-HOW TO KNOW IF YOUR BABY IS HAVING ENOUGH BREAST MILK
Probably the commonest reason why many women discontinue breastfeeding, is the belief that the baby is not getting enough milk. Fortunately most women can and do produce enough milk, but occasionaly, the milk intake by the baby may be inadequate due to a problem in production of the milk by the mother or a problem with the sucking of the milk by the baby. Unlike with formula feeds where the actual amount of milk intake by the baby can easily be assessed by simply measuring the amount of milk ingested directly from the feeding bottles, the objective assessment of milk intake during breast feeding may be difficult. Yet, there are many ways by which a nursing mother may confirm that her baby is having adequate amount of breast milk.
HOW TO KNOW IF YOUR BABY IS HAVING ENOUGH BREAST MILK
1 Each time your baby finish sucking, your breast will feel softer and lighter confirming that it has been adequately drained by the baby.
2. In general, an average normal term baby feeds about about 8 to 12 times a day in the first week of life, but feeds about 7 to 9 times a day by the fourth week of life as its stomach gets bigger and the amount of milk it ingests during each feed gets larger.
3. On the avearge, a properly breast-fed newborn baby will often produce about 6 wet nappies and 3-4 dirty nappies a day, by the end of the first week of life.
4. A term baby normally loses about 10% of its weight in the first few days of life but returns to its birth weight by the 10th day of life. Any delay in the weight gain must be immediately explored to exclude possible medical or feeding problems. While a household scale is usually inadequate to pick these types of weight changes, a medical or clinical scale is more suited to pick such small but significant change in weight.
CAUSES OF INADEQUATE MILK SUPPLY
These can broadly be divided into:
1. INTRINSIC CAUSES OF INADEQUATE MILK PRODUCTION
Few women are genuinely unable to produce adequte amount of breast milk due to problems inherent in their body. Such women include;
1. those born with inadequate amount of milk-producing tissues (i.e. glandular tissue) in their breast.
2. those with previous breast reduction surgeries or breast radiation treatment or therapy e.g. for breast cancer.
3. those with hormonal problems preventing adequate milk production and
4. those with certain medications that prevent milk production.
2. INADEQUATE NIPPLE STIMULATION
The adequate production of milk by the breast and adequate secretion of milk by the nipples are under the influence of two different hormones, prolactin and oxytocin respectively. Their production are closely tied to continuous nipple stimulation by the baby during breast feeding. This can only be achieved by the proper latching of the baby on to the breast and continuous attempt at breast feeding. Usually, when these processes become fully operational, a nursing mother can be seen secreting milk profusely from one nipple, while the baby is feeding on the other breast. To maintain ample supply of breast milk thereafter, continuous nipple stimulation by regular breast feeding must occur. Therefore from the above, it is quite obvious that most women who complain of inadequate milk production are entirely normal but psychological factors such as unproven fears, doubts, lack of personal self belief and poor breast feeding techniques are the commonest reasons such women find it difficult to produce adequate amount of breast milk. Below is a list of the common causes of inadequate nipple stimulation;
1 Poor breast feeding technique resulting in poor latching of the baby on to the breast.
2. Infrequent feeding habit resulting in cessation or slowing down of milk production.
3. Frequent or prolonged separation of the baby from the mother.
4. Mixed feeding of the baby with formula feeds and breast feeds or feeding of the baby with formula feeds before commencement of breastfeeding. This not only reduces nipple stimulation, it discourages the baby from having the urge to suck the breast properly afterwards.
3. PROBLEMS PREVENTING PROPER EXTRACTION OF MILK FROM THE BREAST
Occasionally, the difficulty in breast feeding may be as a result of a structural defect in the infant’s mouth or lips, preventing the baby from attaining a proper latch. Examples include tongue-tie, cleft lips and cleft palate. If you notice any defect or difficulty in sucking by your baby immediately after birth, quickly inform your doctor so that a quick action can be taken to correct the anomaly and allow a proper latching by your baby.
If you have complaints about the adequacy of your breast milk production, consult an experienced medical staff to observe your breast feeding technique and demonstrate how to achieve a proper latch. Another resource that may help guide you on how to properly breast feed your baby is BREASTFEEDING: STEPS TO ACHIEVING A PROPER LATCH.
If you have achieved a proper latch, but you suspect that you are still not producing enough breast milk, the best way to improve your milk production is by increasing the frequency by which you breast feed your baby. Remember, the only way to increase the secretion of the hormone, prolactin, responsibe for milk production in your brain, is by continuous nipple stimulation during breast feeding. This is nature’s way of striking a balance between the demand and supply of breast milk such that the more you breast feed your baby, the more milk you will produce and the less you breast feed your baby, the less milk you will produce. Another way of achieving this, especially if you can’t seem to breast feed your baby as often as you want, is by the use of a breast pump or by manual expression of milk from your breast using your palms.
Galactagogues (or lactagogues) are medications that are supposedly meant to increase the amount of milk production by your breast. Because of concerns about their safety to both the mother and the baby, they are yet to receive a World wide acceptance. For more information on this topic and any other issue, please CHAT WITH OUR CONSULTANTS.
NEXT ARTICLE: MILK OVERSUPPLY
Reference and further reading:
Lawrence RA. Breastfeeding: A Guide for the Medical Profession, 4th ed. St Louis: Mosby, 1994:473- 540. 5.
Cady, B, Steele, GD, Morrow, M, et al. Evaluation of Common Breast Problems: A Primer for Primary Care Providers; prepared by the Society of Surgical Oncology and the Commission on Cancer of the American College of Surgeons for the Centers for Disease Control and Prevention, Publication no. 633-001/20900, US Department of Health and Human Services, 1998. (Available online at: www.utmb.edu/Surgery/clerks/primer.htm) (Accessed on August 8, 2008).
American Academy of Pediatrics and the Americal College of Obstetrics and Gynecology. Breastfeeding Handbook for Physicians, Shanler, RJ (Eds), American Academy of Pediatrics, Elk Grove Villate, IL 2006.