Most expecting moms I know expended a ton of energy preparing for their baby’s arrival. They prepped for labor, studied up on their birth options, and set up their baby’s nursery. But despite all their effort, one major challenge still tended to trip them up after baby arrived: Breastfeeding.
This is no surprise (and totally normal).
While pregnant, we hear endlessly about how natural and magical breastfeeding is. So, naturally, we tend to expect breastfeeding will proceed smoothly, without effort or planning on our part.
Struggling with breastfeeding, therefore, tends to be a shock. New moms are seldom told about common breastfeeding problems (like painful latch, delayed milk production, a low or dwindling milk supply) until they happen. This is unfortunate, because many problems can be headed off with some careful planning, giving you more time to relax and savor your first months with your baby.
We developed this guide, because we thought new moms-to-be ought to know what is coming down the pike, before they have a baby to nurse.
Boosting milk supply – colostrum and the critical first hour after birth…
Full milk production, often known as one’s “milk coming in”, begins only two to three days after birth. Until then, new mothers produce small amounts of an immune-rich pre-milk called colostrum.
Studies show that expressing colostrum within the first hour after birth promotes higher milk production for at least the next 3 weeks.
Your baby will only consume small amounts of colostrum in her first few days. Nevertheless, nursing or expressing even these small amounts colostrum within the first hour of birth has a profound impact on your later milk production.
Studies find that expressing colostrum within the first hour after birth–via nursing, hand expression, or pumping–boosts milk production for at least the next 3 weeks.
Early expression also helps prevent delays in your milk coming in. Delayed milk problem (defined as 72 hours or more after birth) is one of the most common breastfeeding problems. As many 1 out of 5 mothers experience delays. Several studies have shown expressing colostrum within the first hour speeds your milk coming.
Nursing within the first hours also benefits your baby, lowering their risk of low blood sugar and lining their gut with immunoglobulins to help protect against infection. Worldwide, babies who nurse within the first hour have the lowest risk of illness and death.
Given these profound benefits, all women, especially those delivering preterm babies, should whenever possible, nurse, pump, or hand express colostrum within one hour of giving birth.
Note to preemie mamas
Preemie moms are especially vulnerable to delayed milk production and low milk supply.
Labor-related complications and their newborns needing immediate medical attention after birth often preclude early nursing. For mothers with preemies born before 32 weeks, the first nursing session typically occurs 36 hours or more after birth.
Complicating breastfeeding even further, women who deliver early (before 37 weeks) often have not hormonally ramped up for full milk production by the time their baby arrives.
For all these reasons, 4 out of 5 preemie moms will experience delays in their milk coming in.
This makes expressing colostrum within the first hour is especially critical. One randomized trial found that expression within the first hour caused mothers of very low birth weight preemies to have their milk come within the normal range, at an average of 3 days, rather than late, at an average of 4 to 5 days.
In another study of 40 mothers of very low birth weight infants (born weighing less than 1,500 grams), moms who initiated only breastfeeding within the first hour had higher milk production at the end of their first week postpartum. Their higher production persisted over the next 5 weeks, when the study concluded.
The first 24 hours
After the critical first hour, the next 24 hours remain key. Women who nurse or express milk at least 8 to 10 times during the first 24 hours have higher milk volumes at 3 and 5 days postpartum. As a result, their babies lose less weight during the first week after birth. They are also at lower risk of jaundice and dehydration.
Women who nurse or express milk at least 8 to 10 times during the first 24 hours have higher milk volumes at 3 and 5 days postpartum.
In addition to nursing your newborn, hand expression of colostrum into a spoon can boost your milk supply long term. (Hand expression is more effective than pumping for extracting colostrum as well as easier on sore and cracked nipples.) You can express colostrum several times a day. Then feed your newborn with the spoon after nursing. Studies have shown hand expression boosts milk production for up to 8 weeks after birth.
Tools: Dr. Jane Morton, a Clinical Professor of Pediatrics at Stanford University, explains how to hand express colostrum in this video.
The first month: Coming to volume
After your milk has come in, the first 4-7 days after birth, represent what many lactation consultants refer to as the “coming to volume” phase of milk production. This phase can extend for up to a month after delivery.
During this phase, your milk production syncs with your baby’s demand.
If you were dripping milk everywhere and painfully engorged, the next week or two should bring relief. Your supply will drop. You will have fewer soaked sheets, fewer embarrassing leaks, and–slightly–fewer loads of laundry.
If you were not producing enough milk, but continue nursing or expressing frequently, your production may ramp up to meet your baby’s needs.
Newborns’ milk intake rises during their first month of life and then plateaus until around 6 months of age.
Here’s the biggest concern during the coming to volume phase: Making sure your baby is efficiently extracting milk from the breast. Babies who are sleepy, jaundiced, or who have a tongue-tie or another health issue may suckle and seem to be nursing but not effectively drain the breast. If your baby is not moving milk, it can tank your supply.
Recovery from supply issues can take months, and marathon nursing-then-pumping sessions. It’s best just not to go there.
During the coming to volume phase, it is essential to ensure that your baby is efficiently extracting milk from the breast.
To ensure that your newborn is moving milk when nursing:
- Keep track of what’s in her diapers. For each day of life (in the first few days-week), babies will have one wet diaper and one poop diaper (day 1 = 1 poop, 1 pee; day 2 = 2 poops, 2 pees; etc.) and then when you’re milk comes in, she can have 5-6+ wet diapers every 24 hours. For poop, keep an eye on color too – around day 4, poop should be mustard-y yellow (fun, right?)
- Once your milk has come in, you should feel a decrease in engorgement after nursing. Your baby should also seem satisfied and have a mouth full of milk.
- If your baby is not gaining well, or seems constantly hungry, seek help from your pediatrician or a lactation consultant right away. Breastfeeding troubles are best nipped in the bud. Don’t wait. Breastfeeding problems can–in rare cases–be life threatening.
If everything is going well–your baby is gaining well and clearly being satisfied at the breast–this coming to volume phase is an ideal time to add a regular pumping session. Adding a pumping session tells your body your baby needs more milk. In the early weeks, your body will respond by easily ramping up production. This is a great time to build up your rainy day stash of frozen breastmilk.
As long as you maintain a daily extra pumping session, your body will continue to produce extra milk.
Note, however, that you don’t want to accidentally steal milk from your baby’s next feeding. Schedule your extra pumping session should occur within 30 minutes of your last nursing session.
The Bottom Line
New moms are often woefully uninformed about what to expect in the early, critical days of breastfeeding,. Their lack of knowledge leaves them at the mercy of the hospital staff, who themselves are often not up to date on best practices.
Expecting moms who want to breastfeed deserve to start their nursing relationship with their eyes wide open. They deserve to be aware of common breastfeeding challenges. And most importantly, they deserve to know how to troubleshoot these challenges before they mushroom into full-fledged problems.
Next on your reading list…