This post is part of our "Ask the Readers" series.
Reader’s Question: “Is there anything I can do before labor to help make sure my milk comes in right away? Last time, it took a while to come in.”
Answer: This is such an important question. It is also a very common question and concern for new moms who are struggling to find the self-confidence in our new roles. Having confidence in our ability to breastfeed our babies is difficult, especially when we do not completely understand the mechanisms of how breastfeeding works including how breastmilk is made.
Many, if not MOST of us, have never learned about the process of making breastmilk. It’s not something we learn about in school or even as part of our regular prenatal care. Unless you are somehow lucky enough to have someone or something in your life that points you in the direction to learn more, then you probably are unaware of this important process.
First, Some Good Resources
The Lamaze website for Parents is an excellent resource for evidence based information. The Lamaze Pregnancy App is an empowering and informative app for parents. It's also free! Parents can also join the Lamaze week-by-week email campaign and the Giving Birth with Confidence is chock full of great information. Lamaze also offers several online classes (and Family Trees Birth Programs is a presenting partner).
The Process of Breastmilk Production
The production of breastmilk is an unfolding process. Our breasts do not have fully formed breastmilk just waiting around the moment a baby is born. Our body and our baby’s body must first undergo a series of events and changes. This is how our bodies are designed to work. Understanding this unfolding process helps us to see how miraculously we are made, rather than doubt our abilities and then end up doing things to try to “fix” was is not really broken. In most cases, we don’t need fixed. We simply need education about this process and someone reminding us that we are normal.
Breastmilk is not immediately available upon the birth of the baby. It takes approximately three to four days for full breastmilk to arrive. If baby is born on Saturday and breastmilk comes in on Tuesday or Wednesday, that is the normal three -four days wait time– the exact time when it is supposed to come in. Perfectly on schedule. Perfectly normal.
In the Meantime, there is Colostrum
While waiting on the breastmilk to arrive, your breast has a substance called Colostrum available for the baby. Colostrum is nicknamed “liquid gold” for its golden color and because it is so valuable. But much like gold, it is available in small amounts, leaving many new mothers to think they do not have enough “milk” to feed their baby. Oftentimes during this waiting process, new mothers think they are starving their baby. We are a visual society, and our need to “see” things in order to believe they are really happening is important to us. We find it unsettling when we cannot see, cannot measure, cannot control. It is difficult to trust our body when we cannot see what is happening.
Colostrum is available in a teaspoonful size, or even just a few drops, so many of us assume that since we can see or feel it, we must not have enough (or any!). We doubt ourselves. But what is really happening on that chemical level is that our baby is being fully satisfied by the contents of what is in the colostrum!
Think about being hungry and taking a teaspoonful of honey or peanut butter to “hold you over” until the big meal arrives. Honey and/or peanut butter have a lot to offer our body to temporarily satisfy us. We couldn’t really handle much more than a teaspoon of either, as a little bit goes a long way. It satisfies our hunger for a short time, and it gives us calories to burn as energy. It’s useful, and better than a cracker or something else that does not have as many nutrients per unit.
Colostrum is very similar. A little bit packs a punch! Only a few drops or so are needed. Your baby is able to get those few drops pretty efficiently through nursing – even within just a few minutes of latching.
In fact, babies are much more efficient at getting colostrum (and breastmilk!) than a breast pump so it is likely that a mom who tries to pump may not see any signs of colostrum – not because it is not there, but because the pump is not as good at expressing colostrum as your baby is.
Although this leaves many of us feeling defeated, it is in fact… NORMAL. It is what is supposed to happen! Your baby’s nursing is better than a breast pump at getting the colostrum. It be helpful if someone told us this while we are sitting there doubting our body and ability to feed our baby!
Colostrum has many necessary health benefits for newborns including sealing perforations in the newborn gut and boosting newborn immunity. I would encourage reading a quality book about breastfeeding, such as The Womanly Art of Breastfeeding or some articles on Kelly Mom that will discuss these benefits in much greater detail.
The Newborn’s Body Fat
Newborns come into this world with a layer of “brown fat”. That brown fat gives the newborn what it needs to survive over the next few days while she waits for breastmilk to arrive. Your baby does not have to be the chunky type. All full-term babies have brown fat no matter their plumpness. The newborn will burn off that brown fat over the next few days following birth. This is where the normal newborn weight loss comes in. Between the drops of colostrum she receives through frequent breastfeeding and the brown fat she has on her body, your newborn has everything she needs to satisfy her hunger.
The Sucking Reflex
This is a good time to mention that your baby is born with a sucking reflex. She has likely been practicing this reflex while she was still inside your warm uterus. When she is born, she will want to use this reflex. A lot. The best thing to do is to let her nurse as she desires. This has two advantages: 1) It allows her to practice and satisfy her urge to suck, and 2) It helps to stimulate your breast to encourage breastmilk to come in.
Studies show that the more access your baby has to your breast in those very early hours and days after birth, the more breastmilk you will make, long term. So basically, if you allow your baby full access to the breast right away, as often as she wants it, the more milk you will make later. The less time your baby has at the breast, or if supplementation occurs, the less breastmilk you will make later.
Your baby is telling your body how much she needs (or does not need) and your body listens to her directions and maps out a plan for the entire breastfeeding relationship.
Meanwhile… What does this behavior look like in real life?
