Got "Enough" Breastmilk?

by Amy Spangler

Eighty million babies are born each year - 4 million in the United States alone - and according to the American Academy of Pediatrics, breastfeeding and human milk are the best choice for every baby with few exceptions.¹ Breastfeeding and human milk provide countless benefits for mothers, babies, and families. Nonetheless only 60% of U.S. mothers initiate breastfeeding and fewer than 20% breastfeed 6 months or more in spite of the fact that breastfed babies have fewer illnesses, fewer doctor visits, and fewer hospitalizations.²Even in countries outside the United States where breastfeeding is the cultural norm, many parents introduce foods other than breastmilk as early as 3-5 days after birth.³ When asked about this practice, the reason parents give most often is not enough breastmilk.⁴It seems that parents everywhere have little confidence in their ability to meet their baby's needs. First time parents as well as seasoned veterans worry whether their baby is getting enough to eat. The availability of formula and the security that comes from knowing exactly how much a baby eats, has contributed significantly to the decline in breastfeeding rates. Often when a mother thinks her breastmilk supply is insufficient, her baby is actually getting all the milk he needs.

With few exceptions, nearly every mother can produce enough breastmilk to nourish her baby or babies! While a small number of women are reported to have insufficient glandular tissue (too few milk-producing cells) this condition is rare. More often when a mother's breastmilk supply is low or a baby's weight gain is poor the cause is too little knowledge or too little support.
Closing the Knowledge Gap

The more milk you remove from the breasts through breastfeeding or milk expression the more milk you will make. This is the concept of supply and demand. Most women find that 8-12 breastfeedings in a 24-hour period usually produce an ample supply of milk.⁵ However, when you delay or skip breastfeedings or limit the length of breastfeedings you often make less milk.

Some babies breastfeed often enough (8-12 times a day) and long enough (10-20 minutes) but gain little weight. Most often the cause is ineffective breastfeeding due to poor positioning. Correct positioning of the baby on the breast is the key to milk removal. When your baby is positioned well his:

head and chest should face the breast,

nose, cheeks, and chin should touch the breast,

mouth should open wide like a yawn, and

lips should turn out like a fish!

Know the Signs of Milk Removal

If you know the signs of milk removal, you can be sure that your baby is getting enough to eat- look and listen. Listen for suckling and swallowing. Look for wet and soiled diapers. Remember, nothing comes out the bottom unless something goes in the top! A baby that is well-fed:

suckles and swallows while breastfeeding.

has at least 3 stools and 3 wet diapers a day during the first 3 days and at least 4 stools and 6 wet diapers a day during the next 4 weeks.

loses less than 7% of his birth weight the first 5-7 days.

is back to his birth weight by 14 days.

gains 4-8 ounces a week after the first week.

is active and alert between breastfeedings.

is content after breastfeedings.

Watch Your Baby Not the Clock

Every baby is different! Some babies will breastfeed every 2-3 hours, while others will breastfeed every hour for 3-5 feedings then sleep for 3-4 hours. Some babies will breastfeed 10-15 minutes on each breast, some will breastfeed 30-45 minutes on each breast, and others will breastfeed 15-30 minutes on one breast only.

During the first 4 weeks, if your baby does not wake to eat at least 8-12 times in 24 hours, you will need to watch for early signs of hunger or light sleep such as wiggling, finger-sucking, lip-smacking, coughing, or yawning and offer the breast at those times.

Breastfeed as long as the baby wishes on the first breast before offering the second breast. Watch your baby, not the clock. When the baby stops suckling and swallowing or falls asleep at the first breast, break the suction, burp him, wake him, and offer the second breast. If the baby breastfeeds poorly on the first breast and shows no sign of suckling and swallowing offer the first breast again. Make sure your baby breastfeeds well on the first breast before you offer the second breast.

Offer both breasts at every feeding but do not be concerned if the baby seems satisfied with one breast. Each breast can provide a full meal! If necessary, hand express or pump the second breast to relieve the fullness. Avoid water or formula supplements during the first 4 weeks. Supplements can confuse your baby's suckling pattern and limit your breastmilk production.

Last but not least, take care of yourself and your baby! Drink to satisfy your thirst. Eat a healthy diet. Get plenty of rest. Nap when the baby naps. Should problems occur, get help from someone you trust (doctor, nurse, or lactation consultant).

While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby.

American Academy Pediatrics, Work Group on Breastfeeding: Breastfeeding and the use of human milk, Pediatrics, 1997. 100: p. 1035-1039.
Dewey KG, Nommsen-Rivers LA: Differences in morbidity between breast-fed and formula-fed infants. Journal of Pediatrics 126:696-702, 1995.
Tully J & Dewey K: Private fears, global loss: A cross-cultural study of the insufficient milk syndrome. Medical Anthropology, 9:225-243, 1985.
Hill PD: The Enigma of Insufficient Milk Supply. MCN 16:312-316, November/December 1991.
Nylander G et al: Unsupplemented breastfeeding in the maternity ward. Positive long-term effects. Acta Obstetricia et Gynecologica Scandinavica 70(3):205-209, 1991.