Milk is made in the breast on a supply and demand basis. In order to have a robust milk supply, milk must be removed regularly, at least 8-10 times every 24 hours. Moms differ in how much milk they can store in their breasts. Moms with a larger storage capacity may be able to go longer periods without feeding, than moms with smaller storage capacity, but they each make the same amount of milk in 24 hours. Moms with larger storage capacities make milk more slowly but can store more milk. Moms with smaller storage capacities make milk more quickly but store less. It is not possible to know by looking at a mom’s breasts to know what her storage capacity will be. Moms with a smaller storage capacity must remove milk frequently to maintain an adequate milk supply. When breast-milk remains in the full breast, a signal is sent that slows the production of milk.
Hand-express colostrum if baby is not breastfeeding well during the first 3 days. Removal of colostrum in the first 3 days appears to have a significant impact on future milk supply. Breast pumps do not work as well as hand-expression for removing colostrum from the breast and pumps can increase areolar edema, slowing or halting milk removal. If baby is latching and nursing but milk transfer is not certain, mom can hand-express at least 6 times per day, beginning no later than 6 hours after birth, and give the extra colostrum to baby by spoon. If baby isn’t latching at all, mom should attempt to hand express her colostrum at least 8 times a day and spoon feed the baby. Usually the amount expressed at a feed will only be about 1-3 teaspoons, gradually increasing to 3 teaspoons or more per feed by the third day. This is just the right amount for a newborn in the first few days, before rapid increase in supply causes the feeling of the milk, “coming in.”
Be sure that baby is swallowing. When baby latches, the first sucks will be quick and there may be several pauses. Baby’s rate of suckling should quickly become steady and slow to one suck per second. When baby swallows, you will see baby’s jaw drop slightly every 1-2 sucks. Baby should have a pattern of 10-20 swallows before taking a short 3-5 second break. Baby should be spending most of a 20-30 minute feed actively sucking and swallowing. If sucking is fluttery and quicker than 1 suck per second, baby is not transferring much milk. When baby is sucking but not swallowing at least every 1-2 sucks, you can use breast compressions (squeezing breast between thumb and fingers far back from areola) to increase milk flow. Compress breast only when baby is sucking, not during pauses. Hold compression until swallowing slows again then release the breast compression. If baby stops swallowing or falls asleep, unlatch and burp baby and switch sides or re-latch to the same side and continue compressions. Keep switching sides until baby is no longer swallowing. Do not allow baby to fall asleep at the breast unless baby has swallowed consistently for at least a 10-20 minute feed. Do not switch sides if baby is still swallowing. At least 6 very wet diapers and 4 yellow bowel movements per day after day 4 will show that baby is transferring milk. Baby should regain birth-weight by 2 weeks and then gain 5-8 ounces a week.
If your baby is not transferring milk well, it is important to express milk in order to keep up your supply. The best way to maintain a milk supply if baby isn’t transferring milk is to use a hospital grade electric pump. Milk should be removed by baby or pump at least 8-10 times per day. Mom can visit, http://newborns.stanford.edu/Breastfeeding/ and view the video, “maximizing milk production” to learn hands on pumping techniques in order to maximize pumping efficiency. Your milk can stay at room temperature for up to 6 hours so it is not necessary to wash the pump parts after each expression. You can leave the pump parts together for 2-3 expressions (no more than 6 hours total) and then wash the parts. This is especially helpful at night so that you don’t have to immediately wash pump parts or refrigerate your expressed milk at night. You can also bag and refrigerate flanges, bottles and tubing after expressing milk to increase the time between washing parts. Be sure to wash the pump parts thoroughly when you do wash and sanitize them once a day.
© 2012 Laura Spitzfaden, IBCLC Feed the Baby LLC