Getting Milk Production Off to a Good Start
Congratulations on your decision to breastfeed your baby! That is a tremendous gift that you will give that will convey lifelong benefits.
Even if you don't have enough milk, you can have a very fulfilling breastfeeding experience, and there are many ways to increase your milk production. Remember, too, that breastfeeding is more than just producing food for your baby.
Before your baby is born, it's important to learn as much as you can about breastfeeding. Another important thing you can also do now is to find a good private-practice lactation consultant in your area so that you will know who to call if things don't go well. One place to find one is our lactation consultant referral list. If there is no one near you there, try the ILCA LC referral list.
But the best thing you can do to maximize your breastfeeding experience is one simple thing (that isn't always so simple): remove as much milk as possible in the first two weeks. This is because the amount of milk the breasts are programmed to make is determined in the first two to three weeks. The more milk that is removed during that time, the more milk-making capacity your breasts will have. The way this happens is that milk removal establishes as hormone receptors in the breasts. The more milk that is removed, the more hormone receptors that are established. Hormone receptors are necessary to maximize the body's ability to use the hormones that are produced. The more receptors you have, the more effective the hormones will be to make and release milk. Even if you can't remove much volume, just *asking* your body to remove milk by pumping and nursing establishes receptors. So your primary goal in the first three weeks is to do everything you can to remove as much milk as possible. Obviously, the best way to do this is through breastfeeding, but some hand expressing and pumping **with a hospital grade pump** may also be helpful.
In order to get breastfeeding off to the best start possible, it will help to latch your baby as soon after birth as possible, preferably in the first hour. Most babies are sleepy after the excitement of birth wears off, often taking a long nap and not having a whole lot of interest in nursing the first day. However, keep in mind that we are trying to maximize your milk production, so do your best to get your baby to nurse as often as possible when he or she is awake.
If you are having difficulty getting a painless latch, ask the nurses to bring in a lactation consultant to help. It should never actually hurt, even though you might feel mild tenderness at first. Click here for more information on latching.
At the end of the first day or as soon as you are ready, begin hand expressing colostrum after your baby has fed from the breast into a spoon that you can then feed directly to your baby or save for later. Before the milk comes in on Days 3-4, many women find that hand expressing is much more effective at removing colostrum (the early milk) than pumping. Pumping during the first few days can also draw more edema (swelling) into your areola, which can make latching difficult for your baby. You probably won't be able express more than a few drops at first, but that's exactly the amount your baby needs at first.
After your milk comes in and the sense of overfullness that often happens at that time (sometimes referred to as "engorgement") is over, you can then begin using a pump, preferrably one that is hospital grade. Pumping should continue for at least the first two weeks and then until you are sure your baby is getting enough milk . There is no need to purchase a pump now -- in fact the pumps that are sold in stores are not designed for the maximum milk removal efficiency that you'll need in the early weeks. Those pumps are designed for moms who have established milk supplies and are going to be separated from their babies during two to four feedings a day, such as returning to work. If you need a pump in the early weeks, a rental grade (hospital grade) pump will be the best by far. Click here for more information on pumping.
One thing to keep in mind is that the amount of milk you can express is not at all reflective of how much milk you have, especially in the first week. A baby can usually withdraw milk much more effectively. Also, there isn't much quantity until the end of the week, so the amounts you can pump won't be much anyway. Do be sure to give your baby any colostrum that you pump. If it is just drops, wipe it from the bottle with your clean finger and let him or her suck on your finger. You can also use a spoon or a cup. Every drop of colostrum is chock-full of precious immunities and intestinal protective factors that will make a huge difference for his health.
There is no need to begin supplementation until you know *for sure* that your baby is not getting enough milk, and most babies don't need supplementation until the third day, although there ARE some who do need small amounts by the end of the second day.
There are two ways to know for sure if supplementation is necessary: diaper output and weight gain (some of this you know from my book, but I'll just go over it all so it is fresh in your mind).
From the very beginning, keep a record of your baby's diaper output (the nurses will do this for you in the hospital, but if you change diapers, too, make sure that diaper changes are recorded on the hospital record). Once home, keep track on a chart (any kind of chart will do). This will tell you how much milk your baby is getting. Wet diapers should feel as heavy as two tablespoons of fluid if your baby is under eight pounds and three if over eight pounds. It may be helpful to put this amount of water in a dry diaper before your baby is born to see what it feels like. In the first twenty-four hours, there should be at least one wet and one stool diaper. In the second twenty-four hours, there should be at least two wet and two stool diapers. In the third twenty-four hours, there should be at least three wet and three stool diapers. At this point, you should begin feeling your milk coming in. You may feel fuller and sometimes it's a bit more difficult to get baby to latch. In the fourth twenty-four hours, there should be at least four wet and three stool diapers. That "quota" will continue throughout the first six weeks. After that point, stools will slow down in quantity, but will be larger each time, and weight gain will be the more reliable way to know if your baby is getting enough.
Your baby's weight should be monitored closely from the very beginning. It is normal for babies to lose weight in the first few days. It isn't true "weight loss" because those first stools expel all the waste matter that had been accumulating in the colon before birth. After your milk comes in on the third or fourth day, your baby should begin regaining weight at the rate of at least one ounce a day, which should continue for the first four months. Weight readings can be read inaccurately, though, if comparing weights between two scales because scales can each be calibrated differently. For this reason, it is important to have your baby weighed on the same scale each time. At first, this may be the same scale in the hospital nursery. When you go home, it may be on the same scale in your doctor's office. It is important to get that first reading on the scale you will usually be using so that you aren't comparing weights on different scales.
If your baby is not having enough diaper output or weight gain, then supplementation is necessary. Don't hesitate to supplement if your baby needs it -- your baby must have adequate calories to feed well. Adequate fluids also help flush out bilirubin to avoid jaundice, which can make babies too sleepy to feed well. Supplementation need not be a "slippery slope." It's just important to give the supplementation in a way that interferes as little as possible with breastfeeding, and for you to continue to remove as much milk as possible while supplementation is given.
If you do have to supplement, you might consider finger-feeding to begin with. If you want to use bottle, though, it won't necessarily interfere with breastfeeding. We have now learned that bottles *can* be used in ways that are supportive of breastfeeding. There is an excerpt from our new book that explains a method of supplementing with bottles that many mothers are finding to be very helpful for breastfeeding.
If you think you might want to use a bottle if supplementation is necessary, you might consider having a bottle with a good nipple on hand. Gerber, Evenflo, and Playtex all now have wide-based nipples that are MUCH better than the ones provided by the hospital, which are donated by formula companies. Here are links to pages with more information on ways to use bottles that maximize breastfeeding:
Types of Nipples
Click here for more information on supplementing
If supplementation *is* necessary, try not to worry and keep in mind that there is quite a bit that can be done to increase milk production. Try to take things one day at a time and contact us if you need to.