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Monday, February 19, 2018

Not enough milk: debunking breastfeeding myths

breastfeeding, not enough milk

Well check: Dr. Laurie Jones and one-month-old Sophia Gulbis and her mom, Stephanie Gulbis

Human babies have survived on their mother’s milk for millions of years, just like all other mammals, says Laurie Jones, MD, IBCLC. And a woman’s ability to make milk and nourish her baby is not based on a fragile system.

The majority of mothers are quite capable of feeding their young.  In fact, Jones says that 95 to 99 percent of mothers make enough milk for their baby.

When it comes to feeding a new baby, there were no other options but breastfeeding  until the relatively recent past. “We all forget that,” says Jones, an AzAAP chapter member who practices at St. Joseph’s Hospital and Medical Center in Phoenix.

But today, says Jones, many mothers believe that when they have a baby, they won’t be able to make enough milk. “So many of their friends or family have planted the seeds of doubt.”

Modern hospital practices tend to inhibit built-in mechanisms for bountiful milk production, says Jones. “New mothers are bombarded with advertising for formula ‘supplements,’ and their doctor or hospital may give them free formula samples ‘just in case.’”

And that perpetuates the myth that they won’t make enough.  “Our modern culture, beliefs, medical practices, and artificial substitutes have given rise to a false epidemic of not enough milk.”

It’s a combination of factors that lead a mother to begin feeding both breast and formula in the first days and weeks after her baby is born, says Jones, and that’s what leads to a reduced milk supply.

“That’s the number one reason mothers stop breastfeeding and do not reach the recommended 12 months,” says Jones. “It’s because of perceived—or real—low milk supply.”

breastfeeding, not enough milk

Dr. Jones examines Sophia

What works

In the first few weeks when the mother’s body is figuring out how much milk to make, it is critical that she is given unrestricted access to her baby with no rules or limits on feeding.

“Many parents mistake a newborn’s constant need to suck as a sign of being underfed,” she says. “But babies are programmed to suckle frequently to bring in a mother’s full milk production.”

Babies have long been wired that way—because it ensures a safe, close proximity to their mothers. The amount of suckling in the first 5 days is a predictor of the supply for the following six months.  Anything that stands in the way of this natural regulation will prevent a mother from breastfeeding exclusively.

Jones, a pediatrician who is also an International Board Certified Lactation Consultant, helps educate medical professionals on how critical the first few days after birth can be for a new mother to get off on to a good start in establishing her milk supply.

From the moment the baby is born, says Jones, the only thing a new mom needs to do is be close to the baby to allow the mother-baby dance to unfold. Milk production will increase dramatically around the third day post partum.

It sounds simple, and natural, keeping a new mother and her baby close, those first few days right after birth.

But that’s not always what happens for women who deliver in the hospital. Jones points to research showing that on the very first day after birth—post-partum day one—there are an average of 54 interruptions to a mother’s hospital room, with each interruption averaging 17 minutes in length.

Jones sees women start giving formula in the hospital after their baby is born because they think they don’t have enough milk right after delivery. That’s not true, says Jones.

breastfeeding, not enough milk

A spoonful of milk is about 7 milliliters“It’s amazing how nature delivers the perfect amount to the baby,” says Jones.

Facts on milk supply from Dr. Jones

  •  A woman only needs one breast to feed one baby.
  • Expectant women begin making milk around 16 weeks into a pregnancy.
  •  The baby’s stomach can hold about 7 to 15 milliliters comfortably in the first day of life.
  • The average volume of a feeding is 7 to 10 milliliters—about a teaspoon and a half.
  • When mother and baby are kept in direct contact with minimal interruptions, the baby will nurse frequently.  A minimum number of feedings is about eight to 12 per 24 hours.
  • How do you know the baby is getting enough? Count wet (W) and stool (S) diapers:
    Day 1 (1W, 1S)
    Day 2 (2W, 2S)
    Day 3 (3W, 3S)
    Day 4 (4W, 4S)
  • Day 5 to one month—about six to eight of each.
  •  Pacifiers can steal time at the breast and lower milk supply when used in the first two weeks.
  •  Topping off with formula after breastfeeding will decrease a mother’s milk supply, and no formula should be given to a breastfeeding infant without a true medical indication and for a short therapeutic intervention.
  • If the baby won’t latch onto the breast for some reason in the first days after birth, the simplest, quickest option is to hand express the milk in the mother’s breast and feed it to the baby on a spoon.
  • Pumps cannot get the colostrum milk out as easily as a mother can by hand, and there is a lot of set up and cleaning and time distraction involved in pumping.
  • Bottles of pumped milk should be avoided in the first three to four weeks, when the fast flow of the bottle can create breast refusal.

Size doesn’t matter: More breastfeeding facts from Dr. Jones

  • Women with small and large breasts make the same volume of milk per day.
  • The rare 1 to 5 percent of mothers with true insufficient glandular tissue (IGT) who cannot make an exclusive milk supply should have a full medical evaluation before they are given that diagnosis.
  •  The condition would not become apparent until a few weeks after the baby is born, when the infant who is exclusively breastfed is experiencing inadequate growth.
  •  Low milk supply is a medical condition that should be evaluated by a team, including the mother’s obstetrician, baby’s physician, and an IBCLC. Maternal hormones and some infant conditions, like tongue-tie, can reduce supply. Many of these issues can be reversed with the right information and support, and even those rare women with IGT can provide 100 percent at breast feeds with a combination of their own milk and supplemental tubing-fed donor milk or formula.
breastfeeding, not enough milk

Baby Sophia was treated for tongue-tie in the first few days after birth, which helped Stephanie to meet her breastfeeding goals.

You can’t see it…but it’s there!

There’s a misperception that a mother should produce more milk over time, says Jones. But studies show that the milk supply is pretty much the same from month one to month 12. Jones says that is “shocking to most people who are used to seeing bottle-fed babies take higher and higher volumes over time.”

But the same volume of milk grows a human baby beautifully from month one to month 12 for two reasons: (1) the fat and calorie content of human milk changes from day to day and month to month and (2) breastmilk-fed infants burn fewer calories per day than formula-fed infants.

Drinking cow’s milk formula is an inefficient process that makes an infant require more volume over time, and the caloric content of formula is the same every day of the infant’s life.

Breastfeeding is an elegant, mother-baby biological connection, says Jones, yet several barriers today stand to put a wrench in a system that has nurtured humans throughout history. “Mothers doubt their own bodies, doctors unnecessarily supplement, hospitals separate mother from baby for convenience, pacifiers are given to quiet the baby, culture dictates a baby be on a schedule and insurance won’t pay for lactation support after hospital discharge.”

Many forces attempt to undermine an essential biological process, says Jones, “but a mother with the commitment to breastfeed can overcome all these barriers with the right information and support.”

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Vicki Louk Balint

Multimedia journalist Vicki Louk Balint covers medical topics for magazine.

One Response

  1. ummsaaliha says:

    A wonderful article. I will definately be sharing this 🙂

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