5 Ways We Sabotage Milk Supply From Day 1
Hi and welcome to The Lactation Training Lab Podcast. I'm Christine, a childbirth educator, and International Board Certified Lactation Consultant. Today we are going to talk about the five ways that milk supply gets sabotaged from Day One. This is a critical component of what lactation care providers need to know and know intimately, and it's how we help people who intend to breastfeed their babies. We understand what works and what makes things better.
From the start, right from Day One, right from birth, and one of the things that I think helps to put this in context, is understanding that while it would be ideal if most people had prenatal education about how breastfeeding works, the reality today is that most people don't. Because they don't, what we actually do for them and what we tell them in the first hours and days after their baby is born, becomes even more vital and important.
Unfortunately, what's confusing about this is that this is a time of life where hormonally, a new mother or parent is actually not set up to learn new things; they’re not hormonally in a state where the left brain is in control. It's really more of a kinesthetic time. It's more about how things feel and being able to stay focused on the baby, on themselves, on that little world that they've created. Unfortunately, we are in this position where we often have to provide information, we have to provide technique and skill and help, and we have to provide them the kind of anticipatory guidance which will help get them through potential obstacles or challenges that come up.
Many of those challenges are not necessarily even physical challenges or medical challenges; they are simply other people giving them incorrect information, the commercial messages that they receive about breastfeeding and infant feeding, and just other conflicting and inconsistent messages that people get when they have a new baby.
I'd like to start here with the five ways that milk supply really gets sabotaged from Day One. The very first one is calling it “milk supply.” That's a really critical error that we've made over time. Think about the definition of supply, I always think about this in terms of items that I keep in my home. I keep a certain supply of paper towels on hand, and I run low and then I go and get some more. But that process takes work, and I can't make paper towels, so I rely on something else - to go get paper towels when I run low - when my “supply” is low. “Milk supply” is not really the same thing.
The body makes milk; it's a process. Really what we're talking about here is production. The milk is not “just there.” The milk is being made, and there are ways to influence that production, both positively and negatively. By calling it “supply,” we give people the impression that there is only so much, and once they use it, it's gone. Or it's a set amount that they can potentially make or they have a capacity to make a certain amount, and that's unchangeable.
That's not really how it works. That's not quite the same thing as saying “milk production,” which is a process that can be influenced. When we give people the impression, right from the start, that they have a capacity to make a certain amount of milk, that's incorrect. That's simply inaccurate. What we want to do is describe this process as milk production so that people understand that their actions and the information that they take in actually have an influence on that.
The second way that we sabotage milk production is by interrupting or preventing the mother or parent and their baby from having skin to skin time. Skin to skin is something that became more trendy, as the Baby Friendly Hospital Initiative took hold in more and more hospitals in the United States and around the world, but truly skin to skin is something that was done before that. Skin to skin is not just something that is, “oh, that's a nice bonus” or a nice technique or something nice we do in the hospital when the baby's first born. Skin to skin is actually a health behavior that puts the baby in the place where they're supposed to be - in their habitat, the best place that we know for transitioning from womb to world.
When a baby is skin to skin, there are many many physiological measures that we can keep track of, and that we know from tons of research are really improved by staying skin to skin. At the same time, there are many physiological measures for mothers and birth parents which also happen when their baby is skin to skin.
The amount of time that skin to skin is happening really matters, and keeping the baby there without interrupting them is a super important part of milk production and establishing breastfeeding right from the start. Because as babies are skin to skin and as they stay there, they move through a sequence of pre-feeding behaviors which allow them to ultimately latch and begin to feed. Every time they are interrupted - if we think of skin to skin and the pre-feeding behaviors as a staircase that the baby has to climb in order to latch and feed, every time they're interrupted, no matter what step they're on, even if they're already on step eight of nine - when they're interrupted and then they're brought back to skin to skin, it means that they start again at the bottom of the staircase and they have to go through it again, which can be incredibly frustrating, and it also puts delays into that process.
We really want to see ultimately that babies are born and placed immediately skin to skin so that they can move through that sequence of feeding behaviors right away and repeatedly. Skin to skin is not something that should only happen for a few minutes, or for a little bit of time or every couple of hours. Skin to skin is actually where babies should be most of the time. We know from lots of research on preterm babies that skin to skin actually saves babies’ lives when babies are born at a low birth weight and preterm. There's a lot of emerging evidence about babies and their initial stability when they're first born, if they're placed skin to skin before being stabilized, they actually have a better mortality rate. There's a lot of work that's been done on this, and it's really quite clear that the very best place for almost every newborn baby is skin to skin, and we know that one of the things that really is influenced by that is milk production.
