Perceived low milk supply and Frequent feeding.....

So here is my first written article as a Certified Lactation Consultant.... appriciate your thoughts ;)

Are you feeding again? You mustn’t have enough milk? Maybe I don’t have enough?

These are frequently heard comments and thoughts by mums who are simply experiencing normal newborn feeding behaviours. Many mothers are quick to jump to the conclusion they must have a low milk supply. There are however quite a few factors to consider when we look at feeding frequency; the capacity of the breast to hold milk is one that could do with more consideration. It could be easy for a mother to think she has a low milk supply when in fact her breast capacity is simply that of a smaller volume. The mother with a small breast capacity is very capable of making the perfect amount of breastmilk for her baby but because the breast holds a smaller volume of milk the baby requires feeding at the breast much more frequently[1].

The mother, if not understanding of this, may easily mistake her baby who wants to feed as frequently as he does (hourly or 2^nd hourly) as a hungry baby whose nutritional needs are not being met. In fact the opposite is true. Case in point, my 3^rd child baby Rhys, he was a healthy 3.4kg born, lost only 100g on day 4 and was well and truly over his birth weight at one week. At 4 weeks he is a whole kilo over his birth weight. Rhys has had unrestricted access to the breast since birth, at 4 weeks of age he had developed a pattern to his days where he cluster feeds all morning, has a bigger sleep towards the early afternoon then cluster feeds in the evening, when he goes to bed to feed about 2^nd hourly overnight. A very normal feeding pattern of a breastfeeding infant[2].

On one of these mornings the thought came to me, that if I were a new mum who didn’t know any better I would truly believe I did not have enough milk for my little man, I brushed this thought off instantly as I watched him gulp his milk, even if the gulping only lasted a minute or so, and relished in his contentedness and his toes that now were stretching his once loose bonds suit to its limits.

My concern was for those new mums that don’t understand normal infant feeding habits, or breastmilk production and intake by the baby. For if they did understand or at least expect these behaviours perhaps new mums might be more forgiving of their 2^nd hourly (or more frequent) feeding babes and not try to manage or fix them.

When the baby feeds as frequently as it wants the breast doesn’t have to hold large volumes of milk, because the breast is frequently being emptied the breastmilk production is at its most[3]. Furthermore, these babies have the potential to have more than adequate weight gain as they are frequently feeding on milk that has a higher fat content. As we know,  the smaller volume of milk in the breast the higher the fat content contained in the milk[4].

With my first children, premature twins I was constantly doubting my supply; I took herbs and medication to help my milk production and attended a residential program at a sleep school. As I look back now, armed with new knowledge and experience, I most probably didn’t ever have a low supply; my babies just weren’t ready to be put on the 3^rd hourly feeding schedule that I was so earnestly encouraged to put them on by most of the well meaning health professionals.

If I were in the head space to be able to feed them as frequently as they needed feeding they would have had their milk intake adequately met exclusively by myself and not needed complementary feeding with formula and would have managed to gain weight at a steady pace. How could I not see that  by simply putting babies back to the breast for a “top up” was the same as giving the extra milk via the bottle? I’ve since learnt that it isn’t the same, it can be better.

By topping baby up at the breast, mum foregoes all the bottle and pumping/formula paraphernalia and associated complications, baby is stimulating mum’s milk supply, baby is happy and contented from the breastfeed and the suckling. It may be the case for some mums (certainly for baby Rhys) for “a feed” to consist more or less of 6 breasts; babe happily finishing one side, to  switch to the other and repeat this over and over and even over again. Note here BABY initiates the swap by indicating he is finished the one side.

“He’ll get a tummy ache if you feed him again!” Does this frequent switching lead to aches and pains, wind or even colic as so commonly thought? My response is no, not if as I first mentioned the breast capacity is smaller. Now if a mum with copious amounts of milk, frequently switches sides during a feed, baby will receive lots of high lactose thinner milk that comes at the start of a feed (sometimes known as foremilk) this milk can lead to a windy baby as gases are produced in the bowel from the breakdown of the lactose[5]. It is therefore very important for the baby feeding on this (full) breast to drink as much as possible from that first side so that as the volume reduces the fat content increases and baby gets that good creamy milk at the end of the feed. This baby may frequently only feed on one side, or have a little of the other and be contented for some time.

So in the breast that holds smaller amounts of milk, baby gets the fattier milk more quickly therefore avoiding lactose overload that may lead to a windy upset baby. As the breast is always making milk and is never truly empty, you can go on switching sides as many times as baby indicates, till eventually you have a satiated milk drunk babe.

After a big session of cluster feeding like this babe may just treat you to a nice big sleep, longer than the hour or so that he or she might do usually. Maybe.

I wish mums the wisdom to have faith in their bodies ability to nurture their babies, their body or baby may not fit the cultural norm of fourth hourly feeding, neither simply weren’t meant to. Formula is a scientific creation that is exactly the same every time (provided it’s made up correctly), baby drinks the same amount and drinks it at the same time. Breastmilk doesn’t work that way, it’s a living fluid, it changes composition day by day, feed by feed and as indicated previously throughout a feed[6]. This is why scheduled feeds and breastfeeding just don’t go hand in hand, you might be able to get your breastfed baby on to a schedule but it could be an uphill battle that is essentially going against nature. What a lot of energy to win that fight! If you just go with it, your newborn might be feeding round the clock, but I can nearly guarantee you that your 3 month old will be feeding less frequently, and your 6 month old less than that and your 1 year old less again and so on. Provided they have unrestricted access to the breast you can safely be assured their needs are being met. Beside, this time is ever so fleeting, do you want him anywhere else other than at your breast?

   

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[1] Riordan J, Breastfeeding and Human Lactation p. 123

[2] Day J, Breastfeeding Naturally p. 46-47

[3] Riordan J, Breastfeeding and Human Lactation p. 267

[4] Lawrence R and Lawrence R, Breastfeeding A Guide For The Medical Profession,p.120

[5] Day J, Breastfeeding Naturally p. 139

[6] Wilson Clay and Hoover, The Breastfeeding Atlas, p. 30