Granny’s Guide
Milk supply regulation W
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By Yvette O'Dowd
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we app 2 1 ening around 6-
P
erceived Insufficient Milk Supply (PIMS) is so common, it is listed as one of the top reasons mothers stop breastfeeding or begin supplementing with formula. Perceived - not actual - low milk production. There is a difference. The indicators used to assess if a baby is getting enough breast-milk are: Sufficient wet nappies: 5 heavy disposables or 6-8 soaked cloth nappies Good skin colour and muscle tone. If gently “pinched”, their skin bounces back. Their weight, length and head circumference growth is tracking the curve on their growth chart as expected.
Frequent soft bowel motions. 3-4 per day in the first six weeks. Older babies might have less but the poo is still soft. The baby is mostly content after most feeds; allowing for normal cluster feeding and fussy periods.
However, and this is significant, the reasons parents believe their milk supply is low are often very different such as: The baby feeds frequently and more often than they expected.
The baby sleeps for shorter periods and wakes at night more than they expected.
In a recent study in Western Australia, 44% of the mothers had a perception of insufficient milk supply within three weeks of birth. The most common reason for this perception was that their infant was not satisfied after breastfeeds. These normal patterns of feeding and sleeping behaviour are tiring and time-consuming. If you are being repeatedly told by well-meaning family, friends, and health professionals that your baby should be only feeding 3-4 hourly and should be sleeping through the night, it is easy to see how breastfeeding mothers will doubt their milk supply is enough. In the early weeks of the fourth trimester, the breasts themselves give reassuring feedback of milk abundance. Go too long between feeds and your breasts swell and feel heavy. They might even become sore and hard! If someone has told you to stretch out feeds so your baby gets more milk, then this seems to be evidence that is working! 88 Peninsula Kids – Summer 2022/23
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The longer you wait, the “fuller” your breasts appear and the more milk you must be making. Then, suddenly, perhaps even overnight, your breasts no longer feel full and firm. They feel soft and … empty. If you have been routinely pumping milk in-between breastfeeds to create a “freezer stash”, the volume you can pump might plummet. You can go from getting 70 - 150ml to just … 20-50mls.
This change is normal, natural and should be expected …. except nobody seems to warn you it will happen! In the early weeks of breastfeeding, your body produces breast-milk constantly. Your breasts fill and fill and fill. Sometimes you might feel full to bursting point! Luckily, nature put a braking system in place, otherwise you probably would explode. Here’s how it works: the fuller your breasts become, the more of a substance known as FIL (Feedback Inhibitor of Lactation) is excreted. This protein in the whey part of the milk signals to the milk-making glands to speed up or slow down production. Too little FIL from frequent removal of milk and your breast pumps up the volume and quickly replenishes the milk supply. Too much FIL and your breasts get the feedback that less milk is required, slow down, put the brakes on production. Cluster feeding, and power pumping use this system to increase milk production. Block feeding, and weaning, use this system to decrease milk production Put very simply, soft breasts are working hard, hard breasts are hardly working! This system is really useful as breastfeeding is being established. There are so many unknowns for the breasts: how many babies are there? (Twins? Triplets? More?) How big is their stomach capacity? (Small? Medium? Large?) When does the baby feed frequently (cluster feeding) and when do they feed less frequently? Every single baby is unique, and the breasts need time to get to know them individually. It’s like fine-tuning by tweaking all the levels to get the volume just right. Then lock it in. This takes around 6-12 weeks. Lactation now works like a well-oiled machine. Your breasts can confidently produce the milk on-demand, meeting the baby’s needs efficiently and without all that attention to detail.