Now the next way that milk production gets sabotaged is waiting for the baby to cry to initiate feeding. Babies are giving communication cues, showing hunger cues, and telling us that they need to go to the breast, long before they cry. Crying means we've already missed the other cues. So if we are failing to teach parents to look for the cues that babies give to go to the breast, then we are really missing the whole boat on when babies are supposed to be feeding. They know when they need to go to the breast and they know how long they need to stay there.
It's important to ensure that parents are taught those hunger cues that babies display when they're ready to go to the breast, and also that we always explain that those cues always mean “it's time for me to go to the breast,” and that going to the breast is not always a signal of hunger. Sometimes it's a signal that they need to be at the breast for a different reason. There are many reasons babies go to the breast, and they signal that they need to be there whenever they need that. It's not a method of manipulation - they're not capable of that. They simply need to be at the breast because it provides for their needs in some ways that we can measure and that we understand and other ways that we can't see and that we don't yet understand.
Number four really ties right in with number three: using the clock to manage feedings from Day One is not the way to ensure great milk production or even great milk intake by baby. It's really important for the baby to be able to go to the breast - to be facilitated to go to the breast - and to stay there for as long as they need to, regardless of what time a clock says.
Babies don't have clocks. They simply have internal signals which are hormonal to tell them what they need. And when we follow those signals, there's a much better likelihood that they'll get all the milk that they need, and that they will send the appropriate signals to the mother’s or parent’s brain to make all the milk that they need now and in the future.
This is the feedback loop that babies and their mothers or parents have which helps to keep milk production in sync with the baby's needs. When we use a clock to manage when feedings happen or how long feedings are, or how many hours or minutes are in between feedings, we interrupt that feedback loop. Once we have interrupted it, we are no longer able to be so sure.
We really want to make sure, especially in newborn babies that are born healthy and term, that we are allowing them to set the pace. They cue when they need to go to the breast, and they cue when they're done there as well. Whenever they need to, they should be facilitated to be there, and then to stay as long as they want to. There's no reason to limit them. There's no reason to put certain intervals in between feedings. There are really no reasons to interrupt that feedback loop.
When we interrupt it, it can sabotage milk production right from the start. The First 100 Hours of a baby's life, roughly their first four days, are really a critical timeframe for them to be taking in milk and programming the milk production in their mother or parent’s brain so that enough milk will be made for them, and allowing that feedback loop to happen as it needs to without interfering or manipulating or trying to manage it from the outside is really critical in a healthy term baby.
There are, of course, times when management of that routine is necessary, such as babies who are not capable because they've been born preterm or they have other health concerns, but in most babies, they should be facilitated to follow their own internal programming during those First 100 Hours. That's when we have the best opportunity to allow for that programming to happen and to be synchronized with the baby's hormonal needs.
The fifth way that milk supply or milk production gets sabotaged from Day One is when parents and caregivers use a plan called “hope that the baby's latch will improve.” Hope is not help, and help matters because latch is a critical part of knowing that a baby can get enough milk - a quality latch, a good latch, a latch without pain, a latch that is easy, a latch that is comfortable for both parties. These things are critical for babies getting enough milk because a baby with a poor latch does not get as much milk. Many times, parents and mothers are encouraged to continue with a bad latch because it's been so hard to achieve in the first place, or to continue with a bad latch because they believe for some reason, that pain is a natural part of breastfeeding. That's incorrect, that's simply inaccurate. It's really critical that we ensure that parents know that getting a better latch often takes help.
It takes practice and it takes time, and simply hoping that it will get better is not a plan. So as lactation care providers and as other health care providers who are caring for mothers and new parents and babies in their first hours and first days of life, we need to make sure that we are encouraging them to get help with their latch if it's not working. We can't simply send people on their way and say “well, it'll probably get better with time” or “it just takes two weeks and then everything gets all better,” or “most people have some pain and then it goes away.”
Those are all plans based on hope, and hope does not help with latch. It's important to get help with technique to make that latch better, to make sure that the latch is comfortable because it all ties back to the previous two steps. If there's not a comfortable latch, then there's less of a chance that someone can sit and comfortably feed their baby for as long as that baby is asking, or that they'll be ready to put that baby on when the baby signals if they know that that latch is going to come with pain. We can't be sabotaging milk production by discouraging people from getting help or encouraging them to “just keep going” because “keep going” is just a plan that is hope. And hope doesn't help. It's really a critical part of making sure that people can make as much milk as they're going to need when we are giving them the right help and the right information during those First 100 Hours of life.
