Many new breastfeeding mothers are concerned that their little one is not drinking enough. This article covers what is normal, ways to tell how feeding is going, and what to do if low milk supply is an issue for you.
Is supply really low?
Lots of women who worry about their milk supply do not actually have a problem! We live in a bottle feeding culture, with the idea that babies should be fed at pre-defined intervals until they are so full that they sleep soundly for at least a couple of hours. This is not how things work for breastfeeding mothers, who are often left wondering whether they are doing something wrong when their baby feeds frequently or irregularly.
The bottom line is that babies and breasts are designed to work together in a way that is unique for each family. It is normal and desirable for a new baby to feed frequently, eight to twelve times a day in 24 hours. Breastmilk is easily digestible, and babies are not meant to be asleep for long stretches in the early days. When a mother feeds responsively, offering the breast when she notices feeding cues, she works with nature. As the baby takes breastmilk the breasts make more, keeping mum and baby in sync. There is no “right” pattern for feeds, and definitely no “one size fits all” for any age of baby. The time between feeds will often space out naturally as babies become bigger and more efficient at feeding, but it is also limited by each woman’s body and milk storage capacity. A mother does not have to do anything to try to change baby’s feeding pattern, regardless of what her friends, books or google might be telling her.
So how can I tell whether my baby is getting enough breast milk?
The three main questions to ask yourself are:
How is my baby looking and behaving? Is my baby doing appropriate amounts of wees and poos? What is my baby’s weight?
If you are worried right now, there is a bullet point checklist here.
How is baby looking and behaving?
You know that feeding is going well when your baby feeds eight to twelve times in every 24 hour period. There will be times of day when the feeds are clustered together, generally in the evening, and times when your baby may sleep for up to 3-4 hours. A well fed baby will be alert and peaceful at some times in the day. A well fed baby will not be crying all the time, or sleeping all the time.
Normal feeds can be anything from 5 mins to 45 mins, it is what your baby does at the breast that counts. You are looking for active sucking and swallowing, along with the snuggling and pausing that are also natural in a breastfeed. When baby swallows their chin drops further, there is a tiny pause, and they “huff” out of their nose. This article might help you to recognise whether your baby is swallowing milk
Underfed babies tend to get sleepy rather than scream for food, and we need to wake them if necessary. If a newborn baby is consistently sleeping for more than 4-5 hours or more at a stretch, they will not have sufficient feeds in 24 hours. Be particularly watchful of a baby that is premature, underweight, unwell or jaundiced. Sometimes these babies do need a feeding regime, often being woken for food every 3 hours, in order to keep their energy up until they get better. A very sleepy baby who is hard to wake could be dehydrated and needs urgent medical attention (see checklist).
If you are at all worried, please call your midwife, 111 or even 999 if necessary. Do not sit at home being anxious. Health professionals are very keen to hear from you.
Wees and poos
The best indication of what is going in, is what is coming out! Some parents use a notebook or shared app to track poos and wees in the early days.
Baby needs at least one poo (black meconium – see below) and one to two big wees (45 mls) in the first 24 hours. If you are not sure whether baby is weeing, try putting a piece of cotton wool in the nappy, and feel whether the nappy is puffy or heavy compared with a new one. Many brands put a line on the outside of the nappy that changes colour when baby wees.
By the third day the poo should be going green or yellowy brown, see below. Expect at least three wees and two big poos.
By days 4-5 expect at the very least two big yellow runny poos and at least five wees.
The more poos and wees the better.
Red “dust” or crystals in a nappy could indicate that your baby is not getting sufficient milk. Please seek help.
By about six weeks after birth, many babies stop pooing every day and might go several days between poos. This alarms many parents, but it is normal. As long as the poos come out runny when they come, you probably don’t have to worry about it. As ever, GPs and health visitors can chat through any concerns you have about your little one.
What is happening with baby’s weight?
A baby’s weight is monitored closely for the first few weeks. Your baby will be weighed at birth, day 5, day 10, and then at intervals to be advised by your midwife or health visitor. It is considered normal for a new baby to lose up to 8-10% of their birth weight in the first week. Any more than this could indicate an underlying feeding problem and your midwife will advise you on what to do next. Baby is expected to be back to birth weight by the end of the second week. After the second week, most babies put on 150-200g or 5-7oz a week.
Provided that the signs above are OK, there are some things that you might NOT have to worry about.
Things that do NOT NECESSARILY indicate a problem with milk supply:
Baby wants to be held all the time
This is often totally normal. The instant you put your sleepy baby down they seem to wake up and root around to go back the breast. There is more information here.
Baby wants to feed frequently
Breastmilk is very easily digested, and your baby loves to be at the breast for comfort and pain relief as well as food. Newborns will often feed every 1.5-2.5 hours. We are used to a bottle feeding culture where babies are regularly packed full of formula and then sleep like us after a huge lunch. Massive feeds on a set routine are not normal.
Baby feeds for a long time
Normal feeds can be anything from 5-45 minutes, read this article for more information.
Baby is fussy at points in the day
New babies fuss, some more than others. There are many possible reasons for fussiness, not all of them are to do with baby being hungry. This article might help determine whether gas, reflux, an intolerance or allergy might be a contributing factor.
Baby is fussy in the evenings
Almost all babies are fussy in the evenings until they are at least 12 weeks old and sometimes more. Also see this article on the truth about baby sleep.
You can’t express much milk
There are many reasons why a mother might not express much milk. When did you last feed? If you are happily in sync with your baby, there is unlikely to be a lot of extra supply to express.
