Breast milk doesn't arrive right when your baby does. Get the scoop on when to expect your milk production to really take off.
The first few days of breastfeeding can be chaotic, and many new moms are filled with uncertainty and apprehension about what is going on. Besides sore nipples and fussy babies, one of the top concerns mothers have is whether their baby is getting enough breast milk—and if not, what should be done to remedy that.
As a lactation consultant who has helped hundreds of babies over the past eight years, I can tell you that with a good latch and frequent breastfeeding, most babies get plenty of breast milk, and most moms just need reassurance that this is so. But some babies actually do have trouble with feeding, and these cases need to be taken very seriously. Mothers need caring help, and sound advice for how to maintain breastfeeding while making sure that their babies are adequately fed.
When you are worried about your baby's intake, it can feel very upsetting and stressful (that's natural!). But that's why it helps so much to be educated about how lactation works: to know what is normal, what is abnormal, and what is in need of immediate attention. Here's what you need to know.
What is normal in the early days in terms of breast milk intake?
For the first one to four days of life, you produce colostrum. Sometimes referred to as "liquid gold," this yellowish-colored milk is full of antioxidants and antibodies. Although you don't produce a ton of colostrum, it is generally the right amount for your newborn, whose stomach starts out about the size of a marble, and gradually expands to the size of an extra-large chicken egg over the first few days.
One of the amazing properties of colostrum is that it's a laxative for newborns, helping them take their first poop (a black, sticky poop called meconium). Pooping meconium helps prevents jaundice, and all that pooping is part of why babies lose a little weight in the first few days. Other newborn fluids are lost then as well.
So how much weight is it normal to lose, and what would be a problem?
The Academy of Breastfeeding Medicine (ABM) estimates that the average weight loss for newborns is about five percent of their birthweight. A loss of eight to 10 percent can be normal, but should be closely monitored. If a supplement is needed, ABM recommends that moms should first try to hand express or pump their own breast milk and feed it to their babies. If that isn't possible, pasteurized donor human breast milk from a certified milk bank is a second option. Commercially produced formula is the third option recommended by ABM. The American Academy of Pediatrics' recommendations support this view, recommending supplementation with formula only if deemed medically necessary.
By three to four days after birth, colostrum will begin transitioning into "mature breast milk." Amy Schecter, MD, a doctor in Suffern, NY who specializes in helping mothers and infants with breastfeeding issues, explains how breastfeeding frequency may affect how quickly your milk comes in: "Frequent breastfeeding in the first few days can help bring it in a little sooner, and infrequent breast stimulation may delay the process," Dr. Schecter says. "Many women find that their milk comes in a little sooner with subsequent pregnancies."
Some moms will experience their breast milk "coming in" as a general breast fullness; others will become engorged. (You do not have to become engorged to be producing plenty of milk!) At this point, your baby should start to have more poopy diapers, and the poop will transition from black meconium poop to a yellowish-colored poop, which will indicate that your milk is fully in. If your baby is havig at least three stools the size of his fist, the he is most likely getting enough milk. He should gain about an ounce a day after Day 5.
But even more reliable than diapers is tracking your baby's weight. It's important to have your baby weighed by a professional, on the same scale each time if possible, and with the same amount of clothes on. As your milk comes in, your baby should start to gain weight, rather than lose it. Different healthcare providers have different protocols, but I like to see babies back to their birthweights by one to two weeks old, or at least steadily climbing in that direction.
How can you ensure that your baby gets plenty of your breast milk and starts to put on weight?
To make sure your baby gets enough milk ad to establish a strong milk supply, breastfeed your baby whenever he seems hungry or fussy instead of on a schedule, basically anytime your baby shows signs of hunger (licking lips, "rooting," sucking on fingers). This generally amounts to about eight to 12 feedings every 24 hours, though this varies from mother to mother.
Why would a mother's breast milk not "come in" on time?
Certain medical conditions may delay the timing of when breast milk comes in. These include diabetes, obesity, thyroid conditions, and excessive bleeding after birth. C-section moms may also experience a delay, but this is not always the case. "Women who deliver by C-section or have prolonged inductions may notice a bit of a delay in the process," explains Dr. Schecter. "Fortunately, for the majority of women, frequent breastfeeding or milk expression provides all of the colostrum your baby needs until a full supply of mature milk flows in."
Some mothers may not produce enough milk for their babies, for reasons that could include hormonal imbalances, history of past breast surgeries, and a condition called "insufficient glandular tissue," where a woman doesn't have adequate amounts of breast milk-producing tissue.
How can you tell if your baby is getting enough? For the first six weeks, three stools a day and gaining a ounce of weight a day are the benchmark for adequate intake. After six weeks, because stools increase in volume but slow down in frequency, you need to rely on weight alone to determine if your baby is getting enough milk.
Most moms do make enough breast milk for their babies, but if you have any concerns about your baby's breast milk intake or health, you should speak to a lactation consultant or pediatrician right away. If your baby isn't gaining enough weight, you can turn to a lactation consultant to make a plan to increase your supply with more frequent breastfeeding or pumping, or check out La Leche League for guidance and advice. And if for some reason you can't make enough breast milk for your baby, supplementing options can be discussed. Remember: all babies need to be fed, and as long as your baby is healthy and happy, that's all that matters.