Wednesday, July 18, 2012

Supply and Demand of Milk, How the Breast Work

“He wants more milk and I’m empty!”… “I’m afraid to start pumping for work because what if I pump all the milk out and she’s hungry?” … “I’m afraid I’m drying up because I just pumped for 15 minutes and only got an ounce, and she ate HOURS ago!” … “My breasts aren’t firm and engorged anymore, I’m afraid that I’m not making enough.” … “He cries 5 minutes into the feeding and then switches breasts nurses for a minute and starts screaming again! I think I dried up!”… “I don’t hear her swallowing often when she nurses! I’m afraid I’m not making enough!”

Sadly, many women in this culture don’t know how the breast works, how we make milk, or the delicate dance that women and babies do to maintain milk supply. We panic, feel inadequate, and often our fears are reinforced by the medical professionals in our life- or worse.. By our mothers, our female friends, and female family members.

Here’s a primer to how the breast works.

1- The breast is not a bottle. Don’t think of it that way. Think of it as a sink with a faucet attached. There is a constant supply of milk being generated.  Your breasts are NEVER “empty”. There’s a major difference between “empty” and “full”.  When you are engorged your breasts are like a full sink- you have immediate access to a LOT of milk.  You can submerge a cup in a full sink of water, and it will be full in a second. When the sink bowl is empty you have to wait until the stream of running water fills up the cup. This does not mean that there is “no water”. When your breasts are what you feel is “empty” all that means is that the sink bowl is empty. Your baby continues to nurse and more milk flows into the breasts and is consumed as fast as it enters the breast.

2- Supply stabilizes. This is a good thing. Engorgement is dangerous for mom, because milk that is in the breasts and not getting used can cause plugged ducts, infections, and other problems. Not to mention that creating milk taxes mom’s system and nutritional reserves, so it doesn’t make sense for mom to make more than what is necessary. Mom’s breasts should ideally make just enough to meet baby’s demand. Mom’s breasts are smart and will work toward this goal by decreasing supply so that it is equal to, or sometimes even slightly less than demand. Nature likes to play this funny trick where often supply stabilization hits at about the same time as your baby’s growth spurts. So you’ll get a supply stabilization around 6 weeks, followed by the 6 week growth spurt where your baby increases your supply. If you’re like me, you’re not laughing. I had to nurse constantly at 6 weeks because my supply stabilized at 5 1/2 weeks, and my son decided to grow again at 6 weeks. Nurse. Nurse. Nurse some more, and your supply will increase again to meet the demand. And then stabilize again. Nature assumes that your baby will simply increase demand and bring supply back up.  The closer you get to making sure this is true, the more likely you are to continue to have a healthy supply. If you’re exclusively pumping, add a couple of pumping sessions to your day until your supply comes back up. If you’re exclusively breastfeeding, just continue. Switch sides more often, and breathe deeply when your child becomes annoyed. It will pass.

3- When your baby is breastfed, the baby only needs approximately 25 ounces of milk per day. This does not increase or decrease with age  until quite a while after solids are introduced sometime after month 6. (Although when baby is first born their bellies are tiny and they eat less. Mom’s colostrum is plenty to keep them full until her milk comes in) The baby needs no more than one ounce per hour of separation. Breast milk is not formula. The content of the milk changes and so less is necessary because the fat content and nutritional value of the milk rise to meet the baby’s needs. The point? You don’t have to worry about “not having enough” to meet your growing baby’s needs… Except during growth spurts. During growth spurts your baby is going to increase the demand on your breasts substantially. Expect this. Plan ahead. Frozen meals and baskets of handy snacks and juice boxes for the nursing mom and any older kids are a good idea. It gets easier after 6 weeks. It then gets even easier after 3 months, by 6 months? Much much easier. By 9? Sooo easy. By a year? Piece of cake. Take heart. The earliest weeks are the hardest, and it does get better.

4- Sucking without swallowing is not “pacifier” sucking. It’s also not useless. Your baby is getting milk. She might be working toward a letdown cycle. Maybe the first, maybe the second, maybe the third, fourth or fifth. She might be getting one or two drops every minute or two. But she’s getting milk.  More importantly, she’s stimulating your supply. “Non nutritive” sucking is a misnomer. The baby is working with the breast to increase supply and there is always milk. Many moms introduce a pacifier because they’re cautioned to not let the baby use them as a pacifier.. The problem with this is that the baby then becomes accustomed to using the pacifier, and will suck on the pacifier instead of nursing on mom. Nature gave babies the desire to suckle for a reason: To stimulate mom’s milk supply. Babies find it comforting, which encourages them to do it. This is nature’s way of ensuring mom will make enough milk. Nature doesn’t know pacifiers exist, and when a pacifier is used there’s a very real risk that mom’s body will misinterpret the lack of comfort sucking as a signal to decrease milk. Pacifiers CAN be used alongside breastfeeding, but mom should be aware that they can decrease supply. This way, if mom’s supply starts to drop, she has the option of trying to wean the baby from the pacifier back onto the breast for comfort sucking. Keep in mind that this can be hard, though, and it’s best to only use the pacifier infrequently if at all possible.

5- Pumping success does not indicate supply. I breastfed exclusively without supplementation for 6 months after which I offered some solids. I could never pump much. An ounce from both breasts for 15 minutes of pumping was good output. However.. I made enough to feed my baby without needing supplementation. One of the women that I donated breast milk to could also pump an ounce in a session, but she couldn’t make enough to feed her baby without supplementation because she had breast reduction surgery that removed most of her milk glands. She quite simply had good output to the pump, whereas I had lousy output despite having an excellent supply. Some moms can be painfully engorged and only pump a quarter ounce. Others can be entirely soft and floppy and get 4 ounces out…. AFTER they have breastfed their child for a good 30 minutes. Pump output means just that: What you typically are able to pump. It is meaningless. I once weighed my son before and after a feeding, and there was an 8 ounce difference. This was during my “low production” time where if I tried to pump I would not get a single drop. Babies are efficient. Pumps are not.

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