Wednesday, November 23, 2011
Posted by: Jody Lindwall, CNM, MSN
I often hear women voice concern that they are not making enough milk. One of the more common reasons moms supplement with formula or wean their babies early is the perception of inadequate milk production. Usually these moms have fussy babies who seem to want to nurse all the time. It’s easy to draw the conclusion that their babies are hungry, especially if, after giving them a couple ounces of formula, the babies settle down and sleep soundly.
It’s hard for many women to have faith that their babies are getting enough milk when they can’t measure it beforehand. And though these moms absolutely believe their babies are going hungry, they are usually making all the milk their babies need. Newborns don’t need a large quantity of milk, especially not in their first few days of life. And though not being able to see how much milk is being transferred can be frustrating, there are other ways to “see” that the baby is getting enough. By the end of the first week postpartum, a breastfed baby should have five to 10 yellow stools and at least six to eight wet diapers per day. By two weeks postpartum, a newborn should be back up to his birth weight and during the first four months should gain an average of five to eight ounces per week. A baby who meets these goals is a baby who is thriving.
For those babies who do not produce enough wet and dirty diapers or who have not gained sufficient weight, milk supply may be a problem. Thankfully, true inadequate milk supply is rare, but it is not unusual to see it in women who have moderate to severe anemia, had a postpartum hemorrhage, have a history of breast reduction surgery or have insufficient milk-producing breast tissue. These women will usually need several visits with the lactation consultant and close follow-up. Milk supply can sometimes be improved by pumping between feedings, taking herbs or medications that may increase milk production and making sure to nurse on demand, when possible.
Sometimes a mom is making enough milk but the baby just isn’t getting enough of that milk during feeding sessions. This is usually due to a poor latch and a visit or two with the lactation consultant can often correct the problem.
If a mom has concerns about her milk supply, she should see a lactation consultant. In addition to evaluating the latch and correcting any problems, the lactation consultant can weigh the baby both before and after a feeding to determine how much milk the baby is actually getting from each breast. Many communities also offer breastfeeding support groups that are run by lactation consultants. Moms can get feedback and advice within a supportive environment and connect with other women.
If a lactation consultant or a pediatrician has recommended supplementing while breastfeeding to help an infant gain weight, giving formula is not always the only option. The Human Milk Banking Association of North America (HMBANA) has accredited 10 milk banks in the U.S. where families can get donated breast milk for their babies. Please visit the website to find the nearest HMBANA accredited milk bank.
If you’re struggling with breastfeeding, contact your office – we want to help you be successful. Read Jody’s previous posts on the challenges of breastfeeding: overcoming sore nipples and dealing with breast pain.
Jody Lindwall, CNM, MSN, is a Certified Nurse Midwife who sees patients at the Peterkort South Office of Women’s Healthcare Associates, LLC adjacent to Providence St. Vincent Medical Center in Portland.
Online Breastfeeding Resources
Breastfeeding Support/Lactation Consultant Services