How the Breast Works
Congratulations on your decision to breastfeed! You may still have unanswered questions. Here are some that may be crossing your mind as you prepare for the birth of your baby.
How does my body make milk?
The lactating breast is a remarkable creation of nature and is usually capable of making all the milk a baby needs.
You may have noticed during your pregnancy that your breasts have gone through some changes:
- Your breasts may have enlarged and “blossomed”. Rest assured, however, that breast size is not related to the ability to produce milk for a baby. Breast size is determined primarily by the amount of fatty tissue in the breast, not the amount of milk.
- Your nipples have darkened and the surrounding skin thickened
- Your nipple sensitivity and elasticity has increased
- The areola (the dark circle around your nipples) has enlarged and darkened; kind of like a “bulls-eye target for the baby”
- Your areola has “pimple-like” bumps (which are normal – do not try to pop them). These bumps lubricate the skin, kill bacteria, and are thought to stimulate the baby’s mouth during feedings
- You may or may not have some leakage of milk. (Leakage is not necessary to produce milk for your baby.)
All these changes are necessary to prepare your body for breastfeeding your baby. These are just the changes you can see. Your body also changes inside the breast as well:
- An increase in milk-making cells (called aveoli)
- More branching of milk ducts that transport milk from the aveoli to the nipple openings
When a baby nurses correctly, (CLICK HERE) the nerves located underneath your areola (the dark circle around your nipple) tell your brain to release a hormone called prolactin.
Prolactin then signals the aveoli (milk-making cells) in your breast to make milk. The more a baby sucks correctly at the breast, the more prolactin is secreted and the more milk is made. When milk is not being made, milk production is decreased.
Consider the following story to illustrate this:
You are hosting a party. You keep removing the ice from the icemaker
in your freezer. The icemaker keeps making ice because it is empty.
When the party is over and the ice is no longer being removed,
the icemaker stops making ice. Think of your breast as the
icemaker. When your baby is emptying your breast, your body
knows it needs to make more milk. When your baby is
supplemented with formula (or not emptying your breast),
your body does not make the milk.
Therefore:
- It is important for baby to nurse effectively at the breast.
- If the baby cannot or will not nurse, or is separated from the mother, sometimes a pump should be used to empty and stimulate the breasts
- It is important for the mother to nurse often during the first few weeks (usually 10-12 times per day initially).
- To establish an adequate milk supply, it is usually important to feed only your breastmilk to your baby (unless advised otherwise by your healthcare provider, due to special circumstances).
- It generally takes about six weeks for the milk supply to become “well established”.
- If the mother can put off prolonged separation from the baby for that time, it will help build up her milk supply
What does it mean to “nurse effectively”?
To “nurse effectively” means the baby is latched on to the breast well and is actively transferring milk from the breast. You know this by observing the baby at the breast:
- Baby’s lips will be flanged (turned) outward, flush against the breast with the majority (or about an inch) of the areola in baby’s mouth.
- Tongue may be visible when bottom lip is pulled down
- Cheeks are rounded (not sucked in or dimpled)
- Visible movement of the jaw
- Breast compression/movement
- No smacking sound. If you hear this, break suction and take baby off the breast and re-latch baby to the breast. (Break suction: insert your little finger between baby’s gums and your nipple).
- By day 3 or 4 after birth, you should hear and see “swallowing” as the baby receives the milk
Baby must take the nipple far into the mouth; compress the milk ducts with the jaws, and keeping the tongue on the floor of the mouth and “milk” the breast to obtain the milk flow. See Breastfeeding.com – Anatomy of Nursing Breast
- NOTE: If it hurts to nurse the baby, break suction, and re-latch the baby to the breast. When the nipple is pulled into the baby’s mouth correctly, and he nurses correctly, you will make plenty of milk and your nipples will not get sore. If you continue to nurse a baby who is latched on incorrectly, the baby will not be getting enough milk and you may get sore nipples. See LINK
The extra effort the baby has to put forth in nursing will strengthen his jaw and facial muscles, and may help prevent future speech and orthodontic problems.
Picture from Breastfeeding.com
What is “Let-Down”?
When the nipple is stimulated by the baby nursing at the breast, the nerves under the aveoli tell the brain to release another hormone called oxytocin into the blood. The oxytocin reaches the breast and the milk producing cells (aveoli) deliver milk to the milk ducts. This is called the “let-down” or “milk ejection reflex”. Some mothers feel a “tingly” sensation when their milk lets-down while others never feel it at all. Both situations are normal and begin to occur about 3-5 days after the delivery of your baby.
It sometimes takes a minute or so for the let-down to occur, so be patient. You’ll know when your baby is swallowing more often or taking large gulps. Even though you may not feel each let-down when it occurs, chances are you are having several at each feeding.
Some mothers experience what is called “overactive let-down”. This is when the milk flows very quickly from the breast and the baby has a difficult time keeping up with swallowing the breastmilk. You may see your baby gag when breastfeeding when/if this occurs. Simply take the baby off the breast and catch the flowing milk into a cup or towel until the milk ejection slows down. Once the flow has decreased in intensity, latch baby back on the breast and continue nursing.
Low Milk Supply
Many mothers may worry that they lave low milk supply and actually everything is normal. Remember that crying can also be caused by problems other than hunger, so look at other signs also for reassurance that baby is being adequately nourished. You may want to check your worries by checking with an experienced breastfeeding mother, calling the baby’s healthcare provider, and reviewing the SIGNS OF SUFFICIENCY. You can go to the healthcare providers’ office or WIC to check the baby’s weight if there are still concerns. Remember that it is usually considered normal for a newborn to lose up to 7% of their birth weight as they shed some of the extra fluid they were born with. This weight is usually regained in the second week as the milk production increases and baby learns to nurse effectively.
If you are still worried you may have a low milk supply and you are doing all the right things – you are nursing often, the baby is nursing effectively, but baby may be crying a lot AND not gaining weight, there are things you can do to increase your milk supply.
- Rest. That means sleep when the baby sleeps. Take the baby to bed with you and maintain skin to skin contact and nurse the baby, nurse the baby, nurse the baby. (Remember, the more your nurse, the more milk you make).
- While nursing often, nurse until the baby is satisfied at each feeding. And nurse from both breasts so they both get stimulated.
- On the other hand, if baby is not gaining weight, you want the baby to take in more fat. Fat content is increased at the end of a feeding, so make sure to allow the baby to end feeding on one breast before offering the other breast. When baby signals he’s through with one breast, offer the other one. This ensures baby gets more of the breastmilk with the highest amount of fat.
- Usually, you do not need to “time the feedings” (or keep track of the number of minutes of nursing). However, if it seems that the baby is nursing over 40 minutes at every feeding and is still not satisfied and not gaining weight after the first week, you may want to watch the clock and then get some help (see below). This may be a sign that the baby is not nursing very effectively, so go back and review the signs of effective feeding and milk sufficiency
- If you are using formula, cut back gradually.
- Remove all pacifiers or nipple shields, if you are using any.
- Talk to you healthcare provider or physician about some medications that can be used to increase your milk supply.
- Seek help from a board certified Lactation Consultant. LINK to IBCLC, La Leche League
It is actually very rare (less than about 5%) that a mother cannot make enough milk to completely sustain her baby. It could be due to previous breast surgeries, other trauma (injury) to breasts, genetics, or hormonal imbalances which might be interfering with milk production. If you truly think you are unable to make enough milk, please consult with your healthcare provider/ physician or a board certified Lactation Consultant.