This sounds obvious, but check your expressing equipment is working, fits well, and is on the right setting!
Breast pumps do not work like babies, and while pumps can be great we do not love them. Some mums who happily exclusively breastfeed are never able to express a drop. For more information of expressing see this article.
Your breasts do not feel full
Many women never feel full or feel their let down of milk. Even if you frequently felt more full at the beginning of your breastfeeding journey, after a few weeks the supply and demand evens out and you might not feel full between feeds. It is highly unlikely for supply to suddenly decrease for no reason, although some medications or health conditions can have an impact.
Your baby happily guzzles a bottle of formula after a feed
Babies cannot help taking milk from a bottle, especially if it is flowing fast and they are not given the opportunity to stop.
For more detailed information on causes of low milk supply, please click here.
How do I boost my milk supply?
“Demand” more milk
As breastfeeding works by supply and demand, we need to increase the demand! This means regularly taking milk out of the breasts by baby feeding and/or expressing. To maximise supply, if you can, feed or express (or both) at least eight times a day including at least once at night. It is important not to leave gaps of more than 3-4 hours between feeds or expressing while boosting supply. Lots of skin to skin contact and unrestricted access to feeding makes a big difference, and it is helpful if mum gets plenty of support with everything else.
You can find out much more about how to express effectively to boost milk supply here.
Building up milk supply can take considerable effort and a lot of time. Many women will notice a difference after a few days, for others it is a commitment of weeks. Some women may continue to need to supplement with formula. This article might help with decision making for those in the cycle of breastfeed, top up, express, repeat.
There are huge emotional and practical implications in working to build up supply, and a woman’s support network can make all the difference. For a letter to your friends and family on this issue, click here.
Look out for substances that decrease supply
Occasionally a mother might unwittingly reduce milk supply due to something that she is consuming.
Hormonal medications such as those in the contraceptive pill or some brands of IUD can reduce supply. Several medications inhibit milk production, including some medicines for cold and allergy relief. Always check any medications before you take them, and talk to your pharmacist if you are worried. The Breastfeeding Network has a series of well researched fact sheets about different medications here.
Cannabis, alcohol and cigarettes are all knows to reduce milk supply. Nicotine in any form reduces prolactin and oxytocin, key hormones in producing and letting down milk.
Some herbs, if consumed in excess, have been implicated in reducing supply. These include parsley, peppermint, jasmine flower, oregano oil.
Many mothers who are pregnant while nursing experience a drop in supply.
For a more in depth discussion of these issues, and other causes of low supply, please click here.
Eat a balanced diet, drink to thirst
Many mothers are worried about losing weight after their baby is born, but breastfeeding burns a lot of calories. We know that excessive dieting, consuming less than 1500-1800 calories a day on a regular basis, can reduce milk production. If you do wish to lose weight, aim for slower and more gradual weight loss.
A balanced diet is important in getting all the nutrients required for optimal milk production. This can be hard for new mum, and some find that they like to take a supplement. Vegetarians and vegans may not have sufficient B12, and this can cause drowsiness in the baby and slowing down of milk production. In this case some lactation consultants suggest having B12 levels professionally checked. Vegetarian and vegan diets may also be low in protein, calcium, iron or healthy fats, so do make sure that you are getting these. Please seek specialist help if you suffer with anorexia or have had gastric bypass surgery.
Please don’t worry too much about your fluid intake, just drink when you are thirsty. Drinking too much water, beyond thirst, can reduce supply.
Drugs and galactagogues
Certain medications and remedies are available to boost milk supply, although none will be as effective as appropriate levels of feeding and/expressing. The Breastfeeding Network has some well researched information on the medicines Domperidone and Metoclopramide, which are licensed for other conditions but have a side effect of improving milk production in some women. Of the two, evidence suggests that Domperidone is better tolerated with fewer complaints of side effects.
Galactagogues are substances that aid the initiation and maintenance of milk supply at a level which meets the needs of the baby. Almost every culture in the world has a tradition of particular food and drink that are given to nursing mothers. The most comprehensive collection of information on galactagogues I have found are in “Making More Milk” 2nd Ed by Marasco and West. The website www.kellymom.com also lists various milk promoting substances and the best available evidence of their effective doses. It really is important to consider the quality of the product you are considering, alongside the best available evidence around dosage.
A final note
A mother’s ability to breastfeed her baby can profoundly influence her emotions and feelings about herself. Many mothers tell me about their sense of frustration, shame, loss and grief when they cannot fully feed their baby. Some admit to being envious of friends and family who are finding it easy. Some feel that their overwhelming desire to breastfeed against the odds is somehow selfish. It is easy to be hurt by insensitive remarks, criticism or lack of encouragement from those around us. It is very natural to become defensive, give an angry reply, burst into tears, or sit in stunned silence. Here is a letter to friends and family that you might like to share. You are amazing and you are doing your best. That is enough.
Many women interpret their baby’s fussy behaviour at the breast as a sign that their baby is rejecting them or their milk. This is not true! It is an interpretation of your baby’s behaviour, but it is not how your baby feels about you. You are the person who knows baby best, and you are the person that baby knows best. Your baby’s need and love for you are unchanging even when your baby gets frustrated by the milk factory.
Please be kind to yourselves. Being a new mother is REALLY HARD. Take things one day at a time. Celebrate any breastmilk that you can give to your baby, and then try to enjoy your time together.