Milk is made in the breast on a supply and demand basis. In order to have a good milk supply, milk must be removed regularly, at least 8-10 times every 24 hours. Newborns often nurse every hour around the clock in the first few days!
Individuals differ in how much milk they can store in their breasts. Some may have a larger storage capacity may be able to go longer periods without feeding than others with smaller storage capacity, but they each make the same amount of milk in 24 hours. Individuals with larger storage capacities make milk more slowly but can store more milk. Those with smaller storage capacities make milk more quickly but store less. It is not possible to know by looking at an indivudual’s breasts to know what the storage capacity will be. Those 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 (early milk) if baby is not breastfeeding well during the first 3 days. Removal of colostrum in the first 3 days affects future milk supply. Breast pumps do not work as well as hand-expression for removing colostrum from the breast. If Baby is latching but not feeding well, the parent can hand-express after feeds or at least 6 times a 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, the parent should hand express colostrum at least 8-10 times a day and spoon feed the baby. Usually the amount expressed at a feed will be about 1-3 teaspoons, gradually increasing to 3 or more teaspoons 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 fluttery and there may be frequent pauses. After a minute or so, Baby’s rate of suckling should become steady and slow to about one suck per second. When baby swallows, you may hear a soft “kuh” sound and/or see baby’s jaw drop lower every 1-2 sucks. Baby should have a consistent sucking pattern that includes 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. Your breast should soften and baby should release the breast on his own. Some newborns feed more quickly. If your baby nurses for 10 minutes or less but is actively swallowing for the full feed, he may be getting plenty of milk.
Parents often wonder when to offer the second breast: It is not necessary to stop a feed to switch sides. If Baby is actively swallowing, follow his lead and allow him to continue feeding from the first breast. When he stops swallowing for more than a few minutes or if he releases the breast on his own, burp him and offer the second breast. Do not switch sides if Baby is still actively swallowing.
Babies love to comfort suck: If sucking is fluttery and quicker than 1 suck per second, Baby is not transferring much milk. This type of sucking is comforting to Baby and stimulating to your milk supply but does not provide him with calories. If Baby has this sucking pattern after feeding well, then it is fine to let him continue as long as he likes and as long as you are comfortable. It is also fine to remove him from the breast at this point as long as you watch him for cues that he would like to feed again.
Some babies comfort suck for most of a feed: If your baby spends most of the feed comfort sucking, he will not get much milk and your milk production may become low due to lack of milk removal. In this case, you will need to take a more active role with feeding. You may also want to get expert, hands-on help. 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 Baby’s mouth) to help Baby to get more milk. Compress breast only when baby is sucking, not during pauses. Hold compression until swallowing slows again then release the breast. If baby stops swallowing or falls asleep, unlatch and burp baby and switch sides. Keep using compressions and switching sides back and forth until baby is no longer swallowing. Do not allow baby to comfort suck unless Baby has swallowed consistently for at least a 10-20 minute feed.
If your baby is not swallowing well and softening your breasts, 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 removing milk is to use a hospital grade double electric pump. Milk should be removed by baby or pump at least 8-10 times per day. You can visit, http://newborns.stanford.edu/Breastfeeding/ and view the video, “maximizing milk production” to learn hands on pumping techniques in order to express more milk.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. You can also bag and refrigerate flanges and bottles 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.
Consider listening to an audio galactogogue in order to enhance the let-down response.
See additional information on hand-expression, breast-compressions, and milk-expression for more help.
© 2012 Laura Spitzfaden, IBCLC revised 2014 Feed the Baby LLC