Secrets of Supply: Mastering Milk Production
A Guide
Hello, dedicated parents! Today, we're going to dive deep into the fascinating world of milk supply in nursing and when feeding your baby away from the breast. Whether you're nursing your first child or are a seasoned parent, understanding the mechanics of milk production can be a game-changer for your breastfeeding journey.
Supply and Demand - Not Just For Economics
Our journey begins with one crucial statement that echoes through lactation circles worldwide: Demand equals supply. This is the “foundational law” of breastfeeding. In simpler terms, the more frequently your baby or a pump drains the milk from your breasts, the more milk you'll produce. This is driven by the hormone prolactin, which is stimulated to release in response to nipple stimulation.
What Happens If Milk Isn’t Removed Frequently Enough?
If the milk sits in the breast for too long or the breasts get too full and engorged, a protein called Feedback Inhibitor of Lactation (FIL) builds up inside the breast. FIL signals the breast to slow down milk production because the current supply isn't being used. This is Mother Nature's way of conserving resources and protecting your breast tissue from the effects of engorgement and ductal narrowing (formerly known as ‘plugged ducts’).
Therefore, regular and efficient milk removal is the secret to maintaining a robust milk supply and avoiding breast pain. Whether you're breastfeeding directly or pumping, consistency is key.
How Breast Storage Capacity Affects Supply
Everyone’s breasts are different. There are different shapes, sizes, colors, etc., but what really affects milk supply is storage capacity - or the amount of glandular tissue inside the breast that can store milk. People with a smaller breast milk storage capacity need to remove milk more frequently to maintain milk supply than someone who can store tons of milk in the breasts without feeling uncomfortable. You can’t judge a boob by it’s cup size.
Milk Supply When Feeding Your Baby Away From the Breast
If you're using a bottle to feed your baby expressed breast milk or formula, it's vital to maintain the same milk expression routine as you would if your baby were nursing directly. Every time your baby has a bottle of milk, it should ideally be matched with a pumping session to keep up with the demand and supply rule.
Whether you are giving alternate feedings out of preference, convenience, or out of necessity, most people need to express their milk every time their baby gets an alternate feeding in order to maintain an adequate milk supply. While there are exceptions to this rule, if you are not currently expressing more milk than your baby eats, you may want to consider increasing the number of times you express your milk each day.
Failure to do so may lead to reduced milk production, making it more challenging to switch back to breastfeeding later or keeping up with your baby's increasing appetite. In some cases, insufficient milk removal can also lead to painful conditions like mastitis or breast engorgement.
Where People Get Tripped Up
I often hear from clients in my private practice who are pumping, “… but Heather, if I wait longer between sessions to pump, I get more milk!” My answer is, are you though? While yes, waiting longer between expression sessions may yield more milk during that one expression session, it typically doesn’t result in more yield over a 24-hour period. Unless you have a large breast milk storage capacity, which does happen but isn’t as common as one might think, by letting your breasts get super full between milk removals, it is likely you are allowing Feedback Inhibitor of Lactation (FIL) be produced inside the breasts which can lead to lowering of milk production.
The second place I see people getting tripped up is at night. I often get other questions in my private practice, “Heather, my baby is sleeping 6-8 hours at night, do I really need to nurse or pump at night?” or “Heather, I am training my baby to sleep at least 6-8 hours at night, do I really need to wake up to nurse or pump at night?” The answer is: it depends. If your baby is less than 6 months old and sleeping more than 4-5 hour stretches at night, it is likely you are waking up uncomfortably engorged. If so, then yes, you probably should be waking up at least once during the night to remove milk by nursing baby or expressing to avoid a lowering of milk production. Another reason is I often get calls around 4 months when suddenly baby is not gaining adequate weight and mom’s milk supply has dropped; what I often find is the parents are sleep training or recently moved their baby from sleeping next to their bed into a nursery. Because of our circadian rhythm, our prolactin levels are naturally higher at night and, therefore, our milk supply is naturally higher at night. This is often where babies are getting a large chunk of their calories and removing those calories may have unintended consequences.
So, keep that milk flowing, parents! Maintain the balance of demand and supply and remember to pump every time an alternate feeding method is used. If you’re producing a lot less than your baby is drinking or producing a lot more than your baby is drinking, it is time to reach out to an IBCLC Lactation Consultant for assistance! You're doing an amazing job, and every drop of milk you provide plays a crucial role in your baby's growth and development. Keep up the fantastic work!
References:
Amir LH, Trupin S, Kvist LJ. Diagnosis and treatment of mastitis in breastfeeding women. J Hum Lact. 2014;30(1):10-13. DOI: 10.1177/0890334413516064.
Daly SE, Kent JC, Owens RA, Hartmann PE. Frequency and degree of milk removal and the short-term control of human milk synthesis. Exp Physiol. 1993;78(2):209-220. DOI: 10.1113/expphysiol.1993.sp003668.
Prime DK, Geddes DT, Hepworth AR, Trengove NJ, Hartmann PE. Comparison of the patterns of milk ejection during repeated breast expression sessions in women. Breastfeed Med. 2012;7:183-190. DOI: 10.1089/bfm.2011.0072.
Walker, M. Breastfeeding Management for the Clinician: Using the Evidence. 4th ed. Jones & Bartlett Learning; 2017. ISBN-13: 978-1284091046.