I’ve got a bonus here that really kind of ties everything together. The sixth step we'll talk about here - the sixth way that we sabotage milk production is by not being serious or clear about removing milk regularly when the baby isn't latching or can't latch well. We do people a disservice by again, hoping that things will get better or hoping that the baby will latch next time or hoping that the baby will latch better next time.
We have to be proactive, particularly in these First 100 Hours as milk production is being signaled and being hormonally controlled. We really have to be clear. We want to make sure that people understand that if the baby doesn't latch, it's time to hand express. It makes it possible to feed the baby right then as well as to ensure milk removal, which is one of the big keys to milk production.
Milk removal drives milk production. So if we sit and wait for hours and hours for a baby to latch without any milk removal, we're losing precious minutes and precious opportunities for milk removal. When I worked in the hospital, there were so many times that nurses would press and press our lactation staff for a certain number of hours or certain protocol for when was it okay that the baby hadn't latched yet, or how long were they supposed to wait, or how many hours could it be before it was a problem. Well, there's no hard and fast number, but what we do know is that frequent milk removal is a critical component of milk production - not just in the short term, but in the long term as well. There's no reason to wait. If a baby isn't latching, hand expression works. It gets milk out right now, whereas using a breast pump doesn't always get milk out right now in the First 100 Hours.
Hand expression is the next step when a baby is not latching, and there's no reason to wait or to hold out for the next time it's time to try. It's simply something that is the next step. We tend to do a good job of telling people that if the baby doesn't latch right now, it's okay. It doesn't mean that they're never going to latch. It doesn't mean that you can't breastfeed. It doesn't mean your plans for feeding your baby are completely changed and over.
What it does mean is that we do need to be proactive. We really do need to make sure that if the baby isn't latching right now, for any reason at all, that we're still removing milk. It's really that simple. And in the First 100 Hours, one of the best ways to get milk out is through hand expression, and the second best way is really using a high quality breast pump. If it looks like we have a situation where there's going to be a lot of milk expression that's needed, like say a preterm baby or a baby who really isn't latching well or is causing a lot of nipple trauma, then we may have to get a high quality breast pump on board for the long term and have a really good milk removal plan.
What we can't have is people going home with a baby who's barely latching or latching once in a while (and maybe that baby is getting fed some bottles of formula) but no milk removal is happening. We can't leave that step out. We can't just solve the problem of “we have to feed the baby something.” We have to also solve the problem of the brain needing that signal of milk removal in order to know and understand and process that milk production needs to continue happening. It's a very critical component of milk production. It's a very critical step that too often gets missed.
As lactation consultants, we too often get calls from people who have gone home from hospital, and are in that first week, and they tell us they're really struggling with latch, but their milk removal routine is really not adequate for where it should be during that timeframe. Whether a baby is going to the breast, or there's milk removal happening through hand expression or breast pump, or a combination of any of those things, it has to be happening at least eight times every 24 hour period. It has to be happening during the night. The night time is a critical time for milk removal, just like the daytime, they are the nighttime is actually very important because hormone levels are higher, but, night and day, are really, you know, the same when it comes to how often do we have to be taking milk out of the breasts in order to promote milk production.
As we help people through all of that time, right from birth, right from Day One, through the First 100 Hours and beyond, we have to make sure that we are being clear.
* We are talking about what's happening as milk production, rather than milk supply that we are encouraging and facilitating skin to skin, and not just after the baby is first born, but continually, and frequently through all those first days first weeks first months of life.
* We have to make sure we are teaching about hunger cues and how babies communicate when they need to go to the breast and when they're finished.
* We need to discourage using a clock to manage the baby's feedings.
* We need to remember that hope is not a plan for making a baby latch better,
* and also that not removing milk regularly if baby isn't latching is going to sabotage milk production in the short term, as well as the long term.
If you found this interesting and you work with parents either prenatally or you work with them in the early postpartum period in any capacit,. I do have a free webinar which has more information about making milk. It's available on my website https://www.ChristineStaricka.com/free. There you can sign up for the free webinar where I talk a lot more about optimizing milk production in the First 100 Hours of life through these practices. If that interests you, I hope you'll sign up for that.
Thank you for joining me for this episode of The Lactation Training Lab Podcast and I look forward to seeing you in the future. Thanks so much.