Understanding Milk Supply

milk supply by breastfeedingFenugreek for nursing is a popular Google search, and a post I wrote years ago about fenugreek is read daily by someone somewhere in the world. But really what these Moms are seeking is ways of increasing milk supply. I’m a big believer in working to get to the crux of the issue instead of trying to take something to fix it. A solid basis of understanding how breastfeeding works will help Moms to navigate feeding decisions, even before their baby is born.

The key in milk supply is hormonal first, then frequent milk removal from the breast. In an oversimplified way, the three things for successful breastfeeding are to remove milk from the breast, get that milk into the baby and have it not hurt Mom.  Easier said than done sometimes, I know. Remember, too, both you and your baby are learning a new skill together. Be patient and be kind to yourself.

First, a few things that do not effect your supply are your breast size, how much fluid you drink, how much you rest or how stressed out you are. Mothers under dire conditions still produce quality and sufficient milk. What or how much a mother eats also doesn’t correlate to milk supply. There can be underlying medical, social and cultural situations that impact milk supply. For example, medical conditions like thyroid problems or anemia that cause fatigue in a Mom would also interfere with milk supply; it’s not the tiredness that’s creating the problem, it’s the health issue.baby on mom's chest

Without going into a biology lesson, the two main hormones of breastfeeding are prolactin, which is responsible for milk production, and oxytocin which is responsible for the release of milk. You need both to nurse and establish a solid milk supply.

In nursing Moms, between feedings, prolactin decreases and during feedings, it increases. This is crucial information for Moms. If you skip a feeding, or introduce a pacifier early (before baby is one month old), the time betweens feedings lengthens causing lower prolactin levels and therefore, less milk supply. Conversely, if a Mom nurses frequently, her levels are more regularly elevated working to expand her milk supply.

Babies tummies are small at birth, about the size of a shooter marble (6 ml), by the third day, it’s about the size of a ping pong ball (20 ml) and only the size of a plastic Easter egg (60 ml) on day ten. This is why babies need small, frequent feedings.

The research of DeCarvalho1. showed that babies who fed frequently but for shorter durations compared to babies who fed less often but for a longer time both ended up eating for almost the same number of minutes daily (138 minutes/day for frequent nursers vs. 137 minutes/day for infrequent nursers). However, the data bore out that the frequent feeders gained significantly more weight by two weeks of age.

It follows that the frequent-nurser Moms had higher levels of prolactin and made more milk. Nipple stimulation is what increases prolactin so snuggle up with your newborn and nurse, nurse, nurse. You can both get into a warm tub (get someone to help you, babies are slippery when wet) and let your baby just suckle to help up your milk supply.

It’s helpful to know that everyone’s prolactin levels go up at night, so it’s normal to have a higher volume of milk overnight and in the early morning. In late afternoon, you may feel like you need to nurse even more frequently or you may worry that your supply is low, but that is a normal pattern of milk supply.

Oxytocin is responsible for the milk ejection reflex, your let down of milk. Some women feel a sensation when their milk lets down, others do not, which doesn’t mean you are not releasing milk. Stretching of the nipple during feedings is what makes milk flow, so a latch that allows your nipple to be stretched to the back of the baby’s palate is critical.

Oxytocin isn’t released in a steady stream, instead it pulses and that is what drives a baby’s sucking pattern, so you may see a repeated suck, swallow, breath pattern during nice active nursing, then a pause. During this break, perhaps your baby will stay attached but pull away, stretching your nipple, and then return to nursing and swallowing.

baby breastfeeding milk supplyThat little baby hand that always seems to be in your way if you’re sitting up to breastfeed is actually helping to increase your oxytocin through breast massage. Leaning back and reclining while breastfeeding (I love the work of Suzanne Colson and Christina Smilie) can help to position your baby in a way that allows him to grasp your breast but those sweet baby fingers interfere less with the latch.

You can also create a conditioned response to up your oxytocin and release your milk. If you’ve breastfed a baby, this conditioning will be quick and will have carryover from your previous nursing relationships. Your let down response can be associated with sight (a photo of baby), a smell (baby’s onesie), a sound (baby’s cry) or the sense of touch (baby against your skin).

Stress, here, can temporarily halt the release of milk because adrenaline goes up when you’re stressed and that inhibits oxytocin and therefore milk release. In itself, stress will not dry your milk up. Try to consciously relax, breath, calm before you pick up your baby to nurse to let that oxytocin flow!

If you’re concerned about your milk supply, see a lactation consultant right away. It’s important to have early, solid help if you feel you’re struggling. Many insurance carriers cover a visit with a lactation consultant in the baby’s first week. In preparing prenatally for breastfeeding, I recommend meeting, or at least speaking, with some local lactation consultants to see with whom you’re most comfortable. Then if you need help once your baby arrives, you’ve already done your leg work.

I believe that in most cases, if you are committed to nursing, with the right, early support and guidance, you can establish a plentiful milk supply and have a rewarding nursing relationship.

1. De Carvalho, M et al: Effect of frequent breastfeeding on early milk production and infant weight gain.  Ped 72(3) Sep 1983.

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12 Responses to Understanding Milk Supply

  1. […] Fenugreek (Trigonella foenum-graecum) is an herbal supplement that is claimed to be useful for a broad range of various conditions, without any substantial scientific evidence, from baldness, constipation, and heartburn to diabetes, cholesterol and erectile dysfunction.  The focus here, is the widely held belief among lactation advisors, nursing mothers and other birth professionals that fenugreek helps to stimulate milk production and supply. […]

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  4. Great tips! I’ve nursed all 4 of my children for varying lengths of time, due to my own medical condition. I’ve been blessed to never have a problem with milk supply.

    • Leah DeCesare says:

      Supply – too little or too much tends to be an issue for so many new Moms. Understanding the mechanics can help manage it either way, but I hear more women trying to increase supply than slow it, it’s also good to understand how it all works as new Moms establish supply.

      With your new baby coming, your body will be kicking right back into production! :-) Let me know if you want some tips for managing oversupply.

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  10. torrie says:

    is it strange that reading THIS post of yours in particular is what does it for me as far as upping my oxytocin levels for a letdown?! So thanks a ton!!

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