It looks like a mom who sees her baby constantly at her breast and makes her think she is not making enough to feed and satisfy her baby. We feel defeated that our body is failing our baby instead of realizing our baby is doing what she’s SUPPOSED to do to help build an abundant, long-term breastmilk supply.
We are ok. We are normal. Our babies are ok. They are normal.
Please someone, tell us this during this delicate time! Please tell us let our baby at the breast as often as she wants it, and that it does not mean she is starving. There is colostrum there for her. It means she is receiving ALL the benefits from colostrum. It means she has a small belly that fills and empties quickly so it needs refilled frequently. It means she has a healthy reflex of sucking. It means she’s sending the signal to your body to build up a hearty, long term milk supply. This is part of the unfolding process of breastmilk production.
At the end of pregnancy, our body along with our baby’s body are undergoing a complex communication of hormones. While it’s a much more complicated series of events than we can explain here, I’ll try to give you the CliffsNotes version.
When baby determines she’s ready to survive outside the uterus and without the help of her BFF placenta, she sends a signal through the blood stream that tells mom’s body to start the production process of breastmilk. The hormone that starts this process is called Prolactin. Prolactin tells the mother’s body to prepare for a baby and initiates breastmilk production. It also is thought to initiate labor.
Basically, baby tells mom she’s ready to be born and sends the signal to begin the production of breastmilk and as a result, also starts the labor process.
Sometimes medical reasons make induction recommended. Mothers who have their labors initiated through induction are not likely to receive this hormonal message of Prolactin prior to baby being born because the labor was forced to begin before the hormonal communication occurs. Inductions also come with a cascade of other interventions that are known to interfere with early breastfeeding. This gives us another obstacle to overcome.
Induction of labor is not something to be taken lightly and should only occur when there is a medical reason where the benefits clearly outweigh the risks. When there is a medical reason, discuss with your health care provider ALL options of induction that are available, particularly ones that carry the least amount of intervention.
Skin to Skin
There are significant health benefits for both mother and baby when skin to skin is practiced. Skin to skin is the practice of laying the newborn directly on the mother’s body immediately after birth. Babies who are placed directly on their mother’s body just after being born have better body temperature regulation, better glucose levels, better heart rates, better respiration, and more than babies who spend the initial time after birth in a location other than on their mother. Mothers also benefit from having their baby directly on their skin, including help with the breastmilk production process.
The practice of skin to skin is also recommended beyond the initial moment birth. It is encouraged to be practiced at home over the next few weeks and months. This will aide breastmilk production.
Sometimes hospital policies interfere with the skin-to-skin process, particularly when surgical birth (cesarean) is performed. While many more hospitals are recognizing the benefits of skin to skin in the OR, not all hospitals or providers have a policy in place. Therefore, many newborns and mothers are not granted immediate skin to skin in the OR or in the recovery room. This separation of the mother-baby-unit prohibits the baby’s access to early breastfeeding, and often gives hospital staff the ability to supplement with formula or a pacifier – both of which only sabotage the breastfeeding relationship.
Discuss your desire for skin-to-skin contact with your baby regardless if you have a surgical or vaginal birth.
The Value of Postpartum Rest
We are a society who does not value rest, even for new mothers. We judge ourselves, and we judge others, on how quickly we can return to normal and function above and beyond our expectations. Unfortunately, that’s very bad for breastfeeding and for the entire postpartum recovery period.
In many countries outside of the United States, new mothers rest for a full 40 days. Meals are provided in bed, housework is maintained, and all responsibilities other than feeding the baby are done by someone else – usually another woman in the mother’s social circle. In America, we simply do not take care of our new mothers as well as they do in other countries.
At a very MINIMUM, mothers who have given birth vaginally should do nothing more than snuggle skin-to-skin in bed with their baby for two weeks. For those who have a cesarean birth, a longer recovery time is necessary. Babies need full access to the breast at all times. Mothers need to be relieved of all other obligations. The only responsibility a mother has during this recovery time is feeding the baby. The mother’s family and friends must step in to provide the extra hands needed during this delicate time.
Seek an IBCLC for Help
If you are experiencing difficulties breastfeeding, seek immediate help from an Internationally Board Certified Lactation Consultant (IBCLC). Most hospitals have an IBCLC on staff. An IBCLC is someone who has studied and trained through rigorous college-level coursework and passed a very challenging exam that is only given twice a year. It takes months, if not years to complete, depending on what college level science courses the individual has previously taken.
OBGYN’s, pediatricians, midwives, or nurses do not have this level of training in their normal studies. Only the individual who takes it upon themselves to add this additional training and certification has this extensive knowledge. Asking a doctor, midwife, or nurse who has not been trained as an IBCLC for help with breastfeeding is like asking a math teacher to edit your research paper for grammatical errors. Both teachers work in the same field of education, but in totally different areas of specialty.
Nurses who work in the hospital are often trained on basic breastfeeding assistance. They are not adept to help outside of basic help unless the nurse has completed additional training. If patients are having any sort of trouble with breastfeeding, an IBCLC should be involved. If an IBCLC is not offered, mothers should request to be seen by the IBCLC on staff. Do not wait to be offered.
Set Yourself Up for Success
Remember – you are perfectly made.
Wendy Trees Shiffer, MS, FACCE, LCCE is a mother and maternal-fetal health educator. She is the founder and program director for Family Trees Birth Programs serving childbirth professionals and new parents.