“I’m hungry” Early feeding cues
• Stirring, moving arms.
• Mouth opening, yawning or licking.
• Hand to mouth movements.
• Turning head from side to side.
• Rooting, seeking to reach things with her mouth.
“I’m really hungry” Moderate feeding cues
• Moving more and more.
• Hand to mouth movements.
• Sucking, cooing or sighing sounds.
“Calm me, then feed me.” Late feeding cues
• Agitated body movement.
• Color turning red.
Many factors influence how well lactation is established in nursing women and breastfeeding support is crucial in determining success. Medications used as galactogogues can be effective in increasing milk supply but should be used only after all modifiable factors that affect milk production have been addressed including improving latch, and increasing effectiveness of milk removal.
Breastfeeding is healthy for you
• Helps your uterus return to its normal size more quickly.
• Lowers your risk of breast cancer, ovarian cancer, and diabetes.
• Saves you time and money.
• Helps you bond with your baby and make you feel happier.
Start breastfeeding as soon as your baby is born
• Ask your health care provider to place your baby on your tummy as soon as he is born.
• He will be naked, his back will be wiped dry and your health care provider may put a diaper on your baby and a blanket over both of you to keep you warm.
• Your baby will slowly adjust to where he is and will start moving towards your breast. It may take time and you may need to help your baby a little bit to reach your breast and find your nipple. He will try to latch on.
• Many babies are able to latch on and breastfeed well soon after birth. Keep your baby skin-to-skin until he has finished his first feed, or as long as you wish.
Breast Changes to Expect
Once your baby is born and the placenta is delivered, hormones make the alveoli produce milk. Additional blood and lymph fluid also go to the breasts to help produce milk. Some women will notice drops of fluid on the nipple during pregnancy, called colostrum. This thick, golden fluid is also called the “pre-milk,” “first milk,” or “liquid gold.”
Your breasts may become fuller, larger, heavier, firmer and swollen on third to fourth day following delivery. This is caused by an increased flow of blood to the breasts, swelling of the surrounding tissue, and the increase in your milk volume as your breast milk transitions from colostrum to mature milk. During engorgement, you may need to use a larger bra for a few days until your breasts return to normal size. Some women’s breasts may feel swollen and uncomfortable, while others will feel only slightly full. Breast swelling usually begins to lessen within 24 to 48 hours from the time of onset.
Some Effective Treatment Measures for Engorgement
• To help soothe and reduce swelling of engorged breasts, apply cold compresses to the breasts. Reducing the swelling will help the engorgement to subside faster.
• This triggers blood vessels to constrict and helps with swelling and draining and soothes any discomfort.
The two most convenient ways to apply cold to the breasts are by:
Using ice packs outside the bra for periods of 20 to 30 minutes at a time
Using “icy” diapers. Icy diapers are disposable diapers moistened well with water and placed in your refrigerator or freezer for 20 to 30 minutes. These cold “icy” diapers are applied outside the bra until they lose their chill. The diapers can be stored in the refrigerator for reuse after the next feeding. If you leak milk while wearing the icy diapers, throw away the diapers and replace with new ones. Never apply an ice pack directly on the skin. If you are breastfeeding, use cold compresses between nursing or pumping.
Blocked or Plugged Ducts
- A blocked or plugged duct is a small lump in the breast that is tender and may be slightly reddened. These are felt as pea-size lumps under the skin and in the substance of the breast and are sore to the touch.
- Your baby is not yet able to breastfeed, or does not do lots of sucking when put to breast: Hold your baby skin to skin.
- Hand express and pump your breasts at least 8 times in 24 hours, after putting baby skin to skin. Use “hands on” pumping to fully empty your breasts.
- Read the pamphlet “Breast Massage, Expression and Hands on Pumping of Mother’s Milk”
- Use a hospital or rental electric pump.
- Use it on the lowest pressure to start and increase to comfort.
- Pumping should not hurt. It does not help to increase the pump pressure so high that it is painful. Pump near your baby and in the same room whenever possible.
What are the most common reasons for low milk supply?
Breast surgery or use of some medications such as birth control pills. Babies who do not feed well. Babies may not feed well if they are born preterm, are jaundiced, sleepy, or latch poorly. Not breastfeeding or using a pump often enough including during the night. Use of ineffective pump equipment. Drop in supply over time because you have to just rely on pumping. “Sleep training” your baby.
What else can I do to maintain or increase my milk supply? Ask for help. There are some other reasons for a low milk supply. Ask for help as soon as you notice you are getting less milk or that your baby is not satisfied with breastfeeding. The problem can often be solved when you get help right away.
Ask for help if you notice you are:
- Pumping less than 140 ml in 24 hours after the 4th day.
- Pumping less than 500 ml in 24 hours by two weeks.
- Spend time skin-to-skin with your baby every day if at all possible.
- Breastfeed or empty your breasts at least 8 times in 24 hours, including at night.
- Try increasing the number of times you breastfeed or pump to more than 8 times in 24 hours for 3 or 4 days.
If you need more help, then add: Medication or herbs. They can be helpful to increase your milk supply.
Not all herbs are safe to take when you are breastfeeding. Read the package carefully and check with your doctor or midwife, pharmacist or nurse. Women tell us that fenugreek, blessed thistle, fennel or raspberry teas increased their breast milk supply. There are few research studies written in English that confirm herbs increase milk supply. There is research indicating that herbal products often contain substances not listed on the label including product substitution, contaminants and /or fillers. Herbs are not regulated which means no government department is checking to make sure that herbal products are safe. Acupuncture and Aromatherapy. Women who have tried acupuncture or aromatherapy tell us that they sometimes work. To date there are no known research studies that confirm they are helpful with milk supply problems.
Encourage a good latch
Some mothers find that their nipples feel tender. The two most common reasons for sore nipples are poor positioning and/or poor latch. These problems can be solved. Find good breastfeeding support to help you.
There are many breastfeeding positions. Find the one that you and your baby prefer. Be sure that your baby is latched deeply onto your breast and not just taking your nipple into his mouth.
If you are feeling pain or if you feel your baby is not breastfeeding well, get some help right away.
Most mothers make more than enough milk for their babies
The amount of milk depends on how often and how well your baby latches on your breast. Your body will make more milk when your baby breastfeeds more often and has a good latch and suck. Start breastfeeding as soon as your baby is born. Learn your baby’s hunger cues and breastfeed as often as needed.
- Asztalos, EV et al. (2017). Enhancing milk production with domperidone in mothers of preterm infants J Hum Lact.
- Antonio, A. Z. et. Al (2010) Safety and Efficacy of Galactagogues: substances that Induce, maintain andiIncrease breast milk production. Journal of Pharmaceut Sci.
- Bazzano, AN et al. (2016). A review of herbal and pharmaceutical galactalogues for breastfeeding. Ochsner J.
- Hale, T. Rowe H. (2014). Medications and Mother’s Milk. (14th edition) Pharmasoft Publishing, USA.