Establishing a Good Breastmilk Supply: Part One

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Even before a baby is born, many people worry about breastfeeding. Some common concerns we hear from both our doula and lactation counseling clients at Bravo Birth DFW are whether they will have enough milk to feed their baby, whether their baby will be able to latch properly, and whether they will experience pain while nursing. It’s normal to be concerned about these things, but knowing what to expect ahead of time is one of the first steps to successful breastfeeding. Gaining confidence through education and avoiding common mistakes from the very start can help set you up for a positive and long-term breastfeeding relationship. We are here to ease those fears as we explore methods for establishing a plentiful milk supply in a two part series.

First, in order to understand what steps to take to establish a good milk supply, we need to understand the basics of how breastmilk production happens. There are two hormones in the body that control lactation: prolactin and oxytocin. Prolactin makes the milk and oxytocin allows the milk to flow. Both hormones are controlled by the pituitary gland. Outside stimulus can either inhibit or encourage the pituitary gland’s production of these hormones. The following suggestions can be used as a guide to positively affect an increase in the hormones that create a solid milk supply after birth.

Immediate & Regular Skin-to-Skin Contact
Skin-to-skin contact is extremely beneficial both to parents and babies for many reasons. The myriad of benefits that skin-to-skin provides are deserving of a blog post of their own, but for now we’ll focus on the specific benefits as related to establishing initial milk supply. Immediate skin-to-skin is done simply by placing the baby directly on the birthing person’s bare chest or abdomen after birth and remaining together, with minimal interruptions, for at least an hour. This promotes an increase in oxytocin, which is necessary for milk production.

Additionally, although a newborn’s eyesight is generally poor at birth, they do have a well-developed sense of smell. They are very receptive to their own mother’s scent, so being in close proximity to the scent with direct contact to the skin can help attract and guide them to the source naturally, without much coercion. Babies who are immediately placed skin-to-skin have a higher chance of latching to the breast soon after birth, and suckling within the first two hours after birth is positively associated with an increased milk production throughout the duration of the breastfeeding relationship. Those early moments really count; however, skin-to-skin is highly recommended and continues to offer many advantages when practiced as frequently as possible.

Self-Attached Latch
Proper positioning of the breast in the baby’s mouth is essential to stimulating those milk making hormones. Prolactin is increased with nipple stimulation and oxytocin is increased with nipple stretching. Both of these actions are accomplished with a correct latch. But, how is proper latch achieved? In our experience, it seems most people have been taught to hold their breast a certain way, wait for the baby to open wide, then shove the nipple in their mouth and hope for the best. This isn’t the best plan of action to get a proper latch. Luckily, a “less is more” approach is generally more effective. Healthy, full-term infants are typically born with the innate ability to latch without a lot of assistance.

To begin, hold the baby and inch or two from the breast with their tummy turned toward you, keep their shoulders and hips aligned, and their hips flexed. Ensure that your hand is supporting the base of their neck, not on the back of their head, inhibiting their movement. Allow their hands to move freely and touch the breast. Position the baby’s nose, not their mouth, in front of your nipple. As you draw your baby closer to the breast, their natural reflex response is to tilt back their head and open their mouth wide. If the baby does not gape their mouth, this step should be attempted again. As the wide gape happens, allow their bottom lip and tongue to reach the breast first, before the top lip. The nipple should fill the top half of their mouth. Keep their nose and chin close to the breast during the feeding.

There are several things to look out for when checking for a proper latch. The top and bottom lip should flange outward, creating a seal around the breast, rather than curl under. The angle of the corner of their mouth should be wide, not pursed. More of the lower part of the areola and breast should be drawn in and their cheek line should be rounded. Their chin should rock back and forth, toward and away from the breast, not up and down. Every 1-3 sucks, the baby should swallow.

It may take some practice, but, allowing the baby to utilize their reflexes and self-attach, rather than manipulating the latch, can be highly beneficial to achieving proper positioning, preventing pain and nipple damage, and low milk supply issues. In some cases, a poor latch can be the result of an underlying issue and continued problems should be evaluated by a qualified lactation professional, as soon as possible.

Nurse on Cue, Not on Schedule
Even though babies can’t yet speak at birth, they can communicate their needs in a variety of other ways that often go unnoticed. Being able to identify these early feeding cues is important. The best time to begin a nursing session is when the baby is exhibiting feeding cues while in a state of REM sleep. They should not be woken from a deep sleep, only during lighter, REM sleep. In this phase, their eyes are closed but they may exhibit eye movements, eyelids fluttering, suckling motions of the mouth, and subtle body movements. If a feeding isn’t initiated during this phase, the second best time to begin is during the quiet-awake phase. Generally, when a newborn first wakes, their bodies are still, their minds are alert, and they are quietly observing the sights and sounds around them. This is another cue that it may be time to breastfeed.

If the opportunity to nurse is missed during REM phase and the quiet-alert phase, infants may begin to demonstrate more overt feeding cues. Some of these cues include rooting- turning the head with searching movements of the mouth, lip licking, hand to mouth movements, sucking on fingers or anything within mouth’s reach, fidgeting, and sporadic fussing. Crying is a late hunger cue and doesn’t usually begin unless other feeding cues have been missed. It can be difficult to achieve a proper latch when a baby is agitated, so it is best to begin before this stage. Additionally, stress for the nursing parent and the baby has a negative effect on oxytocin. If your baby is crying and upset, soothe them first and begin the feeding when they are calm.

Recognizing these early feeding cues requires staying near to your baby. This is why keeping your baby out of the hospital nursery when possible can be very beneficial to breastfeeding success. Many hospitals have made rooming-in the standard, and because of that, breastfeeding rates have improved.

In order to establish a plentiful supply, infants need to nurse a minimum of 8-12 times a day. When feeding cues are disregarded and a feeding schedule is implemented early on, prolactin levels decrease, which inevitably means less milk is produced; therefore, putting babies on a feeding schedule, while sometimes convenient, may override your body’s signals to produce milk, resulting in low supply, poor weight gain, or even premature weaning. Feeding schedules are not recommended until milk supply is fully regulated, which generally occurs between 6-12 weeks.

While there is more to consider when creating a positive breastfeeding experience, these initial steps are key to success. Stay tuned for Part Two in our Establishing Breastmilk Supply Series! So much more important information is to come. If you are in need of a lactation counselor in Fort Worth, Dallas, or the surrounding areas, we are here to help. Please feel free to explore our lactation counseling page or contact us to set up an appointment.

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