
As a baby becomes more aware of their world (often about 4 mnths) they will tend to "stickybeak" rather than feed. It can take calm and patience to get through a feed. This is a common time for breast refusal. I won't even pretend that I know what 4 mnth old babies are thinking when they refuse to feed, but I do know it's temporary, they won't starve themselves and it will pass!
Some babies sleep through the night unusually early (sleeping through before 6mnths is pretty uncommon) and they they start to wake up again. Many parents feel this must be hunger (maybe, maybe not! - if they are sleeping away from you, they may just want to be with you, and I'm sure every baby knows that if mums nipple is in his mouth, mummy's not going anywhere!)
If you are fully brestfeeding it is somewhat uncommon for your period to return before 6 months. Hormonal changes due to you period and ovulation may result in babies being fussier at the breast, but doesn't really reduce supply. Pregnancy will, though!
There are some medical conditions that may compromise milk production. It's always hard to comment on some-one who says that their milk just dried up. There are so many factors involved - not something you can generally get to the bottom of in a quick conversation at the Health Centre.

Hope some of that helps
Regards
Barb

[soul]

Barb Glare omg that was such a brillinat piece of information! R u a public speaker for first time mothers? You should be if you are not!

[Ca Plane Pour Moi]

Soul...

Barb Glare, IBCLC
International Board Certified Lactation Consultant

I agree, Barb is great! She's on the support panel, so it's good she's the expert here.

Rachael, DS had exactly the same thing at 4 and a bit months, constantly on the breast, crying all night because he was hungry. Took me 2 weeks and my GP to think of supplementing and solids before DS calmed down! It's normal at 4 months, all my friends said it was anyway.

Barb, this is interesting, and I don't want you to feel you have to explain yourself because you don't, I know what you mean, just my insecurities here. When you posted about drugs once again I started beating myself up for DS's early days. But DS, being the bestest and goodest baby in the world (drugs never affected him with sleeping though!) still ended up wanting feeds a lot of the time. I was bullied into artificial supplementation too, which didn't help either of us. Luckily DS dropped the one artificial feed I was willing to give after 2-3 weeks so we were back to being happy again. I think we're almost ready to drop the bottle again now, but as soon as I say that DS wants both breasts and a full bottle at bedtime so I'll wait until he's sleeping more to try to drop the bottle.

Point is that I guess we're all touchy about something and it's no-one's fault if we are, just it's good to clear up misconceptions people have about a subject.

[soul]

I actually got that, but not all of them do public speaking!

[Barb Glare]

Hi,

Thanks for the support, Soul. I do do some public speaking at ABA conferences and the like. I live a long way from Melbourne (Warrnambool) but am prepared to travel sometimes!
Ryn, please don't beat yourself up. I often joke that I didn't get the guilt gene. I think it's something worth building immunity to - guilt. You can do no more than you can do. Like you, I was pressured into giving my first baby formula comps. He never slept! I was exhausted. I regret not knowing more about babies and milk supply, but I didn't. I did the best I could with what I knew. I am somewhat angry with the support I got from professionals and still angry at the misinformation mothers get today.
In the early days babies are designed to feed frequently. After the placenta leaves your body, your prolactin levels increase. This is one of the main hormones that makes milk. The first milk you make is colostrum. Between day 2-4 your milk "comes in" But like most things, it is not all one thing or another. It gradually transitions from colostrum to mature milk. Often womens milk has that yellowy colostrumy look for 2 weeks or so. In response to your baby sucking your body lays down prolactin receptors. The more that the baby feeds, the more prolactin receptors are laid down. . The prolactin receptors are like a "lock" into which the prolactin "key" fits. After some time your prolactin level plateaus at a fairly low level. But you still make milk fine, because of the prolactin receptors that are laid down early. Drugs in labor interfere with this process - baby may be unnaturally sleepy, or may be unco-ordinated when feeding. In our society, babies who sleep are feted, wheras demanding babies are thought to be "naughty" But the demanding ones are the ones who will by and large ensure their mum has a good milk supply.
I hope my e-mails are newver interpreted as making mothers feel guilty. You can't change the past. And I would be the last one to point the finger. I work with breastfeeding mothers every day, and see first hand the challenges they face. And I'm still a breastfeeding mum myself. I still have the same insecurities (well, not so many abotu breastfeeding - but I have a teenager now!) I think it's important that we get as much knowledge out into the community as possible and that the information is held by women.

Warm Regards
Barb

[MantaRay]

Barb, I always find your posts informative, clearly explained and very caring. I am so glad there are well informed people like yourself making the effort to inform others and I wish there was more of it. I just can't believe how little even some medical professionals know about bfing!